Compromise and Conceit

Who Supports Anti-Vaccination Ideology?

February 7, 2015

This slide is a little busy but …

In my recent post on the growth of anti-vaccination ideology in the Republican party I described the process by which I think it’s possible that anti-vaccination politics has got a hold on some prominent republicans, entering through the back door of sexual “morality” (pardon the pun) and gaining prominence through the influence of group dynamics and a general culture of anti science. But this phenomenon is surprising to a lot of people (myself included) because anti-vax ideas are generally seen as a thing of the cultural left rather than the political right. I’m no exception to this rule, and generally saw anti-vax politics as a thing associated with left-wing hippy-dippies. I’ve always been scornful of the idea that it is a part of the political movement of inner city rich liberals (Gwyneth Paltrow’s vag-steamers), and associated more with rejectionist radical vegan and anarchist hippy leftists, and I’ve been aware for a long time that it is also common amongst a certain type of right-wing religious type, but to see it gaining prominence among the mainstream of the American political right is disturbing and unusual. It’s disturbing because bipartisanship in stupidity is dangerous, and unusual because the right is usually happy to define itself in opposition to others, and it’s unusual to see the right adopt ideas that are traditionally associated with the left.

This suggests that anti-vaccination ideas have a long right wing history, and they aren’t getting any new ideas from the left but have had this in their blood for a long time. But this also suggests that anti-vaccination ideology has been bi-partisan for a long time. I’m interested in why that might be and what the implications are for the politics of “anti-science.”

Dan Kahan from Yale, who has a history of researching this kind of thing, has recently published a long and confusing, almost unreadable article exploring the relationship between political views and vaccination policy, interpreted (bravely) in the Washington Post here. To the extent that his findings are comprehensible, he seems to be suggesting that rejection of vaccination is associated equally with right-wing and left-wing political ideals, and that this is very different to rejection of climate science, gun control or marijuana legalization. The Washington Post hints at another issue in analysis of this problem: political views are often inferred from vaccination proportions in geographical regions, but just as with voting, behavior at the aggregate level does not necessarily reflect behavior at the individual level (this is called the ecological fallacy) and just because there are high rates of non-vaccination and measles in affluent, liberal areas doesn’t mean it’s the liberals in those areas that are the cause. Kahan’s research suggests that at an individual level much more complex motivating factors are at play. The Washington Post article also references a paper by Stephan Lewandowsky suggesting free market ideology rejects vaccination, which contradicts Kahan but doesn’t seem particularly unusual: free market ideology is often a part of extreme right wing views in America, so it figures that endorsing one would be associated with endorsing the remaining two.

So why does anti-vaccination ideology transcend political ideology? The first reason, I think, is that it is old. Anti-vax ideas are as old as vaccination, which makes them much, much older than a lot of other “anti-science” ideas like global warming denialism or fear of power lines. Anti-vaccination ideas sprang up around the time that the smallpox vaccine was mandated, and have renewed their strength every time a new vaccine was introduced. This perhaps puts it in the same vein as creationism (though for very different reasons) but distinguishes it from modern anti-science reactions such as to global warming. Having been around for more than 100 years, anti-vaccination ideology has had a lot of opportunities to mutate and infect a wide cross-section of society. Anti-vaccination ideas can be based on notions of purity, distrust of the government, religious ideas about the origin of the products, basic failure to understand conflicting risks, and – as we have seen recently in Pakistan – reactions to fake doctors working for the CIA. So for left wing people it’s about distrust of companies, for hippies it’s about body purity, for vegeterians it’s about animal products, for libertarians it’s about government control and for religious nutbags it’s about religious nutbaggery. But for all these people their objections seem internally consistent given their available scientific knowledge.

Anti-vaccination ideology is also a reaction to an immediate thing. Vaccinations are an injection into someone’s children, that happen now and come with a real though small risk of adverse effects (mostly minor). This makes them a much more powerful thing than evolution (a mere concept) or global warming, which is a risk occurring in the future. Many of my friends have told me how the act of getting their infants vaccinated makes them aware of the desire to baulk, because the experience is visceral and immediate, not intellectual and delayed (none of my friends have relented in their determined pro-vaccination stance, but it gives them pause to think). Thus it is easy for anti-vaxxers to create new generations of concerned individuals, and keep pushing their ideological platform. This visceral experience also cuts across ideological divides, by dint of its physicality, so that it is no longer a debate about abstract future concerns, but becomes an issue with real physical consequences to be discussed now. It is an easy fear to exploit, and it is a fear that easily transcends party lines.

In many ways our reaction to infectious diseases is the opposite of the way we should react to global warming. Eliminating an infectious disease through vaccination requires an easily managed, cheap individual decision that is meaningless by itself and only powerful if everyone else does it. In contrast, the best responses to global warming are institutional, involving shared action through institutions. You can choose to sit in your room freezing in winter and not turning on your heating, but it will make no difference to the carbon economy unless a government acts to change the source of the power you are eschewing, whereas shared action implemented through politicians at an institutional level will make change happen rapidly. Responses to global warming involve changing industrial systems, whereas responses to measles involve individuals sticking a needle in a child. The difference is obvious, and profound. But because the required vaccination rate is very high even a very small number of people reacting against this theory are enough to destroy the whole thing – and it appears that this small group of individuals cross the political spectrum, so it’s the responsibility of people of all political stripes to stomp on this scourge – it’s not sufficient any more for right wingers to assume that this public health scourge is something the left has to deal with.

My suspicion is that the rich liberals of Marin County are simply the most visible and obvious of anti-vaxxers, because they are the ones with the voice who are photogenic, but that anti-vaccination ideas cut across party, racial and ethnic lines and are best dealt with not through cultural communication but through the law. Not getting your children vaccinated is hardly a challenging decision, especially in a society without public health care, and signing a form to get your kid into school is hardly a big deal considering the general overheads associated with starting school. But most of these anti-vaxxers won’t privilege vague health concerns over education and won’t want to make trouble out of it. This is because most of these anti-vaxxers are responding to a vague suspicion about how much they can trust science, not from a determined investigation of the risks of vaccination. This theory is related to my last post, that ordinary individuals have to make judgments about science from authority, and people who reject much of science are doing it from a position of distrust of authority rather than scientific judgment. When their political and cultural guides and (in the unique case of vaccination) the law tell them they’re wrong they will acquiesce because most people’s interaction with science arises through appeals to authority, rather than individual scientific judgments. This makes anti-vaccination ideas very different to anti-global warming ideas. At its best a response to global warming will use economic instruments which force companies to change their practice but (ideally) don’t involve any individual change – individuals won’t even notice – whereas effective responses to infectious disease require strict legislative changes that force individuals to take a specific action.

