Nurses Work for Us

I disagree with Samantha Bond (27/4) that nurses "are the only ones who know what is best the best level of care for their patients". Doctors, administrators, researchers and the Parliament have a role to play too. This arrogance and self-importance belies the self-serving nature of the nurses strike.

Nurses Cash In To Keep Ratios

We've seen many letters and press releases about the wonderful work nurses do. We've read that four out of five nurses in a trial didn't like the patient dependency model (Trendcare) and that over half would "consider" leaving the profession if it were introduced (26/4).

But where is the support for the current system based on crude ratios - a throwback to the 19th century? How could a system that deliberately ignores the ebb and flow of patient needs better serve the community? If it's so damaging, why did the nurses federation in Queensland endorse patient dependency models?

The nurses' union has cast this recent and seemingly arbitrary ratio as a bellwether of community support for nurses. The logic seems to be "nurses do a good job and are undervalued. They really want this ratio - let them have it." This is the nurses' union cynically cashing in the goodwill built up over generations to put their interests ahead of those of the broader community.

HECS Debt And Study

With all the scare-mongering surrounding HECS debt, I hope that senior secondary school students aren't dissuaded from undertaking higher education. The view that tertiary study has both a private and public benefit (so the costs are shared by the state and the individual) has enjoyed broad bipartisan support for decades. Undermining this position with hysterical demands for "free" (ie fully subsidised) education merely polarises the community and allows the government of the day to shift the burden further from its shoulders. It is to our great shame and disadvantage if hyperbole about tens of thousands of dollars of debt means capable students reject university.

Practically, we already have "free" education: the HECS debt is repaid through a slightly (up to 6%) higher marginal tax rate while you earn a graduate's salary. Growing at the inflation rate and unsecured, it is the most benign debt imaginable and nearly everyone would benefit from this offer. There is a great irony here. In my discussions with student politicians about HECS and "free" education, when pushed for solutions rather than ideology they invariably say "tax the rich". Well, guess what: five years after graduation you are the rich and HECS is just another tax!

Neighbourhood Sit-Back-and-Watch

Yesterday's cute homily from Chris Gymer (Letters, 15/4) contrasted neighbourly disputes with foreign affairs. Clearly, we can't go around usurping the role of police by invading our neighbours' houses!

This analogy breaks down because the UN is not a police force: it is a structurally flawed club reflecting geopolitical realities from 50 years ago. For example, democratic nuclear-armed France (population 60 million) has a permanent seat on the Security Council while democratic nuclear-armed India (population one billion) does not. Due to its peculiar veto system it is demonstrably unable to respond effectively to crises. In a month when we remember the tragedy in Rwanda - and watch similar events unfolding now around the world - it is no suprise that reflective people the world over are questioning the UN's axiom that national sovereignty trumps human rights.

Whether or not we support direct military action without UN approval (such as in Kosovo), we should better think of the UN as a toothless Neighbourhood Watch committee operating in a police no-go zone. In this Hobbesian neighbourhood, sadly, posses are the only way to stop abuses within households. Before we take the next step of forming a global police force we must reform the UN to make it representative, resourced and responsible.

Public Transport, Private Risk

Yesterday's letters describing public transport failures (Diana Posner and Moushumi Sikand, 7/4) highlight the problems with the current outsourcing arrangments.

Despite the government's "performance monitoring" regime, the bulk of the risk of system failure is still borne by the travelling public. What proportion of passengers experiencing failure is actually compensated? If a service is punctual, but so full that no passengers can board, will the operator be penalised? If the conditions onboard are filthy and dangerous, but passengers continue to use the service because of a lack of alternative, does the drop in "Customer Satisfaction Index" affect the operators' profits?

The gap between contractual obligation and actual service delivery is where the operators make their money: perversely, they have a strong direct incentive to widen it.

Suppose that passengers could use their met tickets as taxi coupons (for station-to-station trips only) in the event of system failure. Imagine the improvement in service quality if we could pass our costs back to the operators.

Surgery for Smokers

I welcome the surgical priorities debate opened in the Medical Journal of Australia (The Age, 5/4). Difficult decisions about allocating scarce resources to save or improve people's lives should be made by the community, rather than left to specialists. This is why I'm particularly disappointed with the comments by two well-known Melbourne ethicists.

Leslie Cannold says that resources should be allocated "based on need" and presents the usual "thin end of the wedge" argument about the danger of blaming people for illness. (This phrase is actually used by the government spokesman in ruling out such discrimination, contradicting the current transplant selection criteria!).

The research paper makes it clear that non-smokers should be given priority due to their better outcomes from the surgery: while the need may be the same, the same surgery does more good for non-smokers. Given the resource constraints, this prioritisation seems entirely reasonable.

The grandstanding remark by Nicholas Tonti-Filippini, bio-ethicist and occasional Catholic spokesman, that these suggestions are "akin to advocating capital punishment for smoking" clearly add nothing to the debate. Why add such inflammatory invective to the debate? No doubt Dr. Tonti-Filippini was stalling for time awaiting further instruction from the Vatican on his position.

I hope this debate continues but with much improved quality of commentary.