Despite The Bravardo I Do Not Believe This War Is Going At All Well....

This appeared a few days ago:

 Ukraine

‘We’re in 1938 now’: Putin’s war in Ukraine and lessons from history

Some analysts believe Kyiv is buying the west time on the precipice of a world war. Is it being used wisely?

Patrick Wintour Diplomatic editor

Sat 8 Jun 2024 14.00 AEST

When big history is self-evidently being written, and leaders face momentous choices, the urge to find inspiration in instructive historical parallels is overwhelming and natural. “The only clue to what man can do is what man has done,” the Oxford historian RG Collingwood once wrote.

One of the contemporary politicians most influenced by the past is the Estonian prime minister, Kaja Kallas, and not just because of her country’s occupation by Russia or her personal family history of exile.

She lugs books on Nato-Russian relations, such as Not One Inch, with her on beach holidays. And in her hi-tech office at the top of the old town in Tallinn, she argued this was a 1938 moment – a moment when a wider war was imminent but the west had not yet joined the dots.

She said the same mistake was made in 1938 when tensions in Abyssinia, Japan and Germany were treated as isolated events. The proximate causes of the current conflicts in Ukraine, the Middle East, the South China Sea and even Armenia might be different, but the bigger picture showed an interconnected battlefield in which post-cold war certainties had given way to “great-power competition” in which authoritarian leaders were testing the boundaries of their empires. The lesson – and necessity – was to resist and rearm. “The lesson from 1938 and 1939 is that if aggression pays off somewhere, it serves as an invitation to use it elsewhere,” Kallas said.

Her favourite historian, Prof Tim Snyder, adds a twist by reimagining 1938 as a year in which Czechoslovakia, like Ukraine in 2022, had chosen to fight: “So you had in Czechoslovakia, like Ukraine, an imperfect democracy. It’s the farthest democracy in eastern Europe. It has various problems, but when threatened by a larger neighbour, it chooses to resist. In that world, where Czechoslovakia resists, there’s no second world war.”

Snyder said such an outcome had been possible. “They could have held the Germans back. It was largely a bluff on the German side. If the Czechs resisted, and the French and the British and maybe the Americans eventually started to help, there would have been a conflict, but there wouldn’t have been a second world war.

“Instead, when Germany invaded Poland in 1939, it was invading Poland with the Czech armaments industry, which was the best in the world. It was invading with Slovak soldiers. It was invading from a geographical position that it only gained because it had destroyed Czechoslovakia.”

Snyder drove home his lesson from history: “If Ukrainians give up, or if we give up on Ukraine, then it’s different. It’s Russia making war in the future. It’s Russia making war with Ukrainian technology, Ukrainian soldiers from a different geographical position. At that point, we’re in 1939. We’re in 1938 now. In effect, what Ukrainians are letting us do is extend 1938.”

A return to Churchill’s ‘locust years’?

As Christopher Hitchens once wrote, much American foolishness abroad, from Korea to Vietnam to Iraq, has been launched on the back of Munich syndrome, the belief that those who appease bullies, as the then British prime minister, Neville Chamberlain, sought to do with Adolf Hitler in Munich in 1938, are either dupes or cowards. Such leaders are eventually forced to put their soldiers into battle, often unprepared and ill-equipped – men against machines, as vividly described in Guilty Men, written by Michael Foot, Frank Owen and Peter Howard after the Dunkirk fiasco. In France, the insult Munichois – synonymous with cowardice – sums it up.

But Snyder made his remarks in Tallinn last month at the Lennart Meri conference, which was largely dedicated to Ukraine and held under the slogan “Let us not despair, but act”. It was held against the backdrop of Russia and China hailing a new authoritarian world order in a joint 6,000-word statement that intended to create an axis to undo the settlement of the past two world wars.

Many at the conference wrestled with how much had gone wrong in Ukraine, and why, and whether the west would shed its self-imposed constraints on helping Kyiv. In a sense, everyone wanted an answer to the question posed by the Polish foreign minister, Radosław Sikorski: “Ukraine has bought us time. Will we put it to good use?”

In 1934-35, what Winston Churchill termed the “locust years”, and again after the Munich agreement, Britain did not put the time to good use, instead allowing Germany to race ahead in rearmament.

Johann Wadephul, the deputy chair of the German Christian Democratic Union’s defence policy committee, fears the answer to Sikorski’s question is in the negative. “If the war goes on like it is, it’s clear Ukraine will lose. It cannot withstand Russian power with its well-organised support from Iran, China and North Korea and countries like India looking only at its self-interest.”

Europe had simply not reorganised itself for war, he said. Listing the consequences for the continent in terms of lost human rights, access to resources and confidence in the west, he said simply: “If Ukraine loses it will be a catastrophe.”

Samir Saran, the head of the Indian thinktank the Observer Research Foundation, who described himself as an atheist in a room full of believers, nevertheless agreed that something bigger than Europe was at stake as he almost mocked the inability of the west’s $40tn economy to organise a battlefield defeat of Russia’s $2tn economy.

He argued: “There is one actor that has reorganised its strategic engagement to fight a war and the other has not. One side is not participating in the battle. You have hosted conferences supporting Ukraine and then do nothing more. But when it comes to action, Russia 2.0 is grinding forward.

“It tells countries like us that if something like this were to happen in the Indo-Pacific, you have no chance against China. If you cannot defeat a $2tn nation, don’t think you are deterring China. China is taking hope from your abysmal and dismal performance against a much smaller adversary.”

Political will v ‘political won’t’

Yet it is paradoxical. Nato is bigger and stronger than ever. The transatlantic alliance is functioning far better than the US, France and Britain did in the 1930s – and, after five months of hesitation, some of the extra $60bn in US arms may reach the frontline within weeks.

But from Kyiv’s perspective, everything remains too slow and circumscribed, except for the apportionment of blame across Europe. Germany’s Marie-Agnes Strack-Zimmermann, the Free Democratic party’s top candidate for the European elections, takes one side, urging France to hasten weapons deliveries to Ukraine. She said: “We have the problem that, while Poland is doing a lot as a neighbouring country, while Germany is doing a lot, France is doing relatively little.”