I think there are no lessons to be learnt from the battle against global warming to apply to vaccination, and vice versa. They’re completely different political challenges with different causes and solutions. The anti-vaccination movement is also an example of how the notion of “anti-science” is meaningless in a practical sense, and better replaced with nuanced responses to specific complaints, or legal responses to specific objections. In the case of global warming, objections to the science of global warming are best ignored and dealt with through legislative changes and direct government influence on industry. They’re completely different issues with different responses and different causes, and different implications for the interaction between society and individuals. Not all “anti-science” is equal, and in reality “anti-science” is a meaningless concept. Understanding people and reacting to their concerns is the best way for governments to respond to challenges to rational policy.
How Should the Public Interact with Scientists?

February 6, 2015

In preparation for a post on the political origins of anti-vaccination ideology, I want to make a point about the way that the ordinary public interact with scientists. My last post on anti-vax and Republicans has been linked to by a climate change blog, and on that blog one of the commenters is making big claims about what the public should do to understand climate science. In particular he or she says:

‘Trust the science’ is a very ambiguous statement. People should follow the scientific method, but I think what you mean is closer to ‘people should blindly believe what authority figures in science tell them’. This can get very dangerous and appeal to authority is not part of the scientific method. Rather the scientific method involves questioning authority and skepticism.

I think this is an incredibly unreasonable and unrealistic depiction of how people should interact with scientists, and is an advanced form of epistemological nihilism. I want to give a specific example of why, though I’m sure there are many others.

My father left school at 15 to take up a trade as a typesetter, my mother left school at 13 to work in a cake shop and her father left school in Spain at 15 to fight fascism (he subsequently became a forester in England after the war and devoted his spare time to raising a family and learning English). Not only did all my forebears leave school before they got a chance to receive an advanced science education, but they went to school before computers were common, when quantum mechanics was still in its learning stage (e.g. before Bell’s Inequality) and in my grandfather’s case before the invention of the microwave, the guided missile, or a man on the moon. The idea that my parents and my grandfather can “follow the scientific method” – indeed, that they even know what it is – is ludicrous, as is the idea that they have any kind of skill or capacity to question authority where science is concerned. Furthermore, the idea that they should work 9 hour days of physical labour and then come home and devote their time to learning about these things in order to understand policy about important issues like global warming is both unreasonable and, frankly, insulting. If you can’t explain this shit to these people in a way they understand, don’t get uppity that they aren’t willing to put the time into learning your shit properly. They’re busy, and their reasons for being busy are just as valid as yours. I would go further and say that most scientists don’t have a clue about how typesetting works (that’s why LateX was invented!) and would get quite miffed if they got an email from their publisher saying “we can’t be bothered fixing up the typesetting in your paper so that it can be legible in print. You should have learnt this stuff. Your paper is going to look like shit.” Life is too big to learn everything, and this is why we have specialization. Expecting everyone to engage with your trivial little skillset[1] is called “arrogance” in the real world.

So, I don’t think this is how ordinary people should interact with science. In a functioning society, ordinary people should be able to assume that scientists are working for the good of all, that government funds are expended on science in a way that is somehow subject to reasonable oversight and judgement, that experts translate this stuff into public policy, and that ordinary people with no science background can trust that their political representatives are handling the science in a way that is open, rational and coherent. With proper governance structures they can have mild confidence that science is being done ethically and to certain basic standards of intellectual rigor, and with a professional and well-run media they can have some confidence that the popularization of science doesn’t also debase and ruin it. In this sense, while “appeal to authority” is not part of the scientific method it is very much part of how we the public interact with and make decisions about the implications of the scientific method for policy. If 97% of climate scientists say the earth is warming through human influence, then the public should be able to be confident that this means mitigation needs to be debated. If doctors say vaccination for mumps, measles and rubella is needed at a certain age, we should be able to go along with it because we trust that those doctors came to that position through a transparent, ethical process of scientific inquiry, and this position only entered practical health policy through a well-governed and robust process of policy development. We should not have to follow the chain of logic, statistics and biological science that led to this decision in order to support it.

This process by which people actually engage with science in practice is the reason that ideologically-determined views of science are both unavoidable and necessary. Left-wing or working class people will trust that the science minister they voted in from the labour party interprets science into policy in a way that is both a) in the interests of all of society and b) in their class interests; similarly right-wing or rich people will assume that the science minister they voted in will interpret science into policy in a way that represents their love of the free market and eating puppies while kittens cry. This is both inevitable and right (except for the kittens crying). The breakdown of political responses to climate change and the acrimonious debate surrounding it has not occurred because ordinary people failed to follow the scientific method (or did, and found it wanting); it has occurred because a certain part of the political scene in the rich west has abandoned its responsibilities to its electors and started lying to them about a fundamentally important issue. This is a failure of governance and ethics on the part of our leaders, not a failure of ordinary people to engage in scientific critique.

Provided their political representatives hold their best interests at heart, people can be as ignorant as sin about science, and still see good scientific outcomes without even knowing that there is such a thing as “the scientific method.” Conversely, when our political representatives go feral on us and refuse to act on science that is compelling and urgent, it doesn’t matter how educated and engaged ordinary people are – we’re toast. This is why the global warming issue is not being addressed, and in my opinion (as I hope to show in my next post) there is absolutely no lesson to be learnt about vaccination policy from the clusterfuck that is global warming. And in any of these scientific debates, the expectation that ordinary people should engage with science rather than judging it through reference to their authority figures is simultaneously arrogant, unrealistic and ignorant.

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fn1: “Skillset” is one of my most hated words, and I use it here to be deliberately insulting
Is Anti-vaccine Ideology the Next Step in Republican Denialism?

February 4, 2015

Vaccination policy through Republican eyes

The recent outbreak of measles in the USA has brought on an epidemic of Republican anti-science blathering, this time focused on vaccination. First we had Chris Christie saying measles vaccination should be optional, then Rand Paul putting his libertarian principles where his mouth is and declaring all Americans should be free to give each other smallpox; now the National Review Online has stepped into the fray with the rather contradictory policy advice that vaccination obviously works but should be voluntary (and thus, in the case of measles, almost certainly be rendered useless).

