Saturday, August 17, 2002
"Unfortunately," moans US health researcher Denis Altman as he watches health insurance costs spiralling out of all control, "health care costs are rising while we're still in a weak economy, and that dramatically increases the pain for everybody." Read all about it in today's San Francisco Chronicle at

Of course, we're treated to all the usual stuff about the fabled 'Managed Care' system running out of options in a time of aging populations and ever more costly technology. The Yanks have been listening to that stuff for years, and we're beginning to hear it here now. Well, a blogger with more time than yours dismally has on his hands could investigate the relative cost of a young population, with high birth and immigration rates (not merely in terms of the cost of looking after the health of babies, children and mums - but also stuff like education). Like, say, the one poor Billy Hayden's Medibank and Gough's public education system handled so well in the late seventies.

S/he might even point out that technology has money-saving qualities at least as much as it has money-costing qualities. But enough of that.

What, I'm here to ask, about the market power of surgeons and insurance companies and such? Ain't that where a tidy lump of all that money is going?

A little sniffing around at a local uni tells me that when Oz had a public national health insurance system, about 5 per cent of the total cost went on administering the thing. It seems that the cost to Oz's health insurance customers of administrating this new-fangled private system is four times that, simply because to furnish the firms an acceptable profit, our treasury has to cough up a 30 per cent subsidy. This goes straight into shareholders' pockets via those of the few rich enough to pay for private insurance.

We all pay, so that the rich may avoid the queues and protect their share portfolios. Sad but funny.

Funny because every time some brave soul dares speak up for a public health insurance system, s/he gets accused of advocating middle-class welfare!

I've appended below excerpts from an eloquent article from last year. It's about a neoliberal's conversion to the notion of a well-funded 'socialised medicine' model. Only when he gets cancer, mind, but, thankfully, at least in time to come clean on the matter.

Anyway, the author, David Burgess, points out that he got his US$700 000 treatment for nothing because he was living in a country (France) that funded its national health system to the tune of $1800 per capita ($109 billion in all). Money well spent. And Australia's investment is thankfully still of a comparable magnitude. The old 'bleed-the-public-sector-dry-and-then-claim-the-public-sector-doesn't-work' policy is obviously at a fairly early stage.

For the point is, the money was spent on a PUBLIC HEALTH system, NOT on private insurance rebates, NOT on overpaid VMO physicians and NOT on private hospitals. Why's that the point? Because the system that spends most (twice as much as any other in the OECD) is that of our all-privatised model society, the USofA. In the USofA five times as much money per capita goes to the private hospitals and nearly three times as much to physicians as anywhere else in the OECD.

And if friend Burgess were not privately insured to the tune of $4000 per annum (and even then he'd face some serious bills), he'd have been out of pocket $700 000 or, if he's on a wage like mine, just plain dead.


*International Herald Tribune* Friday, March 9, 2001
A Conservative Convert To Socialized Medicine by David Burgess

PARIS - What's the old joke? A conservative is a liberal who has just been
mugged? Well, I am a conservative who has just been "mugged" by the
socialized French health system, and, to my astonishment, I'm a believer.

I have lived in France for nearly 19 years. Until about two years ago I was
very cross about the amount I had to pay in taxes and in "social charges,"
which finance the medical system, in which a pauper gets about the same
medical care as a millionaire.


The doctor lost no time. He called my local hospital, which fortunately was
one of the four in the Paris area that could do the operation that I
needed, and reserved me a bed for the next day.


After my operation, which lasted more than 10 hours, I was in the hospital
another three weeks, then home, where a nurse came by each day to give me
the shots I needed, check and dress my surgical wounds and make sure that I
wasn't losing weight. Then back to the hospital for three days of
chemotherapy every three weeks - four treatments in all.


Why does socialized medicine seem to work in some places and be a disaster
elsewhere? Anyone who reads the British press is assaulted daily with tales
of how cancer patients have to wait months for an appointment with an
oncologist, or a candidate for a hip or knee replacement has to wait years.
In France, such delays can be measured in days or, at most, weeks.

Why the difference? Take a deep breath. These are the numbers, provided by
the French and British health ministries and translated into dollars (bear
in mind that Britain and France have roughly the same populations). French
total expenditure on health in 1999 was $109.5 billion. In Britain it was
about $78.02 billion. Per capita, it was $1,800 in France and $1,312 in
Britain. As a percentage of the gross domestic product, it was 8.5 percent
in France and 5.9 percent in Britain.


Last summer, I asked a friend of mine, a dean at a medical school in New England, what the cost of my care would have been in the United States. "About $700,000," she said. I haven't seen a bill. Well, that is not quite true. I got a bill for 43 francs (about $6.50). I'm not sure what it was for, but I paid it.

I no longer complain about my taxes.