Others say the culprit remains Berlin, and that, despite recognising what a threat Vladimir Putin represents, it cannot accept the consequences in terms of the nuclear risks of going all in for a Russian defeat. Benjamin Tallis, a senior research fellow at the German Council on Foreign Relations, said: “For all of this talk of political will, what we actually face is political won’t. We won’t define victory as a goal.”

Without naming Germany, the French president, Emmanuel Macron, reinvented over the past year as a scourge of Russian imperialism, said: “Europe clearly faces a moment when it will be necessary not to be cowards.”

Ben Wallace, the former UK defence secretary, had less compunction about naming names. “[Olaf] Scholz’s behaviour has shown that, as far as the security of Europe goes, he is the wrong man in the wrong job at the wrong time,” he said of the German chancellor.

Eliot Cohen, a neocon never-Trumper, finds a wider institutional and moral malaise that needs addressing through a theory of victory and a specific practical plan to secure that victory, something akin to Churchill’s call for a ministry of supply that turned the UK into a giant armaments factory.

Cohen said: “It’s not about what people say, it’s about numbers. Are you willing to lift the restrictions on arms factories to run them 24 hours a day? Are you willing to give them Atacms [missiles] and hit targets in Russia, and get Germany to give them Taurus missiles?

“My chief concern is that war is so remote from our societies that we have trouble grappling with what success requires.”

Would Putin turn off his war machine?

Sabine Fischer, a political scientist at the German Council on Foreign Relations, says behind these disputes is the pivot around which every judgment turns: whether Europe believes a Ukrainian defeat can be contained. In other words, what are the consequences for Europe, if any, if Ukraine collapses or a Russian-dictated peace leads to its retention of land gained by military conquest?

Would a victorious Putin husband his resources, turn off the war machine and say the recapture of Kievan Rus had been a self-standing Moscow objective and Russia’s imperial ambitions were now sated? After all, not every state that makes demands has unlimited ambitions.

The Hungarian president, Viktor Orbán, for instance, said: “I do not consider it logical that Russia, which cannot even defeat Ukraine, would all of a sudden come and swallow the western world whole. The chances of this are extremely slim.” An attack on an existing Nato state would be “crazy” since the Nato alliance would have to respond.

But Russia’s foreign policy concept issued in 2023 focuses on a global confrontation with the US and building the alliances to defeat the west. Given Putin’s unrivalled record of broken promises, a Russian peace guarantee might end up as reassuring as Chamberlain’s advice to the British people to have a quiet night’s sleep after he returned from Munich. The US president, Joe Biden, interviewed in Time magazine this week, appeared to regard the consequences as vast. “If we ever let Ukraine go down, mark my words: you’ll see Poland go, and you’ll see all those nations along the actual border of Russia, from the Balkans and Belarus, all those, they’re going to make their own accommodations.”

Others say the Polish response will be less conciliatory. One former Nato commander, who spoke on condition of anonymity, said eastern states would not wait to find out Putin’s next move. “If Ukraine fails, I am certain that our Polish allies are not going to sit behind the Vistula [River] and wait for them to keep coming. I think the Romanian allies are not going to sit behind the Prut River and wait for Russia to go into Moldova. So the best way to prevent Nato from being involved directly in a conflict is to help Ukraine defeat Russia in Ukraine.”

Fischer believes the consequences of a Russian-dictated peace will not be containable. “Ukraine will experience a new wave of refugees fleeing to the west. The terror regime of the Russian occupation will expand and hundreds of thousands will suffer as a result. The economic, political and security situation will change drastically throughout Ukraine. Partisan warfare could erupt, fuelled by the militarisation of Ukrainian society,” she said.

“The threat situation for the states bordering Ukraine would worsen massively. This is true for Moldova, which would again be in the spotlight, as it was in 2022, especially if Moscow were to take over the Ukrainian Black Sea coast. The cohesive power of the western alliance would be shaken to its core. Russia would continue to weaken Europe from within by building alliances with rightwing, chauvinist populist parties.”

Ukrainians, from President Volodymyr Zelenskiy down, have for more than a year tried to frame the consequences of defeat in lurid terms, in an attempt to shake European torpor and galvanise the west.

Olena Halushenka, the co-founder of the International Center for Ukrainian Victory, urged Europe to think about the bombardment of Kharkiv. “Imagine a city the size of Munich is likely to be without electricity this winter. The cost in terms of millions of migrants will overwhelm Europe.”

Wadephul fears even such framing has not worked. “If you ask the average German on the street: ‘Do you really recognise what is at stake? That we have to spend money not for health but for defence?’ the answers show there is still a lot of persuasion to do. Europeans think they can have this war without thinking they are themselves at war.”

He thinks the guilty men are the leaders who pander to voters who dismiss the Russian threat. That takes the debate back to Germany’s, and specifically the Social Democratic party’s, ambivalence about a Russian defeat. It is not a coincidence that the election slogan of Scholz’s SPD was “a secure peace”.

Scholz himself, for instance, refuses to set Russia’s defeat as an objective, and, after Ukraine’s failed offensive, peace advocates within his party have had a resurgence. The party believes its vote is being squeezed by two parties, one left and the other right, both saying the war is unwinnable. In a sign of the times, Michael Roth, the SPD chair of the Bundestag foreign affairs committee and a supporter of arming Ukraine, is quitting politics, saying he found it was like stepping into a refrigerator to hold the views he did inside his own party. 

Dangers of chasing ‘illusions’

Five 20th-century historians, including the Weimar Republic expert Heinrich August Winkler, complained in an open letter that Scholz was not willing to learn the lessons of history or recognise that Russia was bent on the destruction of Ukraine. “The chancellor and the SPD leadership, by drawing red lines, not for Russia but for German politics, weaken Germany’s security policy and benefit Russia.” The government had to come up with a strategy for victory, they argued.