Vaccination policy is one of those areas that is ripe for Republican chaos. As the National Review observes, it involves “elites” (a perjorative deployed in this case to describe doctors) making decisions about what parents should do, and pushing for strong laws to ensure that everyone does what they’re supposed to. Like public education, it is only of value if the overwhelming majority of people do what the “elites” want. In this case, we can calculate mathematically what proportion of the population need to do what they’re told in order to prevent the spread of disease and, unfortunately for libertarians everywhere, the required proportion for measles and whooping cough is so high as to require even strict religious types and conspiracy theorists to obey if we want to prevent everyone getting the disease. This article from the Bulletin of the WHO makes the case for herd immunity, which in the case of measles requires greater than 95% of the population be vaccinated. Allowing parental opt-outs is going to rapidly get the proportion of children vaccinated below this threshold, especially in a society where many people can’t afford medical care. This is particularly likely for measles, mumps and rubella, since the Andrew Wakefield scandal has put the fear of God (well, autism) into parents in the UK and the USA, leading to precipitous falls in vaccination rates for these conditions. Indeed, the UK is now experiencing endemic measles after a long period of only having imported cases, and recent epidemics can almost certainly be traced to the cohort of children who were not vaccinated in the years after the Wakefield scandal. Elimination of these diseases requires strong pressure for all parents to vaccinate their children, and in rare cases these children will experience usually minor side effects. We all literally have to take one for the team, because those black-helicopter “elites” at the WHO tell us to. It’s a Republican’s nightmare.

But Republicans never used to be so fragile about science. This rash of equivocal statements from potential presidential contenders and their lackeys in the media is a new phenomenon. I have a feeling that the Republicans are lurching slowly towards a new orthodoxy of denialism, to add to their creationism and global warming denialism: anti-vaccination ideology. I hope I’m wrong, but I have a suspicion that this next denialist lurch is going to be inevitable given three potent forces driving modern Republican political ideology: populist anti-government rhetoric, potent sexual morals, and a virulent anti-science culture.

The modern Republicans are steeped in anti-science through their long association with the tobacco lobby, anti-environmentalism in the service of corporate interests, and their deep commitment to global warming denialism. US libertarian and right-wing politics is notable for its foolish fixation on DDT built on a foundation of false attacks on Rachel Carson, its hatred of the clean air act, its increasingly fantasist opposition to the science of global warming, and its strict libertarian stance on smoking. Indeed, the link between these ideological strands is hardly surprising given that big tobacco has funded the network of climate denial and anti-environmentalist organizations for years. But as this web of denialism expands, and newer activists grow up and learn their trade in a political environment that is suffused with not just the rhetoric of anti-science activism but also with a deep disrespect for scientists and the scientific process, it is hardly surprising that the Republican political world will become vulnerable to new forms of anti-scientific crusade. Many Republicans seem to be opposed to any form of scientific research, not just that which directly threatens business. How can we forget Senator McCain’s derision for a study of the DNA of bears? It’s easy to imagine that the post-tea party Republican party is easily fooled by anti-science rhetoric posing as scientific critique.

I think this toxic atmosphere turned its sights on vaccination science proper for the first time when the HPV vaccine was introduced, and vaccination got its full attention for the first time. This happened because the HPV vaccine is aimed at a sexually transmitted disease, that is only harmful to women, and in order to prevent this disease one needs to vaccinate girls before they become sexually active. Somewhat alarmingly for those in our community who want to pretend that their daughters are all good little girls, the policy therefore requires vaccination at a surprisingly young age, the implication being that good little American girls might be getting laid rather early. This immediately drew the ire of the sexually conservative wing of the Republican party and associated organizations like the Family Research Council. Initial objections were based on sexual morality, but it entered Republican politics during the primary season for the 2012 presidential election. By this time arguments against the HPV vaccine had become more nuanced, as for example in this National Review piece where the author tries to argue that HPV is different to measles because it is intentionally transmitted and rare (wrong!) and questions why only girls get it, as if this is some evidence of a sexual conspiracy by liberals (in fact this policy is followed because the science suggests it is sufficient to prevent cancer, and more cost-effective). However, in the modern world debates on health policy inevitably require some kind of scientific rhetoric, so by the time of this primary season Michele Bachman had found the spurious scientific objection that it causes mental retardation. In four years opposition to the vaccine had gone from a purely sexual-morality-based principle to a general scientific critique of the safety of the vaccine and the validity and necessity of the policy. All these “science”-based arguments are wrong, but how is a modern Republican to know? They have a kneejerk distrust of scientists and they are so negative about science that it’s hard to believe they would understand or accept any science they read. So of course people who want to object to the vaccine on principle but feel the need to cloak their opposition in scientific rhetoric are going to be willing to believe any rubbish they’re fed.

Finally, overlaid on this mixture of christian anti-sex moralizing and distrust of science we have the libertarian arguments about agency and control over one’s individual choices. For most moderns, health continues to be seen as an individual choice, and decisions about healthcare are things that we take for ourselves when we are sick. Vaccination policy is the exact opposite of this: it concerns actions taken with our bodies when we are well to protect others. It’s all too easy for libertarians to fall prey to conspiracy theories and bad science where vaccination policy is concerned because it just doesn’t sit comfortably with their ideology. So the trifecta is complete, and the entire ideological sweep of the Republican party is vulnerable to anti-vaccination claptrap.

If my theory is correct, then we should expect to see more of this kind of rhetoric as Republican primary season heats up, and we should also expect to see the typical Republican approach to undoing long-standing laws they don’t like: administrative procedures to make them too difficult to enforce, followed by court challenges rather than direct political debate. If we start to see that happen then I think we need to throw vaccination into the large and growing dustbin of sane and rational policies that have become too tough for the Republican machine to handle – along with gun control, universal health coverage, and global warming. Once they take the step to anti-vaccination denialism, what bridge connecting them to the science community is left to burn?
Computer Game Economics and the Eurozone

January 29, 2015

In your bases, pWning your Austerity

Following up on yesterday’s post about the new Greek finance minister, Yanis Varoufakis, today I investigated his involvement in computer game economics a little more. I found this article by Brad Plumer, written for the Washington Post in 2012, which describes the growing role of economists in computer gaming. Modern online multiplayer computer games are now so complex that they have their own economies, and small decisions by the game company can have major effects on the economies operating in the game and, by extension through the money players invest in some products, on the real world economy. The decisions can be political decisions – such as a decision by Second Life to ban certain kinds of gambling – or they can be god like interventions, such as when the people running Eve Online decide to change the distribution of resources in their galaxy. Some companies have recognized that they need to understand the consequences of their decisions if they want to keep players happy, and the company running Eve Online appear to have led the pack by assembling a whole team of economists.

