John Menadue’s sizzling critique of politics, the media and more

Thanks to the many Croakey readers and contributors who came along to the New News conference in Melbourne last week, to discuss the opportunities of the digital revolution for supporting a healthier public debate.

It was good to see you there and from Croakey’s perspective, it was a reminder of how the Internet can be used to support the development of communities of shared interests.

The Centre for Policy Development’s John Menadue reminded us, however, that while Web 2.0 may be exciting, content remains the critical issue. And we have still some way to go in working out how to resource and support those content-makers (this is an issue beyond journalism) who have the will and the skills to provide some much-needed scrutiny and analysis of the health sector and health spending and policy more broadly.

Menadue also made a number of suggestions for how some of society’s powerful institutions (not only the media) could help contribute to a more informed understanding of complex health issues.

Below are John Menadue’s speaking notes:

Under-resourced mainstream media is not in a healthy state. It is failing significantly, with a few notable exceptions, in the health field as in most other fields. It is much more than just the shrillness of the Murdoch media. With so little news to break or analyse, it is not surprising that journalists spend such an inordinate amount of time-sharing opinions with each other.

Can online media fill the vacuum? Crikey/Croaky, Centre for Policy Development and others are in the field, but they will take time to grow. The important issue for online media to recognise is that technology is the easy part. The hard part is content both information and analysis.

In pay television for example, we have excellent new technology that has given us more channels and better pictures, but the improvement in content is marginal. We have more choices, but little increase in value. Online media is much cheaper to produce and deliver, but the continuing problem will be access to good content at reasonable cost. Bloggers give us worthwhile and diverse opinions, but are not particularly strong on the dissemination of factual information.

The Australian polity and the media are in a downward spiral, almost a death wish. Disappointment and disillusionment with politics and the media is widespread and growing.

Trivia and personalities prevailed in the media in the last election campaign. The best example of trivia that I can recall was the Australian Financial Review’s portrayal of Julia Gillard saying ‘Nauru’ instead of ‘East Timor’. As the AFR put it ‘Gillard’s Nauru gaff rocks asylum seekers’ stance’. Really? I have been getting my four children’s names confused for the last 50 years! Even Kerry O’Brien mis-speaks the ABC for the ALP.

Politicians are clearly running away from the big ticket issues – particularly climate change and the two or three track economy that the mining boom is foisting on Australia. Politicians listen closely to lobbyists on these big-ticket issues – 900 full-time of them, or 34 for every Cabinet minister. Journalists are under-resourced to examine policy issues and in many cases have become the mouthpiece of special interests with their well-funded public relations activities. The Australian Centre for Independent Journalism at UTS found in a survey of the 10 major metropolitan newspapers published in Crikey in March this year that 55% of content was PR driven, and 24% of content had little or no significant journalist input. In the specific field of health/science and medicine, the survey found that 52% of content was PR driven, with 23% of content having little or no significant journalist input.

Before I come specifically to health, let me mention the problem in the wider media context.

The Rudd Government introduced timid climate change proposals and then over-compensated the polluters. Frightened by a ‘big new tax’, the government ran away. The result of the power of special interests and the failure of the media to explain has resulted in what Ross Garnaut has described as a ‘diabolical problem’.

For a $7 m advertising campaign, the three wealthy foreign-owned miners saved themselves $7 b in taxes. There were some media commentators, Ross Gittins and Ian Verrender, who wrote cogently on the issues, but much of the media, which was the beneficiary of the miners’ advertising money, either diverted public attention from what was at stake or clambered in political support of the foreign miners. I wonder how those same journalists will react when Chinese state-owned enterprises follow BHP, Rio Tinto and Xstrata in running future political campaigns against the Australian government.  The media was missing in action on this big-ticket item.

On asylum seekers, the government and the media, and particularly the ABC, failed to frame the debate with facts. Television news and current affairs obviously worked on the assumption that if there were no pictures, there was no news. It was easy to get pictures of asylum seekers’ boats floundering in the Arafura Sea, but it is hard to get worthwhile pictures of asylum seekers’ coming by air, despite the fact that over 90% of asylum seekers come by air and not by boat. Tony Abbott said that Australia was being ‘invaded’ by asylum seekers, yet neither the government nor the media took the trouble to point out that asylum seekers represented only 1% of our migration intake.

Special interests in health, as in other areas of public policy, hold sway, with the public and the community largely excluded. The health media has gone missing on the following.

