What of Our Forgotten Children?

Well, after a month of enforced, exam-driven hibernation I'm back. With any luck, this will be the first of three posts between now and friday. At least then I can claim to post once a fortnight on average...

Reproduced below is an article I wrote for a linguistics course I took this semester. I'll leave it to speak for itself. I've neglected to write a headline because I seem unable to think one up. Any suggestions greatly appreciated.

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Abe wanted to go to school. It wasn’t because he particularly liked school. He didn’t really. He had few friends and little reason to want to be there. The only thing it really had going for it was that it wasn’t home. He wasn’t sure why it was he never wanted to go home. He tried not to think about the possible reasons.
To go to school he needed his younger brothers to get out of bed and get dressed. It never occurred to him that he could go without them. He took that responsibility upon himself without even realising it. They wouldn’t listen to him, they never did. So, he needed his mum to get up and tell them to get ready.
He couldn’t understand at the time why it was that she wouldn’t wake up. He just wanted to go to school.

Abe is now 21. He thinks he was probably 13 or 14 when this episode took place. Despite his vivid recollection of that particular morning, he isn’t entirely certain how old he was, largely because events like this were not uncommon. They happened with varying regularity from when he was about 8 until he was nearly 18.
She wouldn’t wake that morning because she had taken a non-fatal overdose the night before. He isn’t sure when he realised that was the case.
“For that whole decade, my home life is a tangled web of confusion. I’m not sure when anything happened. It’s just one big mess. Kind of like my life was. So I don’t know when I worked out she’d overdosed. It was probably on sleeping tablets. They were her favourite. Though it could’ve been anti-depressants or pain-killers. She’d take all of whatever they’d given her.”

He’d known his mum was unwell from shortly after she first got sick. It wasn’t hard to tell. Sometimes she was in hospital for months. Despite knowing she was sick, he has never understood her illness.
“Even now I don’t have much of an idea what’s wrong with her. Not even her diagnosis. She’s told me so many different things over the years. I don’t even think she knows.”

According to the South Australian-based Children of Parents with a Mental Ilness (COPMI) program, alarming numbers of Australian children are affected by their parent's mental illness. Though many children are not impacted, significant numbers face a multitude of challenges, including fear and confusion over their parent's illness, family stresses, disruption to their study, and an increased risk of mental illness.

When asked about whether he faced these challenges, Abe was quick to agree and add a few more of his own.
“It was really hard, I could never have friends over. That just wasn’t done. I don’t know that I faced the stigma directly, I certainly wasn’t aware of it. I suppose I was lucky in that way. But still, I never had any friends over. I always went to their place and that meant finding transport and that wasn’t easy. Especially since for years Mum was terrified of us kids catching the bus. It was too dangerous. The perverts would get us.”

Abe believes that his mother’s illness has affected him in many ways.
“It was definitely a difficult time. I had a lot more responsibility than a normal kid my age. I fed my brothers most, or at least many, nights. I got them ready for school. Once my Dad asked me to hide the razors from her, ‘cause he was afraid she’d cut herself. I hid them, but I felt really bad. I didn’t know what I was meant to do.”

For Abe, the hardest part was thinking that everything he was going through was normal.
“That’s what shocks me the most. At the time it’s all just normal to you. I never realised that life wasn’t meant to be like that. That it wasn’t meant to be that hard or that painful. I really wish someone had told me that at the time. For so long I thought I was weak and pathetic for not keeping everything together perfectly.”

At least one study has shown that mental health workers believe that learning more about their parent’s illness can be of great benefit to the children. Unfortunately, it is difficult to find any information on these topics, let alone child-friendly information.

Children of Mentally Ill Consumers, or COMIC for short, is a South Australian organisation that was formed in February 2000. They aim to provide education and information on these topics as well as advocating for these forgotten children. Unfortunately, there is currently no way of ensuring that all the children who would benefit from their services can find them. No one knows how many children slip through the cracks.

Abe believes he would have benefited greatly from such a service.
“I wish I’d known about it when I was younger. I know how to find things like that now, but when you’re twelve you don’t know these things. It wouldn’t have solved everything, but it would have made it better and even a little bit better would have been a big improvement.”
He also believes that it would be great if there was a support group service for children such as he was.
“Somewhere to go and talk with other kids who are going through similar things. Somewhere that people understand. Most people don’t. They feel sorry for you or disdain or indifference, they never really understand though and you can tell. It makes you feel so alone.”

This may be why studies have shown that the support of family members, especially siblings is a great benefit and should be strongly encouraged.