Into this fray in 2012 stepped the new Greek finance minister, Yanis Varoufakis. Valve, the company now running Steam, wanted to join together a bunch of different games so that players could trade between game worlds. I’m not sure how this works or why one would want to do it but they seemed to think it was a good idea, but in essence what they were trying to do was set up a kind of European Union, in which different games are sovereign in their own resources and political decisions but not in their own currency. So they employed an expert on currency zone economics – Yanis Varoufakis, the new Greek finance minister. According to Varoufakis in the article, his academic colleagues

know I don’t have any actual interest in video games. But I only need to talk to them for a few minutes, and they quickly get excited, asking, ‘Well, what if you tried this . . . ?’

and I can see the appeal of this. You can run experiments, and learn about how decisions will affect the economy, which can provide useful information outside of the computer game world. Varoufakis has apparently used this to show interesting things about General Equilibrium theory, but interestingly the players quickly realize an experiment is being conducted, and game it. What does that tell us about the way ordinary people react to economic policy even when they don’t know it is coming?

Besides being a fascinating field of study in itself, this tells me interesting things about Varoufakis. While some people seem to see him as a threatening radical, and the Guardian‘s initial reaction to his appointment was to publish a whole run of “sky is falling” quotes from German bankers[1], in the world outside of politics it appears he is seen as a serious and intelligent judge of how to manage monetary unions, to the extent that people who depend on getting this right have paid him to help them do so. My guess is that his work on computer game economics will not register at all to Europe’s deep thinkers, or will even constitute a black mark against his name – further evidence he is not a “serious” economist – but it seems to me that he is someone they should listen to, and probably the only finance minister in Europe who might know something about the fundamentals of the EU process. Perhaps all of Europe could benefit from listening to the experience of Greece’s new finance Minister – if they can see past his party and their biases about Greek.

Varoufakis’s ascension to power politics in Europe also puts computer game economics in the spotlight. Maybe it’s time computer game companies started taking the possibility of economic experiments within their worlds seriously, and presenting their virtual worlds to world leaders as an opportunity to study economics in a safe environment. It appears we can learn a lot about the shortcomings of real world theories by testing how they work in worlds in which we can control the fundamentals, right down to the raw materials. There are many questions in economics that could be answered through interventions in these worlds.

My guess is that the European Union will ignore Varoufakis’s expertise, and even if they wanted to computer game companies will have little intellectual impact on the economics world, even though they offer a unique opportunity to test a wide range of economic theories. A shame, for both Europe and the economics profession. Let’s hope the Europeans listen to the economic aspirations of a bunch of dragon slayers and space pirates, and use the lessons learned to fix their most intractable problems!

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fn1: They put these on their execrable blog-formatted “live” news section, so I can’t find them or link them now. Why they thought German bankers would be objective commentators on Greek political appointments is beyond me.
Blogging Leaders …

January 28, 2015

Adventure stories for economists …

As expected, Syriza have won the Greek elections, taking a near majority and forming a government with a minority right wing populist party, and so far none of my fears have been realized (yay). As expected, Syriza’s “radical” economist Yanis Varoufakis has been selected as finance minister, putting him on a direct collision course with the Troika. Varoufakis seems like an interesting guy, and it will be interesting to see what the burden of his position does to him. He is young, an academic economist until he decided to run for parliament, seems to be quite a handsome chap, and is also a dual citizen of Greece and ~~the Duchy of Edinburgh~~ Australia. So now it appears Australia has two finance ministers, Matthias Corman the actual finance minister of Australia who was born in Belgium and Yanis Varoufakis, the Greek finance minister who was born, somewhat surprisingly, in Greece. Yanis Varoufakis has written a book and is also a private consultant for Valve, the game company responsible for Half-Life and Steam. I wonder if he’s a gamer?

That’s a pretty interesting background and, whatever one might think of his political views, pretty solid qualifications for a finance minister. In sad comparison, Matthias Cormann has been a political apparatchik since the 1990s, has an undergraduate degree in law, and has never written anything as far as I can tell. But in addition to writing a book and some academic articles, Varoufakis also maintains a blog. He’s just like me! And in his latest post he has promised to try and keep blogging while working as a minister, which I suspect makes him the first ever blogger finance minister. This potentially means we are going to get some kind of real-time coverage of how and what the finance minister of Greece is thinking as he negotiates with the EU, IMF and ECB on the tricky issue of Greek debt. He has previously written alternative solutions to the problems of public debt in the EU, which seem to have worked their way into The Economist. His blog is a pretty interesting read, and if he does manage to find time to maintain it while managing his new position I think it will make a fascinating and unique contribution to both the blogosphere and the disciplines of economics and politics.

This also gets me thinking: will there come a day when an active role-player gets into the halls of power, and chooses not to stop gaming? Imagine if they turned up at conferences, and you could role-play with the US president … (I bet there’d be no rules-lawyering at that table! “Why can’t I get +2? It’s in the rules!” “I am the president of the USA, you get whatever bonus I give you!”) Or if they were a regular commenter at an RPG forum, posting in between meetings with heads of state to complain about why Bards are the worst character class. Maybe they could run online role-playing sessions where they run adventures in all the trouble spots they’ve invaded and messed up, until it gets to the point that the electorate start thinking the President is only starting new wars so that he can have new campaign settings. That may seem crazy, but it seems like a better rationale for a war than the gloop we were actually fed before Gulf War 2…

Greece has been suffering difficult economic times, and it seems obvious that something has to be done. Austerity has failed Europe dismally, and the economic pressures it is creating are being released through politics of the worst kind, as extremist right wing parties grow in influence across the continent, perhaps most especially in Greece. The search for a solution is going to be really challenging for Syriza, and it is my hope that they will find a solution that makes Greeks better off, and averts the social catastrophe they seem to be sliding towards. Yanis Varoufakis seems like a man well-placed to take on the job, and it is my hope that he can find success despite the challenges he faces. I also hope he can find the time to blog about it, so we can get some insight into what happens both behind the scenes and behind the man. Good luck, Dr. Varoufakis, and I hope more bloggers in future (and eventually, more gamers) can get to the halls of power.

