Search This Blog

Thursday, January 30, 2014

It’s Tıme for Social-Democracy to Exit the Twentieth Century


 
This article was originally written for discussion among activists of the Party of European Socialists (the European-level umbrella party for Europe's socialist and social-democratic parties).  The purpose of the article is to attack the "defeatist realism" that dominates modern social-democracy and to call for a discursive shift; primarily in terms of the language and subsequent mindset that dominates centre-left politics.  Particularly in these times, there is no future in wishy-washy politics that merely plead (without the institutional power to even enforce it) a slightly "nicer" form of capitalism.  Ironically, in a time of crisis and institutional failure it is actually less realistic to be "moderate" than it is to be "radical".  The Left needs a new paradigm and a new way of looking at the world if we are to have any kind of future worth living in.  

By Shayn McCallum


There are a lot of good ideas being generated among social-democratic thinkers these days and, although this article is going to be critical in many respects, of the current state of social-democracy in Europe, it is absolutely worth acknowledging the excellent work being done by progressive intellectuals on constructing a new European political economy.   The task facing social-democracy (and the European project) is, it must be acknowledged,  massive and, in attempting to move forward, it must also be admitted that there is a certain exhaustion, a sense of the weight of history, that seems to have us all dragging our feet.  Fear of repeating past mistakes, or being perceived to be doing so, is of particular concern for a movement that represents one of the oldest political traditions in Europe.   The current, rather timid, mind-set of social-democracy is therefore somewhat understandable but, to contradict a certain French philosopher; “to understand everything is not to excuse everything”.  Social-democracy is well known as a pragmatic political tendency that avoids elaborate theories and, while this approach has arguably had its strengths at certain points in history, it is now rapidly becoming the Achilles heel of the movement, as a lack of clear thinking and analysis is frustrating the kinds of bold clear messages that social-democrats need to be transmitting to the European public.

The Cold War has been over now for over twenty years yet it seems like we still live, and think, under the long shadow cast by the Twentieth Century.  Surely this far into the new millennium it is high time for a radical shift in thinking, especially for social-democrats because, of all the political movements that have survived the last two centuries, social-democracy has, arguably, been the most negatively influenced by the legacy of the Cold-War mind-set.   Social-democracy represented, throughout the Twentieth Century, a “third camp” standing against the theoretical and ideological dogmas of both Bolshevism and liberal capitalism.  Yet, social-democrats, like virtually everyone else, became entangled in the intrigues of the Cold War and wound up pulled both right and left by the gravitational force of the two ideological poles that dominated the global thinking at that time.  When the Cold War ended, liberals and conservatives moved quickly to announce not merely the death of Soviet-style communism but that of all variations of socialism.   Social-democracy was caught unprepared and demoralised.  Trapped in the push-and-pull of Cold-War assumptions about socialism and capitalism, social-democrats were too quick to let go of the socialist tradition (which, after all, is historically as much, if not more, the property of social-democracy as it ever was of the communists) and far too willing to accept unqualified and unjustified liberal assertions of the inevitability of capitalism. 

The confusion on the Left triggered by the exhilarating events of 1989 however, should be long past by now.  Even then, just after the wall had come down, it may be argued that it was not really capitalism that had won but, rather, democracy (however much the dominant discourse of those times attempted to conflate and confuse these two concepts).  It may even be claimed, judging by the results of elections held throughout Europe after 1989, that the true victor seemed to be, specifically, social-democracy.  Yet, the failure of social-democrats themselves to understand the difference between democracy and capitalism meant they were, in essence, defeated even in victory.   The 1990’s were a decade of social-democratic governments elected throughout Europe, however, these governments ultimately delivered the same kinds of neo-liberal policies as the Right.  The result of the flirtations of social-democracy with neo-liberal “lite” policies has been a sharp decline in the credibility of the movement and, more dangerously, in politics as a whole.  In many countries, social-democratic parties have lost votes and faced large-scale defections of members (a process observed at its nadir in Germany’s SPD) and the perceived absence of alternatives in politics, underscored by the perception that social-democracy had transitioned rightwards to become practically indistinguishable from its liberal and conservative rivals, has reinforced the growing cynicism and lack of enthusiasm among European electorates for formal politics as a whole.  This, in light of history, should be setting off alarm bells and it is pretty clear that something needs to be done to regain confidence in politics once more.   It will doubtlessly take time to re-establish the reputation of social-democracy as a force for progressive change but, realistically, it is highly doubtful that this can be achieved without first taking stock of the seriousness of the situation and embracing a fairly radical shift in direction and narrative.

