THE ROLE OF DOCTORS* IN HEALTH SERVICES PLANNING AND MANAGEMENT: ALTRUISM, EXPERTISE AND LACK OF ENGAGEMENT AS PERCEPTUAL DISORDERS

The name and pretence of virtue is as serviceable to self-interest as are real vices.

Francois de La Rochefoucauld

On 20 July 2011 Dr Steve Hambleton, a Brisbane general practitioner and President of the Australian Medical Association (AMA), gave a speech to the National Press Club in Canberra on Fixing Health.

In that speech he said, ‘Evidence shows that where doctors run the management of hospitals, results improve and morale is better’, and added that, ‘if (deeds and actions) are bad for doctors, then they will be bad for patients and bad for our health system’.

In a speech to the AMA Parliamentary Dinner on 17 August 2011, Dr Hambleton reiterated his views and added that, ‘You cannot improve the health system by ignoring the opinions and advice of doctors’...‘(doctors) have the knowledge and experience to make the system work better’, and ‘they are (the) best possible health policy advisers.’

So, what is an intelligent impartial person, concerned about health policy and public administration, to make of these views? Having had some years’ experience dealing with medical practitioners in health services policy and planning and, to a lesser extent, hospital management, I thought I could assist a wider understanding by offering something in the way of explanatory analysis and comment.

But first, a thought experiment.

Imagine if you will a very smart eighteen-year-old, freshly out of high school and off to university. This kid has been told for years they are among the brightest and the best. Academically, they have performed in the top 0.5% of their state. They decide to study medicine. Why? The usual reasons – status, calling, intellectual interest, psychological suitability, family pressure, future wealth, or maybe a combination of some or most of these drivers.

What they are taught and learn, above all, is how to be a highly-skilled technician. As they progress and specialise, their status, wealth, intellectual satisfaction and sense of purpose and achievement rise accordingly. Of all the technical careers one can choose, medicine and surgery rank among the best-regarded. These are demanding careers of great human worth and social value, and their practitioners are rewarded handsomely, in both financial and non-financial terms.

But how do medical practitioners perform at all the other things we require of senior policy thinkers, health executives and leaders? Well, in my experience, and in the experience of just about everyone I have talked to in this business (including some doctors), no better than the rest of the population. And, on average, not as well as other intelligent, well-rounded people who have studied and worked in the wide range of areas that comprise a complex modern health system.

Not surprisingly, what most doctors are good at is doctoring. Intelligence comprises a complex set of qualities. It is passing rare for most aspects of intelligence to be optimised in any one individual; even in those who as teenagers ranked in the top academic 0.5% of their peers.

The qualities of medical practitioners we value are these: diagnosis, rectification and prevention of problems associated with complex psycho-physiological entities, AKA us. Most are employees, or self-employed, or partners or directors of small to medium enterprises. A few have entrepreneurial or high-level management skills, and some show fine leadership qualities – but many of them would struggle to run a school tuck shop without ‘support’. As health managers, they make great doctors.

Yet the problem here is not only about the qualities that most doctors lack – it’s about the ones they have. And what they have, as we all do, is baggage.

The encumbrance in this case is an egregious confirmation bias toward their group.

What evidence, for example, does Dr Hambleton allude to in support of his claim that, ‘where doctors run the management of hospitals, results improve and morale is better’? None, of which I am aware. Of what would such evidence comprise? A survey of doctors?

And what of the claim that (doctors) ‘have the knowledge and experience to make the (health) system work better’. What is Dr Hambleton’s evidence for that? Feedback from AMA members?

But most revealing is his statement that, ‘you cannot improve the health system by ignoring the opinions and advice of doctors’. This at a parliamentary dinner at which Federal Ministers from the Prime Minister down were seated at tables of AMA members...access not ordinarily enjoyed by any other part of the health system.

To pretend that the opinions and advice of doctors’ is ignored by health service executives and planners is risible in the extreme. Numerically one of the smallest parts of the public health system, no other group comes remotely close to exercising as much professional influence and economic coercion on health service systems and delivery. Doctors are, as a rule, engaged to standstill.

So, how could Dr Hambleton seriously arrive at his conclusions? Is it just advocacy of group interests? No. It is that, of course, but it is more. Because many doctors actually believe they should be running all health services. (Indeed I have had one senior VMO surgeon tell me during a surgery planning session – when he wasn’t entirely getting his way – that doctors will just have to run the hospital.)

The AMA’s only plausible complaint could be that doctors are not in complete control.

Being told over and over again for years that one is brilliant, outstanding, or exceptional; it must be very seductive. Only those with the most robust sense of equanimity would fail to be flattered. Being surrounded by and accepted into a revered clique of similar standing, awash with arcane practices and near insuperable barriers to entry, only serves to reinforce a sense of meritocratic hierarchy. Little wonder some doctors – particularly senior specialists – behave as if they’re God’s gift...

Doctors who move into senior health management and policy leadership ultimately must go through a moment like Charles Erwin Wilson, the General Motors (GM) President appointed in 1953 as US Secretary of Defense. When asked in a hearing if he could make a decision adverse to the interests of GM, Wilson answered yes, but added that he could not conceive of such a situation, ‘because for years I thought what was good for the country was good for General Motors and vice versa.’

Yet it appears that Dr Hambleton would, at least at present, fall short of even Mr Wilson’s meagre threshold. Other than demonstrating that the AMA President is, perhaps ex officio, unfit for senior health system management or service planning leadership, what do his statements tell us about doctors compared, say, to other technicians?

Plumbers, on the whole, are unlikely to think that town planning is a complex bureaucratic system developed solely or mainly to provide plumbing services to households, businesses and institutions. Whatever their intellectual limitations (as a group) may be, plumbers are neither so silly nor arrogant enough to think that their function is the only or principal purpose in planning new developments. Important, yes. Indeed, essential for a safe and clean environment. But not the main game.

If only doctors were as sensible and proportionate in their expectations. But alas, they are not and most cannot be, because for them medicine is health and vice versa. And so, mutatis mutandis, they cannot conceive of a heath system other than as a grand structure to support and deliver medical practices. But most of us know that health is way, way more than this. Just as defence is not just about who builds and supplies jeeps, trucks and other vehicles. Not even in 1953.

What’s good for medicine, and for doctors, is not necessarily what’s good for the health system. What’s good for patients is not necessarily what’s good for doctors. Even leaving aside the obvious financial considerations and matters of malice or incompetence, interests sometimes coincide and sometimes conflict. Whatever their merits, health complaint systems are full of such cases.

It is a fact now quite widely known and well-evidenced too that many doctors, when confronted with the option to undergo the same procedures they typically recommend to their patients, choose to forego them. Any doctor who fails to understand this point about divergent interests is frankly unworthy of a senior role in a public health service.

Confusing the part for the whole is known in analytic philosophy as a mereological mistake.

Smart people avoid being tripped up by such altruistic illusions, unless their baggage is blocking the view. The best way to get over your baggage and take the trip that wisdom asks of us – the journey to abstraction – is to leave the old suitcases where they are and move on without them.

Abstraction is a crucial quality for those in senior management, planning and leadership of services for the public good. It is the capacity not just of looking beyond self-interest and putting oneself in the shoes of others (the altruistic position), but of moving to an impartial point of view that considers the overall public interest and prepares one to take a position that may be detrimental to oneself or one’s group.

Only doctors who no longer especially care about the interests of doctors are capable of abstraction. There are some; but they are few.

And Dr Hambleton and those who think like him do not count among them.

* By ‘Doctors’ it is of course meant, doctor doctors (ie medical practitioners), not real doctors (ie people with a doctorate), apart from those who are also medical practitioners. In this article, vets, dentists and other clinicians are not included in the category of Doctors.

CONFIDENTIAL DRAFT REPORT: WHAT ON EARTH IS SEX FOR?
(Report by lead researcher E Brik on behalf of the field team)

(This is a follow up to our first Report - What on Earth is Sex? Note: Apologies to the more squeamish reviewers of the prior report – the authors have on this occasion limited graphic details to the bare minimum necessary for a full understanding of these frankly perplexing phenomena).