And remember, if you find Greek debt challenges too tough, you can always come to Australia and help out our government…
Post Traumatic Stress Disorder in Ancient Warriors

January 25, 2015

No wonder Achilles sometimes wet the bed …

Post-traumatic stress disorder (PTSD) is now a well-accepted aspect of modern soldiering, and it seems to be now recognized that earlier disorders of soldiers such as shell shock that might once have been described as cowardice or weakness were in fact manifestations of the same condition. I did not know, however, that there are accounts from ancient times of this phenomenon occurring amongst soldiers from very different types of warfare, and it isn’t the case that PTSD is a function only of modern warfare. Today I discovered an article describing symptoms of PTSD in Assyrian warriors, from Iraq between 1300 and 600 BC, which were taken from cuneiform tablets. Apparently the Assyrians had a form of military service, with military age males spending one of every three years of their service in combat, and the Assyrians kept extensive documentation of both their campaigns and their medical practice. The article, published in the journal Early Science and Medicine, reports on symptoms of PTSD (especially seeing ghosts and nightmares) taken from some of these tablets. It also gives a bit of detail about Assyrian medical practice, and the importance of diagnosis to Assyrian doctors. The article is a bit jumbled up and confusing, but it makes the case that PTSD is not just associated with modern, extremely lethal soldiering, but is associated in the case of these ancient warriors with fear of death, the sight of colleagues dying, and also the fear of slow death from injury.

The findings themselves aren’t groundbreaking, but I am interested in the general finding of PTSD in ancient soldiers and its documentation. As role-players, we often play warriors engaged in quite brutal old-fashioned combat, often engaged with horrible things from beyond the grave, but in the older games there is no mechanism for the gradual erosion of confidence and strength that constant terror of this kind might cause – indeed, the classic model of gaining XP from experience suggests that our soldiers only gain in strength from continued exposure to slaughter and near death (or, in many cases, death and resurrection!) Of course some of the more modern games have mechanisms for insanity and humanity loss, but these are generally primarily triggered by exposure to sinister magic and beasts from beyond, not from the “mundane” horrors of seeing your friends dismembered, clubbed to death, burnt alive or eaten by zombies. Upon reflection it seems obvious that this would tend to wear one down, and it appears that published accounts from people who did a lot of stabbing, smashing and clubbing to death support the idea that it is a disturbing and sometimes enervating experience.

Some of the symptoms are also quite profound: blindness or deafness, sudden weakness, and loss of sleep. It’s easy to imagine that in a classic D&D setting the inability to sleep would be crippling for a wizard. Inserting some kind of simple mechanic for PTSD from continued battlefield exposure – perhaps ramping it up for multiple back to back battles – would lead to a quite interesting change in play style and get people rethinking battlefield strategies, especially if even “mundane” combat could bring it about, and if it was related more to the length of exposure than the intensity. Players would reconsider frontal assault tactics if there was the possibility that their wizard would suddenly freak out and decide to blow himself up … or their cleric became a shivering wreck incapable of healing them.

I guess we have a tendency to think about psychological health of our characters only in terms of their exposure to hideous dark secrets from beyond the veil. We imagine ourselves as heroes whose basic psychology and morality can only be tempered with by the gods and dark magics. Apparently, and not really surprisingly, the reality is rather different. It would be interesting to see how the tone and style of classic fantasy play would change if it were modified to make the psychology, as well as physiology, of its heroes vulnerable to the slings and arrows of their horde of enemies…
Exhibition Review: Sophie Calle’s “The Unsold”

January 25, 2015

Only what you see man, only what you see

Today a friend took me, without explanation, to see Sophie Calle’s The Unsold (売り残し) at Koyanagi Gallery in Ginza. I don’t often attend art shows – let alone modern art installations – and I almost never visit Ginza, so this was a real novelty for me, but despite my initial misgivings it was definitely worth it. Here is my review.

When I entered the gallery my first glance revealed an installation of everyday objects, including two dresses, that to my jaundiced and cynical eye immediately resembled Tracey Emin’s execrable bed-type stuff, and I was immediately disappointed. However, right at the door there is an introductory explanation (in Japanese and English) of the premise of the work, which changed my mind. Basically, three artists set up a flea market in the grounds of Yasukuni Jinja. They laid out their wares on three squares of cloth, as shown in the picture. One (I don’t recall which) sold worthless every day items, to each of which was attached a story that actually happened (i.e. a real story) with some relationship to the item but in which the item itself was not directly involved (so e.g. the typewriter on sale is not necessarily the typewriter from the story). Another sold a mixture of semi-antiques (cutely mis-spelled as “semi-antics” in this exhibition) and ordinary items, to which were attached completely fake stories with apparent emotional content[1]. The third sold actual antiques, and one of his original photos. For example one person was selling a completely normal bra for about 25,000 yen, and another person was selling a picture of a psycho-analyst (freud?) for 38,000 yen. One of the antiques was an ancient ceramic hot water bottle, and the picture was a pretty cool sea/sky thing. Each artist catalogued what they sold and the amount of money they sold it for – which was surprisingly large. Apparently an American tour guide passed by as this sale was going on and told his charges “there is nothing here, ignore it.” (Cute). The explanation finishes with the simple, curt phrase “These are the unsold.” So the exhibition consists of the material that was not sold.

This exhibition consists of three pieces of cloth on which the remaining items are laid out, attached to each of which is a tag with the price and the story. Behind each installation, on the wall, is a photo of the original setup, so you can see what was sold. On the opposite wall are the tags for the sold items, with their corresponding story. These tags have no information about the item to which they correspond, so you have to wander across to the original picture and guess. The stories are really interesting and believable, though whether they are actually true or not I have no clue. Investigating on wikipedia I discovered that the Eiffel tower story is true, and just as unbelievable as it sounds – Sophie Calle certainly knows how to do crazy things (I can’t remember if the item attached to this story was sold or not).

I’m an uncultured barbarian, so I have no idea what this installation was trying to tell me about whatever, but I thought it was really cool. Trying to understand why people bought these ludicrously overpriced objects because of their vague stories, or didn’t buy some object even though its story was cool, was an exercise in intruding into someone else’s private life. The stories themselves were fascinating, disconnected monologues, none of which I believed (but some of which I have subsequently learnt are real!) I can’t speak for the Japanese but the English used in the broader narrative descriptions – what the exhibition is about, how the artists met – is clear, sparse and strong. The structure of the main introductory sign and its finishing statement, “These are the Unsold” is particularly powerful, and suits the style of the exhibition. It’s a simple idea done well, and it holds your attention. Why did the passersby leave the charred bedspring and buy the useless typewriter? This, I cannot fathom. I wouldn’t buy the red bucket some guy pissed in, but why would someone else buy the bottle. Also the story of the horn is acutely sad and the horn is quite cheap, but apparently un-sellable. What does that mean?

