NZ Budget 2021: women left behind despite the focus on well-being

Originally published on theconversation.com
Prime Minister Jacinda Ardern and Finance Minister Grant Robertson on budget day: well-being for all? GettyImages

Finance Minister Grant Robertson called this a recovery budget for “all New Zealanders”. But was it an inclusive budget? Specifically, what did Budget 2021 offer those women who were significantly affected by the job losses resulting from COVID-19?

The budget priorities included an objective to “support into employment those most affected by COVID-19, including women and young people”. Yet in the budget speech, Robertson announced no explicit initiatives for women workers.

Indeed, as was the case in 2020, the focus was on physical infrastructure — building hospitals, schools, houses, roads, rail and a refurbished Scott Base. Around 221,000 jobs are projected to result, some of which are linked to this capital investment of NZ$57.3 billion dollars over four years.

Such spending initiatives are not gender neutral. Our highly gender-segregated labour market means this investment is likely to generate many more jobs for men than women.

Despite the extension of the Training Incentive Allowance to higher qualifications, and targeted programmes such as Tupu Aotearoa for Pacific peoples, there was no mention of support to increase the number of women in trades.

Some initiatives are already in place, but evidence shows desegregating labour markets is no easy task. Often it is a heavily lopsided process. Women are encouraged into male dominated occupations, but not vice versa.

A focus on building need not preclude investment in the care economy. The latter is just as likely as construction to result in economic growth. Research also shows women need child care to support their labour market participation, and increasing child care places increases jobs (usually for women).

Budget 2021 offered little in this regard. It provided funding for just 3,300 additional places in Out of School Care.

Australia is doing better for women

The lack of a gender lens makes New Zealand a laggard compared to the conservative government of Australia. Scott Morrison’s federal budget, handed down two weeks ago, was accompanied by an 81-page Women’s Budget Statement. New spending initiatives focused on women’s economic security, safety and health and well-being.

The statement included a raft of statistical evidence underpinning the government’s decision to invest in social infrastructure. In addition, new money was allocated for women to enter STEM careers and to fund more services for women taking up work in trades.

Alongside this, frontline services for victims of family domestic violence received an injection of money, and A$16.6 million was committed to support a National Women’s Health Strategy (over four years).



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Obviously, Morrison’s was an election budget. To go to the polls later this year, and to secure a win, he has to ameliorate an anticipated backlash from women voters horrified by the allegations of sexual assault, bullying and discrimination within his own party.

Women were also critical of the fact they were largely overlooked in the 2020 budget, which focused on growing male-dominated industries.

Morrison may not be comparable to Jacinda Ardern in terms of his feminist leanings, but his minister for women, who is charged with championing the Women’s Budget Statement, is Senator Marise Payne, Australia’s Foreign Minister and a liberal feminist.

Some Australian commentators argue the budget offerings for women have not gone far enough. But it certainly appears to be more gender responsive than what we witnessed in New Zealand on Thursday afternoon.

Gender should be central to planning

So what do Ardern and Robertson need to change to ensure our progressive well-being approach accounts for women?

Mainstreaming gender analysis across all portfolios, so the budget process becomes more responsive to the needs of different groups of women and men, would be a good place to start.

Key international organisations, including the OECD, IMF and the United Nations, promote the economic and social value of gender responsive budgeting. Canada, Iceland and a number of other OECD countries have made significant progress in embedding gender analysis across all aspects of new and existing expenditure.



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Three elements are required for successful implementation. First, a high-level strategy to ensure analysts take account of gender in their everyday practice across government (including budgeting).

Second, providing tools, training and disaggregated data to support this analysis (like our own “Bringing Gender In” tool and the Integrated Data Infrastructure). Third, working with parliament and civil society organisations to foster collaboration and accountability.

However, implementation of a gender-responsive budgeting process also requires political will to ensure public servants embrace this work. The adoption of a well-being approach, using Treasury’s Living Standards Framework and He Ara Waiora, represents a good first step. But to ensure budget outcomes are equitable, and resources shared with all New Zealanders, gender analysis is essential throughout the budget process.

International evidence suggests implementation is not always easy. However, without gender-responsive budgeting, the gendered nature of public expenditure will remain invisible. This will be detrimental to the well-being of the economy and to reducing inequality.

Jennifer Curtin received funding from the MBIE Endeavour Fund to design a gender responsive budgeting initiative for Aotearoa New Zealand. She is also a member of the Gender Justice Collective.

Sarah Hendrica Bickerton is affiliated with The Gender Justice Collective.

Udari Herath is affiliated with Gender Justice Collective.

Suzy Morrissey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Mouse plague: bromadialone will obliterate mice, but it’ll poison eagles, snakes and owls, too

Originally published on theconversation.com
Masked owl (_Tyto novaehollandiae_), one of many birds of prey at great risk of secondary poisoning Belinda Davis, Author provided

It’s the smell that hits you first. The scent of urine and decomposing bodies. Then you notice other signs: scuttles and squeaks, small dead bodies leaking blood, tails sticking out of hubcaps.

If you’ve lived through a mouse plague, you’ve seen this, and smelled the stench of mice dying of poison baits.

As a desperate measure to help combat the mouse plague devastating rural communities across New South Wales, the state government yesterday secured 5,000 litres of bromadialone. This is a bait that’s usually illegal to roll out at the proposed scale.

This is a bad idea. While bromadiolone effectively kills mice, it also travels up the food chain to poison predators who eat the mice, and other species. And these predators, from wedge-tailed eagles to goannas, are coming in out in droves to feast on their abundant prey.

When your prey is everywhere

Animal plagues in Australia are fuelled by the “boom and bust” of rainfall.

We have natural, flood-driven population explosions of the native long-haired rat, with accompanying booms of letter-winged kites, their predator. We also have locust plagues when the conditions are right, leading to antechinus or mice plagues which eat the locusts.

Since at least the late 1800s, we’ve had terrible plagues of the introduced house mouse (Mus musculus). But rarely has it been this bad, with conditions currently seeming worse than the last plague in 2011, which caused over A$200 million in crop damage alone.

High numbers of birds of prey — nankeen kestrels, black-shouldered kites and barn owls — are often reported feasting on plague mice.

Snakes, goannas, native carnivores such as quolls, and feral cats and foxes, also take advantage of the abundant food. Pets, especially cats and some dogs, are highly likely to consume mice under these conditions, too.

Poisoning the food web

Laying out poison baits is one way people try to end mouse infestations and plagues. So-called “anticoagulant rodenticides” are divided into first and second generations, based on when they were first synthesised and the differences in potency.