The first sign of this shift should be a change in the language we use.  For a start, we desperately need to stop talking about “decent capitalism”, “responsible capitalism” or any other formula involving the word “capitalism”.  The ideological trap of accepting the TINA (There Is No Alternative) conceit cannot but imprison social-democracy in a fruitless, defensive discourse.  Words matter because they all too often operate as semeiotic indicators that by-pass our own critical, rational thought processes leading us to believe we understand something whereas, in reality, we have failed to think deeply on its meaning at all[i].  We react emotionally to words such as “capitalism”, “socialism”, “democracy”, “terrorism”, “fascism” or “human rights” long before our conscious brain has analysed the embedded historical and ideological content behind these casual labels (which, of course, makes them so useful as mere rhetorical epithets).  

Capitalism, used as a neutral or positive term, is for social-democrats, quite simply “enemy territory”.  If social-democrats attempt to position themselves (especially in the current era which is not the 1970’s by any means) as “the people who do capitalism better” they will most likely fail.  Why not instead try to reposition social-democracy as the “people who are serious about building and defending a democratic society”?  This would have the advantage of refocusing attention on the fact that we live in societies not economies and that democracy ideally means participation, or at least the right to participation, by everyone in the discussion and process of shaping the society we live in.  One of the first problems social-democratic programs run up against is the reality that both globalisation and Europeanisation have, in effect, weakened political (i.e. democratic) control over markets and privileged the economy over social and political factors.  This is not some random, inevitable, freak event of history but the result of a conscious set of choices made by political actors, (including social-democrats themselves) but, like all political processes, it may be reversed or at least reconsidered.  Part of the task of presenting an alternative to the current disaster in Europe, therefore, needs to be building support for change to the existing institutional arrangements of the EU.

The future of European social-democracy largely depends on the ability to kindle a degree of public enthusiasm for institutional change at the European level and this will demand the cultivation of a skilful, passionate narrative able to draw public attention towards issues often perceived as “dull” or “irrelevant”.   Can talk of decent capitalism create this level of public enthusiasm?  Apart from the argument that talk of “decent capitalism” is intrinsically problematic, excessively limiting and undesirable, it is fairly apparent that, without the institutional basis for implementing a regulatory framework, even the idea of “decent capitalism”, however moderate and “reasonable” it may seem, in fact, amounts to little more than a weakly optimistic pipe-dream.

Furthermore, it needs to be asked; what is this “capitalism” anyway?  The term gets used constantly and by all parties.  The centre-left talks of “decent capitalism”, while the centre-right merely uses the term in its unadorned simplicity without the need for qualifying adjectives, yet what is actually meant by this highly charged and loaded noun? There is seldom perceived much of a need to define it at all, as Left and Right alike have blithely accepted that “capitalism is all there is”.  Capitalism, in one form or another, is accepted as the only viable economic system left to us.  However, what if this assumption were ultimately nonsense?  Fred Block, professor of Sociology at Davis University, for example, questions, quite persuasively, the utility of talking about capitalism at all[ii]. 

Capitalism, rather like its 20th Century rival, communism, is a utopia (or a dystopia for many of us) that imagines a society based on a self-regulating market.  The fact that this system causes crises and collapse whenever and wherever its ideologues attempt to impose it has still not heralded a general realisation that, rather like its much-discredited rival, communism, capitalism does not work in any version of reality.  Part of the problem comes from the legacy of the Cold War mind-set where there were only two alternatives and now that communism has collapsed, we have no choice but to tolerate capitalism and hope for a more humanised version of it.

The story we have told ourselves is, however, wrong from the start.  We are trapped, essentially, between the competing, yet complementary, narratives of Karl Marx and Friedrich Hayeck and the economistic world view promoted by them both.  The truth however, has always been more complex than the shadow war waged between these two diametrically opposed, utopian ideologies would suggest.  Historically, the complex space in between these extremes, neither of which have ever been realised as living societies, has been the natural habitat of social-democracy.  Communists complained that the reformist efforts of social-democrats were merely prolonging the life of capitalism and delaying the ultimate triumph of socialism while liberals argued that social-democratic reforms were distorting market forces and would ultimately lead to totalitarianism.  Yet, for all the denunciations from the Left and Right wings of the economistic world-view, social-democracy has arguably proved to be one of the most successful political experiments in history.