I didn’t know anything about Sophie Calle before this exhibition, but reading her Wikipedia page I get the impression that she is a powerful, prodigious and generally unethical talent. My friend has also seen the exhibit Take Care of Yourself, which as the quoted reviewer says seems to be both shallow and deeply engaging. Her attempt to get blind people to define beauty sounds like it has the potential to be very powerful (I don’t draw any conclusions!) and the work where she gets a guy to shadow her and then presents pictures of herself sounds really interesting. Invading others’ privacy, not so much. How come medical researchers have to get ethics approval, but French artistes can pursue some guy across the world, or hijack a stolen diary for money?

Don’t answer that.

Anyway, I’d never heard of Sophie Calle before today and I think her work is a genuinely interesting and challenging example of modern art at its finest. I don’t know what she’s trying to say with this exhibition and I can’t really say what I think of it, but it’s really cool. It would be better if she followed it up with some kind of article in a peer-reviewed journal giving her conclusion about what the purchases and non-purchases mean, instead of leaving it to an ignorant rube like me to try and understand, and if she had found a way to summarize what was bought and wasn’t (e.g. rankings with stories, or a website where you can see all the objects with what was bought and what wasn’t, and its story) then the exhibition would have been even cooler. But despite these missed opportunities this exhibition is very cool, and in general I have to say Sophie Calle’s work seems pretty interesting. I hope more of her stuff comes to Japan, and I recommend visiting it if you are in Japan, or keeping an eye out for her work if you are not.

—

fn1: I may be mis-remembering the exact nature of what these items were, but I hope you get the general gist.
Let’s Play Greek Oracles!!

January 23, 2015
This Sunday Greece is holding a general election in a very tense and fraught environment. It looks likely that the “radical” left wing group Syriza will win, with the threat that they will default on Greece’s debts and possibly lead it out of the Euro, back to the Drachma. Meanwhile Golden Dawn remain a real menace to migrants on the streets of Greece, and there are rumours that they have connections with what is sometimes called the “Deep State,” internal security and police who hold a secret longing for a return to the days of dictatorship and a deep hatred of the left. The London Review of Books published a good and very disturbing account of the behaviour of Golden Dawn and its links to this alleged Deep State, written by a journalist who managed to get some way into the organization. Meanwhile the European Central Bank has announced a new run of quantitative easing, perhaps intended to send a message to the Greek electorate that they might expect some support in their austerity plans, but the austerity program the Greek electorate is facing is shockingly tight and extremely disruptive.

Given this environment, and being safely ensconced far away from the trouble, I have thought of a few possible outcomes of the election, and have a few questions about what might happen. Even though I think asking a question and answering it yourself is the first mark of a dickhead, here are some of my questions with my thoughts on the possible answers.
- Will Syriza win? The polls seem to give them an edge but maybe the possibility of a real default will lead Greeks to return to the status quo
- How will Golden Dawn react? It seems to me that there is a very real possibility they will try and instigate some kind of communal violence, and the state doesn’t seem interested in confronting Golden Dawn
- Will the Deep State act to preserve the interests of the elite? Assuming this Deep State is even a thing, will it react to a communist victory by moving to interfere in the functionings of democracy? If it is true that a large minority of powerful people still hanker after the era of the Generals, will they move to act on this?
- Will Syriza back down on default and exit? Some are suggesting Syriza have been mellowing their rhetoric on default and exit as the election looms, but this could just be a campaigning tactic. Even if they really are starting to feel the heat, backing down on key parts of their platform will probably break them apart and bring about more instability. It seems to me they’re going to be hard-pressed not to follow through on core policies
- What will the effect of this be on other countries, especially the UK? The UK is slated for a referendum on EU membership if the Torie win in 2017. If Greece exits and it is not a catastrophe for Greece or the EU, this will potentially influence that referendum, since the pro-exit people will be able to point to Greece as an example. Likewise if exit is disastrous for Greece. If Greece starts a chain of exits by highly-indebted or highly anti-EU countries it could spell tough times for the EU. Will the much-maligned Greek left be the trigger for a conservative rebellion in the UK?
I don’t have an opinion on what Greeks or Syriza should do, being too far away and too ignorant to have strong views, and although I think much of the narrative on Greece and its economic problems is shallow and ideologically driven, and I’m generally not in favour of the Euro, I can’t say what I think is right or wrong about the whole sorry mess. If Syriza win I hope the transition to radical left leadership happens without neo-fascist street violence, and if Greece exits I hope they are able to solve their economic problems quickly and with minimum fuss. If a Greek exit begins a chain reaction that sees the EU scaled back a bit and maybe made more fiscally flexible I think that would be a good thing, though it won’t change British angst about the EU so long as the free movement of people remains at the heart of the project. But I really really hope that if Syriza win, their victory doesn’t lead to a long period of instability that turns Greece into the neo-fascist cradle for all of Europe. That would spell trouble far beyond Greece’s borders, and well beyond this election, and I hope the Greek people are able to avert such a disaster regardless of how they vote this weekend.
Cyberpunk 6: Big Trouble in Little Boston

January 23, 2015

Let’s enjoy killing Americans together!

Date: 5th October 2177

Weather: Rainy

Mood: Frustrated and exhausted. Who knew killing Americans was this tough?

Outfit: My shiny new combat armour, that I bought with the proceeds from icing Lima. It’s snug and super tough at vulnerable points where other armour fails. Not very breathable and the peripherals on the helmet are a bit weak, plus I get limited movement on my shoulders, but you know you’ve made a wise fashion investment when you can lie still in the hail of a full magazine and just get a bit bruised. That was a good buy!

News: Some corporations are arguing again, which isn’t exactly shocking news in New Horizon, but I heard that Arasaka have signed a contract with one of the big genetech companies and are going to be re-entering New Horizon as “security.” I guess they need the money after they messed up in the Indo zone, but it’s really bad news for me. They’re gonna have a presence in District 68 – my home! – but they have a contract out on me. I can’t see that working out well for me – or for the first 10 or so Arasaka dudes who come to get me.

Back when I was doing corporate wet work there was this guy in our team that everyone called Builder Barry, who had an obsession with American history and used to talk about it a lot. He knew everything about Oil Age American military hardware, what he called the “Golden Age of Military Aestheticism,” and he also knew a lot about American history, though our team wiseguy called him a “tinpot Imperialist philosopher” and accused him of wearing “Budweiser goggles,” which are apparently some sort of super cool American tech that makes everything look pretty or something. Builder Barry didn’t have any actual goggles (he had a really sophisticated set of light-adaptive shift-tacts), and most of his hardware was Asian issue standard, but he did have a big old American pistol that he said he kept “for emergencies” because it never jammed and did a lot of damage. He said every bullet was charged with the “weight of history” or something, though as far as I can tell they were just lead, not even depleted uranium. Still, I guess that weight of history was heavy enough in some parts of the world, because after Builder Barry left our team he went with Arasaka to fight in the Indo zone, got caught by some dudes in what used to be Afghanistan, and as soon as they saw his gun they thought he was an American spy and shot him there on the spot. Is that irony (Pops is always telling me I confuse irony and karma)? The way Builder Barry tells it, everyone used to take America really seriously, and America was really important in the world, and because white people thought they were so perfect everyone also took Europe seriously (can you believe that?!), and everyone worried what Europeans and Americans thought of them. Although from the amount of wars he says they were always fighting, it doesn’t sound like they were very popular.