Wedge-tailed eagles are among the predators that take advantage of the house mouse plague.
Shutterstock

Second generation anticoagulant rodenticides have higher toxicities than first generation, and are lethal after a single feed. First generation rodenticides, on the other hand, require rodents to feed on them for consecutive days to be lethal.

But mouse-eating predators are highly exposed to second generation rodenticides. For most animal species, the lethal doses of rodenticide aren’t yet known.

A scientific review from 2018 documented the poisoning of 31 bird, five mammal and one reptile species. Second generation aniticoaugulant rodenticides were implicated in the death of these animals.

Our research from 2020 found urban reptiles are highly exposed to second generation rodenticides, too. This includes mouse-eating snakes, called dugites, which had up to five different rodent poisons in them.

We also found poisons in frog-eating tiger snakes, and in omnivorous bobtail skinks which eat fruit, vegetation and snails. This is even more concerning because it shows how second generation rodenticides can saturate the entire foodweb, affecting everything from slugs to fish.

Bobtail skinks don’t eat poisoned mice, but they’ve still been found with poison in their systems.
Shutterstock

Bromadiolone is particularly dangerous, even to humans

The NSW government secured bromadialone baits as part of its $50 million mouse plague support package for regional communities.

Five thousand litres of the poison can treat around 95 tonnes of grain, and the government will provide it for free to primary producers once federal authorities approve its use.

Bromadiolone is usually restricted to use in and around buildings. But given the widespread impacts on wildlife, using bromadiolone at the proposed scale will do more harm than good.

Past research on bromadialone has shown residues persist for up to 135 days in the carcasses of voles (another rodent species). In international studies, bromadiolone has been found in the livers of a host of birds of prey, including a range of owl species, red kites, sparrowhawks and golden eagles.

Humans can be exposed, too, by eating the eggs of chickens that ate the mice.
Shutterstock

And it’s not just a problem for wildlife, humans are also at risk of exposure. For example, we can get exposed from eating eggs from chickens that feed on poisoned mice, or more directly from eating other animals that may have ingested poisoned mice.

A 2013 study looked at chicken eggs for human consumption, and detected bromadialone in eggs between five and 14 days after the chicken ingested the poison. It’s not yet clear how many of these eggs we’d have to eat for us to get sick.

So what are the alternatives?

There are highly effective first generation rodenticides that provide viable solutions for managing mouse plagues. They may take a little longer to kill mice, but the upshot is they don’t stick around in the environment. A 2020 study found house mice in Perth didn’t have genetic resistance to first generation rodenticides, which suggests they’re effectively lethal.

Another approach has been to use zinc phosphide, a poison which is unlikely to secondarily poison other animals that eat the poisoned mice. However, zinc phosphide is still extremely toxic and will kill sheep, cows, pets and even humans if directly eaten.

Rolling out double-strength zinc phosphide may be the lesser of the evils in causing secondary poisoning, but only if used very carefully.

And another way to help control the mouse plague is to limit food resources for mice on farms. Farmers can minimise grain on ground, and Australia should invest in research for grain storage facilities that are less permeable to mice.

Mouse plagues are a regular cycle in Australia. Natural predators not only help create healthy, natural ecosystems, but also they help with mouse control. Second generation rodenticides will only destroy and weaken the predator populations we need to help us combat the next plague.

Robert Davis is a member and former director of Birdlife Australia, a member of the Society for Conservation Biology and the Ecological Society of Australia.

Bill Bateman receives funding from the Holsworth Wildlife Research Endowment.

Damian Lettoof receives funding from the Holsworth Wildlife Research Endowment; and is a member of the Australian Society of Herpetologists, Ecological Society of Australia and Society of Environmental Toxicology and Chemistry.

Maggie J. Watson is affiliated with Charles Sturt University and is a member of the board of the Ecological Society of Australia.

Michael Lohr has previously received funding from funding from the Holsworth Foundation and Birdlife Australia. He is a member of with Birdlife Australia

Grattan on Friday: Morrison locked Australia’s border gate and now he’s hiding the key

Originally published on theconversation.com

Australians of Indian heritage are not just trying to get back home — many are attempting to go to India.

Scott Morrison revealed on Wednesday that since April 23, more more than 1,000 people had sought to travel there. “Now we haven’t let them go — for obvious reasons,” he said.

The government declined to provide a breakdown of the reasons given for wanting to travel. Officials will be quizzed at Senate estimates early next week.

We can presume, however, that a significant proportion sought to leave on compassionate grounds — family illnesses and funerals.

These are absolutely legitimate reasons for people trying to travel. They aren’t some indulgence. And our system should be up to dealing with people caught in family crises.

As things stand, those facing such situations don’t have a hope. The only exemptions currently being considered for travel to India are in three categories: critical workers providing assistance in the pandemic there; people travelling in Australia’s national interest (diplomats and the like); and anyone seeking urgent medical treatment that’s not available here (which would be no one, you’d think).

Morrison and his ministers display less emotion than you might expect in their comments about those Australians desperate to cope with illnesses or deaths of loved ones far away. They do not seem able to walk in their shoes.

It’s a similar story with the children stranded in India.

A Senate committee recently heard there were some 173 minors who were not in a family group.

Surely some children could be flown to Australia in a charter, accompanied by Australian officials. An Australian-based parent could then be taken into quarantine with them.

Such an emergency arrangement could be put in place by Foreign Affairs Department officials and Australia’s High Commissioner in India, Barry O’Farrell, who as a former NSW premier has plenty of experience in organising things.

The India issue is just one of the sharp edges of the increasing debate about Australia’s international border. Attention was focused on returnees from India when the government imposed its controversial temporary ban (now lifted). The wider issue of when the border should be opened flared after last week’s budget assumed it would stay basically closed until mid-next year.

What’s dubbed “Fortress Australia” is objectively driven by the slowness of the vaccination rollout, which has Morrison under pressure, not least because it holds back the economy. But politically, the shut gate suits Morrison, because polling and premiers’ electoral experience tell him the public strongly support closed borders.

This week’s Newspoll showed 73% agreeing “international borders should remain largely closed until at least mid-2022, or the pandemic is under control globally”, and this included 78% of Coalition voters.

Only 21% agreed “international borders should open as soon as all Australians who want to be are vaccinated”.

This mightn’t be an unexpected result, but it is a remarkable one. Australians are saying they are willing to be cut off from the world even when we can expect the COVID risk to be much reduced.

Unsurprisingly, in the vanguard of those pressing for the border to open sooner rather than later are the business groups and individual companies.