The question begs to be asked: what if social-democracy were not just “capitalism with a human face” but rather a distinct political economy in its own right?  What if, rather than according to Marx and Hayeck, we decided to read the Twentieth Century through the lens of Karl Polanyi?

 According to Polanyi, capitalism could be understood as the attempt to impose a self-regulating market on society (an attempt, incidentally that was doomed to failure according to Polanyi).  The destruction wreaked by such an attempt however, would always arouse a defensive counter-movement as various groups in society sought to protect their values, traditions and lifestyles from the effects of marketization.  As a socialist, Polanyi believed that the highest form this resistance could take was socialism, which he defined as “the tendency inherent in an industrial civilisation to transcend the self-regulating market by consciously subordinating it to a democratic society”[iii].  Thus, we now have a theoretical paradigm in which the political (specifically democratic) understanding of society is set in opposition to the econocentric ideology of capitalism.  Capitalism, if we choose to use the term at all, may therefore be seen as an anti-democratic attempt to impose the sovereignty of capital through the subtle substituton of market forces for political decision-making, whereas socialism (again, if we wish to use the term) may be understood as the attempt to subordinate the economy to the democratic will of society.

The Polanyian understanding has radical implications and, potentially enables social-democrats to fundamentally re-frame the terrain of political discourse.   Rather than being trapped in the role of “political cry-babies” and “bleeding hearts” who try to “sugar-coat” the necessary pill of austerity to ensure the viability of the market project, social-democrats should reposition themselves  as the political force serious about advancing and deepening democracy, not only in the formal, representative sense, but as a way of life that permeates society at all levels.  In this way, social-democracy can create the kinds of arguments that enable it to seize the initiative and finally begin to put its neo-liberal rivals on the defensive.

Something like this understanding of social-democracy is, in fact, emerging.  Martin Schulz, for example, who will hopefully be the next president of the EU, to a very large extent embodies the vision of social-democracy articulated here, as can be seen from his remarks and speeches in various forums and his impressive track-record as a passionate, dogged fighter for social justice.   Social-democrats must live up to their name and be prepared to be seriously committed to a true socialisation of democracy.  This means new institutions and it means being prepared to struggle, with passion and conviction, for a new kind of society.  This does not necessarily entail the pursuit of ideological utopias but rather what a number of social-democrats have begun to call “a good society”.  This is, it seems, an excellent choice of terms to sum up the goals of modern social-democracy.

Social-democrats have always been reformists.  Social-democracy is not about overthrowing existing structures in some kind of violent act of revolution.  This does not, however, mean that social-democrats are not radical.  At its core, social-democracy has always harboured a deeply transformative potential, albeit not towards some kind of pre-conceived utopia but always in the pursuit of “a good society”.  Moreover, historically, we have always known, more-or-less, the features of this “good society”; a society where individuals are free, and supported by well-developed, democratic and transparent social, political and economic structures to develop to their fullest potential, where everyone enjoys equality of rights, opportunities and standards of living with their fellows, and nobody is subject to exploitation, discrimination or intolerance on any economic, social or political grounds.

Is such an ideal really so utopian?  Given how far our movement has come and the great achievements and successes of our past there is really no reason for pessimism but the times we live in call for boldness and vision not “business-as-usual” or a slightly nicer version of the same.  We need to change our way of thinking and reflect this in our way of speaking.  Let’s stop defending “capitalism” and start talking more of democracy.   Let’s go further and even stop talking about a “market economy”.

It is true that social-democrats have pretty much universally accepted the utility of markets but, nonetheless, markets still need to be kept in their place.  There is a subtle, but important difference between a “market economy” and “an economy which uses markets”.  Moreover, within our movement there needs to be more discussion on which areas of society and the economy need to be protected from market forces for the sake of defending our values of equity, equality and participation.  Of course, having recognised the importance of the political and the necessity of advancing and deepening democracy, social-democrats will need to engage in a forceful,  strategic program of institutional reform at the European level to create the, currently non-existent,  structures to practically enable social-democratic changes to the European political-economy to take place.

