Music for Deckchairs

"In shadowy, silent distance grew the iceberg too": an Australian blog about changes in higher education


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On, on, on

Life chez Simpson was not normal, Helen now reflects, principally because a constant eye had to be kept on anything that might affect Simpson’s performance, whether he was racing or not. … “Social life [as a couple] was non-existent. I often used to think it would be really strange living a normal life, going out and having a meal with people.”

William Fotheringham, Put me back on my bike: in search of Tom Simpson (2002)

In the past 4 months I have kept seeing accolades to Andy’s amazing productivity – the 100+ articles, the zillions of case books, etc., and I have always told people that yes, he led a normal life, yes, he got plenty of sleep and yes, he even took plenty of naps. But that’s not really true. His life was not normal, at least not to me, and it certainly wasn’t balanced.

Patty Sun, “Thoughts on Work-Life ImBalance from Those Left Behind“, 2014

It’s Tour de France time again, and I’ve been reading William Fotheringham’s sensitive and ambivalent search for the story of British cyclist Tom Simpson, who died on Mont Ventoux in 1967. In the history of professional cycling, it’s one of the landmark stories of ambition, risk and terrible loss—the grainy prequel to all the doping scandals that came later. Fotheringham spoke directly to Simpson’s widow Helen, and to those who were closely involved at the time of his death, including Harry Hall, the mechanic who helped Simpson back onto his bike on the mountain, and was the last to hear him speak.

He had seen riders pedal themselves into a state of exhaustion or hypoglycaemia before, but of Simpson collapsed against the bank telling him to put him back on his bike, he can only say, ‘At that moment I don’t know what I thought. I just don’t know.’ What Hall does know is that Simpson’s last words were murmured, in a rasping voice, just as he was pushing him off: ‘On, on, on.’ He could have been exhorting the mechanic, or telling himself to keep going; Hall seems to think it was both. (p34)

500 metres further up the mountain, Tom Simpson fell again, and did not survive. He was 29, and he left Helen and two tiny daughters.

What can we possibly do with this kind of career sacrifice? When someone pushes himself to these limits, who takes responsibility? Who exploits ambition, and who profits from it? Fotheringham puts a subtle case historically against both the Tour organisers and the newspapers that followed the race, both of whom had an interest in promoting the heroic struggle of cyclist against mountain.

At the turn of the last century, the public appeal of the Tour de France lay in the fact that the competitors were pioneers, setting off to do things no right-thinking mortal would attempt … That was the great attraction for its first organiser, Desgrange; that was why his paper’s circulation went up during the Tour. (p111)

Fotheringham also lays out sympathetically the personal and cultural circumstances under which any individual might calculate that the price paid for professional success can’t be too high. It’s such a sad read; I can’t imagine how it must feel for his family to have lost someone so publicly, even to the extent that his final wavering moments on the mountain are preserved in shaky black and white footage on YouTube, remixed to funereal soundtracks by many cycling fans. And those fans—and all of us couching it through the Tour again—are part of the problem. Isn’t this exactly what we came to see?

Patty Sun is the wife of law professor Andrew Taslitz, who died earlier this year. Like Helen Simpson, her loss has been shaded by public celebration of her husband’s professional work made in comments like this:

He is one of the most amazing faculty members I have ever met. So many of us excel at one of the three major aspects of being a faculty member. Taz excelled at all three. I was always amazed at how he could write reports for committees, facilitate tenure files, attend events, write multiple law review articles a year, write a book every other year, and still manage to be one of the most effective teachers in the country. … He was certainly one of a kind, and of the kind that this world could use much more.

Tom Simpson memorial (Flickr: Mirko Tobias Schaefer)

Tom Simpson memorial (Flickr: Mirko Tobias Schaefer)

Let’s think about this for a moment. What happens when academics celebrate each other’s achievements in these terms? What happens when we think this is something the world needs more of? Which world? All I can think of is the cyclists who make the pilgrimage to Tom Simpson’s lonely memorial on Mont Ventoux and leave their water bottles there, passing on a powerful message to every young rider who comes along after them, hoping for a spot on a pro team.