The first and most obvious thing to say about sex here on planet Earth is that it is an activity confined to the living. Dead creatures don’t do it (although they may have it done to them) and inanimate things like manacles and vacuum cleaners don’t do it either (although, again, these can be employed by living things for sexual purposes). This is because sex is a biological mechanism: it is the way that (most) living things get together to make other (similar) living things.

Thus, if it is for anything, sex appears principally to be for one thing: reproduction, just as we surmised in our previous paper. But is it, or could it be, for anything else too? Lead researchers selected a well-known and successful mammal found here on planet Earth, a higher order primate known as Homo sapiens, as a suitable subject for more detailed examination.

Homo sapiens (or humans, as we refer to them colloquially) are comparatively long-lived creatures. They mature slowly for over twenty Earth years, developing sexually in their teens, and remain sexually active for up to a further forty years or more. While patterns of sexual activity diverge widely from individual to individual across the species, it does not appear to be seasonal: on average, humans engage in sex in a relatively consistent pattern throughout the Earth year (roughly 365 days of 24 hours each).

Human sex takes many forms and conjugations, and can occur as often as daily (and sometimes even more frequently) or as rarely as one finds with Panda bears (annually, if at all). The teenage years and indeed human life before reproduction appears however to revolve around the pursuit of sexual relations to quite a high degree. Nevertheless, with the passage of time and partnering, a modicum of regularity (and the common appearance of children) brings activity down to more manageable frequencies.

Detailed study of a large and representative sample of Homo sapiens recently undertaken shows that, when partnered*, sex occurs on average roughly twice weekly (a week = seven Earth days). Even assuming a relatively late start of twenty years of age, and an earlyish finish at sixty, this would mean on average that humans have sex about 4000 times in their lives. At first this struck the researchers as an astonishingly high figure (tiring even to contemplate), until we carefully factored in variables in the data.

These factors include periods of illness, injury, exhaustion, dearth of opportunity or available mate/s, a pathological lack of interest in sexual congress, unattractive options for sexual partners, resort to masturbation#, more appealing alternatives to sex (eg sport on television) or engaging in other activities without a sexual partner or that deter sexual congress (such as fishing, knitting etc). As a consequence, we have cut the estimate by 50% as the basis for more thorough-going analysis.

Even so, one can quickly adduce that this is still an inordinately high figure. Indeed, field researchers have speculated on how the species could tackle the other major challenges of life on planet Earth when so much time and energy is apparently taken up exchanging bodily fluids. A clue is the time taken for sexual congress, which, as with frequency, varies greatly: from as little as fifteen seconds (ie 1/240 of an Earth hour) per event up to, on occasions, many hours at a time!

Although further research needs to be undertaken to make definitive findings, it would appear that the amount of time taken up by human sexual activity on average is somewhat less than an hour, even including the preamble we characterise as foreplay, and tends to reduce as Homo sapiens age and, importantly, as members of the species become more familiar with their sexual partner.

The latter factor may also play a role in philandering (sexual cheating), as human partners appear to become sexually bored with the effluxion of time, their penchant for dressing up, introducing supplementary mechanical devices and engaging in related theatrics notwithstanding. Indeed this has led some researchers to postulate a theory of serial monogamy in Homo sapiens. (For those with a scholarly interest in the subject, these matters are canvassed in more detail in Appendix C.)

In any event, it became clear to the research team shortly after commencing our work that we needed to understand better the link between sex and reproduction in Homo sapiens. After all, evidence shows that the average number of living offspring that human couples produce is somewhere between two (minimum replacement level) and three. This would, on the face of it, suggest that an awful lot of human sex is going on for the production of not very many progeny.

What on Earth could be the reasons?

Careful readers of our previous report will have noted that the shared sexual mechanism in Homo sapiens includes genital ganglia, stimulation of which is integral to the confluence of genetic material. Although there is some scholarly debate on this point, it appears on the face that the principal purpose of these ganglia is to trigger an emission from the male into the receptive female. This however leaves it unclear if the existence and excitation of the female genital ganglia are in some way reproductively advantageous, or are a so-called evolutionary free-rider.

Whatever its aetiology, both sexes can achieve what is called orgasm, although the male orgasm is more in the way of a necessary component, while the female orgasm is somewhat less common (though it is by no means unknown, and can on occasion occur multiply). The female orgasm may function to increase the probability of successful fertilisation; otherwise its prospect may serve as an inducement to the female to have sex, or may merely be a di-morphological side-benefit of the mechanism for ejaculation in the male.

(This is perhaps fitting, as the female human [as readers of our previous report will recall] invests far more reproductive energy and time than the male and, it should be said, experiences a great deal of pain and distress in the reproductive process, due in part to being bipedal, upright and having a highly pronounced cranial-torso volumetric ratio. Perhaps a clue to human sexuality lies herein.)

While we have not yet undertaken the important neuro-psychological laboratory research to understand the cognitive functioning of Homo sapiens in detail - we are, after all, still in the field - many of the creatures actually appear to enjoy having sex. That is, there is a phenomenological component to the human sexual act – a sense of experience perceived, and in all probability recalled, that acts as a powerful inducement to replicate the activity. And often.

Sexual pleasure also (and this for some of our research team is the clincher) appears to function as an inducement to engage in sex for its own sake: that is, engaging in sexual activity that does not, and – controversially – sometimes cannot, lead to reproduction. (This challenging proposition is explored in more detail below.) So, in short, the preponderance of researchers contends that either humans are cheating nature, or the purpose of sex is much wider than we might have supposed.

Indeed, no other postulation explains the data: 99.9% plus of human sexual acts do not result in reproduction – a ratio of 1000 to 1! And, we contend, no species would survive such a pathetically low strike-rate unless it had evolved not just despite, but precisely because of, such a strike-rate.

Moreover, there is firm evidence to show that Homo sapiens, when it is so inclined, finds reproduction relatively amenable, despite the absence of a female ‘season’ in this particular species. There are, after all, over six billion of them on the planet, and counting. Only two other families of species on Earth seem to be more pervasive: rodents and cockroaches. On-site calculations indicate that human mates intending to reproduce successfully fertilise on average with fewer than ten copulations. So, even accounting for the need to evolve a mechanism for successful reproduction, at least 99 times out of 100 humans are having sex without the faintest intention to garner progeny!

Yet there may be more to the human story than just strong evidence that most sex is not intended to result in the getting of offspring: some of our research team argues that humans typically intend quite the contrary! What evidence has been observed for this striking thesis? (We recommend that the more delicate of readers divert their attention from the following discussion, as we now traverse in some detail a simmering scholarly dispute in which we are bound to consider a sub-set of the actual sexual practices of Homo sapiens – some of which are, to be candid, unedifying.)

There is no easy way to raise this issue but to dive right in. Our field researchers were frankly staggered to find, in reproducible study after reproducible study, and controlling for all conceivable variables, that a statistically significant proportion of human sexual activity involves practices that render reproduction not just highly unlikely, but physically impossible!

Astute readers will recall that Homo sapiens conforms to the typical mammalian morphology extant on planet Earth; that is, they have as well as genitals a well-developed digestive tract (mouth to anus via tongue, throat, stomach, intestines etc) and a respiratory apparatus that co-deploys the oral cavity as well as nasal passages and throat, then diverts to the lungs. It is however (the sexual use of) the human mouth and tongue as well as the anal cavity that have excited the most interest amongst our field researchers.

Close examination of humans in sexual congress (often recorded at night with low light and with the benefit of infra-red technology) indicate that a wide variety of anatomical features are employed sexually; when erect and available for sexual purposes, for example, the male organ - the penis - seems to be happily engaged entering just about any warm, moistened orifice in which it can fit. Moreover, many of the female of the species seem more than happy to have their labia attended to orally, with scarcely a passing interest in the aforementioned erection. Little wonder then that much ejaculation and female orgasm occurs without any prospect of reproduction.