“My brothers are the only ones who really understand, and even then they went through it differently. They didn’t have to cook so much. They didn’t hide the razors. The youngest one doesn’t remember Mum when she was well.”
Abe described how, in some ways, he struggled not just because his mother was unwell, but because he had known her when she was well.
“I think in some ways it’s so much harder for me ‘cause I remember what she was like when I was five and she was like the perfect fairy tale mother. She read to me and taught me and my friends to read. She was always there and had all the answers and was always happy and smiling and cheerful. I know that’s through a five year-olds eyes, but that’s how I remember the non-sick mum and it’s just so much harder because I know she’ll never be back. It’s like my mother died and I’ve got a defective replacement. I still love her, but I hate her too.”

It’s a concept he spent quite some time trying to explain, how you can love someone and hate them and even wish that they would die.
“For the longest time I hated myself, because every time she tried to kill herself or overdosed or went in to hospital, I wished that this time she’d just bloody well finish it all off. It would be so much easier if I could just grieve for her once. Instead, I grieve for her every time it happens. I didn’t know how much more grieving I could survive. I didn’t want her to come to any harm, but I wanted to stop hurting.”

COPMI’s aim is “to develop these children into happy, healthy young adults regardless of their parents’ health”. The extra challenges these children face and the less-effective coping skills they learn from their ill parents leave them especially susceptible to developing mental illnesses of their own. Between ten and twenty per cent of children without mentally ill parents will develop a psychiatric illness in later life. Anywhere between one quarter and one-half of children with a mentally ill parent go on to develop such an illness.

Abe now works full-time in the retail industry and hopes to run his own store one day. He has been diagnosed with depression on two separate occasions in the past three years. Though he is quick to take personal responsibility for his illness, you can’t help but wonder if he would be healthier and happier had things been different.
“I lack the coping skills that many people have. I’ve learnt a lot of them in the last couple of years, since I took responsibility for myself and stopped blaming everything on my mum and everything that happened. I think that’s a key step. You have to take responsibility for your life.”
His mother is still ill and he has now distanced himself from her, seeing her only on special occasions and at infrequent lunches.
“It’s not something you want to do. I wish I could have a better relationship with her. But at some point you have to realise that being there in the middle of it all isn’t good. You have to realise that there’s nothing wrong about looking after yourself first. It’s okay to survive. It’s a hard thing to do. If there was one thing I would tell someone in a similar situation to what I was in, it would be that. I’d tell them, it’s important to protect yourself, you have to look after yourself and be well yourself before you can look after them and help them become well.”



Abe spoke with me on the condition of anonymity, as such Abe is not his real name.

Can the Democrats Side-Step Questions They Dislike?

Last night I attended a YACSA Pizza and Politics night in town. About fifteen people showed up to listen to short presentations from:

Senator Simon Birmingham - Federal Liberal Senator and #2 Senate Candidate for SA;
Ruth Russell - Lead Democrats Senate Candidate for SA;
Sarah Hanson-Young - Lead Greens Senate Candidate for SA; and
Tony Bates - Lead Family First Senate Candidate for SA.

Unfortunately, the ALP representative was a last minute apology.

The presentations at the start of the night were fairly routine. They all ran slightly overtime and were full of the standard policy statements.
Simon Birmingham proved himself an articulate and confident voice, with a sound understanding of a wide range of issues. Though I disagreed with a number of his positions, I was impressed with the depth and bredth of his knowledge.
Ruth Russell was her usual self and seemed to love to name-drop. You'd have thought she was stumping for Senator Stott-Despoja between ideological flights of fantasy with, seemingly, minimal groundings in hard facts or data.
Sarah Hanson-Young was a fairly typical young Greenie - fiery, passionate, and angry.
I have to give bonus points to Tony Bates. His speaking style was perhaps a bit reserved and formal for such an event and his spiel was not especially convincing. However, he was willing to come to an event where he was unlikely to have any supporters (and indeed, everyone present was anti-family first). That takes a certain amount of courage and determination. His willingness to engage with us was not unimpressive.

The question period went for over an hour and was by far the highlight of the evening. Numerous questions were answered and several things became apparent.

* The Democrats and the Greens agree on so much they could practically be one party.
* The Democrats like to say "Natasha Stott-Despoja" an awful lot. You could be forgiven for thinking that it was the Stott-Despoja Party and not the Australian Democrats.
* There is a big difference between experienced, competent candidates and fresh faces.
* Family First is not the pure evil it is often made out to be.

I was surprised when Mr Bates explained that Family First had a policy of completely free tertiary education. I was also somewhat appalled. I am, and always have been, fully against free tertiary education. The current pay-when-you-earn-enough system is fairer and more effective in my opinion. One could mount an argument that the current thresholds are too low, or the rates are too high. Overall though, it seems to me that it is unreasonable to ask people who are earning below the median wage to pay for other people to earn above the median wage.

