This site covers a 15 year involvement in
studying, commenting on, and acting to expose the practices of
corporate medicine. It is intended as a resource. During this time I
have written to medical associations, regulatory bodies and to
politicians. I have pressed for an open senate inquiry and for public
debate through the media. Over the years I put some of this material
on to the site and wrote other pages to round it out.
Original purpose:- In 1989 I became involved in a battle with National Medical Enterprises, now renamed Tenet Healthcare to expose practices which I believed were occurring in Singapore. Similar conduct by the company was revealed in the USA in 1991. I obtained much of the information and wrote many of the submissions which caused the Australian government to step in and force the company out of Australia.
This site was initially created as a response to defamation actions against me and a failure by the company's ethics committee to address matters put before them. I took the battle to Tenet/NME in the USA and also set up this web site to provide information about the company. I asked visitors to the pages to write to Tenet/NME and put pressure on them. Those pages have now been removed.
The corporate invasion of Australian health care:- I have continued to collect information as multinational and national corporations, strongly supported by politicians have sought to enter and dominate Australia's health sector. I have unearthed decidedly unsavoury conduct. I have made this available to relevant authorities and argued against their being allowed to operate in Australia. I placed material, sometimes simply the submissions I had written into pages on the www site to make them more widely available. Mostly these are companies which have attempted to enter Australia or shown an interest but I have included others where this is relevant to understanding corporate behaviour.
Companies included:- Over the years I have included material about Tenet/NME (USA), Generale de Sante Internationale (Europe), Mayne Nickless (Australia), Columbia/HCA (USA), Vista Healthcare (Singapore), managed care, Kaiser (USA), Sun Healthcare (USA), Vencor (now Kindred healthcare-USA), Integrated Health Services (USA), Beverly Healthcare (USA), Mariner Healthcare (USA), Genesis Healthcare (USA), National Healthcare Corporation (USA), Centennial Healthcare (USA), Extendicare (USA and Canada), HealthSouth (USA), Alpha Healthcare (Australia), Endeavour Healthcare (Australia), Foundation Healthcare (Australia), Lifecare (Australia), Primary Health Care (Australia), Healthscope (Australia), Ramsay Healthcare (Australia) Revesco (also called Medical Care Services and Gribbles - Australia), and Sonic Healthcare (Australia). In 2003 Mayne sold its hospitals to a Citigroup owned company forming Affinity Health. Pages describing this purchase and Citigroup's conduct have been included. A new page touching on some aspects of the misconduct of the pharmaceutical giants has been added. In 2006 pages were added describing how Australia's aged care system was turned into a marketplace. Many of the companies operating retirement villages and nursing homes have web pages.
Theory:- During 1997 and 1998 some more theoretical material analysing the processes and seeking to understand what was happening were added. The way in which US multinationals were seeking international opportunities was addressed in other pages.
The nature of the material:- The
submissions and other material put on the site were each written to
different people and for different purposes. I would not be at the
meetings when corporations attacked my criticisms. I needed to
include in the submissions responses to possible criticism. There was
the risk of litigation and I included a defense in my documents. As a
consequence many documents are long and the same information is
sometimes repeated in different documents. As readers access web
pages directly via the www this duplication is in part a consequence
of the medium.
Aged care and nursing homes:- There was a major update in April 1998 and there were major developments during 1999. The scandalous neglect of the frail elderly in corporate nursing homes across the USA had been widely exposed. There had also been widespread fraud. Financial mismanagement consequent on share market pressures had resulted in financial collapse and many of the largest aged care chains entered Chapter 11 bankruptcy. Sun Healthcare was among the major offenders in allegedly neglecting patients. It entered chapter 11 bankruptcy but has since emerged. Updates since then have included additional information. Since then there has been the exposure of similar problems in nursing homes in Australia.
Managed care:- A massive community backlash against managed care in the USA has forced states and federal governments to respond and pass laws protecting citizens from managed care corporations. Lawyers have taken up the issues and the major HMO's faced class actions which threatened to rival those against the tobacco companies. The share prices of HMO's and also of health care providers tumbled. Health care shares once the darlings of wall street were shunned by 2000. This battle was fought and although some victories were obtained the HMO's essentially won the war and retained their dominant position in the USA. Pages describing managed care and these events were added in January 2004. I have not attempted to analyse individual HMOs.