• At the April COAG meeting, State governments and their health bureaucracies were left in control of hospitals. Kevin Rudd described it as the ‘greatest reform in health since Medicare’. That was nonsense. John Brumby and the states won the arguments over hospitals and got a lot more money to boot. Where were the professional and searching journalists in mainstream media? We were all overwhelmed by the spin.
• Compared with many other countries, we have a much higher number of hospital beds. Australian governments have an obsession with hospitals at the expense of non-hospital care. But no journalist to my knowledge has examined this obsession we have with hospitals and hospital beds.
• The media is yet to examine the gaming that goes into waiting lists. These waiting lists are more rubbery than Goodyear tyres.
• The AMA resists any significance change in archaic work practices in health which if implemented could give this country enormous improvements in productivity. Health is our largest sector and our largest employer. There is serious concern about lack of national productivity improvements in recent years, but the potential for health sector productivity improvements is scarcely ever mentioned by mainstream media.
• Many media economists extol competition, but the Australian Pharmacy Guild maintains its protection from competition through location rules, the cap of 5,000 on the number of community pharmacies, and the exclusion of pharmacies from supermarkets. But scarcely a peep from mainstream health journalists.
• The media responds to hot button issues like a particular death in a hospital, but scarcely examines the systemic problems that cause about 10,000 avoidable deaths in our hospitals each year or 200 each week. That is the equivalent of one Bali bombing or one Victorian bushfire every week of the year.
• The health insurance industry retains its corporate welfare subsidy of $5 b per annum. Yet the mainstream media spends more time publishing the views of this highly protected industry, rather than examining alternate policies to produce better public outcomes.
• At the last election, pathology companies, such as Primary Healthcare Ltd, ran ads against the government’s attempt to curb burgeoning pathology costs. It was obviously affecting their profits. In the 8 years to 2008-09, pathology services, paid for by Medicare, have increased 62% and benefits paid increased by 71% – way ahead of inflation. Put another way, medical services per person from 1995-96 to 2008-09 have fallen by 5% for consultations, but risen 30% for procedures and 65% for diagnostic, including pathology. No wonder the government needs to act. Whilst Australian Financial Review journalists were talking up the problems of the pathology sector, nowhere did they frame the discussion with some facts about the enormous growth in pathology and the excessive level of referrals. Their stories seemed like public relations handouts from Primary Healthcare Ltd with minimal journalistic input.

How can the information base be improved to promote public health and a healthy media?

The health sector is so large, complex and technical that it is difficult to understand. This is a problem for all, including journalists. It is also true for ministers, both federal and state, who are easily captured by their health bureaucrats with their mastery of detail.

1. The best-informed health commentary is, and I hope you will excuse me for saying it, in Crikey/Croakey and CPD. But their resources are limited and their readership falls far short of mainstream media. Hopefully such organizations will continue to grow and develop. But content is the hard and expensive part.
2. Health information and policy advice is biased heavily in favour of governments and their bureaucracies. They are able to dominate the debate with this monopoly of information. With the balance of power now to be held by Independents in the House of Representatives and with the Senate to be controlled by the Greens from July 1 next year, there is a unique opportunity to substantially expand the resources, both quantity and quality, available to members of parliament through parliamentary committees and the parliamentary library. The media and the community would be much better informed. (By far the best information I was able to find recently on asylum seekers came not from the Minister for Immigration and Citizenship and his department, but from the Australian parliamentary library.) The proposed parliamentary budget office will also be a considerable help, but it will be limited to budget and fiscal matters which are only one part of a much wider agenda of economic policy.
3. Julia Gillard was rightly criticised for her proposed citizens’ assembly on climate change. It was obviously a diversion from the main issue. But she had a point about our need in many policy areas, including health, for a better-informed community that will enable our leaders to make some tough decisions. I have been a long-term advocate of citizens’ assemblies, deliberative polling, and citizens’ juries to explore at every level, local, state and national, informed community views on hard issues in health. We need community groups who are informed by experts and not dependent on the Herald Sun or the Daily Telegraph.
   
4. The federal government has proposed a number of authorities to report on health performance, eg the National Performance Authority will report on emergency departments and elective surgery waiting times, adverse events, patient satisfaction and financial management. There will also be an Independent Pricing Authority and a permanent Australian Commission on Safety and Quality in healthcare.  All these new monitoring authorities will be helpful in providing the information-base for more informed reporting and public discussion.
5. This new information will not only help public policy, but also provide better information to consumers to help each of us make better decisions about our own health ‘My hospital’ similar to ‘my school’ should also be helpful.
6. The establishment of an Australian health commission would also facilitate better public understanding and analysis of health issues. Such a commission would implement government health programs, subject of course to the government setting out the principles and policies that should guide the commission, eg universality, equity, subsidiarity, pooled funding, etc. I foresee this commission working in the same way as the Reserve Bank in the economic field. The Reserve Bank has proved itself to be independent and largely immune from pressure from special interests. Importantly the Reserve Bank, as should an Australian health commission, facilitates and leads an informed debate on health issues and policies. That would better equip the media and us all in understanding.
7. Other health authorities, such as Medicare and the Australian Institute of Health and Welfare, should be instructed to facilitate public discussion on important health issues and help us get away from the current debates that are really a two-way discussion between the minister and special interests. The information they supply must be much more customer-friendly, and highlight the key issues where greater public understanding is necessary. It would make for a better-informed media. The key issue that we don’t discuss in health is that we can’t have all we want and that priorities and hard choices have to be made.

There are many ways in which public interest journalism in health can be advanced. With the failure of under-resourced mainstream journalism, the key is enhanced information and independent advice to facilitate a more informed parliament, media and community which would in turn make it easier for adaptive leaders to make the necessary but hard decisions in health.

New technology is important but the real problem is access to good content. As in all media, the key is not so much technology as content.