I was less surprised when Mr Bates explained Family First's manufacturing policy. They are protectionists. I have seen this policy from them several times before, it is effectively an infant-industry argument and I am curious as to how well they could implement it. Personally, I think many Australian industries have been coddled for far too long. If they aren't export competitive after sixty-years, they aren't going to be.

Ruth Russell had to before the night finished, as did Sarah Hanson-Young. So, unfortunately I was unable to ask them my question. Fortuitously, Sandy Biar and Aleisha Brown stood in for Ms Russell. Mr Biar is the Democrats candidate for Adelaide and I have met him on several previous occasions through student politics at the University of Adelaide. Ms Brown is their candidate for Makin. I had never met her before, but know her name from around campus where she is the current President of the Democrats Club.

I asked them to explain how they reconciled Compulsory Student Unionism with a belief in Freedom of Association. Ms Brown demonstrated her inexperience in a stammered and broken response in which she outlined the importance of student services and how they have been cut since Voluntary Student Unionism was introduced.
Mr Biar then stepped in and delivered a more articulate response, albeit one that contained no additional content. I was most disappointed. The Democrats were once a bastion of civil-liberties and civil-rights. They now seem to be a collection of angry, bitter radicals.

After the formal proceedings closed, there was some opportunity to mill around and speak to the various candidates. I spoke with Sandy Biar about the VSU question I had raised and he indicated that he actually supported VSU, though that was not Democrats policy.

This came as a shock to me. What happened to the Democrats being a collection of like-minded individuals who were not hampered by a need to toe the party line? Is this indicative of a broader change within the party? Are the Democrats now as restricted as Labor and the Liberals? Does the policy of conscience voting exist in theory alone?


Events such as last night's YACSA Pizza and Politics are phenomenal means for young people to interact with their representatives and candidates. My only regret is that the evening couldn't last longer.

Furthermre, it seems to have had a limited impact on my voting intentions. My current intentions for the House of Reps remains the same (an unfortunate state of affairs induced by my disdain for the Liberal's Tracy Marsh and wariness of Sandy Biar, leaving me little choice but Labor's Kate Ellis). My impresions for the senate race have modified slightly. Family First shall move from their traditional place at the bottom of the ballot, to be replaced by long-time competitor for last place by One Nation. Family First will now sit at second-to-last (unless a particularly nasty one-issue party stumbles along). Simon Birmingham was fairly impressive and I'll probably include him in my top ten.

Yes, I vote below the line. Always have. Always will. This year I aim to meet every Senate candidate for South Australia and every candidate for the seat of Adelaide (along with as many other candidates as I possibly can). I suspect that shall be quite the tall order. This blog will hopefully record how I go and detail a few interesting meetings with politicians of various stripes and sizes.

Edit: I fixed a few spelling-errors and added the hyperlinks. Daniel. (22:30 17-Oct-07)

Is Health Care A Place For Free Markets?

Below is an essay (and I use that term loosely, reports with headings do not an essay make) I recently wrote for Public Finance III. I present it here in a largely unedited format.

Apologies for any problems with the tables. I seem to be having some rather embarrassing difficulties coding them properly.

Edit: Looks like the tables work fine, just didn't display nicely in the preview. (Also, fixed an extra line break in Table 2).
Second Edit: Fixed the nbsp in Table 2.
Third Edit: Did the same thing for Table 1.
Fourth Edit: Added labels. Here's hoping that's all that needs updating.

Daniel O'Brien.

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Health care provision is a complex and multifaceted subject with numerous different approaches to its provision. The role of the public and private sectors in financing and delivering health care differs greatly across nations and the impact these have on health outcomes are complicated to measure. Health care ranks in the top three expenditures in both GDP and tax spending in the majority of OECD nations. This government intervention is predicated on the argument that it can provide superior equity and efficiency to private markets.


I -Efficiency of Health Care

Besley and Gouveia state that ‘in an idealised economy, health insurance would be provided competitively. … The markets in which individuals purchased medical care would also be perfectly competitive. The resulting allocation of resources would be efficient’ (Besley and Gouveia, 1994). For perfect competition to be viable an insurance market needs to meet five conditions (Barr, 2004).