For the sake of completeness, it should also be noted that a non-trivial minority of adult human sexual interactions actually do not involve both sexes, and thus preclude reproduction as an option. This sex is, by its very nature, of the oral, anal and otherwise varieties – examples upon which, prudence and good taste dictate, we shall not dwell.

(It should however be stated by way of clarification that researchers found Homo sapiens to be a comparatively clever, imaginative and dexterous creature. It would appear that these talents are happily employed in human sexual exploits. Non-reproductive sexual activities are by no means limited to human orifices. For example, the research team had not imagined the range of potential employments for the opposable fingers and thumb of these higher order primates until engaged in our seminal fieldwork.)

There is considerable debate amongst researchers over the proportion of the species that engages in what we have come to term homosexual (to be contrasted with heterosexual) congress. Some field workers have contended that as many as 10% of humans are homosexual or engage in homosexual relations. Others argue it is a much lower proportion (no more than 5%) and that some or much of that activity includes members of the species who are quite happy going both ways (so to speak). This behaviour we characterise as bisexual - it has been an irritating complication for modelling in the research project as is it very difficult to monitor or predict.

As one could anticipate, much debate amongst the research team has ensued over the evolutionary status of homosexual (and, to a lesser extent, bisexual) behavior in Homo sapiens. How did it come about? What would or could be its evolutionary purpose? Scholarly views (as always) diverge sharply on this issue. There are two major schools of thought: one group favours an adaptationist explanation for homosexuality – either by it conferring advantages, particularly at the level of group selection, or as a cultural parasite (a view propounded by some of the newer graduates and the more absolutist members of the research team).

The other major view considers homosexuality to be non-adaptationist. This is either because it is a past adaptation now redundant (though it is difficult to see what such a previous adaptation might have been, other than to maintain sexual function when the sexes were separated) or because it is a so-called spandrel, a mere evolutionary by-product of a conscious and (relatively) sophisticated cognitive apparatus. Many in the research team remain undecided on this debate. Perhaps the most telling point to note however is that, if almost all human sex is not for reproduction, then (other things being equal) it won’t much matter with whom one is having non-reproductive sex.

So much for the research team’s initial views about reproduction – there is now compelling evidence to show it is little more than an occasional by-product of human sexual activity – sometimes intended, sometimes not. Much more work needs to be done with this fascinating, complex (and somewhat quirky) species to understand better its cognition, motivations and behaviour – not just its sexual behaviour. Appendices A and B set out our research proposal and the funding submission respectively for Stage 3 of the Research Project.

The research team seeks urgent approval within three Earth months (a quarter of an Earth year) as we have sufficient resources to sustain us only for that period and have not as yet been able to establish an effective means of communication with Homo sapiens, other than through inducing interaction with manacles and vacuum cleaners. It would be a great pity to let this opportunity go to waste just as we are beginning to understand how humans tick.

Unlocking their (presumed) language and belief systems could open up more opportunities to develop relations with this most bizarre of creatures that extend beyond their odd sexual proclivities.

© Earth Year 2010 – Author and Lead Researcher: E Brik ______________________________________________________

* The activity of unpartnered members of the species diverged wildly and was comparatively difficult to measure in the absence of electronic monitoring. Subcutaneous implant devices (necessary for dexterous creatures with opposable thumbs) have been ordered and researchers hope to have them deployed for Stage 3 of the Research Project, assuming Ethics Committee approval and the resolution of long-distance supply issues.

# Researchers were careful to ensure that only activities involving two or more Homo sapiens (over sixteen Earth years of age) were considered for the purpose of analysis, so excluding some exotic activities with other creatures that raised frankly challenging issues of consent.

ON MY PECULIAR ATTRACTION TO JULIE BISHOP

Federal Member for Curtin, Deputy Leader of the Opposition and Shadow Treasurer

I have an admission to make. I’ve recently been struggling with a compelling desire to find out all I can about Julie Isobel Bishop - not as a virtual stalker, mind; just in the way of some getting-to-know-her research. Luckily, she has a website, julie-bishop.com, on which are depicted flattering photographs of Julie in smart frocks and pearls.

Although you won’t find her birth date on her website – she must be shy in that regard – I can tell you that Julie was born on 17 July 1956 in Lobethal, South Australia, an historic German village 33 km from Adelaide and 410 metres above sea level.

Lobethal’s own website tells us that it is a pleasant and substantial village with its roots deeply embedded in the early history of South Australia. Aside from the curious ecological conundrum of a German village having its roots in the Adelaide Hills, Lobethal seems very boring, even by South Australian standards.

My research reveals that Julie was raised in the Hills as a daughter (like we were assuming a sex-change?) of a long-established farming family. What exactly do they mean when they say, long-established family? It makes them sound like a grove of fruit trees.

Yes, the Bishops first set their roots down in Lobethal in 1867, and haven’t required more than the superphosphate bounty and occasional watering for over a century.

Families are by definition long established. Do they just mean the Bishops haven’t moved around much? After all, even we urban peasants have a history. Do you know of any family that has suddenly sprung, sui generis, into existence in the last week or two? If you do, please alert the relevant authorities. These facts should be recorded.

But back to Julie, who, as you will know, is the first ever female Deputy Leader of the Federal Parliamentary Liberal Party, and now Shadow Treasurer. This is v important.

Julie was elected to the House of Representatives as the Member for Curtin, Western Australia in 1998, and has been elected again and again and again since. They must like her in Curtin, and I’m sure it’s not just for her dress sense.

Despite its communitarian associations (the federal parliamentary seat, created in 1949, is named after the Australian Labor Party’s much revered wartime Prime Minister, John Curtin) it has always retained Liberal members. Look at the map and you’ll soon see why: the seat comprises the affluent and established western suburbs of Perth in the area between the Swan River and the Indian Ocean.

Centred on Subiaco, Curtin includes Mt Hawthorn, Floreat, Leederville, West Perth, Nedlands, Dalkeith, Peppermint Grove and Claremont Beach. These places even sound expensive, don’t they? It is in these locales that reside such emblems of taste and style as Alan Bond and Rose Hancock.

Julie, I think you'll agree, looks comparatively young for 52 (I reckon she’d be a swimmer, and I hear she works out). Her electorate has the highest percentage of people aged 65 or more in Western Australia. So no wonder she looks young - everyone else in her electorate is beyond pension age.

And I note that, though born in SA, Julie first made her mark in Perth. Just like that famous political pensioner, Bob Hawke. I wonder if she plays around like Bob did?

To find out, I thought I’d examine her schooling. Her website tells us that Julie was educated at the St Peter's Collegiate Girls' School, an Anglican educational facility in the foothills of Adelaide's Eastern Suburbs.

I can reveal that St Peter’s was founded in 1894 by the Community of the Sisters of the Church. You may also be interested to know that, as girls graduate from St Peter’s, they become Old Scholars. (A bit different to my old school, Cumberland High in northwest Sydney, graduates from which were referred to as Truants.)

Trivial Pursuit question: What other former federal Liberal Party Minister is also an Old Scholar of St Peter’s? Answer: No, not Alexander Downer; it’s Senator Amanda Vanstone! Who’d have guessed? She is older than Julie, and not nearly as svelte and pretty. I bet Amanda was the goalkeeper in the hockey team. I wonder did they get on at school?

The school website says the Sisters who opened the school (St Peter’s, not Cumberland High) were Englishwomen who had joined the Anglican Sisterhood founded in 1870 by Miss Emily Ayckbowm, who originally taught at St Trinian’s…(OK, I made that last bit up).

The website also notes that Julie’s Alma Mater provides five personalised buses to pick up and drop off your daughter from your door. Personalised? What, so the girls get to spray their own Tags on the windows and body panels? Cool.

The destinations and routes are West Lakes, Tea Tree Gully, Southern, Golden Grove and the Adelaide Hills. (I wonder which one Julie took: Adelaide Hills? Or was she picked up? Picked up, I would guess.)