There is even a suspicion that anti-war politicians with access to intelligence reports are leaking pessimistic accounts of German intelligence assessments, reinforcing the impression that Ukraine’s position is hopeless. Ralf Stenger, an SPD member of the Bundestag’s intelligence committee, said Ukraine’s failed offensive last year showed “we can and must prevent Ukraine from losing, but we cannot ensure that it wins”. Anyone who “keeps demanding that weapon A must be delivered more quickly and weapon B in even greater quantities” was chasing illusions, he added. Always increasing the dose when the medicine was not working was “not convincing”.

Critics say this fatalistic narrative – dovetailing with Russia’s main objective, which is to convince the US that further aid is futile – also makes little attempt to identify the lessons of the past two years about the failure to organise a war economy in Europe. Macron coined the phrase “war economy” at the Eurosatory military technology conference outside Paris in June 2022, but there is little sign the promise of such a fundamental reorganisation of Europe’s armaments industry has taken place, or even that anyone was appointed to bring it about.

Liberal market economies are inherently likely to be slower to adapt to war than their authoritarian counterparts, but one of the lessons of the 1930s, and those locust years, is that organising for rearmament entails planning and not just false reassurances, which were the stock in trade of Chamberlain and his predecessor Stanley Baldwin.

The reality was that Britain, overstretched and in debt, fell behind, and calls for a ministry of supply to coordinate the flow of arms were spurned. Nevertheless, Chamberlain complacently predicted that “the terrifying power Britain was building” by boosting its defences “would have a sobering effect on Hitler”.

Something similar happened with regard to ammunition supplies for Ukraine in Europe. In 2023, leaders said they would have 1m shells ready for Ukraine by March 2024, only to admit they could reach only half that number. They promised to reach 2m a year in 2025.

One prominent Ukrainian military adviser said the reality was that the Russian arms industry could now churn out 4.5m shells a year, each costing about only $1,000 to manufacture. Meanwhile, in Europe and the US, a total of 1.3m shells were being produced at an average cost of approximately $4,000. That means Nato is 10 times less efficient, and struggling to locate explosives.

He said: “We need a central plan like in the first or second world war. If governments have an existential demand, a company should not have the ability to make as much profit as they want. It should be regulated. Industrial warfare requires national institutions and a Nato-level industrial warfare committee, which would regulate prices.

“Right now, we have dozens of really high-level, super-important targets each day. And we have only one missile we can use a week, and this is actually insane.”

Some say the picture is improving, but the stark fact, according to Sikorski, is that 40% of the Russian government’s budget is devoted to defence. It is Russia, not Europe, that has built a war economy.

The Ukrainian adviser predicts the west may have caught up in two to three years in drones and munitions, but that means the next few years are the most dangerous the region would face.

In the short term, it is the absence of Patriot batteries, a surface-to-air guided missile, and US-supplied F-16s, agreed in August 2023, that leaves Ukraine so exposed. Only six EU member states – Germany, Greece, the Netherlands, Poland, Romania and Spain – operate Patriot systems. Germany has offered a third battery, and the Dutch part of theirs, but Greece and Spain say they have nothing spare. The date for F-16 deliveries depends on the speed at which pilots can be trained.

But Michael Bohnert, an engineer at the Rand Corporation, sees no sign of a public coordinated military plan to raise the firepower needed, let alone new munitions factories. Incredibly, the adviser to the Polish chief of staff, Krzysztof Król, admitted to a conference last month that after two years “we have not yet created proper conditions for a Ukrainian victory with our plans because political leaders had not yet told them the objective”. If that objective was conveyed, he added, “the military leaders could easily decide what is required. As it is, we give enough only for Ukraine to survive.”

To the extent any European leader has grasped this lacuna, it is Macron, with his emergency meeting in Paris on 26 February to look at ammunition shortfalls and repeated speeches on the existential threat to Europe from the alliance between the far right and Putin.

It will take two meetings, one involving the G7 leaders in Italy next week and then the 75th anniversary Nato summit in Washington in July, to reveal whether the west wishes not to contain Putin, but to defeat him – with all the risk that carries, including for China.

Macron will know many in Europe see the external threat as coming from migration, not Putin, and above all as a French politician, he knows the popular lure of an easy peace. Flowers, not tomatoes, greeted the French prime minister Édouard Daladier, to his surprise, when he returned from Munich in 1938. Knowing full well the threat posed by Hitler, and that he and Chamberlain had betrayed Czechoslovakia, the only democratic country in central eastern Europe, he turned to his counsellor and said of the cheering crowds: “Bunch of fools.”

Here is the link:

https://www.theguardian.com/world/article/2024/jun/08/putin-war-ukraine-forgotten-lessons-of-history-europe

I hate to say it but I have a real fear the Russians are going to win this war - unless the West really gets is act together - as it did in World War II.

As best I can tell it is not going well and sadly Ukraine is not getting the speed and volume of help it needs. Biden et. al. need to get their act together and fast!!!

David.

This Was Always Going To Be Dud And So It Has Proven,

This appeared last week:

Only 20 doctors sign up to government’s $24 million Medical Costs Finder website

Australian taxpayers have spent $24 million to set up a website that has barely been used.

Frank Chung

June 7, 2024 - 12:59PM

The reason fewer GPs are bulk billing as consult costs rise

Royal Australian College of GPs Vice President Michael Clements discusses why fewer doctors are offering bulk billing as consult costs continue to rise.

A $24 million website meant to let Australians compare costs of medical procedures has only been used by 20 doctors nationwide to display their fees, it has been revealed.

Medical Costs Finder, a $2.5 million initiative launched in 2019 under the Coalition, was intended to allow patients to shop around for affordable care.

The former government allocated a further $17 million in 2020 to enhance the website and encourage individual doctors to list their fees, in an attempt to give patients greater transparency around out-of-pocket costs.

But a Senate Estimates hearing on Thursday heard that so far only 20 doctors had voluntarily listed their fees, equating to, in the words of independent Senator David Pocock, “over a million dollars per doctor on the website”.

The website was set up in 2019 under the Coalition.