Programmatically, good ideas are emerging and excellent practical measures to institute a new political economy are being developed within our movement.   There is much reason for optimism but there are challenges that should not be underestimated.  When the Pope is prepared to denounce the evils of capitalism from the Vatican it is embarrassing that the socialist movement timorously hesitates to do so.  Free markets lead to unfree people and the ruination of nature.  Indeed, the proverbial elephant in the room when it comes to modern capitalism is the looming environmental crisis that threatens to make our piddling concerns over the fate of the Euro as significant as the squabbles of two fools over who gets the comfiest chair on the deck of the Titanic.  We do need to question and revise our economic goals and assumptions and recognise that the capitalist mentality of endless growth goes against all the logic of nature and its imposition of limits on all its systems.  Sustainability needs to be more than a slogan but something social-democrats are prepared to bravely explore and develop into a politicised, tangible reality.  Doing this will require more than a passing nod to greenwash-type palliatives.

Furthermore, we also need to reject and forcefully attack the nonsensical “common-sense” idea that capitalism is about “freedom” whereas socialism (or social-democracy) “inhibits freedom for the sake of equality”.  It takes very little reflection to realise that true freedom is totally dependent on a significant degree of equality, just as equality is fundamentally predicated on freedom.

To illustrate this point; freedom without equality ends up a grotesque lie, equivalent to the observation of Émile Zola that the law forbids rich and poor alike from sleeping under bridges.  Without equality, there is no means of exercising formal freedoms.  Likewise, equality without freedom can only ever amount to the equality of prison inmates who resemble each other in the misery of their condition.  Yet, in a prison (or a Soviet-type state) this “equality” must be enforced by guardians or commissars who are empowered to do so, thus, there can be, in this case, no true equality at all.  True equality can emerge only under conditions of freedom just as freedom can only be meaningfully enjoyed when it is available equally to all.

Social-democracy is perhaps the only political tradition which can claim a history of pursuing both freedom and equality as part of its most fundamental values and raison d’être.  The future success of social-democracy lies in how well it learns to speak to the human heart and imagination.   Once upon a time, socialists were renowned as dreamers and story-tellers rather than policy-wonks and say-anything-to-get-elected spin-doctors.  It’s about time we re-learned the art of inspiration through a political narrative capable of capturing the public imagination, if only because this story was based on the finest, most beautiful values of humanity.  These may still, even now, be summarised in the old French revolutionary slogan of “liberty, equality and fraternity” which, somehow, still manages to express everything most essential about a “good society”.



[i] Considerable work has been carried out on the importance of language in politics by the neuroscientist George Lakoff and, in a highly parallel manner, Drew Westen.  See the following publications:
Lakoff, George: The Political Mind: Why You Can’t Understand 21st-Century  
Politics with an 18th-Century Brain, Penguin, NY 2008
Westen, Drew: The Political Brain: the Role of Emotion in Understanding the   
Fate of the Nation Public  Affairs, NY 2007
[ii] Block, Fred.  2012.  "Varieties of What?  Should We Still be Using the Concept of Capitalism."  Political Power and Social Theory, vol. 23.
[iii] Polanyi Karl (2001 (1944) The Great Transformation, The Political and Economic Origins of Our Time, Boston,
                                                 Beacon Press  p. 242
 

Monday, January 13, 2014

Reform of Public Health can Ensure a Much Fairer Deal for Low Income Australians



Above: Australia's Health Care System is in Dire Need of Reform


By Tristan Ewins
Tuesday, 14 January 2014

Terry Barnes, a former former senior advisor to Prime Minister Tony Abbott has suggested a $6 dollar surcharge on bulkbilling via Medicare in order "to send a price signal". The suggestion is contained in a submission sent to the government's Commission of Audit, so may end-up becoming government policy.

The motive behind this proposal, apparently, is to save money through an 'efficiency dividend'; deterring only unnecessary bulk billing. However, welfare lobbyists are pointing to the regressive distributive outcomes of the policy; as well as the possibility that genuinely ill low income and welfare dependent Australians may not seek medical care when they need it. And also that the decision may place more strain on our hospitals. Of crucial note here: a great number of doctors already fail to bulk bill – and in that sense a 'price signal' already exists for many.

The Federal Government had already made some controversial decisions recently on the Health services front. The Conservatives' decision to remove means testing from the Private Health Insurance Rebate will also involve regressive distributive outcomes when it is ultimately implemented.  (according to Abbott, when the Budget is in surplus)  Dan Harrison of the Sydney Morning Herald has pointed out that abolishing the rebate entirely could save $3 billion. Though because the rebate is the 'Conservatives' baby' that outcome is unlikely so long as Abbott is in power.

On the other hand, the Conservatives like to retain the pretence of 'providing for the battlers'. And there are ways in which this could be provided for even should the government decide to adopt a surcharge and maintaining the rebate in some form.