The first condition is that the probability of an individual needing treatment must be independent across all individuals. This is a reasonable assumption except during major epidemics. The second condition requires that the probability of an individual needing treatment be less than one. Though this condition is met for the great majority of illnesses, it is not met for significant categories, notably pre-existing chronic diseases and congenital illness. This leads to significant gaps in coverage in the private health care market. The third condition requires that the probability of an individual needing treatment be known or estimable. Though this is generally true, difficulties arise with policies that provide long-term benefits such total permanent disability cover. (Barr, 2004)

More substantial difficulties are found with the fourth and fifth conditions. The fourth requires that there be no significant adverse selection problems. Adverse selection is prevalent within health care insurance. As premiums rise, those who are less likely to need treatment will purchase less insurance. Thus the likelihood of treatment being required within the insured population will increase and the insurance company will be required to make a greater proportion of payouts, this will put further upwards pressure on the premium and lead to further adverse selection problems. This results in significant difficulties in acquiring insurance in high risk groups, notably the elderly population. (Barr, 2004)
The fifth condition requires that there be no significant moral hazard problems. Moral hazard is a major problem within many health care insurance markets and arises in three ways. Individuals with health insurance may be less likely to take precautions with their health. More substantially, some health care is choice-driven, notably pregnancy and doctor-consultations for seemingly minor conditions. This leads to either an increase in the consumption of health care or to gaps in coverage. The most substantial moral hazard issue is the third-party payment problem. This arises as a result of the arrangement of agents within the health care insurance market. Effectively, the primary cost-bearing agent, the insurance company, is divorced from the decision making of the doctor and the patient and thus has little direct impact on the level of consumption. Furthermore, neither the doctor nor the patient face the full social cost of health care and will thus over-consume. In the extreme case, where insurance companies cover all costs, the doctor and patient face zero private costs and will consume all health care that provides a positive private benefit, resulting in serious over-consumption. (Barr, 2004)
This can be further exacerbated where the doctor is paid on a fee-for-service basis and thus will have a positive private benefit for all health care consumption.

The failure to meet these conditions causes the health care market to fail to operate in a perfectly competitive manner and thus there is an inefficient allocation of health care goods. Government intervention, through public financing or delivery, may be useful to provide a more efficient allocation.


II - Equity of Health Care

Barr discusses two concepts of equity within health care. The first is that of horizontal equity, which calls for perfect information and equal power. Both of these are often absent within health care.

Patients face great difficulties in assessing their health care needs. Medical knowledge is very technical. Patients are generally ignorant as to the quantity of health care that they need and the quality that they are receiving. They are ignorant of various treatment options and of likely outcomes. Even previous personal experience in consuming health care is rarely of assistance, as many medical services are only used once in a life-time by any given individual.
This lack of information is exacerbated by the costliness of a mistaken choice, the high likelihood of the irreversibility of medical procedures and the high emotional involvement of the consumer. This can be exacerbated further by the potential for urgency issues (such as following a motor vehicle accident) and for patients to be incapable of making rational decisions (such as if they are unconscious or mentally impaired by their illness).
Unequal power is a result of patients lacking knowledge as described above, though expanded to include their rights in respect to the relevant health care system and their confidence and ability to articulate their legitimate grievances. Barr writes that it is implausible to imagine that this is the state of affairs for all consumers, though in the final analysis the issue is empirical (Barr, 2004).

The second concept is vertical equity - the redistribution of health care from rich to poor. This redistribution has become the norm in modern western economies. There are several reasons why such redistribution may be considered desirable. Firstly, the rich people may benefit directly from the altruism of helping others. Secondly, unhealthy people are likely to be less productive and may in fact foster further illness. In this case, providing health care to the poor may have a direct impact on the consumption level and general well-being of the rich. For example, more workers available will lead to lower wages which lowers costs for firms and thus lowers the price of goods consumed by the rich. Additionally, health care measures such as vaccinations are most effective when substantial portions of the population are treated. The rich gain direct health benefits from the vaccination of the poor and it may thus be in their best interest to provide such health care.


III - Arguments For and Against Government Intervention in Health Care

In markets facing externalities or other substantial failures, government intervention may be able to foster a more efficient outcome. Governments are also the principal mechanism for the redistribution of wealth for equity purposes.

Though many have argued for less government intervention in the health care sector, it is generally agreed that private health care markets suffer from significant failures as discussed above. Thus in most instances, the arguments for and against government intervention in health care markets are actually arguments about whether such intervention induces a more or less efficient outcome. For government intervention to be desirable on an efficiency basis the gains from an increase in efficiency must offset any deadweight loss incurred.

Governments face a myriad of options for intervention. These range from simple regulation, to public financing of private health care, to full public delivery in place of a private market. Simple regulations such as mandating minimum qualifications to become a doctor can help address some, but by no means all, of the incomplete information problems. Alternatively, governments can provide public financing of health care with or without public delivery.