The revelation, which is reminiscent of the Rudd Labor government’s failed GroceryWatch and FuelWatch websites, came while the ACT Senator was quizzing Health Department officials about the “astounding” out-of-pocket surgery costs paid by private patients in the territory, citing data from Private Healthcare Australia.

According to the private health insurance peak body, ACT residents pay at least 50 per cent more than other parts of the country — a typical knee replacement in the ACT costs $4508, cataract surgery $1575, prostate surgery $2568, shoulder reconstruction $3500 and gallbladder surgery $2165.

Mr Pocock said he found the difference “staggering”, noting that gallbladder removal in other states costs $600 or less.

Health Department deputy secretary Penny Shakespeare replied that the higher out-of-pocket costs were a result of prices set by individual surgeons, and recommended patients use Medical Costs Finder to compare fees.

When Mr Pocock then asked how many doctors’ fees were shown on the website, he was left stunned when Health Department official Brian Kelleher confirmed the national number was just 20.

“Ms Shakespeare, you just told me people can go to the website and see the different fees and make their mind up and now you tell me your website has 20 doctors in Australia with their fees,” Mr Pocock said, as first reported by The Guardian.

Ms Shakespeare replied, “There are different parts to the website. There are individual doctors able to disclose their particular fees and then we have average fees broken down by jurisdictions.”

The Senator pressed, “How does that assist people to shop around if there’s 20 doctors with their fees?”

Mr Kelleher said 640,000 people had visited the website, which provides information on 1300 medical items and 150 services, but Mr Pocock suggested “the vast majority of people who visit (are) bitterly disappointed”.

Health Minister Mark Butler pointed the finger at the Coalition.

“The former government did nothing to make the Medical Costs Finder a useful tool for consumers,” Mr Butler said in a statement on Friday.

“It’s a service that has been left gathering dust and doesn’t provide transparency of out-of-pocket costs. I’ve asked my department for advice on how we can improve the current Medical Costs Finder and transparency.”

Mr Butler said the government was “committed to working with consumers, the colleges and private health providers to improve transparency of out-of-pocket costs for medical specialist services”.

The opposition has been contacted for comment.

Morgan Begg, director of policy at the Institute of Public Affairs, said the fact that “millions of dollars have been wasted on a frivolous medical cost finder website is yet another reminder of the utter disregard governments have for the money which belongs to hardworking taxpayers”.

“This latest example follows the revelations the NDIS has wasted $2 billion on items not in client packages, but has instead been spent on cars, holiday, and even illegal drugs, as well as over $600,000 on a speechwriter,” he said.

“The federal government continues to find new innovating ways to waste our money in the midst of a cost-of-living crisis on things that don’t actually provide a service or benefit to the community at all.”

In a statement on Thursday, Private Healthcare Australia called on the government to force doctors to list their fees on the website.

The peak body said its data showed out-of-pocket costs for common procedures in private hospitals had increased by up to 300 per cent over the last five years.

“It’s simply not possible for health funds to continually chase rising out-of-pocket costs without contributing to hyperinflation in health, which leads to higher premiums,” said Private Healthcare Australia chief executive Dr Rachel David.

“With cost of living hurting and medical out of pocket fees spiralling, it’s time for the government to intervene and publish doctors’ fees on the Medical Cost Finder website. In Senate Estimates today it also was revealed that only 20 doctors had listed their fees on the Medical Costs Finder website, which cost taxpayers $24.2 million to set up. As ACT Senator David Pocock pointed out — that’s $1 million per doctor.”

Dr David said consumers “should be able to check what doctors are charging and shop around, even if it means crossing state borders”.

“Paying more for treatment doesn’t guarantee a better outcome,” she said.

“We need to do everything possible to protect consumers with private health insurance from bill shock. This will keep our private sector strong and keep pressure off the public system.”

frank.chung@news.com.au

Here is the link:

https://www.news.com.au/lifestyle/health/health-problems/only-20-doctors-sign-up-to-governments-24-million-medical-costs-finder-website/news-story/cb9c6b8f1dd37379ed60c009c7979d07

What a saga – showing that even Coalition Governments can attempt to implement stupid ideas – and thinking doctors would take time to disclose their fees on a public web-site was as stupid as they get.

!t was never going to work and anyone who gave the thing a moments’ thought would have predicted what happened!

David.

This Fiasco Is Going To Have A Major Impact On Health Sector Budgets I Fear.

This appeared last week:

The NDIS is a taxpayer sinkhole. Is it an economy killer too?

The uncontrolled growth in the NDIS is contributing to Australia’s inflation and productivity problem, economists and business operators believe.

John Kehoe Economics editor

Jun 7, 2024 – 7.10pm

The stagnating economy and shocking revelations this week about widespread defrauding of the $44 billion National Disability Insurance Scheme have more in common than it seems.

Criminals and shonks were exploiting the NDIS to pay for drugs, luxury holidays and cars, NDIS integrity chief John Dardo revealed.

Nine out of 10 NDIS plan managers surveyed showed signs of fraud, and the justice system would be overwhelmed if all the scams were prosecuted, Dardo said in explosive testimony to the Senate.

Opportunists are setting up businesses purportedly to service people with disabilities, only to line their own pockets. The cost of the NDIS has surged from $13 billion in 2018-19, to $30 billion in 2021-22, to $44 billion in the current financial year, and is projected to hit $61 billion by 2027-28.

The NDIS actuary has warned that unbridled growth could take the scheme to $125 billion a year by the early 2030s, unless the government takes drastic action on eligibility rules. Belatedly, NDIS Minister Bill Shorten introduced proposed changes to parliament this week.

The rapidly growing scheme, which started about a decade ago with broad community support, is not only a concern for taxpayers. The out-of-control NDIS partly explains why the nation has a productivity and inflation problem.

Employers in aged care, childcare and cleaning are losing staff to $70-an-hour, self-employed NDIS jobs, they say.

Warehouse operator Carla Ryan says her business has suffered from a constant stream of workers leaving for higher-paid, unskilled NDIS work. “It leaves us to constantly push up pay rates, well above award, to keep finding and retaining good staff,” she says.