School bus tickets for St Peter’s can be purchased from the School Shop.

This is nice, isn’t it? For St Peter’s girls, there’s no lugging a backpack or, as I did, a Samsonite case 4km home after missing the sole Harris Park Bus Company death trap, built circa 1946; the one from which all student passengers had to disembark if it were to manage the climb up Bettington Road, North Rocks.

Do you think they might let a middle-aged atheist male who attended a state high school in Sydney on for a ride with the girls in a St Peter’s bus? Purely for research purposes, mind. No, more likely just Old Scholars, I’d say.

And maybe Alexander Downer. He’d be considered safe.

As well as an excellent school bus service, current facilities at St Peter’s include:
· A heated Swimming Pool (outdoors – 25 metres)
· Six Tennis Courts and an Oval (approximate size: two soccer pitches)
· A Multipurpose Sports Courts, Fitness Courts & Gymnasium
· Art Spaces (with spray cans?), Music Studios and the School Hall
· A Chapel, School Museum and Boardroom
· A Lecture Theatre (seating 140)
· A Health Care Centre (with three beds; but only for the girls, OK); and
· The School Shop, selling 2nd hand textbooks & uniforms (for the scholarship girls)

No Pony Club, alas. But the school can host Weddings, Baptisms and Funerals for Old Scholars. While there is no public record of Julie marrying at St Peter’s, it must be a comfort to know she has somewhere welcoming to go to when she dies.

A most entertaining and informative history of the school, Not Saints, But Girls (just in case we were wondering), was written by Dr Janet Phillips and published in 1994. Copies are also available from the School Shop. Goodo.

We can tell Dr Phillips, senior lecturer in History at Flinders University, is a serious scholar, as she has also published (with Peter Phillips), 'History from Below: women's underwear and the rise of women's sport', in the Fall 1993 issue of the Journal of Popular Culture.

Speaking of garments, the school makes it very clear that all St Peter’s girls are required to own a blazer. In Terms 2 and 3 the blazer must be worn to Chapel and assembly. And the jumper may not be worn as the outer garment outside the school grounds at any time.

Quite right, too. Wearing their jumper without a blazer is something those state high school girls would do. I wonder if Julie still has her school blazer? Does she still occasionally dress up in it? I hope she does. Without the jumper. Or a frock.

* * *

Right out of school, Julie attended the University of Adelaide, where apparently she was elected secretary of the Law School Students' Association. There she had a direct role in organising the essential events in the Law School calendar, including (and I quote) "the pub crawls down Hindley Street and Rundle Mall, the Law School picnic at McLaren Vale and the Law School ball at Burnside Town Hall".

Oh yes, she could be a rager, blazer or not. After completing a Bachelor of Laws in 1978, Julie practised law, joining an Adelaide law firm, Mangan Ey & Bishop.

Was the Bishop bit a coincidence, I wonder, or was it added when she became a partner of the firm at just 26? It wouldn’t have been a family law firm, by any chance? Surely I detect here no whiff of nepotism or filial privilege …

In the Sydney Morning Herald of 7 September 2007, Mark Davis wrote of Ms Bishop that,

‘Julie reported for her first day's work in February 1979 as an articled clerk at a small city law firm with ribbons in her hair and stars in her eyes.

The young lawyer in the Liberty print dress was sent straight to the Supreme Court, where one of the firm's partners was defending a man accused of murder. Nearly three decades later, Bishop still recalls every detail of that first assignment as a 22-year-old.

The defendant, she said, “was accused of shooting his wife seven times in the back with a pump-action rifle on a Sunday morning in full view of suburban Adelaide." And how did it feel to walk into Adelaide jail to take instructions from her client? “It was terrifying. I found it to be the most soulless, heartless place I could ever imagine.”

Gee, and there I was expecting South Australian prisons to comprise inviting brick and timber buildings with charming courtyards gardens; sort of like St Peter’s, just with higher walls.

Mark continued, “From the family orchard perched in the hills to the bleak stone walls of the old jail down on the city's plains, the contrast between Bishop's upbringing and the reality of criminal law was marked.”

Would that be because of the Liberty print dress, or the ribbons in her hair?

“But”, Mark concludes, “It did not dissuade this young lawyer on the move.”

Gosh, no. Primed after a few years for the legal and social whirl of the west coast, in 1983 Julie took her frocks and bags and accessories and moved to Perth where she practised as a commercial litigation solicitor with Robinson Cox, now Clayton Utz (no yucky criminal law, there). She became a partner of Clutz in 1985, and managing partner in 1994.

In 1996 Julie attended Harvard Business School (yup, the one in Cambridge, Mass) and completed the Advanced Management Program for Senior Managers. Then she was admitted as a Fellow of the Australian Institute of Management. The ribbons had gone, but the print frocks remained.

Over the years Julie has held a number of positions, including Chair of the Western Australia Town Planning Appeals Tribunal, member of Murdoch University Senate, member of the board of the Anglican Schools Commission (qu’elle surprise), and a director of SBS.

She has twice participated as an Election Observer for the Commonwealth of Nations in recent parliamentary and presidential elections in Zimbabwe. Encouragingly, on these trips there is no mention of frocks, printed or otherwise. Not even alligator-skin handbags.

Of course, Julie served in the Cabinet of the erstwhile Coalition Government as Minister for Education, Science and Training and as the Minister Assisting the Prime Minister for Women's Issues. Before that, she was Minister for Ageing.

Now she has become the Shadow Treasurer. And as soon as she’s appointed, what do those nasties on the Treasury benches do, cheered on by media meanies? They poke fun at Julie because she doesn’t know the current interest rate. Well, why should she? She doesn’t have a loan. Next they’ll be expecting her to know the price of bread and milk and petrol. But c’mon, she’d have a housekeeper for all that.

I mean, really. She didn’t go to the Harvard Business School to learn that stuff. Julie can’t help it if she’s rich and privileged and out of touch. And her constituents obviously don’t mind. Look at her CV, they say, it must run to more than a dozen pages - 8pt, narrow type.

Prior to her appointment to the Ministry, Julie was Ambassador of the Muscular Dystrophy Association in WA, on the Council of Governors of the Lions Ear and Hearing Institute, a patron of CanTeen, and vice patron of Westcare Incorporated.

Julie was also on the Board of the Cancer Foundation WA, and she remains a patron and active member of many business, cultural and sporting organisations in her electorate. It just goes on and on and on. The civic service and social whirling never let up.

The NNDB website helpfully notes the following essential information about Julie:
· Gender: Female (Yup, definitely no sex change)
· Race or Ethnicity: White (bread)
· Sexual orientation: Straight (Tick, for hetero guys)
· Occupation: Politician (No doubt there)
· And her boyfriend is Peter Nattrass, Mayor of Brisbane (Cohabiting).

Hey, what? Cohabiting! But, even worse, Rottentomatoes.Com says she is married to the current Lord Mayor of Perth, Dr Peter Nattrass.

Hold on. Is this the same Peter Nattrass? How many are there? Could there be a pair of them, mayors of different cities? Is she two-timing doppelgangers across the continent? Or did he move?

And what else happened? Have they married? I didn’t know anything about this last bit. I’m sure she doesn’t wear a wedding ring. I’m, I’m, devastated…

Actually, NNDB, an American website that clearly wouldn’t know Brisbane from Barbados, got the city wrong (it is Perth, so I guess there’s only one Peter Nattrass after all).

Rottentomatoes.com got it wrong, too – Mr Nattrass is an ex-Mayor, and it appears the married bit was also incorrect. They’ve been partners for about 13 years. Phew.

And I’ve heard Mr N is way older than Julie, like about 104. So she’d be getting a bit bored with him by now, wouldn’t she? Yeah, I reckon he might be struggling to keep up.