Copyright © 2001 the International Herald Tribune
Tuesday, August 13, 2002
Equity, Society & the Merchants of Menace
Another rant by Rob Schaap

"The law, in its majestic equality, forbids the rich, as well as the poor, to sleep under the bridges, to beg in the streets, and to steal bread." So wrote Anatole France

To put it another way, albeit much less elegantly: equality is not equity and form is not substance. I make no apologies for stating the bleeding obvious, as I live in a society where:

* 'equality' is something an indirect tax regime brings about;

* 'equity' is something to do with whatever a publicly built infrastructure is worth to the lucky few who now own it;

* 'substantial' refers to what went on at the constitutional convention; and

* 'formal' refers to piss-ups where the blokes wear ties and the sheilas wear frocks.

In short, we are a society which has forgotten the bleeding obvious, and consequently fails to address the fact that it is obviously bleeding.

Those who praise the GST and the concomitant drops in higher marginal income tax rates might well point to a certain equality in the new arrangements. We are indeed approaching the 'flat tax' scenario we all mocked so heartily only a decade ago. But, as Anatole France reminds us (and as we really knew all along) taking an equal proportion out of unequal incomes means charging equally for the upkeep of a society which dispenses its favours very unequally indeed. The equality is purely formal, and tendentiously so. When Australians proudly trumpet their long-standing commitment to equality, they are extolling little more than a romantically nationalistic myth, a sort of white arm-band view of history. Our institutions, our legislative framework and our regulatory regime - the structures which actually constrain and enable our lives together - are almost identical to those of societies much less wedded to such fancy notions. If British society is class-ridden, so is ours - and if American society worships the rugged acquisitive individual, so does ours.

That is, after all, what 'globalisation' means. But globalisation is nothing new. It is as old as capitalism itself. What do Karl Marx and Friedrich Engels describe so vibrantly in the first dozen pages of *The Communist Manifesto* if not globalisation? Two lads in their twenties saw it all unfolding a century and a half ago. They, too, saw a certain equality coming to the fore ("All are instruments of labour), with an attendant inequality ("more or less expensive to use"), and a profound social cleavage that would ever blight capitalist society: that between those who own and control society's productive assets, and those who can only sell their labour if they are to live. This last is the ultimate inequality; the fatal contradiction. Our society insists that all are equal in their freedom to buy and sell their wares and themselves. By way of this very semblance of equality do we hide from ourselves a correspondent absence: that of equity. It is not fair that some may own the assets society needs to reproduce itself whilst those who actually have to work with those assets do not. It is not just. that our society frames improvements in our welfare (our wages and conditions) as a 'cost of production', but a meteoric rise in that of shareholders as 'the creation of wealth'. Little wonder that JK Galbraith once characterised our society as one committed to the daft notion that the poor produce more the less they get, and the rich produce more the more they get!

At the core of our society lies an inequity that alienates us from each other precisely in the way it brings us together (as buyers and sellers), and destroys just as it produces (for as we become able to produce more, there is room for fewer producers). Formal equality and substantive inequity are two sides of the same coin. Karl and Fred theorised that these contradictions would ultimately destroy capitalism as competition ate itself, leaving ever fewer competitors, ever more workers depending on ever fewer tenable incomes, and thus ever more product looking for ever fewer buyers. On this view, inequity might get some of us at first, but it'll get us all in the end. As Shakespeare's Merchant of Venice said, 'they are as sick that surfeit with too much, as they that starve with nothing.

Point one: For the socialist, equity is economically important.

So what if Karl and Fred were wrong? What if our economies are just taking a quick breather before resuming their triumphal march? What if we really do have the good fortune to be alive just as we enter the much-vaunted 'new economy'? What then?
Well, that would mean the economists are right. Sure, the world isn't going to be fair, but the lot of the underprivileged will improve in sympathy with, if not to the extent of, that of the privileged. Pizza and lager for all. But remember, the engine of this new economy is going to be something (very) loosely called 'information'. So let's devote a minute to what 'information' might be.

Well, for information to happen, someone has to produce data and someone else has to pay attention to that data. And for this process to fuel economic growth directly, it has to be bought and sold. Which means access to a channel is going to cost you, and access to information is going to cost you. Which means rich people can afford more of both than poor people can.

This matters if you bear in mind the theory that we construct our identities as individuals and societies within communication. If the bulk of that communication is allowed to be commoditised (and remember, it has to be if we're to have our 'new economy'), that would mean we'd literally be producing a society in the image of 'the market'. All our relations with others would be mediated by 'the market'. Sure, it starts with a few developments we can handle, like:

* our footy team gets either bought up or wiped out; or stuff we used to watch is suddenly only on pay TV;

* or Nike decides who plays in Brazil's World Cup Final side;

* or you can suddenly not find a thing on the internet because the commercial sites have taken over the search engines;

* or you can't buy a T-shirt any more that doesn't transform your breasts into advertising spots;

* or Michael Jackson outbids Paul McCartney for the rights to songs the latter wrote and then sells them on to be used as advertising jingles;

* or someone tries to demand royalties every time someone else wants to sing 'Waltzing Matilda';

and then we move on to some developments which aren't quite as easy to handle, like:

* library and public service broadcasting budgets are decimated;

* and we have to pay as individuals for the education our society needs us to have;

* and private schools demand that their students buy expensive lap-top computers;

* and our telecommunications infrastructure is sold at fire-sale prices to the lucky few who can afford to buy shares;

* and the electro-magnetic spectrum itself is auctioned to the highest bidder (indeed sometimes just given to selected big boys);

* and public phones are demolished in rural areas just as residential service to those areas is wound down;

* and traditional remedies and hybrids get expropriated by large corporations who promptly patent them;

* and then they patent the very genes that constitute us.

