Game already over
I enjoyed James Brown’s comprehensive, as can be, coverage of the players in the Game of Syria (“The deepening quagmire”, October 3-9). Without a shadow of doubt in my mind (as a former resident of Damascus) the endgame will only come about via diplomatic concession. Current and any proposed military intervention without foreign ground troops will only delay the inevitable. The Russians certainly have realised this and their endgame will be an annexed portion of Syria – namely the Alawite heartland between the Mediterranean and the line from the Turkish border through Aleppo, Hama and Homs. Damascus and the rest of Syria will be lost to the Sunni conglomerate. Russian President Vladimir Putin will protect Bashar al-Assad in his new enclave and in doing so get to keep the vital Med port of Tartus. The West and Barack Obama have already been outplayed ... we just don’t know it yet.
– John Simmonds, Collingwood, Vic
Definitely a contender
Pryor’s wonderfully insightful cartoon is perhaps too kind to Tony Abbott (“Only in the movies”, October 3-9). Our ex-PM is more tragic than melodramatic, more Jake LaMotta than Terry Malloy. But like both these sad examples of blind machismo, when the young Abbott added pugilism to his CV – in his case to help win a Rhodes scholarship – he didn’t know he was only buying “a one-way ticket to Palookaville”.
– Philip Bell, Bronte, NSW
No quick fix for system’s ills
The medicalisation of ordinary life is an important topic (“Diagnosis excessive”, October 3-9), particularly in the context of the much-publicised Medicare review. However, it’s disturbing to see the sensational way in which this issue is being framed. Such quotes as “Everywhere you look, there’s waste”, and “Swan doesn’t think commerce is the only driver of excess …” arguably demean the debate into black-and-white values of good and bad doctors. The article rightly points to the neglect of social determinants of health, which implies the need to rethink wider social policy and support. Swan thinks fee-for-service is a problem as it rewards bad medicine and overservicing. Outcome-based funding is touted as the solution, but this ignores that such strategies from Britain have been highly problematic, with regular reports commissioned to look at more “reforms” required due to problems from performance management, bureaucratic targets needing inspectors and regulators, and a widening gulf between clinicians and management. Value-laden reporting here sidesteps our problem with policies that discourage time spent with patients, that ration GP numbers, ignore the litigation risk in medical work, and problems in training of our doctors. “Undoing diagnoses”, as your article calls for, used to be “just practising good medicine”. We might well need a wider review than the politicians and bureaucrats want, one that reinstates expert care in practice and allows professionals the time and space to do that. Simplistic framing of complex issues that calls for centralised control is a prescription for chronic illness.
– Gil Anaf, Norwood, SA
Competition and the profit motive
My GP highlights two factors pushing up medical costs. First, doctors covering their backsides by ordering tests of debatable relevance to prevent being sued for malpractice for not ordering every test that might, just might, be relevant. Second, patients whose problem is boredom and stress, what she calls the “well but worried”, clogging up the system. But the biggest emerging threat is the push towards “competition” by private-sector providers of ever more tests and treatments. When the profit motive attaches itself to health services, then oversupply and overprescribing morph from problems into profit centres. Medicine is a natural monopoly, best supplied by government with the profit motive divorced from supply and accountability guaranteed at the ballot box. As our trade minister negotiated a Trans-Pacific Partnership against the greed of pharmaceutical companies, we must keep medicine in the hands of doctors and out of the hands of “entrepreneurs” eyeing endless government largesse.
– Lee Kear, Kambah, ACT
Tony or Miley?
When former PM Abbott did not win the 2010 election, it was opined he would wreck the joint – that’s pretty much what happened (Editorial, “Bitter resignation”, October 3-9). When in government, a predictable wrecking ball-style Abbott proved even too much for his own party – nearly a two-year waste of precious government time for our country. The jury is out as to whether Abbott from the backbench and his substantial 44 supporters will continue on their disruptive merry way. Those who voted for Abbott in 2013 certainly have a lot to answer for!
– John Fryer, Ryde, NSW
Stop the American rhetoric
There is a great deal of noise about “bringing down an elected prime minister”. I keep waiting for someone, anyone, to point out that this is not America and we do not elect prime ministers. The nation votes and a party or a coalition wins. That party or coalition then selects the prime minister. Since a parliamentarian’s first loyalty should be to the nation, if that chosen leader does not or cannot provide good governance, surely it is the duty of the parliament to replace him or her. Why is no one from any party saying this loudly and publicly?
– Susan Rogers, Faulconbridge, NSW
Kudos for wordplay
I love your headlines: “Just a humble cabinet-maker”, “Dutton for punishment”, “Greater Goodes”, “Bolt from the blue” (September 26-October 2)… Keep it up, please.
– Joan Croll, Drummoyne, NSW
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This article was first published in the print edition of The Saturday Paper on Oct 10, 2015. Subscribe here.