* * *

I know what you’re thinking: this guy just needs to get over the Adelaide Hills family; the high church religion; the private girls’ school; the law firms; the Harvard bloody Business School; the Liberal Party membership; the excessive good works; the frocks; her sleeping with an ex-Mayor; and come to terms with the fact that he fancies a (slightly) older Tory woman.

Oh yeah. Sure, it’s easy to say. But you don’t know how hard this is for me. I have issues; and my partner has even more issues. And not because my partner’s a man. She isn’t.

My partner is blond, like Julie; she is attractive like Julie (no, what am I saying!! She’s way more attractive than Julie); she is smart and accomplished like Julie (but in a quiet way); and she’s three years younger.

So what issues could my partner have with Ms Bishop?

Don’t start me. My partner’s never met her - she doesn’t even know I have feelings for Julie - yet already, like Tatie Danielle, she hates her.

Actually, hate might be a bit harsh; its more that just seeing Ms Bishop on the TV news or current affairs sets her off.

What could the source of this enmity be? After all, both attended private girls schools (although my partner’s was Catholic). Each is a university-educated, middle class Anglo-Celtic woman with good teeth, stylish hair and a pleasant disposition. They’re both socially integrated. No obvious dysfunction – no history of abuse or drugs, no criminal record.

I’m sure, like my partner, Julie would make a polite and engaging dinner companion. Surely their similarities exceed their differences?

Ah, but here the similarities end. See, just as with a lot of lefty women, what my partner can’t tolerate about the first female deputy leader of the Federal Liberal Party is not Julie herself, but the things she stands for.

First, Julie should understand that the point about going to a high church girls’ school is to repudiate it. This is the only fair and decent thing to do.

Second is just her general, all round smugness. One should learn not to wallow in one’s advantages. It is unseemly.

Third is the shameless advocacy for WA wealth and privilege. That is tacky.

Fourth is her Alligator-skin handbag approach to nature and the environment.

Fifth is the calculatingly Protestant CV full of good works.

Sixth is her public adoration of the irksome reactionary, Sir Charles Court – former Liberal Premier of Western Australia - with whose death, Julie writes, ‘the State lost its greatest visionary’.

Seventh, the Harvard effin’ Business School.

Eighth, perhaps Julie’s eyes are set just a tad too deep for her to be thought truly beautiful…

Oh, how can I admit I fancy a woman, even from a safe distance, who is a prospective object of loathing of my one true love?

What’s the solution? Forget her?

If only I could. But in quiet moments my mind wanders off without me, my fingers drift back to type in ‘julie-bishop.com’, and I’m lost again in a sea of smiles and print dresses and agreeable community events in West Perth. Wishing I could counsel her, over a dinner in Peppermint Grove, on the simple joys of a middle class, left-of-centre life.

Or what about a quick drive down to Canberra for a ‘chance’ meeting, maybe in the members’ pool of Parliament House, my clutching a bunch of yellow roses and a bottle of Pol Roger, (Cuvee Winston Churchill, mais non)? But how would I gain surreptitious entry at precisely the right time? I don’t have a pass to Julie’s life.

Anyway, I’m sure there would be a bevy of guards and attendants keeping an eye out for all the potential, pathetic, middle-aged Julie stalkers. God, I think I might even be beginning to understand the allure Maggie Thatcher had for the likes of Clive James. Weird. And more than a trifle embarrassing.

Hell, I’m not coping with this. Either I’m going to have to get over it, or publicly reveal my peculiar attraction. Just give me some time to think about how, OK? I’m still struggling.

And there’s a cranky blond lefty in the house to consider. Fortunately, I have a bit of time. I just heard the front door slam. I think my partner’s just gone out to buy some bread and milk.

© ENRICO BRIK, OCTOBER 2008

THE UNDESERVING STATE

Toute nation a le gouvernement qu’elle mérite
Joseph Marie de Maistre, 15 August 1811

Whether or not every country has the government it deserves, there is little doubt that the people of the state of New South Wales must have done something truly, badly awful to deserve their government – something really appalling, and not just once or for a short period, but repeatedly, and for a very long time.

What could it be that has made NSW so undeserving of good government? It clearly isn’t the fault of just one political leader – these have been rotated almost routinely. In a little over three years we have had three Premiers and as many leaders of the Opposition. And it can’t be just one party, or we would have replaced it with the clear alternative.

While NSW has had a Labor government now for over 13 years, the story cannot be told from one side of politics alone. Sure, the party of reform and progress – the party born of a communitarian movement for the betterment of ordinary working folk – has become a macabre corporate parody, subsumed by its internal interests as the only will to power.

But even in opposition, the Tories - the high church coalition of metropolitan individualism and agrarian socialism - have done little more than highlight to the electors the paucity of real choice in NSW. Lacking Labor’s unrepresentative union domination, the NSW coalition makes do with religious activists, business failures and local non-entities.

Both sides are also staffed these days pretty much by career hacks; the only distinction being that Labor has more 25 year olds to draw upon from the union well; before they transfer their meagre gifts to a safe seat or the corporate sector. Yet this can’t be the whole story – the reservoir of talent in NSW politics has rarely been ocean deep.

It can’t even be solely the composition of the NSW Parliament (although this must be part of the story), as we electors had an opportunity to change it dramatically in the last election held only 18 months ago, and we did not take it. So no, there must be a more profound and complex explanation for our undeserving state.

Why are we so unmeritorious, here, now, in 2008? Even taking into account Sydney’s rampant housing costs, we pay our politicians a living wage. If they make it through two terms, they get a fine fat pension. Sure, some of them are jailed, or join Macquarie Bank.

But not all Ministers of the Crown dance around Parliamentary offices in their underpants, with all the panache of Homer Simpson, acting as if their political fundraising from property developers for years has, pari passu, given them title over the joint. Plenty of them go on and do useful work in the community after they’ve left politics.

We’ve got all the usual good governance things, too, like a bicameral Parliament. The government of the day doesn’t control the Legislative Council, so it can function as a house of review. It can, and does, initiate Parliamentary inquiries, which publish reports, and things happen. There is some consequential change, isn’t there?

We’ve got preferential voting and fixed terms, so the Treasury benches don’t get the referee’s whistle to call the end of one match and the start of the next. And we’ve got an anti-corruption commission, an Ombudsman, and more Commissions of Inquiry than you could poke a sharp beak at. So all the bent politicians are now ex-politicians, right?

Is it that we are simply dim or slow? No, I don’t think that’s right or fair. NSW isn’t South Australia or Queensland, after all. And while we may have come in part from convict and trooper stock, we’ve been so well hybridised with indigenous and exotic breeds that now we wear our blended heritage like a stylish tattoo: as a skin deep fashion statement.

So what has the wealthiest, most populous state in one of the modern world’s great success stories – a peaceable, roughly fair, freeish kind of democracy, with admittedly too much sun and barely enough fresh water – done to deserve its government? Wasn’t a history of faltering, lowbrow mediocrity enough? Why this abject and utter disaster?

Is it perhaps because we are all gone mad, or become the victims of post-modernist ennui? No, it can’t be this either, because we should have seen the pattern of disease spreading across state and even international boundaries. And we haven’t – the world may be a stage, but in no other company have we seen the play quite so poorly cast.

There is something peculiar as well as widespread about the political pathology of NSW. Of course, some of the story is just the Rum Rebellion retold – a political virus mutating, ‘flu-like, across the 19th and 20th centuries and into the 21st. Our addiction to grog, gambling and property deals – and their revenues - has hardly changed in two hundred years.

And so we have seen with every year a government more and more dependent on tax revenues – and hitherto, political donations – from precisely these three industries. Indeed, so ugly did this get that one of the last desperate steps of our most recent erstwhile Premier was to introduce public funding of parties’ election campaigns.

Thus, instead of banning spending on high cost political advertising, our taxes will in the future pay for the pleasure of us watching and listening to our political protagonists mislead, dissemble, prevaricate, diminish, exaggerate and distort any factoid, impression or opinion in pursuit of our tick at the polling booth.