When I was diagnosed with cancer, I started to think about the connection between why professional cyclists dope and why academics overwork, and got about half way there: that it’s impossible to keep up with a doping peloton unless you’re willing to entertain the same personal cost. Richard Hall has taken up this post a couple of times, in a way that has cleared up something for me. In his latest discussion of academic labour within the “anxiety machine” of the university, he connects the shame culture of performance management to practices of self-care, and ultimately to the ways in which both our hidden and attention-seeking gestures of overwork entangle us with the lives of others:

Just as the high-performing athlete recalibrates the performance of those around her, and creates a productive new-normal, so the workaholic professor does the same. And the irony of my sitting here at 11.22pm writing this is not lost on me. And maybe this is because I am committed. And maybe this is a form of flight or a defence against the abstract pain of the world. Maybe it is a form of self-care, through which I am trying to make concrete how I feel about my past and my present. And maybe as Maggie Turp argues, this form of overwork and performance anxiety is a culturally acceptable self-harming activity. I am performance managed to the point where I willingly internalise the question “am I productive enough?”, which aligns with “am I a good academic?”, which aligns with “am I working hard enough”, which risks becoming a projection onto those around me of “are you working/producing enough?”

This is such a vital step: to connect the personal pathology of overcommitment (including to the welfare of others) to the creation of profit from machines and systems that facilitate labour. And then to think about what it means to understand universities in these terms, especially as we lurch towards a more competitive and more marketised higher education system. In other words, in thinking about the hamster-wheel cultures of academic overwork, we don’t need to look much further than the mechanics of the wheel itself, whose whole design and purpose is to keep on keeping on, which is precisely the problem. As Harry Hall, the mechanic who put Tom Simpson back on his bike, later reflected, cycling and rowing were the two most dangerous sports for athletes because of their mechanised nature: “The individual is pushing a machine which doesn’t know when to stop. It always asks for another pull of the oars, another pedal stroke.” (p41)

But the anxiety machine of the academy isn’t a component, like a bike or even a hamster wheel: it’s the whole system. It’s all of us, helping each other on, on, on. It’s the formal incentives and rewards for overwork that we chase, and it’s all the informal ways in which we perform, celebrate and even lament our own willingness to work to exhaustion—without ever stopping long enough to think about how we could change this, and why we should.

Things to read

If you’re looking for one thing to read on academic productivity, Melonie Fullick’s post “By The Numbers” is outstanding. Also thanks to Deborah Brian for sharing the work of Maggie O’Neill on the slow university.

Nadine Muller’s post on stress, self-care and the need to work together to achieve change in academia is great.

And please, please read Patty Sun’s shattering take-down of the personal cost of academic overwork.


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Sightings

Updates below

In a bizarre coincidence, when I opened the book to scan the contents I found myself looking at the section about sharks.  In particular, “surviving if you are in a raft and you sight sharks—”… I wonder if anyone would be interested in using this as a model for an edtech field manual for surviving the Higher Ed apocalypse.

Jim Groom,”Survival: the manual” July 7 2014

Thanks to Jim Groom, I’ve been thinking about Jaws in this plainly bizarre week in the short history of commercial MOOCs. For all its singular qualities, and for all the symbolic load placed on it by film theorists, Jaws is at heart an ordinary mystery: something unexpected and unexplained happens, someone goes missing, and everyone else spends the movie piecing together clues, disputing priorities, and dealing with what comes next.

But there’s a small scene in the middle that often gets forgotten, where two kids prank the holiday crowds at the beach with a cardboard fin—and in doing this set up the perfect opportunity for the real shark to glide in to calm water, unnoticed by everyone until it’s too late.

This week’s edtech weirdness had both mystery and something like a distracting prank, involving a MOOC in which the professor was yanked from view, then bobbed up again briefly, before vanishing again. Paul-Olivier Dehaye, a maths lecturer from the University of Zurich, put up a three-week course: “Teaching Goes Massive: New Skills Required” (#massiveteaching) through Coursera. The landing pages raise questions about the Coursera approval pathway and standards: two weeks of short RSA Animate style videos, and a final week where students will do more or less whatever they like in an “Experiment Area”. Dehaye is likeable, clear and thoughtful about his topic, but the videos aren’t elite brand rocket science—certainly, nothing that an informed and curious teacher in the office next door to you couldn’t have thought up.