Virgin CEO Jayne Hrdlicka was criticised by Morrison for an “insensitive” comment after she said this week: “COVID will be part of the community. We will become sick with COVID and it won’t put us in hospital, and it won’t put people into dire straits because we’ll have a vaccine. Some people may die, but it will be way smaller than with the flu.”

Obviously businesses, especially airlines, have commercial interests at stake in the border opening (although this isn’t across the board – some businesses are advantaged by the present situation).

But, more significantly, the health experts are now talking about the transition to a more open Australia.

Nick Coatsworth, a former Commonwealth deputy chief medical officer and a specialist in infectious diseases, said in an address last week to the Royal Australasian College of Surgeons: “At a point in the future when a significant majority of our community is vaccinated, there will be pressure to open our borders. We must not resist that. In fact, when the time is right, we should be leading the calls for it.”

Coatsworth isn’t saying the border should be open tomorrow but that the conversation needs to shift to how we live with some COVID circulating.

This is back to the days when Morrison used to talk a lot about “living with the virus”.

But at that time Morrison did not expect Australia would go beyond “suppressing” community transmission to more or less eliminating it. And this success has changed community expectations.

What medicos like Coatsworth are saying is that you can’t forever have the gold standard we have now.

Morrison not only wants this until the election – at the moment he does not want to jump the conversation forward.

His message is the government has plans – such as for vaccinated people to have guaranteed interstate travel (vaccine passport) and for selective arrivals – but he doesn’t want to go into detail yet.

It’s a stark contrast to those detailed colour-coded spreadsheets for lifting lockdown restrictions he flourished last year.

NSW Premier Gladys Berejiklian is anxious for more ambition, urging both a faster vaccination rollout and an earlier international opening.

At the centre of the issue is the shambles with the vaccine program. The rollout has two central problems: its tardiness from the start (with supply shortages and implementation glitches), and then the big hiccup of “vaccine hesitancy”. People became wary of the AstraZeneca vaccine following advice that in rare cases it caused blood clots.

Morrison dismissed a poll published in Nine newspapers this week that showed about three in ten people said they were unlikely to get vaccinated. He said he preferred to focus on the other seven in ten and “get on with them”.

But the hesitancy could remain a major difficulty at least until people can access more choice of vaccine later in the year, and it hampers returning to normality and increases the danger of outbreaks. The president of the Australian Medical Association, Omar Khorshid, has argued giving people a date for opening the international border would encourage more to get vaccinated.

Khorshid is blunt, telling the ABC: “When we open those borders, we’re going to get both of those viruses [flu and COVID]. … We’re going to get a bad flu season. Plus, we’ll get a certain number of people who get sick from COVID. And we’ve got to make sure our [hospital] system is ready to cope with that and our public understand that this is part of our pathway towards getting back to normal.”

A few months ago there was much haste in federal circles to map out Australia’s international reopening and announce it. The AstraZeneca issue derailed that plan. Now there’s not even an effective communication strategy, just a bland information push for eligible people to get the jab.

Australia’s dilemma is that it has effectively achieved local elimination and (so far) maintained it, but it is stumbling in the vital follow-up — rapid mass vaccination. Morrison seeks to turn this weakness into a political strength but is running into headwinds, albeit not from the public.

Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Like a high-wire act, Victoria’s budget is a mix of hard work, luck and optical illusion

Originally published on theconversation.com

David Tadevosian/Shutterstock

Victoria’s budget shows a Treasurer engaged in a high-wire balancing act: ensuring a job-rich economic ‘soft landing’ on one hand, while trying to improve the state’s long-term fiscal position on the other.

The budget partly delivers on both goals but, like any difficult circus act, it is part hard work and skill, part luck, and part optical illusion.

The balancing act

Last year, the brief for federal and state budgets alike was simple: spend to support the economy.

Australia was in the grip of the COVID recession, and nowhere was this more acute than in Victoria.

The economic conditions required targeted and effective stimulus, and Victoria delivered in spades.

This year’s test is a little more complicated.

The recovery is going well – Victoria’s jobs have returned to pre-crisis levels, a remarkable turnaround given the hit to the employment from the second lockdown – but unemployment is still elevated.

The challenge for fiscal policy is now to “stick the landing” by quickly getting unemployment as low as possible so wages can grow again.

The federal government made a reasonable attempt at meeting this challenge last week when it delivered a budget focused on creating jobs, particularly in the care sector — even if the quality of its spending fell short and the outlook for wages growth remains poor in the short-term.

But the federal government has one big advantage: for the time being at least, the low cost of debt has given it breathing space on the fiscal position.

This is not true to the same extent for Victoria.



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Victoria’s cost of borrowing is still low – the government can borrow for 10 years at an interest rate of less than 2%, only slightly higher than the Commonwealth’s.

But credit ratings agency Moody’s recently downgraded the state’s credit rating from AAA to AA1 and cut its outlook to “negative”.

That brings the health of the balance sheet into slightly sharper focus.

And this means a treasurer walking the tightrope of more spending to support the economy while at the same time making sure that he reins in future deficits.

The hard work: taxes and spending are up

For the budget balance, the Victorian government has made some difficult decisions to raise more revenue. The budget includes more than $5 billion in new taxes over the next four years.

Tim Pallas cuts the deficit while supporting the economy.
JAMES ROSS/AAP

The new property “windfall profits levy” and the increase in land tax are two significant steps forward in building a more efficient tax base, even if the accompanying increase to inefficient stamp duties is a step backward.

And the significant extra spending on mental health is partially offset by a new Mental Health Levy on payroll tax for businesses – 0.5% for payrolls over $10 million and another 0.5% for payrolls over $100 million, raising $2.7 billion over four years.

This will slightly increase the inefficiency of the progressive payroll tax base, but should not be a major drag on growth.

But the overall focus on revenue is warranted.

It carves out a point of difference between Victoria and the federal government, which studiously avoided the “revenue question” in last week’s budget.

To support the economy, the additional revenue from these measures is more than offset by new spending – more than $12 billion over four years.

The centrepiece of the Victorian budget is the mental health package. The government claims it will create 3,000 jobs in the sector in addition to improving the quality and availability of care.

There are also additional skills initiatives and spending on health and child protection services.

The good luck and illusions

The housing market has done its bit for the treasurer’s success delivering a windfall $5 billion over the three forward years, primarily driven by big uplifts in stamp duty and land tax.

The other very helpful change, this time to accounting practices, delivers $6.5 billion over three years in “other administrative variations”.

The removal of the “capital assets charge” is consistent with other states, but it’s a one-off sweetener for the bottom line.