But again, important as this is, it cannot be the whole truth of the matter. Other jurisdictions are beholden in part to corporate largesse while funding their campaigns from the public purse, yet some at least manage to conduct their politics in the public interest. Look at Quebec, or Belgium.

Perhaps there is a clue not in the government of NSW precisely, but in its relationship with other Australian governments. Australia is reputed to be the most over-governed country in the western world. Perhaps governmental competition is the real problem.

By way of explaining why so many Australians work in the media overseas, it is said (particularly by Americans) that in Australia there are too many journalists chasing too little news. Maybe Australian politics is like that, too. Maybe there are too many politicians, with too little talent, trying to do too much to too few.

There is something to be said for this assay of our federal system. And it is surely tougher for politicians in the states than in the Commonwealth (or the succubus territories). Resources are not only stretched across the levels of government, powers are fundamentally distorted to the disadvantage of the sovereign states, and particularly NSW.

This is so not only because of vertical fiscal imbalance – the Commonwealth has the bulk of the revenue raising powers; the states the preponderance of the basic (and costly) government responsibilities – but also because of the incessant judicial trend to prefer the Commonwealth over the states in constitutional disputes about their respective powers.

In short, more and more, the Commonwealth is where the action is. Or, more accurately, while the clout lies with the Commonwealth, the hard work remains with the states. This is particularly galling for NSW. The joke not so long ago was, NSW would be in favour of uniformity, so long as all the other the Australian states were uniform with NSW.

Now, the biggest state continues to receive a disproportionately low amount of taxation revenue, but suffers a diminished political influence. While it is perhaps not quite as bad as Bob Carr once joked, that the job of Premier is becoming little more than the Mayor of NSW, it is certainly a less appealing place for an ambitious political operative.

There is no doubt that NSW is attracting less capable political talent. It ranks now down with the pack of mainland states – Victoria and Queensland, and to an extent even SA and WA. And on a per capita basis, NSW may not perform as well as most of the others. Its political talent is trickling elsewhere, and the only elsewhere in Australia is Canberra.

* * *

What is my evidence for this drought of political talent? Careful analysis over many years, coupled with my own professional experience. While not a political functionary, I have worked long enough, and close enough, to see some of the talent in NSW at play, particularly over the last five years. And it has not been an edifying experience.

I have met and advised the last two Premiers, and seen at close call the work of their predecessor and a number of their Ministers. I have worked at various levels with many ministerial advisors in NSW politics. And I’ve socialised with more current and former ministerial staffers than I care to recall. The NSW Parliament and Governor Macquarie Tower are not strangers to me.

So lets talk specifics: Morris Iemma and Barry O’Farrell; Nathan Rees, Carmel Tebbutt and John Della Bosca. We have heard it said that Morris Iemma is quite a personable man, almost decent. And he might well be. He is certainly unremarkable enough to be nice.

When I first had dealings with Iemma and his staff, in 2003, he was the Health Minister. Bob Carr was Premier, and the health system was going through one of its serial bouts of morbidity – this time the symptomatic eruptions were over Campbelltown and Camden Hospitals. Other bureaucrats and I were brought in to manage the crisis. For nine months.

My first impression of Iemma, at a tour of Campbelltown Hospital conducted in a strained attempt to assuage the ropey staff (particularly the nurses), was of a compact introvert – like a quiet but wary pet perhaps, or a loyal retainer with a keen eye. There were, at the time, also rumours of Bob Carr leaving politics (accurate, if premature, as it turned out).

Speculation spread, as it will among staffers and public servants, about the probable and possible contenders to replace Carr, who was seen as a smart issues manager and quick to resolve political problems, but empty of policy commitment. Talk turned to Iemma. All of us, including a future Health Chief Executive, laughed and said, No way, he hasn’t got it.

And so it turned out. Morris Iemma didn’t have it. He really was fit only to be the help. But the Centre Unity faction of the Parliamentary ALP chose him to be Premier, and so he was. For three years he led NSW, without the capacity to do so. Even as a dud Premier, he won an election. So what does this say about the political competition in our undeserving state?

I first saw Fatty O’Barrell (as he was known) in action in 1992 as the Chief of Staff to Bruce Baird – the then urbane if vapid NSW Transport Minister. It was the last days of the Greiner Government. O’Farrell might have been a bit XXXL, and the beard was to a taste acquired only by women named Rosemary, but he was considered an impressively astute operator.

I expected him to do well. After all, once John Brogden’s mental health imploded at the time of Iemma’s elevation, there wasn’t exactly a whole football team of competition on the opposition benches. But somewhere along the way from apparatchik to protagonist, Barry lost his bottle. Did his courage diet away, I wondered, or did he shave it off?

O’Farrell now reminds me of the lion in The Wizard of Oz – he sort of looks the part, except he’s a bit soft around the edges. His paws are clawless; he holds his tail up like he’s worried he’s going to trip over it; his growl just isn’t convincing – he doesn’t seem to be frightening anyone except, perhaps, himself. Maybe he should grow back the beard.

So, no real challenge there yet, but I guess the final visit to the Wizard won’t come until the election in March 2011. In the meantime, we have the newly inserted Nathan Rees.

I’ve met Mr Rees only once, a few years ago in the then Premier’s office. Perhaps he was having a hard day. But I am not at this time in a position to disconfirm the hypothesis that he’s an arrogant bully – a saner, leaner, hirsute version of Michael Costa, as yet un-sacked.

Maybe Nathan has matured. Maybe he will grow into the job. But it worries me (and here I could be showing my age) that at 40 he doesn’t seem to have done much with his life. I shouldn’t be blunt Nathan, but being a union official and political advisor are not enough.

Passions for cycling and literature are meritorious, of course, and honest labour in Granville with the Council Garbage Service no doubt rounds out one’s life experience. Still, I worry about Nathan’s excessively earnest efforts to demonstrate his sleeves-rolled-up Westieness. Like Rees, I grew up in Northmead: there is nothing intrinsically worthy about it. There is little to be ashamed of in being middle class, Nathan. Get over it. Move on.

Actually, I quietly suspect that Rees spent his childhood not in Northmead, but in Pymble – perhaps as the son of an executive in an American chemical company, his mother in reality the proprietor of a trio of florist shops. I can see Nathan, at seventeen, repudiating his days in the Gordon Junior Rugby Club, lured by the socialist romance of humping bins.

So, if Rees doesn’t end up cutting it as NSW Premier, who could? There are in fact now only two members of the NSW Cabinet with any proven ability – Deputy Premier Carmel Tebbutt, from the left, and John Della Bosca, the formerly rotund born-again cyclist of the right - both of whom have just returned to the front bench. Of the rest, who could say?

Perhaps the talent has flowed elsewhere. If this is right, we should detect in Canberra a flood of gifted politicians and staffers pouring in from NSW. So lets examine the evidence. The coalition first: John Howard; Malcolm Turnbull; Brendan Nelson; Tony Abbott; Joe Hockey. All blokes, but not a bad haul if we include the immediate past Prime Minister.

As well as the current Leader of the Opposition, we have the now former leader and - at least in his own mind - a potential leader, as well as an amusing fat guy. But still, whatever your politics, these fellows aren’t duds. The thesis is holding up so far: Not much Tory talent in Macquarie Street might mean more in Canberra.

What about the ALP? Well, here the proposition is promising but a little less certain. Who is there? Tanya Plibesek? Hmmm. Looks good, but time will tell. She’s 38. Will we still admire her political presence when she’s a more dowdy 48? I hope so.

Anthony Albanese? With a face only the aforementioned Ms Tebbutt could love, he’s a quirky performer. Not dissimilar to the tall ex-rock star with the shaved pate. Quirky. And quirky is fine as far as it goes, but good government it does not make.

How about Greg Combet? A Victorian import who could yet end up another Simon Crean. Tony Burke? Too early to say. Bob Debus, perhaps? Surely if one retires to federal politics, it is ordinarily only to the Senate.