In the case of public financing without delivery, health care services are provided by private firms. There are two general ways in which this financing could be structured. The first is through private finance for ‘easy’ cases in the form of regulated insurance markets, with state financing covering residual (i.e. largely uninsurable) conditions and for those unable to afford basic coverage. Regulations take the form of minimum standards of coverage and compulsory insurance for all citizens.
The second method is state finance. In this the state pays all medical bills, using either a social insurance system or tax revenue. As social insurance systems are not strictly actuarial, they avoid most of the gaps in coverage problems that arise in purely private markets. (Barr, 2004)

Alternatively, the government can both finance and provide health care. Such systems can overcome many of the failures inherent in private markets. Barr argues that public delivery systems such as the UK’s NHS can provide more efficient outcomes. He argues that doctors deciding treatment addresses the problems of consumer ignorance and that the system avoids many gaps in coverage by abandoning the insurance principle and providing tax-financed health care that is free at the point of use. The minimal use of fee for service arrangements limits the third party payment problem. Administrative rationing of health care provides a restriction to the quantity consumed, this helps prevent over-consumption of health care arising from the null cost to the consumer.

The issue of vertical equity is a normative one, that is to say it is values based and depends on the beliefs of individuals. Libertarians often support redistributions for the utility-boosting reasons described above, but believe that this should be on a voluntary basis rather than through enforced taxation. They often believe that the current level of redistribution is larger than the optimal level. Socialists support redistributions for their own sake, arguing that they increase equity and that the current level of redistribution is likely suboptimal.


IV - Role of the Public and Private Sectors in Australian Health Care

Australia’s health care system features a significant portion of both public and private involvement.
The federal, state and territory governments all play a role in the funding and delivery of health care. Medicare, the national health insurance scheme, is administered and funded by the Commonwealth Government. The state and territory governments administer the public hospital system, which is jointly funded by the state/territory and Commonwealth governments.
The private sector is composed of a mix of both not-for-profit and for-profit organisations and accounts for approximately one-third of health expenditure in Australia (Australian Bureau of Statistics, 2007). The private sector plays a strong role in the delivery of health care services, accounting for 55.8% of operating room use in 2004-05 (Australian Bureau of Statistics, 2007). 41.2% of hospitals in Australia are private, accounting for 32.4% of hospital beds (Australian Bureau of Statistics, 2007).


V - Differences between the Australian Approach to Financing and Delivery and the United Kingdom Approach

Within the United Kingdom the private sector plays a significantly smaller role than it does within Australia. Private insurance covers only 11% of the population as compared to approximately one-third within Australia (Ross et al, 1999). There are also fewer co-payments required in the United Kingdom, with payments required only for pharmaceuticals, eyesight tests and up to 80% of dental costs (Ross et al, 1999). Funding is overwhelmingly through general taxation.
Health care delivery within the United Kingdom is also predominantly provided by the government rather than the private sector. All hospital staff are salaried employees of the state, whilst general practitioners are self-employed individuals who contract their services to the state. Though similar conditions exists within Australia for general practitioners, hospital staff, especially doctors, within Australia undertake substantial quantities of private work, often within the hospital system. The Australian system also features a far greater proportion of fee-for-service arrangements than the United Kingdom system does.


VI - Differences between the Australian Approach to Financing and Delivery and the United States Approach

The United States health care system is substantially different from the Australian system. Financing within the United States is predominantly through private means, with 61% of the population in employment-related health cover, underwritten by tax concessions (Ross et al, 1999). The Federal Government finances free basic cover for the elderly and disabled, along with a safety net for the poor. However, there are no assurances of universal coverage and some 14% of the population is not covered by insurance or safety nets. This contrasts strongly with Australia which provides often free cover to all citizens and a number of non-means tested safety nets (alongside stronger safety nets for low income earners).
The majority of health care within the United States is provided by private, for-profit organisations (Ross et al, 1999). Again, this contrasts strongly with Australia where nearly two-thirds of hospital beds are within public hospitals (Australian Bureau of Statistics, 2007).


VII - Comparisons between the Australian, United Kingdom, and United States Health Care System Costs

Health care costs can vary quite significantly across countries. There are a number of ways to measure health care expenditure. Traditional methods include measuring the proportion of GDP spent on health care and comparing per capita PPP.
There are some potential difficulties in using the proportion of GDP as a measure of health care expenditure. In recessions when much of the economy is contracting, health care expenditure stays relatively constant (even more so in countries with a large public health sector). Thus the proportion of GDP spent on health care will rise in a recession and decrease in an expansion without underlying changes in actual health expenditure (Ross et al, 1999).
Per capita purchasing power parity avoids this difficulty. However, it does introduce problems concerning the use of a given basket of health care goods. This becomes particularly problematic when one considers that many basic health care goods differ substantially across nations. An example is the prevalent use of aspirin in the United States as compared with the use of paracetamol in Australia. Though direct costs of these two drugs are comparable, this may not be the case with preferred surgical procedures or powerful new drugs, especially chemotherapeutics. Furthermore, PPP is not adjustable for inflation and can thus not be compared across time (Ross et al, 1999)
Therefore, it is best to look at the data in conjunction with one another. That is, to compare both PPP and the proportion of GDP, along with other measures as available. Table 1 shows the expenditures in both PPP and the proportion of GDP for Australia, the United Kingdom, and the United States. It is quite evident that the United States spends far more per capita than either Australia or the United Kingdom. Indeed, it spends nearly twice the United Kingdom as a proportion of GDP and more than double in terms of PPP.