And that should have been the first clue, I think. The course goal is “personal growth”, for which—thankfully—no certificate is offered, and the content is quite vague: “‘Readings’ will come naturally during the course as basis for discussion. … In the first week, we will provide a short summary of proposed content of the course. The content of the later weeks will be decided on by the students, and should cover the proposed content and more.”

But after the first week some or all of the content was deleted, and then Dehaye was himself removed, leaving enigmatic clues on Twitter, some participation in Metafilter discussions, some blog comments here and there (including on George Siemens’ blog), and a deleted Etherpad document that he wrote to explain his actions.

MOOCs can be used to enhance privacy, or really destroy it. I am in a real bind. I want to fight scientifically for the idea, yet teach, and I have signed contracts, which no one asks me about. If you ask me something, I can tell you where to look for the information. My plan becomes to flip the tables. I want to “break out” and forge an identity outside of the course, on Twitter, because I realize this is the only way for me to fight for this identity, engage with my students, and those big shots all simultaneously (journalists, educational analytics people, etc).  … Meanwhile I want everyone to organize their own learning, which I know is happening by looking a bit around. Some people don’t like my course, which is fine. It’s your choice, that’s part of the point. Still, I get lots of emails from coursera asking what is going on. A lot of pressure from them now. They are confused just like you were, and I intended to confuse them even more because they were not ready to challenge their own pedagogical practices fast enough, judging from past experience.

After blogger Apostolos K pointed out that these strange goings-on hadn’t attracted much coverage, and George Siemens wrote “Something Weird is Happening at Coursera“, the story was quickly picked up. Carl Straumsheim treated it as “The Mystery of the Missing MOOC” for Inside Higher Ed; Steve Kolowich covered it for The Chronicle first as a mystery (“In a MOOC Mystery, a Course Suddenly Vanishes“) and then as an experiment (“University of Zurich Says Professor Deleted MOOC to Raise Student Engagement“). Jonathan Rees had two goes at it, both worth reading: “The worst of the best of the best” on his own blog, and “Even super professors deserve academic freedom” for The Academe Blog. Rolin Moe, whose MOOC blog is touchingly subtitled “Debating, debriefing and defining the learning trend of 2012-“, wrote it up as “Dr Famous is Missing“.

By the end of the week, opinions diverged. Yesterday Michael Gallagher argued in a beautiful post that to exploit students in a research project raises questions of trust that can’t be overlooked even if the intent is to criticise (“Teaching vs. research and MOOC brouhahas“); today George Siemens congratulated Dehaye on starting a conversation about our vulnerability to commercial data mining by companies like Coursera.

I’m still absorbed by the freakishly odd coincidence of Dehaye’s co-authored take on a probability problem that’s apparently well known to mathematicians, involving 100 Prisoners And A Lightbulb, with George Siemens’ July 5 post (published just before all this turned into a thing) on the latent knowledge in any class, involving 100 learners in a room. This is Siemens, but could be Dehaye:

The knowledge and creative capacity of any class is stunning. Unfortunately, this knowledge is latent as the system has been architected, much like a dictatorship, to give control to one person. In many cases, students have become so accustomed to being “taught” that they are often unable, at first, to share their knowledge capacity. This is an experience that I have had in every MOOC that I’ve taught. The emphasis in MOOCs that I’ve been involved with is always on learners taking control, learners joining a network, or learners becoming creators. In a Pavolovian sense, many learners find this process disorienting and uninviting. We have been taught, after a decade+ of formal schooling, to behave and act a certain way. When someone encourages a departure from those methods, the first response is confusion, distrust or reluctance.

I’ll call my theory of knowledge and learning “100 people in a room”. If we put 100 people in a room, the latent knowledge capacity of that room in enormous. Everyone in this room has different life experiences, hobbies, interests, and knowledge. We could teach each other math, physics, calculus. We could teach poetry, different languages, and political theory. The knowledge is there, but it is disconnected and latent. Much of that knowledge is latent for two reasons: 1) We don’t know what others know, 2) connections aren’t made because we are not able with our current technologies to enable everyone to speak and be heard.