Firstly, the means test on the Private Health Insurance Rebate needs to be restored. And the savings should be directed to a restructuring of the scheme. Savings here could be balanced between improvements in the Private Health Insurance Rebate for low income policy holders on the one hand, and improvements in the public health care system on the other.

Welfare dependent and low income Australians could then receive an 'amnesty' for rebate eligibility. That is: so long as they were low income or welfare-dependent they would not face spiralling private health insurance costs should they fail to take out private health insurance. The existing 'Lifetime Health Cover' policy – which imposes a cumulative loading building up with an additional "2 per cent per annum" for consumers over 30 who do not have private health insurance cover – effectively discriminates against the poor. Low income Australians effectively 'have a gun at their head' – and a choice to invest in private health insurance they cannot afford; or to take their chances with an increasingly neglected public system. It should be observed, also, that disadvantaged Australians could feel driven to take out the most minimal private health insurance policy just to avoid this cumulative loading, even though they receive only threadbare coverage in return.

But providing an 'amnesty' with regards the 'Lifetime Health Cover' policy would also make fiscal sense in that further subsidies for low income groups would be likely to win more Australians over to private health insurance. (which after all was the stated purpose of the whole policy!) This is quite simply because high income earners can already afford private health insurance; but for low income groups a stronger rebate and an amnesty could be decisive. And for those low income Australians who had already passed the 'deadline' of their 30th birthday – the lack of a full rebate as exists under the "Lifetime Health Cover" policy is already a clear deterrent against taking out private health insurance into the future.

Importantly, while older Australians already receive a higher rebate (40 per cent), the same cannot be said for other pensioners. So by the same logic, a more robust rebate for welfare dependent policy holders of 50 per cent could make private health insurance a more realistic prospect for many. Notably: Seniors' private health insurance from Medibank Private can cost in the vicinity of $2000 a year already. Before the rebate, that's about 10 per cent of a Single Aged Pension in one hit; and it's before we even begin to consider the impact of other cost-of-living pressures for low income Australians. (energy, water, communications, accommodation, transport) So to redress poverty and disadvantage, such measures must be combined with reform of pensions as well.

The mean-spirited provisions of the Aged Pension, Newstart, Disability and other payments ALSO already provide a deterrence preventing the poor and vulnerable from seeking medical care as needed. Therefore robust subsidies should be provided at a generous enough rate not only to address distributive injustice from austere pensions, but also negate the existing deterrence for low income Australians from seeking care as needed. New tax cuts for low income earners, and payments for the welfare-dependent could therefore be provided at a minimum rate of an extra $500 a year. Bulk-billing has already been progressively eroded for far too long. But such reforms could provide a 'way around' the dangers provided by that trend.

Of course there is the option of simply excluding pensioners from any surcharge which apparently is being considered; though should that policy be implemented it should also apply to ALL those considered to be on low incomes by any reasonable measure. The existing low income bracket (necessary to access the Low-Income Concession Card) applies to singles up to $500 a week, and couples up to $848 a week. This is also far too restrictive and mean-spirited. Arguably the bracket should be increased to thresholds of at least $650 a week for singles, and at least $1000 a week for couples – indexed to inflation or a cost-of-living index – whichever is the most generous. A mixture of restored means testing, and the exclusion of low income and welfare dependent Australians from any 'surcharge', would likely have a progressive impact.

It is conceivable that the measures suggested here (taken together) would not save $750 million over four years as anticipated by Terry Barnes with his specific proposals. Indeed – including robust pension and tax reform and an expansion of eligibility for 'low income' concessions - they could cost the budget bottom line – and need to be supported with other structural saves and progressive tax reform. Though it is important to observe that in 2012 Cassandra Goldie of ACOSS (the Australian Council of Social Service) argued that means tests for the Private Health Insurance Rebate and other associated measures could on their own save "$2.4 billion over three years".

The point would not necessarily be overall savings for the whole package of proposals here, but greater efficiencies and a fairer system– the benefit of which would be passed on to the disadvantaged, the poor and the vulnerable both through socialised health care and state subsidy for a means-tested Private Health Insurance Rebate. The 'price signal' suggested by Barnes could still apply to non-disadvantaged Australians, recouping some of the associated costs. Though special provisions could also apply to the chronically ill, with the surcharge being waived from such people entirely. Sending a 'price signal' to the chronically ill just wouldn't make sense as it is indisputable that such people need constant care and feedback.