Well, clearly something is afoot. And whatever it is, it's well under way. In not one of these instances is the sum of human happiness enhanced. Each points to a greater inequity than pertained but a couple of decades ago. And each rips unceremoniously through the fabric of our social being. To introduce such inequity into our networks of communication is to produce a wholly skewed culture. We have long lived in a commercialised culture, but the information society is that society which goes that extra yard. Enter, the commoditised culture, existing only in and for the realm of filthy lucre. And when it comes to such transactions, the people with the lucre hold all the cards. It is the rich who will make us who we are (sometimes consciously and sometimes not) for we will have nothing left with which to make ourselves. We cannot then be as the liberal would have us be. If we are not free to make of ourselves what we will, to be who we would be, our very lives would belong to others. Tom Friedman calls this trade-off between material wealth and declining personal freedom 'the golden straitjacket'. Shakespeare's Merchant tarnishes even that discomfiting image: 'you take my life when you do take the means whereby I live'.

Point two: For the liberal, equity is humanly important.

But let us leave aside these (apparently) contending political ideologies. Isn't our society built precisely to accommodate a range of opinions on such things? Isn't that what democracy is all about? Well, yes it is. But democracy presupposes a constituent entity we call 'the citizen'. And this citizen must be the equal of all other citizens in terms of her political rights and obligations. But rights and obligations are, in themselves, merely formal categories. Citizenship is a practice, it is something we do. And when we try to do things, we're trying to do them in the real world.

In the real world communication channels and information are becoming commoditised. The degree of our formal freedom to have our say and inform ourselves is absolute, but not so the degree of our substantial freedom. Where Kerry Packer may speak to five million Australians whenever he likes, we may not. Where a Queen's Counsel is able to interpret a law that applies to us all, we are not. Where an educated man is able critically to analyse issues, an uneducated man might not be. Where a woman with a networked computer can gain access to a Green Paper, an on-line book, an electronic newspaper or a mailing list, a woman without one can not. In fact, the more we depend on electronic communication, the less are the poor involved in debates about their own future. Poor people only feature on the news when someone has killed, maimed or starved them, and they hardly turn up on the net at all.

Little wonder then that, in the absence of any real public deliberative process, 'public opinion' has effectively been reduced to statistical representations of triennial moments. Poor people get to vote, and that's all they get. The vote is a great thing - just ask people without it - but it is a pale shadow of its ostensible self if it does not represent the fruits of an ongoing process of social deliberation, open to all, where participation is free and undistorted by power and wealth. Sadly, the vote represents no such thing. We are a democracy in our form but a plutocracy in our substance. Thus spoke The Merchant: 'A goodly apple rotten at the heart. O, what a goodly outside falsehood hath!'

Point three: For the democrat, equity is politically important.

It is one thing to live in a society that is not equitable, but it is quite another to live in one which is busily abandoning it even as an ideal. We don't even seem to think equity is worth pretending to pursue. In 1776, Adam Smith spoke of the price mechanism as 'the invisible hand', a benign metaphysical stand-in for God which would ensure that all would be for the best in the best of all worlds (apologies to yet another notorious fatalist). Our political leaders follow this quaintly old-fashioned notion devotedly, which rather takes the gloss of their pronouncements against those out-dated socialists and bleeding-heart 'old-world' liberals. Karl Marx and John Stuart Mill wrote their famous tracts nearly a century later - after the industrial revolution had produced an accumulation and concentration of wealth and power which approximates our world a lot more closely than did the nascent petit capitalism Smith discerned in his day. To our self-professed betters, 'globalisation' is the process by which a two-hundred-year-old, phlogiston-like ethereality confers its divine grace over ever more of our planet's surface.

Well, there are some things this invisible hand can't do. 'It' can't give us equity (nor much else, when you actually come to think about the planet as a whole). Equity is something we need; if not as a likely destination, then at least as a guiding light. And equity is something only our hands can build. If we don't grasp that particular nettle soon, we shall be embracing The Merchant's own fatalistic submission, 'that in the course of justice none of us should see salvation: we do pray for mercy'.

Adam Smith was great enough a moral philosopher to know invisible hands don't mete out that particular commodity, either. 'Tis indeed becoming a quality most strained …
political economic and cultural observations in the register of dismal dilettantism

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