Table 1 – 2004 Health Expenditures in Australia, the UK, and the US
	GDP (2004)	Per capita US$ PPP
Australia	9.5	3128
United Kingdom	8.1	2560
United States	15.2	6037

All data are 2004 figures
Source: OECD, 2007


It can also be important to look at differences in public expenditure across countries. The most frequently used method is to describe public expenditure as a proportion of total health expenditure. In 2004, the United Kingdom’s public expenditure was 86.3% of total expenditure, nearly twice that of the United States’ 44.7% and one-third higher than Australia’s 67.5% (OECD, 2007). It is interesting to note that across these three nations there seems to be a negative association between total health care expenditure and public health expenditure. This is perhaps empirical evidence that a public health system is more adept at avoiding the problems that contribute to the over-consumption of health care than a private system is.


VIII - Comparisons between the Australian, United Kingdom, and United States Health Care System Outcomes

It is not sufficient to compare health care costs across nations. If higher costs are associated with superior health care outcomes system may be preferable to the low-cost, low-outcome system. As such it is important to consider the health outcomes across the three nations. Unfortunately, health is a difficult concept to precisely define and there are thus extreme difficulties in measuring outcomes. Commonly used health indicators include infant mortality and life expectancy at varying ages. There may be some discrepancies in these data caused by changes in health care. For example, there is some evidence that infant mortality can rise slightly in the presence of greater reproductive services. This is because the availability of fertility treatment to women who previously could not become pregnant results in a greater number of high risk pregnancies. There are also associations between greater health and general welfare and delaying the age of first pregnancy. As age of first pregnancy is a significant factor in the risk of pregnancy, this too can have a negative impact on infant mortality. However, it is likely that these impacts are relatively minor and, as such, infant mortality and life expectancy are the most widely used health indicators.
Table 2 shows three health indicators for Australia, the United Kingdom, and the United States. Australia has the best results for each of the health indicators. The United States’ infant mortality is significantly high – only two OECD nations had higher rates (Mexico 19.7 and Turkey 24.6) (OECD, 2007). It should be noted that all three nations have infant mortality rates that are higher than the OECD average.

It is interesting to note that the country with the more mixed public-private system produces the best results of the three countries examined. However, the data set is far too small to provide any conclusive results.

Table 2 – 2004 Health Indicators for Australia, the United Kingdom, and the United States
	Infant Mortality	Life Expectancy at Birth	Life Expectancy at Age 65
			Female	Male
Australia	4.7	80.6	21.1	17.8
United Kingdom	5.0	78.9	19.1*	16.1*
United States	6.8	77.8	20.0	17.1

All data are 2004 figures except * - 2002 data
Source: OECD, 2007

IX - Conclusion

Government intervention in health care provision is an important and difficult topic. The clear failure of private markets to efficiently allocate health care services, and the superior health indicators in countries with stronger public involvement in health care clearly indicate the desirability of government intervention. The precise method of intervention is a far more contentious issue and it is strongly debateable which precise mix of public and private financing and delivery is optimal. Indeed, it is likely that there are a range of optimal solutions, varying with preferences, circumstances, and other factors.

References

Australian Bureau of Statistics 2007, ‘Health care delivery and financing’, Year Book Australia, no. 89, Cat. No. 3010, pp. 277-294.

Barr, Nicholas 2004, ‘Health and health care’, Economics of the Welfare State, 4th edition, Oxford University Press, Oxford.

Besley, Timothy, and Gouveia, Miguel 1994, ‘Alternative Systems of health care and provision’, Economic Policy, vol. 9, no. 19, pp 199-258.

OECD 2007, OECD Health Data 2007 – Frequently Requested Data, http://www.oecd.org/dataoecd/46/36/38979632.xls Last accessed: 01/10/2007

Ross, Bill, Nixon, Jen, Snasdell-Taylor, Jamie, and Delaney, Keir 1999, ‘International approaches to funding health care’ Occasional Papers: Health Financing Series, no. 2, Commonwealth Department of Health and Aged Care.

Could Australian Politics Be A Little Biased?

John over at Australian Politics - a blog, posted about today's announcement of the new Australian Hospital Nursing Schools scheme by Prime Minister John Howard and Health Minister Tony Abbott.