“I see and hear constantly about people who are choosing to work three nights a week, sleeping over at an NDIS-funded caring role where both the carer and cared-for person are mostly asleep, for $2400 gross, or $800 a night.

“This is versus a large range of alternative jobs they are prioritising this over, including tradie jobs, warehouse jobs, waiting jobs, accountant jobs, jobs of all types.”

Ryan also questions the impact of the NDIS on productivity and wage inflation. “Then on total inflation? Then on RBA rate rises?” she asks.

The national accounts published this week reveal that labour productivity, measured as GDP per hour worked, has flatlined over the past 12 months and is sitting 5 per cent below its pre-pandemic peak.

Productivity is the key determinant of living standards. The higher it goes, the higher real wages can sustainably rise as workers become more efficient at producing goods and services in a low-inflation way.

Reserve Bank of Australia governor Michele Bullock reiterated on Wednesday the importance of a productivity recovery to ensure wage rises were sustainable and don’t fuel inflation in a full-employment economy.

But there is a twist in the productivity numbers that comes back to the NDIS problem.

Productivity in the private sector is growing reasonably healthily and is back above its pre-pandemic level. But productivity in industries where governments set or highly regulate prices – healthcare and social services, public administration and safety, and education and training – has been going backwards.

This is the so-called “care economy” that Treasurer Jim Chalmers has talked up as key to Australia’s productivity aspirations. The care economy, particularly the NDIS, is becoming a bigger share of the overall economy as more people join the NDIS and an ageing population puts more demands on aged care and healthcare.

But the social assistance sector is also becoming less productive relative to the private sector.

Australia is now suffering a version of what economists know as Baumol’s cost disease.

Named after American economist William Baumol, his theory from the 1960s explains why prices for the services offered by people-dependent professions with low productivity growth – such as the NDIS and aged care – keep going up.

Almost one in three jobs created last year were in NDIS-related sub-industries like allied health and non-childcare social assistance, according to investment bank Jarden.

At a time of high inflation, policy economists now believe the uncontrolled growth of the NDIS is contributing to Australia’s inflation and productivity problem.

Former Treasury economist and former National Disability Insurance Agency executive Hassan Noura says labour shortages across the economy are contributing to supply side capacity constraints and putting upward pressure on inflation.

“Given this context, an important economic policy priority is to facilitate the smooth reallocation of labour from low to higher productivity jobs and sectors,” says Noura, now director of People Economics.

“When it comes to the NDIS, we need to talk about the quality of jobs and the quality of supports delivered, not simply the number of jobs and supports. Many of the jobs being created by the NDIS are not frontline care jobs directly benefiting people living with disability.”

Noura adds that a lot of the jobs that have been created are low-paying administrative and intermediary jobs, such as support co-ordinators and plan managers that help participants to submit their NDIS invoices and navigate the excessively complex NDIS ecosystem.

“Other jobs are being created to help combat and police the growing fraud in the sector,” he says. “The far better solution for participants and for the productivity of the economy would be to simplify and re-design the NDIS so that these jobs would not be needed in the first place.”

He says that while frontline care jobs “are more productive and more directly benefit participants”, caution and nuance are needed when creating jobs.

“For example, it’s great for people living with disability, and the productivity of the economy, if we create 1000 more allied health jobs that deliver hundreds of thousands of additional therapy sessions that are truly needed and effective and that lead to better outcomes.

“It’s less great, if not wasteful, and bad for the productivity of the economy, if we are creating these jobs to over-service NDIS participants with additional and/or ineffective treatments that do nothing to improve outcomes.”

Since June 2020, the number of businesses in social assistance and healthcare has exploded by about 49,000, according to the Australian Bureau of Statistics. The rate of business growth in health and social assistance is nearly three times the pace of population growth. Healthcare and social assistance businesses grew at a faster rate than any other sector in the year to June 30, 2023, expanding by 6.7 per cent.

While much of this is a natural evolution of the ageing population and a symptom of a wealthy nation demanding more personal care services, Australia is indisputably expanding jobs and businesses in low-productivity sectors that are funded by taxpayers. The NDIS has more than 170,000 unregistered providers receiving payments from an NDIS plan manager.

Queenslander Jim is critical about the services provided by the taxpayer-funded NDIS.

“A friend of mine who lives with his mother in a massive Queenslander overlooking the Brisbane river, with Rolls-Royces and Range Rovers in the driveway, has received tens of thousands of dollars from the NDIS because his mother is in a wheelchair,” he says.

“Anything remotely associated with the upkeep of the house is paid for by my tax dollars. A new pathway and driveway costing tens of thousands, paid by the NDIS because he rolls his mum down there once a week, despite the fact that he rolled his mum down the old one, with no problems, for 20 years.”

The NDIS has also paid for new airconditioning, a new fridge, and fixed half the property’s roof, he claims.

Meanwhile, Sheryl Brady, a mother of two sons with Down syndrome who receives help from the NDIS, says the government sets the prices providers can charge at too high a rate.

“Therapists were immediately able to charge a much higher rate than before, when the NDIS began,” she says. “And charges for support workers are also too high.”

She is also sceptical that higher pay attracts superior workers. “Inexperienced therapists are going into private practice too soon to get the higher pay,” she says. And support workers “find it’s good pay where they can sit on their phone and not do much, and the client/participant hasn’t always got the knowledge or skills to complain.”

Since the end of the pandemic, the economy has been running at full tilt. Demand in the economy is running ahead of the economy’s capacity to supply goods and services in a low inflation way, a point made by RBA governor Bullock this week.

At the same time, federal government spending has expanded from 24.5 per cent of GDP before the pandemic to about 26 per cent – the equivalent of about $35 billion a year more in spending, in addition to increases by state governments and large nominal wage rises.

The NDIS, which is a program with 650,000 people, now costs more than universal Medicare and rebates for private health insurance for the entire population.

Australia is now among the biggest government spenders on disability in the world, outlaying more than $84 billion a year (more than 3 per cent of GDP), for items such as the NDIS, disability support pensions, and carer payments.