Landing the trick

On the key indicators of performance, things are heading in the right direction, although not as fast as we might hope.

Unemployment is coming down and the numbers look much rosier than the treasury’s previous estimates in November. However, it is still expected to be elevated over the next four years.

Whereas the federal government is forecasting nationwide unemployment of 4.5% in 2024-25, Victoria projects 5.25% by that date, and unemployment above the 2019-20 level of 5.4% for at least two years.

And wages growth for Victorians is expected to be subdued, and will go backwards in real terms in the next financial year.



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Budget balances have improved by several billion over the next four years, although the government still expects a deficit of $2.5 billion in 2024-25.

Net debt is expected to reach 26.8% of gross state product by 2024-25, with interest costs estimated at 0.8% of gross state product by that date.

The result by the end of the four year projections period is a return to the size of government before the crisis – albeit a level that was high by historical standards.

There’s no playbook for state treasurers coming out of a pandemic recession.

Victoria’s treasurer Tim Pallas is trying to walk the tightrope of strong recovery and fiscal responsibility.

It looks as if he’s pulled it off without too many major stumbles, with a bit of help from the stronger than expected recovery, the housing market, and a change in accounting standards.

The Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute’s activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities as disclosed on its website.

Danielle Wood does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Why the TGA should reschedule MDMA and psilocybin for the treatment of mental illness

Originally published on theconversation.com
Shutterstock

The Therapeutic Goods Administration (TGA) is considering rescheduling psilocybin and MDMA from their current classification as Schedule 9 prohibited substances to Schedule 8 controlled substances.

This would allow psychiatrists to use these drugs in combination with psychotherapy for the treatment of conditions such as depression and post-traumatic stress disorder (PTSD).

Here’s why we believe that would be a good idea.



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A bit of background

On February 3, the TGA announced an interim decision to retain psilocybin and MDMA as Schedule 9 drugs.

The TGA cited limited evidence of therapeutic benefit, safety concerns, potential for abuse, and lack of suitably trained psychiatrists.

But the final ruling, which was expected on April 22, has now been delayed while the TGA seek independent expert advice on the “therapeutic value, risks, and benefits to public health” of the change.

If MDMA and psilocybin are reclassified, they would be administered in a supervised environment.
Shutterstock

The case for MDMA and psilocybin

Research on psychedelic substances such as LSD and psilocybin first began in the 1960s.

The number of clinical trials involving psilocybin or MDMA has increased steadily in the past decade, with more than 70 studies completed since 2010.

Around 60 trials are underway in Europe and the United States involving MDMA or psilocybin.



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The results of completed studies are very promising.

For example, last month, a study of 59 patients with major depression showed just two sessions of psilocybin-assisted therapy was as effective as a six-week course of the antidepressant escitalopram. The proportion of patients who no longer qualified for a major depression diagnosis after treatment was twice as high in the psilocybin group.

This month saw results of one of the largest trials of MDMA-assisted psychotherapy for PTSD published. The phase 3 study used MDMA-assisted psychotherapy to treat 90 patients with severe, chronic PTSD. After three sessions, 67% of participants no longer qualified for a PTSD diagnosis, compared to just 32% of participants undergoing therapy alone.

These latest studies add to a growing number of trials from around the world showing the therapeutic benefit of psilocybin or MDMA in depression, PTSD, anxiety associated with terminal illness, obsessive-compulsive disorder, alcohol and tobacco dependence, and social anxiety in adults with autism.

Scientists are now investigating the use of psilocybin in other conditions for the first time, such as anorexia nervosa, general anxiety disorder, and opioid and cocaine dependence.

Studies are showing MDMA and psilocybin can be effective in treating a variety of mental health problems.
Shutterstock

Are MDMA and psilocybin safe?

Unlike many Schedule 8 medicines, psilocybin- or MDMA-assisted psychotherapy treatments are not taken regularly. The substance is usually used just two or three times with trained specialists as part of a psychotherapy program.

Despite the safety concerns cited by the TGA, there haven’t been any serious adverse reported events due to psilocybin or MDMA from dozens of clinical trials. Less serious effects can include temporary anxiety, paranoia, fear, nausea, post-treatment headaches, or mild increases in blood pressure and heart rate.

Of course, these trials use pharmaceutical-grade drugs administered by a doctor.

However, one of the most comprehensive studies of the harms of commonly used illegal drugs found even illicit forms of psilocybin and MDMA are among the least harmful. In fact, “mushrooms” containing psilocybin had the lowest overall harm score, while illicit forms of clinically-used Schedule 8 substances like cocaine, cannabis and ketamine were all more harmful than psilocybin or MDMA.

We don’t know what dose of psilocybin would be lethal to humans, but it’s estimated to be about 1,000 times greater than the therapeutic dose. No overdose deaths due to psilocybin toxicity alone have ever been reported.

Use of illicitly manufactured MDMA — which often contains other drugs or impurities — has occasionally caused deaths. An estimated 600,000 Australians use illegal MDMA each year, and an average of about three deaths per year since 2000 have been associated with MDMA toxicity alone.

But illicit use of MDMA of unknown dose and purity is much more dangerous than administration of pharmaceutical MDMA under medical supervision in a clinical environment.

A growing field

In recent years, respected academic and medical institutions around the world have launched dedicated centres for psychedelic and MDMA research, including Johns Hopkins University and Imperial College London.

And research into the therapeutic effects of psilocybin and MDMA has recently started in Australia. St Vincent’s Hospital in Melbourne is conducting a clinical trial using psilocybin-assisted psychotherapy to treat anxiety and depression in terminally ill patients. A clinical trial at Monash University is looking at psilocybin-assisted psychotherapy for generalised anxiety disorder and MDMA-assisted psychotherapy for PTSD.

The Australian government recently announced A$15 million in funding for research into the medical potential of psychedelics and MDMA.



Read more:
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It’s hard to reconcile the TGA’s interim decision to retain Schedule 9 for substances with demonstrated benefit in several mental health conditions and fewer safety concerns than many existing Schedule 8 medicines.

The US medicines regulator recently granted MDMA and psilocybin “breakthrough therapy” designation; a special status for highly promising drugs that speeds up their path to the clinic.

The down-scheduling of psilocybin and MDMA could have enormous medical benefit for Australian patients, especially when Australia spent A$10.6 billion on mental health between 2018-2019.

Samuel Banister receives funding from the National Health and Medical Research Council.

Sarah-Catherine Rodan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Native forest logging makes bushfires worse – and to say otherwise ignores the facts

Originally published on theconversation.com

The Black Summer bushfires burned far more temperate forest than any other fire season recorded in Australia. The disaster was clearly a climate change event; however, other human activities also had consequences.