At the moment, I’m not sure that we know enough to be sure what the plan was with #massiveteaching. So I’m keeping an open mind to the possibility that what looked like a prank was an attempt to start a different conversation—including, and perhaps especially, with students—about the risks of corporate data mining and the lessons from Google advertisements or Facebook’s experiments with emotional manipulation. The fact that it didn’t work smoothly, and might make Coursera much more twitchy about allowing experimental course design in the future, shouldn’t necessarily be the measure by which it’s finally judged.

Meanwhile let’s keep one eye on the ocean where the real sharks are. As ever, the timely counsel in confusing times is from Jim Groom, who seems to me to be looking in the right direction:

I don’t know what it is, but Sharks remind me we are deeply vulnerable always.

Me too.

Update

People are still writing about this. Two very good posts today:

According to Apostolos K, Coursera/U Zurich have resumed the course without Paul-Olivier Dehaye, which seems to me a reasonably complicated thing to do if the whole designed purpose of the enterprise originates with him. It’s a bit like the Mayor of Amity Island putting on the cardboard fin to prove that there’s no shark.


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Down on main street

“We think it’s fair to ask the student to pay $3 extra a week to get the chance to earn a million dollars more over a lifetime than Australians without a university qualification. … Mr and Mrs Mainstreet are paying almost 60 per cent of the tuition fees of a uni student and they are also paying back the loan at the 10-year government bond rate of 3.8 per cent, whereas the student’s loan is indexed at CPI, currently 2.5 per cent,” Mr Pyne said.

Uni loan changes ‘cost $5 a week’, June 4

Since Christopher Pyne made fairness in higher education the surprise water cooler topic in this budget, there have been strongly negative reactions to the hiking up of student debt from all over the place. The government is now campaigning hard on the idea that fee reforms are both essential and inconsequential: the impact is tiny, the freedom is vast, and the overall costs are just as likely to go down as up (this is what the Minister calls the magic of the market, so do clap if you believe him.)

There are some practical problems with trying to pass off education debt as similar to other kinds of reputable middle-class debt, like mortgages or business loans, rather than, say, experience debts or gambling debts. Education might pay dividends in the end, but while it doesn’t, there’s no asset: no car to repossess, no house to put on the market, no shares to sell. Graduates who don’t go on to the full-time career for which they trained not only don’t see the promised premium earnings, but they can’t get a refund or put their degree on eBay. They’ve had the experience, and their numbers haven’t come up. Now they’re in a hole.

Behind this is the more important problem that there are no standards of responsible lending applied to education debt. If you’re offered a university place, you’re entitled to go into debt to complete your degree, just like that. It’s a no-doc loan of the worst kind, because it has to be — your future capacity to repay is itself the asset you’re going to debt to acquire. So no one’s responsible for even minimal risk evaluation of prospective undergraduates and their families. To put it brutally, universities can recruit underprepared students to make up numbers and protect their revenue stream, and at the moment have no real skin in the game when it comes to graduate employment.

Until now, the risk has more or less worked for Australian students even in non-vocational degrees because interest rates have been low, and it hasn’t worked for the lender because the incentive to repay is correspondingly weak. Students who have been able to pay fees up front have been better off, but not to a life-changing degree. But still, graduates have got stuck below the repayment threshold for a wide range of reasons, or have nicked off overseas, or have died with their debts unpaid. All of this amounts to a prediction that Australia could have $13bn in doubtful debt by 2017—a hill of beans compared to the trillion dollar toxic debt swamp in the US, but significant for a small education market like ours.

So it’s obvious why the government wants to adjust repayment terms: both to get more money back from those who repay tidily, and to use the threat of compounding interest to round up those who aren’t repaying much at all. It should be a low risk strategy: as owners of the national education debt pipeline, the government clearly expected to be able to tweak both interest rates and repayment thresholds while still offering a better deal than any commercial lender, and by these means to turn education debt into a more attractive asset.