This is more than double the share of GDP in the United Kingdom and Canada, and around the same levels as the European welfare states of Iceland, Finland and Sweden. So much for the claim a decade ago the NDIS would “pay for itself”.

Workforce participation rates of family carers have barely budged and some family members double-dip on the $44 billion NDIS and separate $13 billion carers payment.

When government consumption grows at a time when the economy is at full capacity, then household consumption has to fall to make room. Inflation and a higher income tax burden on households is the equilibrating mechanism.

One disability service employer says: “All the dirty secrets about fraud and dodgy providers have been known in the sector for years. The media stories now coming out are still only scratching the surface.

“We’ve been trying to get the government to listen that our sector does not have a regulatory system, which is pathetic,” they say. “It’s the fastest-growing government scheme and biggest cost blowout, but it has the least regulation, with no checks and balances.

“Someone can get out of jail today, get an ABN and start providing services tomorrow.”

He declines to be identified because he says disability advocates are “sensitive” to anyone publicly criticising the NDIS, and that being named could hurt his business.

The NDIS is fast becoming Australia’s equivalent of the UK’s once-treasured but arguably broken National Health Service.

It has become a monster, and appears to be slowly killing the economy.

Here is the link:

https://www.afr.com/policy/economy/the-ndis-is-a-taxpayer-sinkhole-is-it-an-economy-killer-too-20240606-p5jjp6

This really feels like an uncontrolled financial disaster and I fear the impact on the health sector is going to be enormous!

There is only so much money in the Federal Budget and you can bet that, already, funds are being shifted from Health to try and cope with this emerging humongous blowout.

I do not believe “this will end well” for the health sector - or the economy in general! Finding the will to reign in the cost of the NDIS is, I suspect, just too hard for Government until we are all pretty much ruined!

David.

See also:

https://www.theaustralian.com.au/commentary/ndis-rorts-and-extravagant-wages-are-dragging-down-the-economy/news-story/049c1969777013d73e2693705adaab39

D.

The Story Just Seems To Be More And More Amazing. Be Assured It Will Return To Earth!

This appeared a few days ago:

Nvidia leaps into the $3 trillion club and could soon own it

June 6, 2024 — 3.17pm

Move aside Apple. If you haven’t heard of computer chipmaker and market rock star Nvidia, you haven’t been paying attention.

It is big enough to be its own stock market index. If it were an economy, Nvidia would kick France off the seventh spot in world GDP rankings. As an investment, it has spawned countless millionaires and billionaires in a few short years and is likely to deliver an even bigger crop in the months ahead.

Nvidia has now become the third member of the most exclusive of clubs – companies whose stock market value has topped $US3 trillion (that’s $4.5 trillion Australian dollars) – and pressed ahead of Apple to be just whisker shy of the top spot, currently occupied by Microsoft.

Even James Packer has become a latter-day Nvidia disciple – having doubled down on his investment in recent months.

But despite its size and meteoric rise in the market, Nvidia is hardly a household name. Most of us still don’t even know how to pronounce it. For those who want to sound informed at dinner parties, “in vidia” is its phonetic spelling – and it’s derived from the Latin word for “envy”. How appropriate.

With Nvidia’s chief executive and co-founder Jensen Huang getting mobbed by tech groupies at public events, what is the company’s secret superpower?

This company makes best-in-class computer chips – a vital ingredient for data processing. The recent boom in its earnings and value comes off the back of the excitement around the next iteration of artificial intelligence, generative AI, which requires an exponential lift in processing power.

If, as they say in business parlance, chipmakers are the picks and shovels of the AI explosion, then Nvidia is an earthmover.

Huang recently declared AI was the beginning of the next industrial revolution and that Nvidia would turn data centres into AI factories.

There are a few other players in this market (AMD, Intel) and while their share prices have also been on a tear, there is daylight between Nvidia and the rest of the pack.

Demand for Nvidia’s top-of-the-line processors is far outstripping supply as Microsoft, Meta Platforms and Google parent Alphabet race to expand their AI computing capabilities and dominate the emerging technology.

The recent explosion in Nvidia’s share price – which increased its market capitalisation by more than $US1 trillion in six weeks – is what has investors’ heads swivelling.

Over those six weeks, Nvidia’s market capitalisation has grown by more than four times the market value of BHP.

The company more than doubled sales to US$61billion in the year that ended in January 2024. That number is poised to nearly double again to over US$110 billion by January 2025. That is an 11-fold increase in sales (along with gross margin expansion) compared with the numbers in 2020.

Such breathtaking speed has naturally drawn the ire of sceptics who suggest caution about Nvidia’s ability to continue expanding its business and its share price at warp speed. Overtaking Apple on the trillionaires chart will add more fuel to that fire, but can Nvidia really deliver a repeat performance as far as its share price is concerned?

Nvidia’s stock price necessitates sustained double-digit revenue growth off its new US$110 billion base – and this is certainly possible. But there are investors who suggest that Nvidia’s outsized share price returns would imply revenue growth even greater than double digits.

Nvidia’s stock is responsible for a third of the S&P500’s gains this year, but the question is whether maintaining this breakneck pace of growth is realistic.

Nvidia doesn’t trade in a vacuum. Its share price performance will be influenced by broader market sentiment. And this calendar year, that sentiment has gone in the share market’s favour – particularly for the “growth” technology stocks (that typically populate the US Nasdaq Index).

Nvidia is part of the Nasdaq and S&P500 index and has been a large contributor to the overall positive performance of both. So for now, it looks like the tail is wagging the dog with Nvidia calling the shots.

Here is the link:

https://www.smh.com.au/business/companies/nvidia-leaps-into-the-3-trillion-club-and-could-soon-own-it-20240604-p5jj63.html

I have to say I suspect we at peek ‘hype cycle’ here and that while the company has grown amazingly the share price and market value are really not presently reflecting reality and will be seen – a year or two from now – to have got ahead of themselves!!