Taking timber from forests dramatically changes their structure, making them more vulnerable to bushfires. And, crucially for the Black Summer bushfires, logged forests are more likely to burn out of control.

Naturally, the drivers of the fires were widely debated during and after the disaster. Research published earlier this month, for example, claimed native forest logging did not make the fires worse.

We believe these findings are too narrowly focused and in fact, misleading. They overlook a vast body of evidence that crown fire – the most extreme type of bushfire behaviour, in which tree canopies burn – is more likely in logged native forests.

The authors say logging increases the risk of intense crown fires.
Australian National University

Crown fires vs scorch

The Black Summer fires occurred in the 2019-20 bushfire season and burned vast swathes of Australia’s southeast. In some cases, fire spread through forests with no recorded fire, including some of the last remnants of ancient Gondwanan rainforests.

Tragically, the fires directly killed 33 people, while an estimated 417 died due to the effects of smoke inhalation. A possible three billion vertebrate animals perished and the risk of species extinctions dramatically increased.

Much of the forest that burned during Black Summer experienced crown fires. These fires burn through the canopies of trees, as well as the undergrowth. They are the most extreme form of fire behaviour and are virtually impossible to control.

Crown fires pulse with such intense heat they can form thunderstorms which generate lightning and destructive winds. This sends burning bark streamers tens of kilometres ahead of the fire, spreading it further. The Black Summer bushfires included at least 18 such storms.

Various forest industry reports have recognised logging makes bushfires harder to control.

And to our knowledge, every empirical analysis so far shows logging eucalypt forests makes them far more likely to experience crown fire. The studies include:

A 2009 paper suggesting changes in forest structure and moisture make severe fire more likely in logging regrowth compared to undisturbed forest

2012 research concluding the probability of crown fires was higher in recently logged areas than in areas logged decades before

A 2013 study that showed the likelihood of crown fire halved as forests aged after a certain point

2014 findings that crown fire in the Black Saturday fires likely peaked in regrowth and fell in mature forests

2018 research into the 2003 Australian Alps fires, which found the same increase in the likelihood of crown fire during regrowth as was measured following logging.

The combined findings of these studies are represented in the image below:


Author supplied

Crown fires take lives

The presence of crown fire is a key consideration in fire supression, because crown fires are very hard to control.

However, the study released last week – which argued that logging did not worsen the Black Summer fires – focused on crown “scorch”. Crown scorch is very different to crown fire. It is not a measure of how difficult it is to contain the fire, because even quite small flames can scorch a drought-stressed canopy.

Forestry studies tend to focus more on crown scorch, which damages timber and is far more common than crown fires.

But the question of whether logging made crown scorch worse is not relevant to whether a fire was uncontrollable, and thus was able to destroy homes and lives.

Importantly, when the study said logging had a very small influence on scorch, this was referring to the average scorch over the whole fire area, not just places that had been logged. That’s like asking how a drought in the small town of Mudgee affects the national rainfall total: it may not play a large role overall, but it’s pretty important to Mudgee.

The study examined trees in previously logged areas, or areas that had been logged and burned by fires of any source. It found they were as likely to scorch on the mildest bushfire days as trees in undisturbed forests on bad days. These results simply add to the body of evidence that logging increases fire damage.



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Forestry industry studies tend to focus on crown scorch.
Richard Wainwright/AAP

Managing forests for all

Research shows forests became dramatically less likely to burn when they mature after a few decades. Mature forests are also less likely to carry fire into the tree tops.

For example during the Black Saturday fires in 2009, the Kilmore East fire north of Melbourne consumed all before it as a crown fire. Then it reached the old, unlogged mountain ash forests on Mount Disappointment and dropped to the ground, spreading as a slow surface fire.

The trees were scorched. But they were too tall to ignite, and instead blocked the high winds and slowed the fire down. Meanwhile, logged ash forests drove flames high into the canopy.

Despite decades of opportunity to show otherwise, the only story for eucalypt forests remains this: logging increases the impact of bushfires. This fact should inform forest management decisions on how to reduce future fire risk.

We need timber, but it must be produced in ways that don’t endanger human lives or the environment.



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Philip Zylstra has previously received research funding from the NSW Office of Environment and Heritage (now part of DPIE) and has collaborated with some authors of the research being discussed. His research is currently funded by the Wettenhall Foundation, Koorabup Trust, the Australian Network for Plant Conservation, and the Big Scrub Landcare group.

Grant Wardell-Johnson receives funding from ARC and has worked for the Western Australian Forests Department and the Department of Conservation and Land Management (CALM)

James Watson receives funding from Australian Research Council, National Environmental Science Program, Bush Heritage Australia and Wildlife Conservation Society. He sits on the scientific committees of Bush Heritage Australia and BirdLife Australia and chairs the Key Biodiversity Area Australian National Coordination Group.

Michelle Ward also works for WWF (Australia) and the University of Queensland. As a PhD Candidate, she received funding from the Federal Government’s Research Training Program.

Decoding the music masterpieces: how Carmina Burana, based on Benedictine poems, travelled from Bavaria to a beer ad

Originally published on theconversation.com
shutterstock

Carl Orff’s Carmina Burana is one of only a handful of 20th century classical concert pieces that can claim to have become embedded in popular culture. Its opening movement in particular has featured in epic film battle scenes, coffee, beer and cologne commercials, dancefloor hits and even inspired an internet meme about misheard lyrics.

Both the origins of the work and its composer are, however, much less known. Born in Munich in 1895, Orff’s lasting musical contribution outside composition was in the field of music education.

What we know today as Orff Schulwerk is an approach to teaching music that encourages children to explore and develop their musical creativity through singing, improvisation, movement, and rhythmic play.

Orff Schulwerk became influential across the West in the years after the second world war (and helped make percussion instruments in particular part of the standard kit of the school music room) but Carmina Burana — the sound of which reflects some of the vocal and percussive interests of the Schulwerk approach — dates from just before the onset of that war.

Premiering in June 1937 at the Frankfurt Opera, its compositional history therefore also intersects with aspects of the racial, cultural and aesthetic cultural policies the Nazi Party introduced across Germany after its rise to power in 1933.

An earthy manuscript

The title simply means “Songs from Beuern” in Latin. Beuern is a variant of the German word for Bavaria, Bayern, but here it specifically refers to a village south of Munich at the foothills of the Bavarian Alps.

The village was home to a Benedictine monastery founded in 733. When it was dissolved in 1083, its library was transferred to the Court Library at Munich.