I will avoid discussion of John's take on the nursing schools, though I will say that I am, in theory at least, a supporter of the Government's proposal. I was a partner (admittedly the junior partner) in a community nursing business for two years and involved in the administration for well over a year prior to that. Though not a nurse myself, I was privilege to a lot of conversations over this time about what makes a good nurse and how nurses should be trained.
Every nurse who worked for us bar one was trained before the current university system was in place. And every nurse that I remember speaking to, both within and outside the business, thought that the in-hospital training system was far superior to the current university system. Certainly, my experience was that the hospital-trained nurses were superior in skill. It is important to note that that may be a function of their (often far) greater experience after training (due to an obvious age discrepancy). I must admit to a strong level of bias and little objective consideration of the topic and will thus avoid any formal consideration of the topic.

The focus of this post, however, is not the scheme announced by Mr Howard and Mr Abbott today. It is, what I believe to be, the shocking misrepresentation of Mr Howard.

Read the press release.
Now, does Mr Howard sound like he is taking all the credit for himself, or does he sound like he attributes it to "the Government" which he routinely refers to as "we". Is 'we' a term commonly used to describe a single person? Or, is it a term commonly used to refer to a collection of people, such as, perhaps, a team?

How do your views correlate with John's take?

Traditionally I have enjoyed John's well-reasoned, well-written, and justly balanced posts. Today I was disappointed. I fail to see how Mr Howard "pointedly talks about 'I'". I think that the copious use of 'we' is evidence that he was speaking of a team. Mr Howard does make significant usage of the 'I', when discussing personal anecdotal evidence to support the policy, when discussing his personal opinion of the policy. Does membership of a team preclude a personal opinion? Why would we expect our elected representatives not to hold personal opinions? Indeed, should we not both expect and demand that they not only hold personal opinions, but cleave strongly to their personal principles and beliefs?

It is ludicrous to think that someone who obtained Mr Howard's position would be anything but a team-player. Furthermore, I must ask, why is it that Mr Howard must talk of the 'team'? Why should he be compelled to suddenly, specifically and overtly, discuss the team that has been in existence for, supposedly, his entire prime ministership?

In a second post, John has further attacked Mr Howard along these lines. I have yet to have the chance to read the other sources John has drawn from - partly because he has neglected to provide any link to them and I am thus trawling for them on my lonesome... I will update this post as I gain the opportunity to read through these speeches.

For those who would choose now to label me a Liberal and Howard-supporter: I intend to vote for Kate Ellis in the House of Representatives at the forthcoming election. Ms Ellis is the current Labor Member for Adelaide and a thoroughly decent and capable person (whom I was fortunate enough to meet at the Youth Parliament Mentorship Dinner back in July). Her Liberal opponent is Tracy Marsh, whose basic platform seems to be "I am a good mother and I'll do what Mr Howard tells me to" - not exactly a strong position. At this stage I intend to preference the Liberals over the ALP in the Upper House.

As previous posts demonstrate I have a tendency to support the Liberal's positions more frequently than I support the ALP. Thus, I must wonder if it is merely my personal prejudices and biases that form my opinion that Mr Howard did in fact refer to the team. I must ask, would someone without biases, or with biases against Mr Howard see it otherwise?

Please, leave a comment and let me know how you feel the nursing press release reads. Do you think that Mr Howard was explicitly referring to himself? If not, do you think it is fair to assume that he was implicitly doing so (and, effectively, using the royal 'we')? If you do think he was implicitly doing so, why do you think so?

Is this a blow to the global warming theory?

Steve McIntyre recently discovered that NASA's data for temperature trends in the US has a rather serious error - caused by a y2k bug of all things.

Unfortunately, http://www.climateaudit.org/, a website operated by McIntyre is currently offline (I imagine it's getting pummelled after the recent mentions in the blogosphere). Thus I cannot really comment on the data itself.

Several other blogs have picked up the new findings and run with them. Tim Blair, Watts Up With That?, and Michael Asher at DailyTech have all commented on the new data, which has caused some notable changes in the top ten hottest years on record (in the US).

The most obvious change is that 1998 has now been bumped down a rank by 1934. The three sites go on to make a point of the fact that five of the top ten years now date from before World War II.

That certainly sounds like a compelling piece of data. Except that the old top ten list saw four pre-WWII years, so really the change is only minimal. I haven't yet had the opportunity to find out how much the overall order of, say, the top 100 years has changed. There is some talk at Watts Up With That? about overall changes in the order.

All three sites note that this only makes a change in US temperature records, not world-wide temperature records. They then go on to attack global warming theory, suggesting that this change in the data invalidates the theory (it should be noted that Asher only attacks through implication and I could well be misinterpreting him).