But this is proving a hard sell. Having spent a lot of time at home this year, I’ve come to think that if Christopher Pyne had watched more daytime TV, he would understand why we’re not jumping at the idea. It’s because we know more than he realises about disreputable debt: last resort borrowing, predatory lending, and household debt that’s being juggled across multiple credit accounts. Australians at home are hassled all day long by TV commercials focused on compounding debts owed to intimidating lenders, and financial underpreparedness for illness, accident and death. This is what’s in the basement of our national consumer confidence: a realistic sense of how quickly debt picks off the most vulnerable in this prosperous economy.

Like someone spruiking a raw food juicer or a funeral plan to this frightened audience, the Minister has to work hard to convince us to turn a blind eye to what’s lurking in the shadows of deferred payment, and to focus instead on the transformative power of the product. It’s why he’s making his case at the highest perch of generalisation, glossing over earning disparity between male and female graduates, graduates in different disciplines, graduates living in different parts of the country (especially in the country parts of the country), graduates from different social backgrounds, and with variable levels of educational preparedness before they start their degrees. He’s also hoping we don’t understand the impact of part-time and precarious employment, regional employment, misadventure, illness, disability, parenting, or the fact that the economy itself is slowing down.

In fact, everything that makes a real difference to graduate lifetime earnings is invisible from the Minister’s penthouse, leaving us with the simplification repeated in speech after speech after speech: graduates will make 75% more than non-graduates, and in case we’re not sure what that is, why—it’s a million dollars.

Jackpot.

Or not. Just as with cancer mortality modelling—about which I know a thing or two—the aggregates, multipliers and generalisations across a demographic slice that make up this million dollars are all bundled inside speculation about external variables, and can’t possibly predict what will happen with the accuracy required to judge the personal risk of going into long-term debt. When someone says “X life expectancy” or “Y lifetime earnings”, they’re pretty much saying “83% percent reduction in wrinkles”—it’s really up to you what you make of this as you stand at the counter with the wrinkle cream in your hand.

And yet the Minister’s gone on repeating his million dollar pitch long after even the friendliest economist has quietly pointed out that the facts are more complicated. Because this is exactly what you have when you don’t have responsible lending guidelines: a cheap and shouty sales pitch involving lifetime guarantees, a sprinkle of FOMO, and a miracle product. And he’s energetically trying to nudge Australian taxpayers into resenting university graduates, despite the evidence that Australian graduates themselves go on to become Australian taxpayers to a very significant degree.

Yesterday Stephen Matchett, in his excellent daily newsletter on Australian higher education, suggested that student debt has become the equivalent of the $7 Medicare co-payment to health reform: it’s the pill that the electorate just won’t swallow, no matter how it’s sugar coated. I think he’s right. What’s taken us all by surprise in this budget is that across every portfolio, with remarkable tin-ear consistency, the stakes have been pushed too high, the reasoning has been too lazy and too divisive, and the reactions of Australians to the central topic of budget fairness have been really widely misjudged.

Oh, and also, the rustling up of patronising stereotypes to explain it all is really wearing thin.


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Seven dollars in modern Australia

“I think it’s a sad reflection on the modern Australian attitude that they can’t see that all areas have to make a contribution and they look at it as a narrow, sectional issue.”

Commission of Audit Chair, Tony Shepherd, on responses to the Federal Budget, May 23*

This week my daughter turned fifteen, and she went to the doctor—a political act in modern Australia.

She went because of a constellation of puzzling symptoms which we’ve been sort of monitoring for a few months. Finally, we came to the conclusion that these symptoms are persistent, significant, and affecting her school attendance, and we couldn’t diagnose them ourselves. So off she went.

Our GP asked her questions, considered the symptoms widely, and sent her home with the trifecta of health care copayment: a prescription, and referrals to both pathology and diagnostics.

Whether these tests find something, or nothing, she learned something that will affect her future health care costs, which are entirely likely to fall on Australia’s public health system; someone who is neither a teacher nor a parent listened to her, and took her puzzling symptoms seriously, in a trustable way. And she learned a bit about how the system itself works, and what happens when you ask for help.