There, in 1847, a modern edition was made of perhaps the most remarkable work in the collection: a beautifully illuminated manuscript of secular poems in both Latin and Middle High German. These “Carmina Burana” soon became well-known across Europe.

In the mid 1930s Orff asked the German poet and jurist Michel Hofmann to organise 24 of those poems into a libretto for what he envisioned as a kind of secular oratorio with staging elements. The original poems had been preserved with their own melodies, but Orff was not aware of their existence when composing his own settings.

The full title — Songs of Beuern: Secular songs for singers and choruses to be sung together with instruments and magical images — reminds us the original performances were more than concerts. They were envisioned as theatrical events.

Codex Buranus (Carmina Burana) with the Wheel of Fortune, Bavarian State Library, Munich. Circa 1230.
Wikimedia Commons

The famous opening chorus, O Fortuna, velut Luna (O Fortune, like the moon) refers to the Wheel of Fortune and the vagaries of fate. Returning in full at the end, the chorus gives the work a dramatic and musical frame.

Inside that frame, Orff and his librettist placed three groups of poems that deal with, respectively, the transient joys of springtime (Primo Vera), the tavern (In Taberna), and erotic love (Cour d’amours).

Much of the pleasure I suspect we receive from Carmina Burana comes not just from the high literary quality of these poems but also from the fact they concern themselves with topics far from what we might imagine were the usual interests of a benedictine monastery. They can be punchy, earthy, funny — and sometimes surprisingly confronting.

A Roasting Swan laments its fate to those who are about to consume it.

I would challenge any carnivore to hear the extraordinary twelfth movement Olim Lacus Colueram (“Once I lived on lakes”) which gives voice to a roasting swan, and not be drawn to contemplate – if only for a moment – vegetarianism.

But is it fascist?

In his book The Twisted Muse (1997), musicologist Michael Kater asserts that Orff was a central figure in what he describes as a “School of Nazi modernism” which also included composers Werner Egk, Boris Blacher, Gottfried von Einem and Rudolf Wagner-Régeny.

A popular and critical success from its first performance, Carmina Burana was performed regularly in Germany throughout the second world war. The subject matter certainly appealed to Nazi sensibilities that sought to legitimise the Third Reich through association with past empires, particularly the Germany of the medieval era.

But what about the music?

Being approved by a fascist regime does not in and of itself make something fascist. And, in any case, it is notoriously difficult to try and define what a fascist music might be as we are more wont to do in the case of, say, architecture.

As I have suggested elsewhere, we could be forgiven in fact for concluding that Nazism (and fascism more generally) is something which happens to music and musicians, and not something with which a musical work can be complicit in a uniquely musical way.



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Yet I do think it is possible to explore such a possibility — albeit with due caution. Hannah Arendt, who spent a great deal of her later life trying understand how Germany had descended into fascism, described in her book The Origins of Totalitarianism one tell-tale characteristic of fascism as being the “emancipation of thought from experience”: a kind of willed stupidity.

Can a piece of music encourage or mimic such thinking? Can it foster a kind of of “stupid” listening? Well, as far as Carmina Burana is concerned, we might note its heavy reliance on the repetition of small musical motives does lend the work a sense of unquestioned (or, at worst, unquestionable) ritualistic force which might lead us to think something similar.

André Rieu conducts the opening chorus O Fortuna.

A visual parallel might be Albert Speer’s infamous Cathedrals of Light, the array of spotlights he used to monumentalise the Nazi Party rallies in Nuremberg around the same time as Orff was composing Carmina Burana. Here we are certainly presented with an effect without just cause – the awe-inspiring vista (also achieved in no small part by the sheer blunt force of repetition) overwhelms us without encouraging us to reflect on whether that response is actually merited by what the spotlights accompany.

The deployment of artistic effects without legitimate justification is, however, not just a property of fascist aesthetics. It is also a commonly asserted property of kitsch. Should we be surprised, then, to find that the opening chorus of Carmina Burana also now pops up in concerts by the so-called King of Classical kitsch, André Rieu?



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André Rieu gives his audience exactly what they want: entertainment

The frequent use of this opening chorus as an advertising jingle is also, I think, revealing. A famous Carlton and United advertisement for draught beer declared to its audience that they were watching, simply, “a big ad.”

Here, the ad-makers themselves seem to have recognised, named, and exploited the empty grandiosity some would say indeed lies at the heart of the music.

A Big Ad, indeed.

That opening chorus has also made an appearance in the soundtracks of numerous feature films, most notably 1981’s Excalibur, where the shared medieval fantasy elements no doubt made some dramatic sense. But it has also been frequently applied to subject matter far removed from medieval topics; and often for comic and ironic effect.

In a 2001 essay for the New York Times the renowned musicologist Richard Taruskin went as far as to suggest that Orff’s music “can channel any diabolical message that text or context may suggest, and no music does it better”.

He continued “it is just because we like it that we ought to resist it”.

‘Behold Excalibur!’ Carmina Burana adds oomph to an already powerful narrative.

Nevertheless, as another commentator subsequently noted, Taruskin’s description of the work’s effect is also “almost the definition of a guilty pleasure.”

Maybe that’s the best place for us to start our engagement with the work today. Let’s continue to enjoy and be impressed by Carmina Burana — but also let’s not forget to ask ourselves why we might find it so enjoyable and impressive in the first place.

The Sydney Philharmonia Choir performs Carmina Burana this weekend and Melbourne Symphony Orchestra will perform it in July.

Peter Tregear does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Book review: Geoffrey Robertson makes the case for naming and shaming human rights abusers

Originally published on theconversation.com

A.M. Ahad/AP

Geoffrey Robertson is one of Australia’s most acclaimed international jurists and human rights advocates. His latest book, Bad People – and How to Be Rid of Them, explains the history of international human rights law and acknowledges its failings.

Bad People is not a textbook; it is aimed at anyone with an interest in the international human rights framework and its enforcement mechanisms.

Most importantly, it is a call to action for Australians and others in democracies to demand the introduction of “Magnitsky laws”.

Magnitsky laws are named after a Russian whistleblower, Sergei Magnitsky, who was tortured and died after exposing a massive tax fraud scheme involving Russian officials. These laws seek to combat human rights abuses by naming, blaming and shaming individuals, denying them the right to enter democratic nations, stripping them of ill-gotten funds, and barring them and their families from local schools and hospitals.

Magnitsky was a Moscow lawyer and tax auditor who died in custody in Russia at the age of 37.
Alexander Zemlianichenko/AP

The US was the first country to pass such laws in 2012 to sanction Russian officials and Chechen warlords, sending a strong signal to the Kremlin that action could and would be taken for human rights breaches.