They certainly aren’t popular with me, after today’s little farce! We have decided to go topside on a mission for Alt, but that means getting passports which means dealing with some dude that Pops knows, who wants us to ice this guy called Blue who, coincidentally, is the guy who seems to want to kill our hacker Ghost. But before we can get to Blue we thought we should get his hacker, Rice, who might know useful stuff (hackers usually do). Ghost managed to find out where Rice lives (maybe all hackers put their address on the internet like Ghost did?) so we went to get him. A pretty simple job really – go into this apartment complex in the American sector, lock all the doors so the hacker can’t get out and the local thugs can’t get in, then grab Rice and offer him a range of enhanced interrogation options. What could possibly go wrong?

Everything, that’s what. For starters we planned on electronically locking down the doors of all the apartments on Rice’s level, because everyone knows Americans are insane and if they see a bunch of heavily armed people entering their apartment complex their first thought will be “let’s go kill them and rob them of their expensive and deadly guns,” so we wanted to make sure they couldn’t get to us. Only many of these cheap American sector apartments turn out not to have doors, so when we turned up there were lots of people coming out to get us. Also there was a riot going on outside the apartment when we arrived, because Americans love cheap beer and rioting. The riot was no problem at first but we had to leave Ghost unguarded in the van to do his hacking, which it turns out is a big mistake in a riot.

So we went inside and straight away there were people coming to get us, these two dudes with nunchakus who charged us when we were trying to shoot Rice’s bodyguards. I just ignored the nunchaku dude while I picked off the bodyguards, but Coyote didn’t kill him fast enough and so he grabbed me and threw me to the ground and started trying to take my helmet off like some kind of pervert. Coyote killed him for me but by the time that job was done more bodyguards had turned up and one laid down a blistering rain of fire on our doorway. Coyote managed to duck aside but I was trapped under the body of the dude who he had just chainsawed to death, and as I rolled out I took five bullets, I can tell it’s five because I have a big nasty bruise for each and every one. Fortunately my pretty new armour took the worst of it and I was able to do keep fighting. Coyote ran around them and we were able to take them out, but things weren’t going so well. Pops was down on the stairwell fighting off this horde of American barbarians who were coming up to get us so they could steal our gear, and an AV was hovering outside Rice’s window, while he smashed the window and prepared to jump out. Ghost was meant to be hacking that AV and making it fall to the ground, but because we left him unguarded some hobos broke into the van and started whaling on him. We knew he was in trouble when we lost our feed, so we decided to withdraw and save the van and the hacker without getting our target.

Unfortunately withdrawing wasn’t such an easy deal. Pops had to hold off those guys from below, and while we were moving up the stairs some second-rate corporate security outfit landed at the top of the stairs in an AV, and started firing down the stairwell. Coyote managed to drop a flashbang on the guys Pops was holding off, which convinced them to leave, and then got a grenade right in the mouth of the AV to very impressive effect, but somehow one of those armored corps made it through alive and dropped a grenade on me. My armor was good but apparently not good enough and I went down from the shock. While all this was going on Ghost was in some kind of gunfight with two hobos, trying to get back our van, and managed to lose his assault rifle and also Tail, who fell out of the van somewhere – we didn’t even know he had come with us the useless little runt. Anyway we took a different exit out of the building when we discovered the corps had a machine gun mounted in their AV, and we got control of the van again. By then Rice had fled in his AV, so we have to follow it and track him down.

In all I killed three guys and injured maybe five more, Coyote took down maybe 6 guys. As per a la usual, it was only Yours Truly who got hurt, but I was in the thick of it so whatever. Also I think I need to improve my grappling, because these roughhouse suburban type criminals like to drag you down and rip your helmet off so they can stab you in the neck, which is really icky. I think we under-estimated the Americans and if we hadn’t been working well as a team we’d all be dead. Next time we need to hire backup and get a bit more protection for our hacker. But none of us are dead and we have a bead on Rice’s AV so we can still follow him and get the job done. Stay tuned for some enhanced interrogation!
Parsing the Australian GP Rebate Debacle

January 14, 2015

Strange things are happening in Australian politics at the moment. The Federal government appears to be shooting itself in the foot with rocket launchers, and doing everything it can to become that rarest of entities, a one-term Federal government. There are many examples of the government’s reckless desire to consign itself to the dustbin of history, but most of them are beyond my ken. However, one that touches on an issue I’m vaguely familiar with – health – stands out as a particularly egregious example of policy-making stupidity, in which the government squandered a chance to implement a potentially important policy that would have improved the budget bottom line, then doubled down on an incredibly bad policy that is guaranteed to annoy essentially everyone. In an electorate with compulsory preferential voting and consistently high electoral turnout, this really is a recipe for electoral disaster – and completely avoidable.

The policy in question is the General Practice co-payment, and although it’s a politically tricky task – better governments have floundered over it – it has a sound public policy basis and with the right political guidance a new government riding high on popularity should be able to get this sort of thing introduced. That’s what first term governments in Australia do. So what went wrong?

A brief primer on Australian health financing

Very briefly, Australia’s health system is managed primarily through General Practitioners (GPs), family doctors in the USA, who are the first port of call for health concerns. In theory every time you visit you pay the GP and present the invoice to the government-run single payer health insurer, Medicare, who reimburse you a fixed rate depending on the type of service you received (this is called a rebate). Your GP can choose to charge you more than this rebate, in which case you have to wear the difference as a co-payment. Many GPs opt to provide a service called bulk billing, in which they don’t take cash from their patients but bill the government directly for only the rebate. This makes the service essentially free at the point of care for the patient, but reduces the amount of money the GP can make; it does however reduce the overhead for the GP, since they don’t need to manage a cash system in their office. GPs in Australia are essentially private health providers, claiming fees from a government single payer, and the system is deregulated sufficiently that many large international and national healthcare providers run large, multi-doctor and very modern clinics (often with allied health services attached), all charging the patient essentially nothing. Crucially for the health financing debate in Australia, hospitals are funded by State governments, while GP rebates through Medicare are funded federally. Note that Medicare is not like the US version (only for elderly people); in Australia it is the name of the universal health coverage scheme that all legally resident Australians can access.