Speaking of the Senate, there is John Faulkner and, now too, Mark Arbib, the immediate past General Secretary of the NSW ALP – a high-powered party fundraiser and (I kid you not) the son of a property developer - who was apparently influential in this latest rotation of undeserving Premiers.

Of these eight NSW Labor members, maybe four or five will endure as genuinely worthwhile political participants in Canberra. The evidence at this stage is inconclusive. Still, it’s way better than the situation back in NSW itself.

We established above that, in NSW as at September 2008, there are actually just two members of the Cabinet known to be worth paying: Carmel Tebbutt and John Della Bosca (as long as he agrees to separate from his current partner, who is clearly a bad influence).

While, in the Opposition there are, ummm...I just don’t know if there are any. Maybe Mike Baird (son of Bruce)? Youngish. Eager. Apparently personable. Reasonably articulate. Pru Goward perhaps? No, no, no. We have enough evidence now – Bob Carr; Peter Collins; the inane Maxine McKew - to support a law barring ex-journalists from seeking high office.

Greg Smith, perchance? No way. There is a touch of the Thomas Cromwell about this man. It’s not the sixteenth century. We do not encourage wars of religion here. We have an agnostic state, and a good thing too. We neither want nor need an ultra-conservative Christian lawyer leading us in NSW.

So, we are left with the NSW Labor Party, run from Sussex Street by its General Secretary and a union leader who holds the cards of just 30% of the workers in NSW, via two of the least pre-possessing creatures to emerge from the crevices of the right-wing Centre Unity faction in a generation. A faction that is now the oxymoronic symbol of the Party’s demise.

This is the real reason that NSW politics has so little talent: what intelligent, capable, self-respecting individual, with a genuine interest in public policy and the betterment of society, would subject themselves to the vile and corrosive world of politics not just inhabited by, but profoundly influenced by, Edward Moses Obeid and Joseph Guerino Tripodi?

And what alternatives are there for a centre leftish liberal in NSW? Does the disintegration of the Democrats presage the fate of the self-devouring ALP in NSW? Will Obeid and Tripodi, along with Karl Bitar, John Robinson and Nathan Rees, be the last men standing? What happens if they are? Where does one go? Not to the quasi-religious Greens, the party of Colonic Irrigationists: too Puritan; too communitarian; too brown rice and tofu.

What alternative could emerge in a state where administrative responsibility is borne by those without fiscal power; where the perquisites of office become the only inducement in the competition for positions; where the mechanisms of retention and control of decision making are quietly and insidiously corrupted by union control and corporate allure?

Ultimately, it seems, the only solution is a constitutional reconstruction – one that addresses the vertical political imbalance and recalibrates the powers and responsibilities of good governance between the Commonwealth and the other governments of the country, whatever they are: states; territories; or perchance, regions.

For this, though, we will need to search for leadership in the future not from current or ex-politicians of NSW, but from the Commonwealth. That’s where the merit lies. Unless a real Wizard turns up, it looks like another informal vote in March 2011.

We truly live in an undeserving state.

© ENRICO BRIK, SEPTEMBER 2008

FREE WILL AND THE PROBLEM OF FAT PEOPLE

I know this is going to sound like defensive overcompensation, but I don’t hate fat people. Really. I realise not all of them are lazy and stupid. I’m sure a lot of them can’t help it.

In fact, out of 50 people at my last birthday party, quite a few were overweight, and three were technically obese. We had catered enough. Chubby folk were welcome.

I guess I’m like a priest with homosexuals: it’s not fat people I hate; it’s just their fatness.

And it’s certainly not that I think they don’t have a right to exist – hey, I’m no Fatscist – it’s just that the corpulent can be an unpleasant sensory experience.

They seem like they don’t care about the affect they have on other, slimmer, people. They’re slow. They get in the way. They block aisles. They block out the sun. They occupy more than one seat on public transport. And they wear girth-inappropriate clothing.

You see, while I care about fat people quite a bit, I know most of them also eat way too much crappy food, and don’t do enough, if any, exercise. Like an obese woman’s Lycra, my toleration is strained.

It would be charitable to report that, when I quiz tubby folk about the amount of exercise they engage in, they all tell me they do a good, sweat-inducing workout for an hour a day. But they don’t. Most of them tell me they maybe walk up a flight of stairs. Once a week.

I had a boss once who was so big that fatty flesh sagged down her lower limbs. I kid you not - even her ankles were obese. I’d like to say I enjoyed working for her; and in many ways I did – but it was a near full-time job dragging the cream biscuits out her mouth. And I suspect she is not alone. There are more than a few who quietly relish being big - whose sense of self-worth flourishes in proportion to their size.

Nevertheless, I’m one of those simple folk who reckon what we have here is not principally a psychological puzzle, but a pretty straightforward problem of physics, chemistry and biology – if you devour more stuff than you burn up, you tend to increase in size.

The one sure-fire way to avoid eating too much, and to expend at least as much stuff as you consume, is for we mammals to exercise. There is just no other way around this, except surgery, which is expensive, dangerous, painful and ultimately unsightly.

We being Homo sapiens, our forebears came out of the trees, stood upright, and started walking around. A lot. They did this to gather and catch food. To avoid predators, they even ran. If they failed to do this they died, their offspring went hungry, and they did not become grandparents.

The state of nature was sort of like flying budget airlines – there weren’t just major penalties for carrying excess baggage, you actually missed the 'plane. Being gross did not confer any evolutionary advantages, as the biologists say, except in times of famine.

I am not aware of any recent shortages of food, except in the Sudan or Somalia. In war-torn, sub-Saharan Africa, maybe it is good to be fat. Unless you have to run away from soldiers.

But in metropolitan Sydney, or London, or Birmingham, Alabama, we do not notice any food shortages, let alone famine. Quite the opposite. Even if you’re broke, the challenge is to avoid eating and eating. Just look at all the fat welfare recipients.

We evolved to move around – and without a motor. So, a la Norman Tebbitt, I say get on your bike. Or run. Or swim, or row, or gym. Play football, netball, baseball, anyball. Throw a bloody Frisbee. Chase your children. Or the cat. Just get off your fat arse.

This is not to say everyone should be thin. Like Fats Waller, I enjoy a bit of meat with my potatoes. Clearly, if you look at the lads and lasses in athletics or rugby teams, we evolved a whole bunch of body shapes. Lean and muscular are fine, but chunky and stocky are good, too.

The problem is not shape, or even size, so much as sub-cutaneous composition. It’s not just the corporeal structure, it’s the covering: the gelatinous, blubbery, fattiness of fat.

Speaking of Alabama (as we were earlier) they’ve got the right idea on incentives. Not a jurisdiction we usually associate with progressive social policy, Alabama struggles as the second fattest state in the world’s second fattest country.

Alabama’s State Employees’ Insurance Board thinks you should pay more if you weigh more. In August 2008, Health.com reported that the Board will, from 2011, start charging overweight state workers - those with a body mass index (BMI) greater than 35 - $25 a month for health insurance, which is currently free for all state employees.

This is fair – the porcine bureaucrats of Alabama have nearly two and a half years to get their weight down. And the board already charges extra if you smoke.

Another excellent idea appeared in a piece published in The American on August 8 2007, entitled,Targeting Foods Is a Needlessly Indirect Way of Encouraging Weight Loss. It says:

“Isn't keeping the obese in the lifestyle to which they've become accustomed truly an expensive proposition? If it is expensive - managing chronic diabetes and so on - there is a solution that has received surprisingly little public attention: the fat-person tax.

It’s simple, transparent and neutral. This system would operate smoothly…everyone would submit an official Body Mass Index (BMI) report with their annual tax return, and (the Tax Office) would make the tax calculation for you. It would be a progressive tax: the fatter the taxpayer, the higher the tax. The top of the normal range for BMI is 24. A BMI above 25 would pay a small surtax, say 5 percent, BMI 30s would pay 10 percent and so on…”

You know, it’s really refreshing when you see conservative Americans getting serious about public policy issues like this. No wonder in the USA in 1969 the National Association to Advance Fat Acceptance (NAAFA) was formed. (No, this is not a parody. It really exists.)