Now, I am somewhat dubious about anthropogenic global warming. The more I read, the more I am uncertain as to the credibility of the IPCC, and the more I question the hype and fanatacism that seems to follow the doomsday theories of global warming. I have previously questioned the validity of the term 'consensus' and I still hold to that position.

However, I must ask, how does a change in one set of US temperature data make any sort of appreciable impact on global warming theories?

If the error were in global records then I could perhaps see the reasoning.
If these records were the only source of temperature data that were used I could perhaps see the reasoning.
If the attack included any sort of mention as to how widespread the use of these data are then I could perhaps see the reasoning.

As it is, none of these seem to be the case (I freely admit I have done only a cursory search on the topic of how frequently various temperature records are used in scientific research). I must ask why these particular opponents of global warming are clutching at straws when there are far more legitimate targets around.

Between attacks like this, A Western Heart's assault on the British Met Office, and the never-ending supply of comments about cold or wet days, months, or seasons disproving global warming it comes as little wonder to me that the proponents of global warming have been so disparaged as to instantly deride anyone who dares voice dissent from the 'scientific consensus'.

I do wonder, though, when did 'sceptic' become a dirty word? Is it not true that all scientists are meant to be sceptics? To critically and thoroughly question all findings and beliefs?

I would have thought that even the prevailing 'laws' of the day should be treated with some scepticism. Whilst it is right to treat them as a solid and likely approximation of reality, is it not also right to consider the possibility that they are incomplete or mistaken. Even Newton's Laws didn't prove infalliable.


On the topic of 'scientific consensus', here is a quote from Michael Crichton, which I feel nicely sums up my opinion: "Consensus is the business of politics. Science, on the contrary, requires only one investigator who happens to be right, which means that he or she has results that are verifiable by reference to the real world. In science consensus is irrelevant. What is relevant is reproducible results. The greatest scientists in history are great precisely because they broke with the consensus."

Howard Sensible? Rann Scary?

Prime Minister John Howard released a YouTube video today to announce the Defence Gap Year program. The video itself is fairly bland and boring - Mr. Howard would do well to avail himself of a better speech writer and some public speaking ability. The idea behind it seems fairly sound to me though. I would have given some serious consideration to spending a year between high school and medical school in the army. As it was, I seriously considered joining ADFA through their students program. The only thing that stopped me was that I wasn't sure that I wanted to commit myself to something for the ten or so years. A year in between high school and uni would have been a brilliant way to find out whether I wanted to joing the defence force or not.

That said, economics has proven itself significantly superior to medicine, so maybe I should be grateful I didn't enlist.

The topic has also been mentioned at Blogocracy, and discussed as a process story at Larvatus Prodeo.

In unrelated news, South Australian Premier Mike Rann and Attorney-General Michael Atkinson have announced that they are "preparing to overturn the ancient legal principle of ‘double jeopardy' ".

Later on in the announcement they talk about when you will be able to retry cases.

* When there is fresh and compelling evidence - I'm all for this one. It makes sense. I would like to see how they define 'fresh' and 'compelling' though. Especially 'compelling'.
* When the acquittal is tainted - now, this one scares me quite a lot. 'Tainted'? What exactly do they mean by 'tainted'? Part of me fears that this is merely code for 'whenever the government so desires'.

There are also some other relatively minor changes. I haven't yet had the time to look around for a copy of the bill, but will hopefully post some comments after I have a thorough read of the legislation.

There doesn't seem to be any sort of comment from the South Australian law community yet (at least not that I could find in the ten minutes I spent googling the topic), but there are some comments on similar law reforms in New South Wales and Queensland.

Daniel O'Brien.

Minor Updates

Hey All,

As one or two of you have previously noted, my blogroll has been woefully incomplete in the past. That particular oversight has now been, mostly, rectified. Take a look at the new Political, General, and Friend's Blogrolls.

I must make special mention of a few of the blogs.

Freakonomics is an amazing blog by one of the preeminent economists of our time. Jointly maintained by Steven D. Levitt (a professor of economics at the University of Chicago) and Stephen J. Dubner (a professional journalist), the blog never ceases to provide new, interesting, and topical insight into the world around us. Most importantly, Levitt has a masterful understanding of the difference between correlation and causation. I would give my left arm to be half as good as he is, and I'd give my right arm to write as well as Dubner.

John Quiggin has written some pieces that I find truly impressive. The professionalism of his arguments is difficult to deny. It doesn't hurt that he's an economist and seems to take a similar stance to me on many things.

Andrew Norton is sometimes a bit hit-and-miss. Sometimes thoroughly mediocre (though this could be a function of his choice of topic and my interest level) and frequently insightful, eye-opening, and brilliant. Read it.

If anyone knows of any blogs that I haven't listed that I should be reading, drop a comment and let me know.

Daniel.