It will be fascinating to see how sustainable the share price rise turns out to be!

Get back to me a year from now but I really suspect the rise is grossly overdone…

David.

It Looks Like Ransomware Has Become A Much Larger Problem Globally In The Last Few Years.

This appeared a few days ago:

‘A case of when rather than if’: Why are hospitals becoming more of a target for ransomware attacks?

Lauren Chadwick

Fri, 7 June 2024 at 8:45 pm AEST·5-min read

‘A case of when rather than if’: Why are hospitals becoming more of a target for ransomware attacks?

A ransomware attack against a lab provider disrupted several hospitals and primary care doctors in London this week, delaying operations and blood tests.

The attack had a “significant impact,” with the lab provider Synnovis stating it was a “harsh reminder that this sort of attack can happen to anyone at any time,” but the NHS does not know the full impact on data at this point.

“All urgent and emergency services remain open as usual and the majority of outpatient services continue to operate as normal,” an NHS spokesperson said on Thursday.

“Unfortunately, some operations and procedures which rely more heavily on pathology services have been postponed, and blood testing is being prioritised for the most urgent cases, meaning patients have had phlebotomy appointments cancelled”.

A ransomware attack is one in which malware prevents people from accessing files to force the victim to pay for access.

It reflects what experts have called a growing trend of cyber incidents in the health sector.

European healthcare sector ‘increasingly targeted’

“The healthcare sector has been increasingly targeted as digitalisation has expanded the attack surface and giving rise to increased phishing and ransomware attacks,” Laura Heuvinck, a spokesperson at the EU Agency for Cybersecurity (ENISA), told Euronews Health.

An ENISA report published last year found that ransomware attacks represented 54 per cent of cyber incidents in the sector from January 2021 to March 2023, with this type of attack being named a “prime threat in the health sector”.

Yet just 23 per cent of health sector organisations had a dedicated ransomware programme in 2023, the agency said.

The report, which covered part of the COVID-19 pandemic era where the health sector was a primary target, found that most of those behind the ransomware attacks were driven by financial gain.

“Attacks mostly target patients' data such as electronic health records which are then used for example for fraud, identity theft or use sensitive data for extorsion,” the agency spokesperson added.

EU healthcare providers and hospitals were particularly affected by the incidents compared to health authorities and the pharmaceutical industry.

A French Digital Health Agency report last month noted a “persistence of incidents of malicious origin” in 2023, with 581 reports of cyberattacks in healthcare, at least half of which were malicious.

But they also noted that the year was marked by a “significant reduction in major incidents and stability in the number of incidents that had an impact on patient care”.

Some 53 per cent of structures said that a cyber incident had no impact on their functioning, and analysts said proactive monitoring of information systems had helped make cyberattacks less effective.

There was, meanwhile, an increase in ransomware attacks targeting US hospitals in 2023, according to a report this year from the software company Emsisoft.

Ransomware attacks affected 46 US hospital systems spanning more than 140 hospitals last year, and at least 32 hospital systems had protected health data stolen, Emsisoft said.Why would criminals target the healthcare sector?

Alan Woodward, a computer security expert at the University of Surrey in the UK, said hospitals may be at risk as they “aim to communicate between a lot of different providers,” making their systems more “open”.

“It's one of those things where the more connectivity there is, the attack surface grows, so that there's going to be more opportunity for criminals to get in,” said Woodward.

“Just imagine the number of emails going backwards and forwards to a hospital and all the people in the hospital every day…You only need one to get through with a bit of malware in it; it spreads”.

An example of this was the 2017 global WannaCry ransomware attack which impacted 80 hospital trusts in England.

One analysis from Imperial College London put the cost of the massive cyberattack at nearly £6 million (€7 million) for the NHS due to appointment cancellations and delays to life-saving care for patients.

“The bottom line is criminals don't care. They really don't care who they hit, and I think some of the thinking probably in their mind is if we attack things that are critical, people might be more likely to pay up because they’ve just got to have it,” he added.

Hospitals are also already stretched resource-wise.

“IT isn't their core business, but they are very dependent on it,” he added, so “finding time and resources to make sure you've got the latest software, the latest versions of things that are not vulnerable, it's difficult”.

What can hospitals do to prevent attacks?

“Most hospitals now are prepared for the fact that it’s a case of when rather than if they’re going to be attacked,” said Woodward.

People need to know who to call and what actions to take in the event of a cyberattack as part of their incident response plan.

But overall, ransomware typically gets into a system “by fooling somebody,” says Woodward.

“One should never ever victim blame when it comes to cybersecurity. But what organisations should do is repeatedly run awareness education of how this could happen, you know what to look out for,” he said.

All logins should also have multi-factor authentication, he added, and education should include password hygiene.

Experts say that the key is also to not pay the ransom, with some pushing for an international ban on these payments.

A 2022 Sophos survey across 31 countries found that the healthcare industry was the most likely to pay ransom but also paid the least amount.

“The only solution is to financially disincentivise attacks by completely prohibiting the payment of demands. At this point, a ban is the only approach that is likely to work,” said Emsisoft threat analyst Brett Callow in a blog post earlier this year.

“The advice always is please don't pay up because A. you just embolden the criminals and B. you guarantee nothing. You don't guarantee getting your data back,” Woodward added.

Here is the link:

https://au.news.yahoo.com/case-rather-why-hospitals-becoming-104537883.html

Not good this trend is spreading globally and increasing in frequency – we really need of Health IT to be working 24/7!

Surely there must be some technical ways of reducing the impact of these attacks? Making sure the attacks do not pay would be a good first step!

Suggestions welcome!

David.

AusHealthIT Poll Number 750 – Results – 09 June 2024.

Here are the results of the poll.

Do You Anticipate AI Will Be An Enduring And Sustained Influence On Digital Health Over The Next Few Decades i.e. - It Is A True Megatrend?

Yes                                                                             24 (67%)

No                                                                               11 (31%)

I Have No Idea                                                              1 (3%)

Total No. Of Votes: 36

A fairly clear cut vote suggesting we have a sustained trend with AI assisting digital health!