One big problem with Medicare is that the essentially free nature of bulk billing services (and many non-bulk billing services, if GPs don’t increase their fees) is that patients are not discouraged from attending GPs for essentially irrelevant medical problems, have no incentive to wrap their problems into one visit, and have no incentive not to visit a GP for problems (like common colds) that the GP essentially can’t treat. This can lead to over-servicing, which causes congestion and reduces the efficiency of GPs as a service. It should be noted that compared to British GPs – who essentially run a poor-quality outpatient referral service – Australian GPs provide a wide range of services up to and including medical imaging, management of chronic and potentially fatal illnesses like cancer and HIV, and even minor surgery. They genuinely are the workhorses of the system, with a lot of responsibilities, and over-servicing is a serious issue. One solution often proposed for over-servicing is a mandatory co-payment that would force all patients to pay a nominal upfront fee to discourage frivolous GP attendance.

The Abbott government’s co-payment proposal and its aftermath

Into this policy issue stepped the new, first term government, run by Tony Abbott, a conservative ideologue who is probably better described as radical than conservative (as many conservatives are). Abbott won government on a platform of trust, promising “no surprises,” and certainly didn’t promise a major health financing change that I can recall (I can find no evidence either way that isn’t blatantly political, with a quick search). Immediately after the election Tony Abbott identified the classic “Budget shortfall” (every government since Fraser, except for Gillard, has done this it seems, and Gillard only didn’t do it because she was replacing her own party leader…) and started identifying “savings” that could reduce the deficit, which was in “crisis.” One proposed measure was the GP co-payment, which would be a $7 co-payment for all patients visiting a doctor. This unannounced and unsupported policy change attracted uproar, since it would fundamentally change the way that health financing worked, and no one was expecting it. After a long period of anger and clear messages from the Senate that the measure wouldn’t pass, the government relented and reduced this co-payment to $5, apparently voluntary. That’s right, the government was going to seriously go out on a limb for a policy that would give GPs the choice to become tax collectors for the government. Would you trust your doctor if they had volunteered to collect extra tax for the government?

Once this proposal had been sufficiently ridiculed the government canned that too, and introduced a nasty and cunning administrative change that will see the rebate for a 6-10 minute doctor’s visit reduced from $37 to $17. Obviously doctor’s costs won’t change, and so for a large proportion of their consultations they will face the choice of a $20 reduction in payment, or passing on all or part of that payment to patients. This is going to represent a huge increase in cost to patients, well above the $7 co-payment. Imagine, for example, that you are seeing a decent private doctor who charges you $50 for your service. Under the old system you pay the $50 and get a $37 rebate from Medicare; you end up paying $13, a fair whack of cash but no big deal. Under the co-payment system this would have increased to $20; under the new rebate revision, unless the doctor decides to carry the extra costs, you will now only be reimbursed $17, so your new fee is $33 – a more than 100% increase! Crucially, this move doesn’t need to go through parliament, so the government can effectively charge a rebate without getting senate approval. This is a hugely unpleasant change, and without huge numbers of concessions (for e.g. the elderly and those with chronic illness) it will lead to a huge increase in GP costs. If, for example, you’re taking statins for high cholesterol, your GP is your primary source of management and your management will probably require one of these 6-10 minute sessions every three months – so your medical bills will increase by $80 a year. This is actually a lot of money to some people.

The result of this should be obvious. While the $7 co-payment would discourage needless medical visits without necessarily significantly increasing costs for patients, the huge rebate change will destroy the bulk billing system, causing many poor people to drop out of GP service and shift to Accident and Emergency (A&E) departments in hospitals. GPs will attempt not to change their cost structure, and so will double the time they spent with each patient, massively increasing waiting times – except that their poorest patients will have disappeared to the A&E. This will mean that in the end GPs will see less patients who they charge more, and A&Es will become congested with patients attending for unnecessary minor complaints. With GPs charging more per visit for less visits, total medicare revenue won’t change – but less people will be seeing their doctor on time. The budget hole will not change in the slightest, waiting times won’t change at GPs, and A&Es will see an increase in pressure.

A&Es, as I mentioned above, are funded by state governments, not the Federal government.

So the government tried to implement a potentially important but unpopular policy, and when this failed switched to implementing a completely counter productive and unpopular policy that will seriously affect everyone through increased health care costs. They showed no policy sense and no leadership. Brilliant.

What does this tell us about this government’s policy approach?

As I mentioned above, getting a co-payment through Australian politics is a tough ask, and takes political skills, but it has two major policy benefits: it raises more money for Medicare, which is generally accepted to be underfunded, and it reduces unnecessary service use, which is a major problem in free or nearly-free health systems. With Australia’s growing burden of non-communicable disease and preventable health problems it’s probably a good idea, and $5 or $7 is not horrifically punitive, though for the very poorest in Australian society it’s tough. Australians in general are wealthy though and $7 is the price of a piece of cake – it’s really not the end of the world. Nevertheless, it represents a major shift in policy approach away from the bulk billing philosophy, and steering that policy through requires a nuanced debate in which the government prepares the public, then debates with the public, then compromises. It’s also potentially the kind of policy that involves expending a lot of political capital for not much gain – the co-payment is a good idea but not necessarily the best way to solve the problems it is intended to fix, and may not be worth any government expending political capital on. Instead, this government introduced it soon after an election, in an environment where it is accused of multiple broken promises, without any preparation or debate. It even managed to anger the Australian Medical Association, historically a very pro-conservative organization (one of its ex-presidents was a Liberal leadership contender, and an ex-Liberal health minister moved on to become one of its directors, I think). But then, having angered everyone who cares, the government dropped the plan in exchange for an even more punitive and vicious policy that will obviously fail to achieve any of the stated goals of the previous policy, and probably won’t raise any extra money but will put more pressure on Australian hospitals.

Is this not the very model of political naivete? To me this is an example of a government that has no policy framework at all. They were simply looking for ways to raise money and tried to cloak them in a policy goal that they didn’t really understand or care about, and when their mistakes were pointed out to them instead of backing down and finding a better solution, they simply dropped the cloak of policy rationality and turned vindictive. And this seems to be what they have been doing for much of their policy “development” since they won office. This is no recipe for sensible government, and the GP co-payment debacle is a classic example of how mean-spirited this government is, as well as its complete lack of interest in any real policy goals.

If this is how they go about all their policy development, the sooner they become a one-term government the better.

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