Since then, the US has used the Global Magnitsky Act to impose sanctions on more than 200 individuals and entities from two dozen countries, including Saudi Arabia, China, South Sudan, Myanmar, Iraq and Cambodia.

Robertson’s response to the failure of the international human rights framework is to promote powerful Magnitsky laws as a “plan B” to coordinated international action.

Bad People – and How to Be Rid of Them, by Geoffrey Robertson.
Penguin Books Australia

How international courts have been weakened

Robertson charts the rise of human rights immediately after the horrors of the second world war, and then despairs of the growing trend of nations retreating from the jurisdiction of international courts or refusing to comply with their rulings.

Robertson describes how the United Nations succeeded in establishing a coherent human rights regime, but failed to carve out effective accountability mechanisms to enforce breaches. Instead, enforcement relies on individual nations’ leaders being motivated to legislate human rights into their domestic laws.

Although the UN Universal Declaration of Human Rights has been broadly accepted, punishment for war crimes and crimes against humanity has been inconsistent and complex.

Consequently, Robertson argues the International Criminal Court (ICC) does not serve as a deterrent to perpetrators of most human rights abuses.

Eroded confidence in international law

The book provides a useful history of the ICC and the way the US, China and Russia have limited its operations by using their veto powers when legal action is proposed against them or their allies.

In the past four years, for instance, Russia has vetoed ICC action 14 times, China five times and the US twice. Robertson suggests the mere threat of a veto by superpowers behind the scenes have seen other initiatives withdrawn.

As a result, Robertson laments the once-powerful ICC is now confined to punishing rebel warlords and leaders of pariah countries.

More than 70 years after the Universal Declaration of Human Rights, the growing threats of isolationist foreign policies and anti-democratic regimes are pulling at the threads of our international human rights framework. Shifting geopolitical balances and the populist politics of Vladimir Putin, Xi Jinping, Narendra Modi, Donald Trump and the Brexit campaign have eroded confidence in a global system of law and order.



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Australia is not immune from this trend. In February 2020, the ICC prosecutor described Australia’s offshore detention regime as “cruel, inhuman, or degrading treatment”.

But, the ICC decided not to prosecute the Australian government, despite saying its actions appeared “to constitute the underlying act of imprisonment or other severe deprivations of physical liberty” forbidden under international law.

The problem with Magnitsky laws

Robertson’s solution is to impose sanctions against individuals, corporations and other entities.

He argues Magnitsky laws are not an alternative to coordinated international criminal justice, but an assertion of the fundamental values that countries insist should be respected by other nations.

The problem is these types of sanctions can be abused for political reasons. We have already seen the tit-for-tat actions of nations that bring sanctions against the citizens of their enemies, such as the Russian counter-sanctions against US citizens in 2013, including former Vice President Dick Cheney’s chief of staff.



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Among democratic nations, it is unlikely Magnitsky laws would ever be used against friendly allies. Can you imagine any of Australia’s allies sanctioning an Australian official for a First Nations’ death in custody or for the over-representation of First Nations people in the country’s criminal justice system?

If enforcement of human rights breaches is seen as political or inconsistent, then Magnitsky laws may not be the universal panacea Robertson suggests. However, this doesn’t mean the push for individual accountability is not justified. As he writes,

human rights are not rights in any meaningful sense unless they are capable of enforcement.

Robertson leaves us with a sensible pathway to a better world through laws that hold individuals accountable for their evil deeds. Magnitsky sanctions might, at least, make murderers, crooks and abusers think twice before implementing their plans.

Geoffrey Robertson will be speaking across Australia in the coming weeks, with engagements in Melbourne on May 22 and Sydney on May 25 and 26, to be followed by Brisbane, Adelaide and Perth.

George Newhouse is affiliated with the National Justice Project, a not for profit legal service, that advocates for the enforcement of international human rights.

When it comes to media reporting on Israel-Palestine, there is nowhere to hide

Originally published on theconversation.com

AAP/EPA/Mohammed Saber

As lethal violence kills ordinary people in Gaza and Israel, news outlets across the globe are constructing versions of events that will keep eyeballs on their content.

After all, war is the most compelling news story of all. And given many people who care about this situation have no direct experience of it, they depend on media reports to form a view.

But when reporting on something as terrible as political violence, journalists face an impossible choice.

While professional ethics of journalism demand “objectivity”, language just won’t come to the party. This is because language has no neutral mode. Once you step into the process of saying anything about the violence in Gaza, language makes you take a side.

There are essentially two main modes for reporting on geopolitical violence. The first and dominant mode is typical of mainstream news reporting. It strives for objectivity by presenting selective factual events devoid of context. It briefly summarises complex events, while not allocating blame or responsibility.

While the effects of events on ordinary people can be reported on, these are typically presented as an unfortunate but unavoidable byproduct of something otherwise official, rational and purposeful.



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This style is susceptible to the favoured tropes of militaries and, therefore, to inadvertently reproducing official narratives. Destructive and lethal violence becomes obscured by terminology like “operations”, “campaigns”, “offensives”, “strategies”, “targets” and “phases”.

This language construes the violence as if it has a higher purpose. The particularly eager journalist will report the official name of an “operation”, as in this example, where the BBC’s diplomatic correspondent tells readers Israel has named its operation “Guardian of the Walls”.

And they will expound on the types of weapons technology being employed, as if the make and model of the plane and the bombs it unleashes have any real bearing on these events.

The problem with this mode of reporting is that violence is objectified and dehumanised. Objectifying violence means it is construed as if it happens by itself, without reference to either the political masters who order it, or those tasked with enacting it.

And dehumanised, because it fails to put front and centre the most important perspective of these events: those killed, injured, bereaved and traumatised by the actions of (usually male) leaders, who refuse alternative means of resolving differences.

Here’s an example of this “objective” style from a recent report on the BBC’s website. The violence, referred to as a “conflict”, as “rockets and air strikes” continuing, as a “concentration of militant rocket fire”, as “Israeli air strikes”, is all divorced from the human agents of this violence.

And the dead Israelis are killed “in rocket attacks”, while the scores of dead Palestinians are simply a “death toll”.

BBC news report.

An obvious and often conscious effect of this style is to treat two sides as if they are equal participants in this violence. This is the effect of journalistic shorthand, such as the “Israel Gaza conflict”, or the “Israeli-Palestinian conflict”.