At fifteen, she’s entering a period of consequence well known to health professionals. Over the next few years, she’ll either take or avoid the risks that will have long-term impacts on her adult health and wellbeing. Thanks to this positive encounter with someone who minded enough to ask tactful, sensible questions, it’s just fractionally more likely that she will know that Australia’s health workers have her back. So whatever the technical results of this visit, she learned something that will last but will be very difficult for our healthcare system to measure as a positive impact.

I was thinking about this when I read this morning’s remarks by the Chair of the Commission of Audit, the group that advised the Federal Government that we bring an end to the principles of universal health care in Australia. These are the principles that mean that any teenager can learn how teenagers should be able to access healthcare services at no cost.** And here’s the thing: although we’re public health care patients, we already don’t attend a bulk billing GP practice, so the fact that the proposed health care copayments have come to matter to me as much as they do isn’t self-interested or sectional—even in the context of cancer treatment.

I can’t believe we have to spell this out in modern Australia, but what matters here is the fairness of ensuring that those who are already the most disadvantaged get the benefits of whatever we can collectively provide. This is why it’s so important that teenagers’ access to the people and services who will make most difference to their later health (and the later health costs that they impose on all of us) isn’t determined by their capacity to pay. Teenagers are minimum wage workers if they’re lucky, and they’re not all safely located in a family who can pay for them. Seven dollars is a big deal; twenty-eight dollars even more so.

So although I’m not generally one for marching and placards, tomorrow I’ll be joining the local rally to save our Medicare system from these damaging, divisive healthcare cuts, and it’s quite likely that I’ll do it again next weekend in Sydney.

This really is a turning point for modern Australia, and the evidence all around us is that Tony Shepherd is decisively wrong: it’s precisely because of how this affects other people that so many of us are taking to the streets.

Links

If you want to know more about the Save Medicare campaign, it’s here. Do also check out Co-Payment Stories. There are campaigns being run by medical researchers who don’t want the promised squillions for their research at this social and health cost; and campaigns being run by doctors and nurses also. The coverage of all of it at Croakey blog is excellent, and there’s a Pozible crowd funding campaign to support South Western Sydney GP Tim Senior to write for Croakey here.

The Save Medicare Rally in Wollongong is at midday on Saturday 24th May, and there’s another in Sydney on 31st May.

If you’re not a marcher, here are some petitions:

And really, there’s something about this maddening Budget that is also very inspiring: its fundamental unfairness has proved that we can all still see beyond “narrow and sectional issues” to something worth standing for.

 

* I read this article thanks to Mary-Helen Ward.

** Thanks to Tim Klapdor for the reminder that in many regional centres there are already no bulk billing options. I’m curious about the source of our Health Minister’s “Having 70% of non-concessional patients bulk-billed is unsustainable.”  


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A couple of beers

I can think of no more significant benefit from community contributions in health than to invest in cure and discovery research by our people for our people … As a result, it may be an Australian who discovers better treatments and even cures for dementia, Alzheimer’s, heart disease or cancer. If we start investing now, this new and historic commitment in medical research may well save your life, or that of your parents, or your child.

Federal Treasurer Joe Hockey, Budget speech,  May 13

It’s been a while, but I’m still here. Cancer treatment is an absorbing, revealing, boring, depleting experience, sometimes all on the same day. The drugs used to treat cancer have powerful side effects, and the drugs to alleviate their side effects have side effects, and sometimes these drugs also provoke allergies, both allergies to the drugs, and triggered allergies to other things.

Cancer is also administratively taxing—there are forms, and appointments, and deadlines, and things to remember, all at a time when chemotherapy and Mariana Trench depths of fatigue make it quite hard to finish sentences.

Then there’s the way cancer messes with the people who love you, and disrupts their experience of work, school, and everyday life, and at the same time surrounds you with the kindness of both friends and strangers. All of this deserves time and care and attention.

And finally there’s the weird billboard politics of cancer, which means that it rears up when you least expect it. This week my daughter joined a local soccer team, and I found myself frozen at the washing machine holding up a soccer shirt that says “Are You Breast Cancer Aware?”

Gosh, yes we are, thanks for asking.