Any insights on the poll are welcome, as a comment, as usual!

A great voting turnout. 

1 of 36 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

This Has Really Reached The Stage Of Total Absurdity!

This appeared last week:

India sweats in 52.9C heat? Maybe not

By AFP

Updated 6:46PM May 30, 2024, First published at 11:27AM May 30, 2024

Power usage in India’s capital surged to a record high on Wednesday as residents of the sprawling megacity struggled to keep cool during a crushing heatwave, with temperatures sizzling above 45C.

India’s government-run weather bureau said a station reading showing a potentially record-breaking temperature in the capital may have been due to an “error” in the measuring equipment.

As people sought relief from scorching temperatures, the electricity grid groaned under a record peak power demand of 8302 megawatts, according to official data.

The India Meteorological ­Department, which reported ­“severe heat-wave conditions”, this week issued a red alert health notice for Delhi’s estimated 30 million people, and authorities on Wednesday warned of dire water shortages and ordered teams to clamp down on wastage.

The weather bureau also said it had sent a team to investigate a staggeringly high reading at an automatic weather station.

“Mungeshpur reported 52.9C as an outlier compared to other stations,” the ­bureau said, referring to a station in a Delhi suburb.

“It could be due to error in the sensor or the local factor.”

The bureau’s multiple other sites recorded a maximum temperature over Delhi on Wednesday that “varied from 45.2C to 49.1C”.

Bureau meteorologist Soma Sen Roy said officers were “checking out” whether the station had recorded it correctly.

On Tuesday, two Delhi stations – at Mungeshpur and at ­Narela – posted readings of 49.9C.

In 2022, Delhi temperatures were recorded to have hit 49.2C.

In 2016, 51C was recorded in Phalodi on the edge of Rajasthan’s Thar Desert, the highest confirmed temperature in India.

AFP

Here is the link:

https://www.theaustralian.com.au/world/india-sweats-in-529c-heat-maybe-not/news-story/81f69828e12ea67b0aa98dae8bab67b3

I find this utterly incredible. I have no idea how anyone could survive temperatures like this! No matter what the actual reader was, it was clearly lethally hot!

If this is even half true I am very glad I am in the second half of my life and not the first. It looks like things are going to get pretty terrible as we move forward!

David.

I Am Looking Forward To Seeing How These Changes Work Out Over Time.

This appeared last week:

New pharmacist prescribing powers see thousands of women bypass their GP

June 1, 2024 — 1.30pm

New prescribing powers for NSW pharmacists allowing them to treat women who present with uncomplicated urinary tract infections (UTIs) have come into effect today.

Bypassing the need for a GP appointment, women aged 18 to 65 can pay for a private consultation with a pharmacist trained specifically to deal with UTIs, to be prescribed antibiotics.

In a 12-month clinical trial led by the University of Newcastle, 1000 participating pharmacies provided 17,000 consultations.

The trial results have yet to be released, raising concerns among GPs that the prescribing powers have been implemented prematurely, risking misdiagnosis and ineffective use of antibiotics.

Hailing the trial as successful, Pharmacy Guild New South Wales branch president David Heffernan said he was aware of only one adverse event. A patient’s UTI was so advanced she needed intravenous treatment after oral antibiotics proved ineffective.

“I’m very proud of the trial – it was robust, and we worked with GPs in a professional and collaborative way,” he said.

“It’s a very positive thing – there’s one disease state out of thousands that we’ve had red tape removed to treat. It’s about opening up options for patients.”

During the trail, Heffernan said, on average one woman presented to a participating pharmacy each week, meaning many still chose their GP for treatment.

However, Royal Australian College of General Practitioners NSW and ACT chair Dr Rebekah Hoffman said she was concerned about the powers being made permanent before the release of the trial results.

“The trial [is being] used as a rationalisation after the fact rather than a genuine evaluation … We still have genuine concerns about the lack of supporting evidence for patient safety given the potential for adverse events, as well as cost-effectiveness, and appropriate communication back to the GP,” she said.

Hoffman said she was also concerned about antibiotics being prescribed inappropriately, or pharmacists misdiagnosing UTIs instead of more serious health problems.

In a similar trial in Queensland, two patients were misdiagnosed with UTIs. One had chlamydia and another had a 15-centimetre pelvic mass.

“Pharmacists aren’t [adequately] trained to diagnose a UTI and this doesn’t change that, it just puts the cure before a diagnosis,” Hoffman said.

A spokesperson for NSW Health said the trial was under evaluation.

“[The evaluation includes] a review of service satisfaction levels, how often antibiotics were supplied, how often women were referred to other services and what, if any, medical and pharmacy services the trial participants required after the consultation,” the spokesperson said.

NSW Health Minister Ryan Park said similar trials and models has been implemented in Queensland and Victoria.

“Empowering pharmacists to expand their scope of practice is critical to relieving pressure on our GPs, and improving timely access to care,” he said.

The number of GPs in Australia has been declining since 2018. There were about 9550 GPs in the 2022-23 financial year, down from 10,062 the year before.

Blooms The Chemist health programs pharmacist Alex Elia said pharmacists’ response to the policy was overwhelmingly positive, as it was from patients who said they had struggled to book a GP appointment.

“As pharmacists, we are healthcare providers and provide medication, counselling, information … but sometimes in those conversations you fall short of being able to help customers,” she said.

The government had paid pharmacists $20 a consultation during the trial, but pharmacies can now set their fee, to be covered by the patient.

A separate trial allowing pharmacists to treat impetigo (school sores) and shingles is under way.

Here is the link:

https://www.smh.com.au/national/nsw/new-pharmacist-prescribing-powers-see-thousands-of-women-bypass-their-gp-20240530-p5jhyf.html

If ever there was a case of wait and see how it works this has to be it. I only hope our systems are good enough to detect if there is a real excess of patient problems as the approach is rolled out.

I think that this change should not result in major harm but I hope it is not seen as a way to go further in expanding the pharmacist scope of practice beyond what is sensible.

We wait and watch!

David.