These formulations avoid allocating blame to one side or the other. The BBC report shows a scrupulous formulation so that “rockets and air strikes” appear side by side, even when the syntax of this formulation doesn’t make sense. In their phrase “rockets and air strikes have continued”, while “airstrikes” can continue, “rockets” themselves can’t.

And the “they said while the others said” structure keeps up the illusion that this violence is symmetrical.

I don’t want to minimise the horror for ordinary Israelis of suffering rockets fired by Hamas foot soldiers. I can’t begin to imagine the fear that I could lose a child to this kind of horrendous violence.

But the numbers of dead and scale of destruction belie this false equivalence. Just ask yourself: where would you rather be?

Herein lies the alternative mode of reporting this violence. When the violence you are reporting on is illegitimate, you naturally strive for language that fails the “objectivity” test.

You will focus on the brutal and inhumane consequences of the violence. You will make the perpetrators of the violence visible, and you will demonise them. You will emphasise the scale of the violence and its devastating effects on families and communities.



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We can see these linguistic features in the reporting by The Electronic Intifada.

The style goes against everything in the standard journalism textbook. But its crowning, remarkable achievement is that, of everything that is going on, the killing of children is at the heart of this news report.

News report from The Electronic Intifada.

While we like to believe that what we politely call “war” is used as a last resort, this quantitative history of war shows that, as time goes on, human societies have been more addicted to war, that what we think of “civilisation” appears to correlate with more and more lethal wars.

For the journalists who report this violence on our behalf, there is nowhere to hide. There is no neutral, objective mode. Your choice is to stand so far back from the “conflict” that you obscure its brutal irrationality and, in so doing, unwittingly or otherwise, put your support behind the most powerful belligerents.

Or you can come in close and show mutilated and traumatised children, and suffer the journalistic ignominy of “biased” reporting.

Annabelle Lukin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

4 ways to fix private health insurance so it can sustain a growing, ageing population

Originally published on theconversation.com

Caley Vanular

Since 2015, the share of younger people (aged 20 to 39) with private health insurance has dropped from 24% to 22%.

People in this age group contribute more in insurance premiums than they claim in pay-outs. So this decline ends up pushing prices up for the 44% of Australians with private insurance.

And new private health insurance coverage data shows this trend continuing.

Our latest Grattan report outlines a four-step plan to stop this trajectory and fix the private health insurance system. The first step is preventing insurers increasing premiums if they cannot demonstrate the policy offers value for money.

What’s the private health insurance ‘death spiral’?

An ageing population, increased use of health services, and rising health-care costs are driving up the benefits insurers have to pay out each year.

As pay-outs increase, insurers raise premiums, to recoup these costs.

Rising premiums make health insurance less affordable and less attractive — particularly to younger and healthier people.



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As younger, healthier people drop their insurance, the insurance “risk pool” gets worse; people who hold insurance are older and more likely to use their benefits and use them to a greater value.

This increases the cost of premiums, younger people drop out, and the death spiral starts again.

What does the data say?

The chart shows the overall trends in private health insurance over the past six years.

Over this time period, the number of people with private health insurance over 65 — who are likely to draw on their health insurance, receiving more in benefit pay-outs than they pay in premiums — has increased dramatically.

At the same time, the numbers in all other age groups is declining, albeit with a slight uptick in the September quarter of 2020, possibly associated with people being allowed to defer premium payments during the COVID crisis.

The picture is particularly stark for 20 to 39-year-olds. People in this group make the pool of people insured less risky overall.

So far, policy tweaks have failed

In 2017 the federal government announced several rearrangements of private health insurance deckchairs to make the product more affordable or to encourage young people into insurance.

This included:

simplified gold/silver/bronze/basic labelling of products
increasing excesses from A$500 to $750 for singles, and double that for families. Premiums are lower for people who accept higher excesses to reduce premiums
premium discounts from 2% for 29-year-olds to 10% for 18 to 25-year-olds.



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But these initiatives have failed to entice young people into private health insurance.

What are the solutions?

Our report proposes four key changes to:

1. Address premium increases, which are currently too great and too frequent.

Over the past 20 years, private health insurance premiums have grown
faster than inflation, faster than health-specific inflation, and faster than wages. If people want to keep their same level of insurance, they have to fork out more and more.

Insurers that won’t or can’t offer their customers value for money should not be allowed to raise their premiums.

Private health insurance premiums have been rising faster than inflation.
Shutterstock

A new private health industry plan could reinforce the incentives for insurers to improve their claims ratios. This is the proportion of premium revenue returned to members in the form of benefits.

The health minister could also require funds to provide additional justification for a proposed increase if the proportion of their premiums returned to members is worse than the average claims ratio.

2. Reduce private hospital costs.

Unnecessarily long stays and examples of low- or no-value care are more common in private hospitals than in public ones. This drives up the cost of private hospital care.



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A new private health industry plan should create incentives for private hospitals to become more efficient. One way to do this would be for insurers to pay private hospitals in a similar way to how government funds public hospitals. This would mean insurers pay private hospitals for the patients they treat, not for how long patients stay in hospital or the other services hospitals provide.

Improving private hospital efficiency and reducing low- or no-value care could reduce premiums by 5%.

3. Reduce out-of-pocket costs.

Out-of-pocket costs on medical bills are often in the hundreds of dollars, and sometimes in the thousands. In 2019-20, the average medical out-of-pocket cost was $544, and the average hospital out-of-pocket cost was $411.

Out-of-pocket costs are a major source of people’s dissatisfaction with private health insurance, and astonishingly high billing by a minority of doctors is a major cause of these costs.



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Comprehensive, public information on fees and costs would help. But even that is unlikely to significantly reduce the size and prevalence of out-of-pocket costs, because patients face an inherent power imbalance when dealing with doctors.

A new private health industry plan should include the structural reform required to reduce surprise out-of-pocket payments. This may come about through downward pressure on medical bills, or with more deals between doctors and insurers to bridge the gap.

Patients face a power imbalance when dealing with doctors.
Shutterstock

4. Reduce the price private insurers pay for medical devices.

Surgically implanted medical devices include hip and knee replacement devices, cardiac stents and pacemakers. Currently, medical device manufacturers and importers, and private hospitals charge more than twice as much for these as public hospitals, a nice gravy train which they lobbied health minister Greg Hunt to retain.

This year’s budget revealed the minister backed down on a plan to reduce the cost of health insurance premiums by stopping medical device rorts. The budget announced yet another process of investigation and analysis, rather than making the tough decisions to end the excess charging, which would allow cuts in private health insurance premiums.



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Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute’s activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website. Medibank is an affiliate partner of Grattan.

Anika Stobart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.