Again: the Federal Government must account for distributive outcomes as a consequence of any policy. We do not need disadvantaged Australians to be deterred from seeking medical assistance when they are in need. And neither should we be imposing a surcharge whose structure and impact is similar to a regressive flat tax.

Finally there is the prospect of the privatisation of Medibank Private.

Certainly the Ideology of privatisation has never been more entrenched. And to be honest this is as much Labor's responsibility as it is that of the Conservatives. But without getting in a general debate about privatisation, there are two very likely or certain consequences of any Medibank Private privatisation that deserve attention.

Firstly Medibank Private is paying the government almost half a billion in the financial year up to October 2013. Though Fairfax has its net profit rate after tax at $233 million. This was following a shift on the part of Medibank Private from a 'not for profit' footing to a 'for profit footing' under the Prime Ministership of Kevin Rudd in 2009. Arguably this policy had the effect of undermining the mission of Medibank Private to provide very strong competition in the sector in order to drive the cost of private health insurance for consumers down.

But regardless of Rudd Labor's decision, to forsake Medibank Private's substantial dividends at a time when the government is arguing there is a 'budget emergency' does not make sense. Privatisation, here, will likely cost the Budget bottom line and lead to further austerity against the vulnerable later on.

Yet because of the central historic mission of Medibank Private in injecting a vital dose of competition into a sector which otherwise could be marked by greater collusion in the context of an oligopoly, there is a convincing case to restore Medibank Private to a 'not for profit' footing. Any foregone tax revenue should be made up elsewhere (the alternative is likely a poorer deal for consumers). Privatisation of Medibank Private would undoubtedly cost consumers over the long run 'on two fronts' – not only forsaking dividends, but 'shutting the door' on a return of the enterprise to a 'not for profit' footing.

And what is also notable is that currently a good portion of the Private Health Insurance Rebate is recouped when increasing numbers of health consumers choose Medibank Private for their health insurance policy.

This leaves the Federal Government with little more than an ideological agenda: an outlook which Abbott had disavowed in his book 'Battlelines' – where he claimed to be a 'practical' conservative."

Well: if Abbott meant it when he made those arguments then it is time to put rhetoric into practice.

And for Bill Shorten and Labor: stating that any Medibank Private privatisation will be reversed by an incoming Labor government could also provide a welcome and popular deterrent.

To conclude: others on the Left may be surprised or dismayed that I am arguing for reform of the Private Health Insurance Rebate which do not amount to its outright abolition. In principle certainly I am in favour of a massive injection of funds into socialised health care. I am in favour of a radical expansion and progressive restructuring of the Medicare Levy - with billions injected into dental, mental health, the Pharmaceutical Benefits Scheme - and all areas of need.

I am also genuinely afraid that the mooted $6 surcharge could be 'the thin end of the wedge' for a gradual erosion of public health, and the further entrenchment of a 'two tier health system'. Here arguments about the 'ageing population' need to be met head-on with counter-arguments pertaining to distributive justice: and with reference to the priorities of our welfare state and social wage. Certainly we have one of the most tightly targeted welfare states in the world; and further progressive reform of tax, elimination of 'corporate welfare', and appropriate targeting of some programs (eg: the Private Health Insurance Rebate again) – could save many billions. As Richard Denniss of the Australia Institute also infers constantly: 'welfare for the rich' in the form of superannuation concessions should be abolished – potentially saving tens of billions. This can be extrapolated from his claim that over $10 billion could be saved from removing the concessions from the top 5 per cent income demographic alone. So removing those concessions from the top 15 per cent, say, could go a very long way to neutralising the 'ageing population crisis', with the associated health costs. Do we really need 'welfare for the rich' in the form of superannuation concessions for millionaires? And what rationale is there when such a policy does nothing to further reduce the overall costs to the Budget when both Concessions and Pensions are taken into account ?

Progressive reforms in public health are more likely to occur under a Labor government. But so long as we endure under a Conservative government Labor and the Greens need to be open to compromises which could be of benefit to their core supporters amongst the poor, the vulnerable and the disadvantaged. Apparently no decision has been made yet on the matter of the policies suggested by Terry Barnes. But should some kind of 'surcharge' be implemented the compromises I am suggesting here could matter a great deal for disadvantaged Australians in the meantime.

That is until the next Federal election – when it is to be hoped a renewed Labor government will make the most of a progressive mandate on distributive justice – radically and progressively expanding public health.