I bet NAAFA has something to say about the article in the July 7-14, 2008 issue of Newsweek entitled, The Obese Should Have to Pay More For Airline Tickets, in which Jerry Adler observed that it is indisputable heavy people are more expensive to fly.

Over the last decade or so, out-size Americans have required an additional 350 million gallons of jet fuel a year, just because of their increasing weight.

And they take up more seat space.

One of the few experts reported to endorse a penalty for fat fliers is Laura Zoloth, who heads the bioethics center at Northwestern University in the USA.

For her, it's a question of fairness to the person in the next seat, rather than carbon emissions. (Right on, Laura. One seat per passenger, or pay double fare.)

By contrast, Jerry tells us, the director of research at Yale University's Rudd Center for Food Policy and Obesity, a Rebecca Puhl, thinks weight should be a protected category, like race or gender, which would make discrimination against fat people illegal.

"Some people can diet, exercise, do everything right, and still have a tough time losing and keeping weight off," she says. Must be a member of NAAFA.

This is a theme also articulated by Robin Marantz Henig in the New York Times Magazine of 13 August, 2006 – he reported Richard Atkinson, who has been studying obesity, as having always maintained that overeating doesn’t really explain it all.

Apparently Atkinson’s epiphany came when he was a medical fellow at UCLA engaged in a study of people who weighed more than 300 pounds and had come in for obesity surgery.

“The general thought at the time was that fat people ate too much,” Atkinson said. “And we documented that fat people do eat too much — our subjects ate an average of 6,700 calories a day. But what was so impressive to me was the fact that not all fat people eat too much.”

OK. So some fat people are not gourmands, they just have big guts (and butts). But 6,700 calories a day? What’s more, if some people in the study ate normally, others must have consumed more than 6700 calories per day! Riders in the Tour de France, the world’s toughest annual sporting event, wouldn’t come close to consuming that much fuel.

Still, the Australian ABC Online reported on 12 August 2008 that researchers have also shown it may be possible for at least half of overweight adults to be both fat and healthy, with close to a third of obese men and women having normal blood pressure, cholesterol and other measures of heart health.

And being lean does not necessarily protect people, either. Close to a quarter of normal-weight US adults in one study had risk factors for heart disease or diabetes. (Well, du’h.)

"We really don't know as much about obesity as we think we do," said Judith Wylie-Rosett of the Albert Einstein College of Medicine in New York, who oversaw the study.

So maybe we should just get over fatness as a problem.

Except of course that, even if a third of obese people have normal health, two-thirds of them don’t. And, as The American pointed out, they have lots of chronic health problems, all of which are slated to rise dramatically in the next five to fifteen years.

We also know a very important social fact, too – poor diet, lack of exercise and obesity are, like smoking, all strongly correlated with class – as I alluded to above, the poor and welfare recipients are unhealthily fat. Far fatter than the middle class and the well-off.

And, in decent western societies (except most of the USA), we end up paying for their health care. So obesity affects us all, if not on our hips, then in our hip pockets.

* * *

In the problem of free will, Compatibilism is the thesis that determinism and free will are compatible. There are differing versions of Compatibilism that need not detain us here – they are all essentially variations on the have-your-cake-and-eat-it-too theme; one that is going to be intrinsically appealing to fat people.

Because, of course, if you eat your cake and you still have it, there is in principle no limit to the number of times the one cake can be consumed. (This is just like in the Magic Pudding, which confirms my suspicion that its author Norman Lindsay was not only a fine drafter of risqué art, he also had a philosophical bent.)

There are two other basic positions in the free will debate: Strong Determinism (in which there is no free will, properly called); and Incompatibilism, the thesis that there is free will, and some things are not strictly determined.

One feature of the problem of free will is it seems to come in differing grades: there is FREE WILL, Free Will, and plain old free will.

FREE WILL is the full blown, fuck you, I’ll do whatever I want kind of free will – for instance when, despite years of careful upbringing, your sole heir and successor comes home and tells you they’ve made a really disappointing lifestyle choice - like deciding to become a motor dealer.

On the other hand, Free Will is not as confronting. It’s more the, I’ll just have another slice of pizza with the glass of Chianti and go for a jog after lunch, kind of position. We quietly know we could go for that jog, but after the second glass, and especially the third, the lifestyle benefits can happily be put off until tomorrow.

Little old free will is the weakest of all – it’s the well-known, I’ll just shove this needle in my arm again and I’ll feel better and all the pain and self-loathing will go away for a while, kind of free will. Which is to say, not really free will at all.

So, if some form of Compatibilism is right, which is the kind of free will that best applies to portly people?

Many will want to tell you its just little old free will. And perhaps, for some, it is. Maybe their weight, appetites and incapacity to exercise are strictly determined by genes, hormones or whatever - maybe they couldn’t do otherwise.

On the other hand, anti-Fattists (and, paradoxically, some pro-Fattists) will want to tell you its FREE WILL. Less common, but no doubt there are some whose lifestyle, if not their identity, is bound up in a soft carapace of their own choosing.

For most, though, I reckon its really Free Will. It’s the, Yeah its hard, there are challenges, it requires effort, I could fail, kind of free will.

Well, sure it’s hard. If it were easy, you wouldn’t be tubby. But if it were impossible, smokers would never quit, and fat people would never get fitter and thinner. Yet they do.

So, my findings on the three grades of free will are this – there is the Junkie grade, the Fat Person grade, and the Motor Dealer grade - each with a commensurate level of personal responsibility and blame: low; moderate; and high.

Sadly, however, personal responsibility does not necessarily accord with social acceptance or opprobrium. There may be good reasons to be tougher on some people, even if they can’t help it. Because of the social consequences (and their underclass overtones), we see fit to punish junkies, yet reward motor dealers, even though both are vile but only the latter are responsible for their actions.

And, on the whole, society neither rewards nor punishes, but merely tolerates, fat people, despite the fact that they could take up less space and use fewer resources.

It is through these examples that we see how society is not only unfair, but also capricious, and does not take free will as seriously as we might hope and suppose.

My solution is modest: a formal system of penalties and benefits. As much as I’m attracted the idea, this is not just about a fat-person tax. I think we should use risk profiling as they do in the insurance industry, and impose a social impact charge.

This should be enforced only when there is a negative consequence on others – either individuals or society generally – of a person’s fatness. Like with airline seating or the challenge of negotiating bus aisles. Oh, and the biggies - health costs and fuel imposts.

How could this work? How would we measure people? Sometimes the problem is kilos, sometimes its just size. We need a fair and transparent arrangement, here. We need a system. Enter the bureaucracy: but not fat cats - this time we need the lean police.

The article in The American I referred to earlier has the right idea. BMI helps, because it takes into account both mass and volume. But we need a way of regularly monitoring BMI – and we’ll need to be wary of bulky BMI cheats who, like unclean cyclists swapping urine samples, may try and substitute some scrawny person’s figure for their own.

We could also reward outputs. There could be a range of tax rebates and product discounts, based on the amount of physical energy you’ve expended.

To put this into effect, we could be required to submit a quarterly PAS – Physical Activity Statement – signed off by our registered personal trainer, through which we could earn tax credits or receive discount vouchers for health foods, gym membership and cycling gear.

Plus, we could punish some inputs, like super-taxing junk food products, banning their advertising, and requiring really ugly depictions of obese people on their packaging. It might seem crude and unfair to the free-marketeers at The American, but it’s worked a treat with cigarette smoking.

You know, the more I think about this, the better I like it. This system is going to be really complex. Luckily, I work as a some-time consultant to the government sector, and this could keep my clients, like public health bureaucrats, in business for the rest of my career.

Maybe they’ll need a consultant to work up the project brief - just don’t let the likes of NAAFA know.

© ENRICO BRIK, SEPTEMBER 2008