Cancer also popped up this week in Australia’s Federal budget, as our Treasurer tried to sell a proposed services tax on GP visits, blood tests, diagnostic imaging and prescriptions that will disproportionately whack patients in cancer treatment, in the name of an imaginary Australian funded by revenue from this impost who finds a cure for cancer. You couldn’t make this up.

Because I’ve had more to do with Medicare in the last six months than I have in the twenty years since I emigrated, I really mind about this rubbish. The fact that my breast cancer was diagnosed at all was the result of GP visits when I was reluctant to think that I had something to worry about. GPs are critical to early cancer detection; any barrier to GP access is one that risks much more significant costs to our public health system later on. So it really doesn’t even make sense from the perspective of health budgeting.

When copayment for health services was first mooted, we heard quite a bit about behavioural economics: if people had to pay for their access to no-longer-universal healthcare, they’d be more conservative in their use of it. So it was genuinely surprising when copayment extended to pathology services. Are we really now suggesting that chemo patients, as well as others with chronic disease, should think twice about out-of-hospital blood tests or X-rays? Or do we think these patients should rock up to Emergency Departments and hospital pathology departments (which are two different things) to get their blood taken?  Even though chemo patients specifically require disruptive special treatment when they get there, because of their heightened risk of infection?

On the other hand, do we really think that local pathology collection centres will run more efficiently if they have to figure out how to process these copayments for everyone, now they’re not allowed to take cash?

The Treasurer’s answer to this has been to swerve towards another imaginary Australian, an idler with all the wrong priorities. I was standing in the middle of my kitchen on Thursday morning when this insulting nonsense came out of the radio:

But, but, I’d say to you, Chris, one of the things that quite astounds me is some people are screaming about $7 co-payment. One packet of cigarettes cost $22. That gives you three visits to the doctor. You can spend just over $3 on a middy of beer, so that’s two middies of beer to go to the doctor.

Let’s have some perspective about the costs of taking care of our health. And is a parent really going to deny their sick child a visit to the doctor which would be the equivalent payment of a couple of beers or one-third of a packet of cigarettes?

This is a crude and stupid switch from the conventional “price of a cup of coffee” device governments flourish when they want to persuade us that rising costs are trivial. Trading beer and cigarettes for healthy choices is just so much more obvious. It’s the foundation of responsible citizenship, isn’t it?

Except that, as the interviewer wearily pointed out, this stereotype of the delinquent parent choosing another beer over their children’s health trivialises the pressure on low-income families, that aren’t confined to simple choices between one modest thing and another. Sometimes neither are within reach, even if this is very hard to imagine from a more privileged position.

So now think about the parent on welfare in a country town whose sick child’s health visits includes travel costs, that will now be hiked up by rising fuel prices. Or imagine the parent of a sick child who’s also trying to hang on to part-time study, facing rising tuition costs and the prospect of significantly increased interest rates on deferred loan repayment.

And these imaginary parents aren’t sequestered from the rest of the economy. So have a think about the person who’s serving that beer: probably young, perhaps also a uni student, maybe another parent, about to be hit by changes to welfare for the under 30s. Discretionary spending on small items like a cup of coffee or a beer aren’t trivial to the casual workforce sector they hold up, who in turn are making choices about what they can afford. The retail and services precariat are always the canaries in the mine of consumer sentiment, the first to feel it when a combination of factors limits the money left over from food, rent and cost to work. This is behavioural economics.

Anyone can play the game of the imaginary Australian, and sometimes it’s good for us to do this—it’s a really basic exercise in political empathy. But the point of a universal healthcare system is that we don’t have to trade in these limiting stereotypes. Instead, we accept that we all win when these most basic healthcare services aren’t withheld—from anyone—for the price of a couple of beers.

So as both a taxpayer and a public health cancer patient, and with all due respect to my university colleagues in medical research, I don’t care whether cancer is cured by an Australian. I don’t. But I really do care about the experience of other Australians living with serious and chronic illness. If making it easier to see GPs, access pathology services and fill prescriptions helps reduce the numbers of people who go on to need hardcore (and costly) medical care, and then also reduces the cost of living through treatment itself, that really is something to defend.

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