Pharmaceutical Giants:- There has been a public outcry and much publicity describing the ruthlessness and the greed of the drug multinationals particularly in relation to patents, drug pricing for AIDs and 3rd world diseases, and the attempt to undermine Australia's drug system through international trade agreements. I have not written about these widely publicised issues but in 2004 have included some material describing their less publicised fraudulent activity.
International expansion - the WTO and the world bank:- US corporations have sought to expand internationally. Local communities, particularly the medical profession have been reasonably well informed and multinational health care corporations have not always been welcomed. Acting through the Coalition of Service Industries they have now enlisted the support of the US government in using the World Trade Organisation and international trade agreements to open foreign markets. They plan to force nations to remove the local "barriers" to corporate access. A process called "liberalisation".
The world bank has also become the focus of economic rationalist health care theories. The chairman of Australia's National Competition Council has been marketing his solutions to health care to the world bank. This requires attention. I wrote some pages about these issues in 2000. Since that time the conduct of the pharmaceutical giants in relation to AIDS and other diseases in poor countries has caused outrage as has an attack on Australia's drug system in recent Australia/US trade negotiations. While this threatens the costs of health care, the threat that actual medical services will be globalised and liberalised is more serious as this impacts more directly on care.
Aged Care:- Aged care, particularly corporate nursing home care is the most revealing sector. In 2001 a new page was added thoroughly analysing corporate nursing home care in the USA. In addition individual pages were written for a large number of nursing home chains. Because the events provide such an excellent understanding of the marketplace I appended large numbers of references and relevant extracts from these references. I have expanded on the theoretical insights and written pages addressing the personality of major participants, and the culture of individual companies. There are still some gaps but there is enough.
Healtheon:- Bill Gates, Rupert Murdoch and Jim Clarke are spent large sums developing a new corporate entity which aimed to use the Internet to coordinate the complex US system and make it even more competitive. They had international ambitions. At the time I was concerned that they were attempting to impose another layer of market control. This has not turned out to be a threat to health care and I have removed this material.
Australia:- In Australia, the process of privatising public hospitals died a natural death and there have been no more privatisations. Colocated hospitals have not worked well and enthusiasm has waned. There was a massive fraud linked to the federal health department and serious problems in the newly privatised aged care system were exposed. There was wild business enthusiasm to corporatise general practice and many were purchased. These corporations were not the cash cows that were promised and share prices languished as has enthusiasm. Several pages were added in 2002 describing and analysing these events. It is planned to update these in 2004.
In late 2003 Mayne hospitals were purchased by a wholly owned subsidiary of the giant financial services global conglomerate, Citigroup. Pages analysing these events and describing Citigroup's dreadful track record were added in 2004
International:- Privatisation in New Zealand has disenchanted New Zealanders. The labour government reversed a number of market policies. It claimed to be abandoning competition and adopting a policy of cooperation. In the United Kingdom Public Private Partnerships have been widely introduced and many other countries including Australia and Canada are experimenting with the idea. Alyson Pollock has been a trenchant critic of this policy. The Guardian has been critical of the consequences. Canadian citizens are still fighting a bitter battle to preserve their health system and prevent corporate intrusion. The Recent Romanow Royal Commission has come our strongly against a corporate dominated health system. There are insights and lessons to be learned. These matters have not been explored extensively on this web site.
Lessons for the future:- There is a vast amount of information challenging the application of market theory to health care. It is now necessary to critically analyse the thinking and theories behind the application of market theory to health care and examine the behaviour of those who maintain their position in the face of overwhelming evidence. If we are to move away from this model then there are lessons from the past to help us plan the future. On the web site many pages refer to the dysfunctional forces generated in the corporate marketplace. In 2004 several pages were added using Citigroup as the vehicle to analyse the marketplace and illustrate the adverse influence which these large financial groups have on health care
Society too is changing:- The all
encompassing theories of the 20th century have been found wanting and
the whole idea of all encompassing theory is being challenged. The
young postmodern thinkers lay emphasis on the individuality of
experience and the uniqueness of understanding in each situation. In
confronting theory they emphasise its limits rather than its
universality. Nowhere is the individuality of experience greater than
in the experience of illness. Nowhere are the limits of modern
economic ideology more glaringly exposed. The insights from this sort
of thinking have major application in health care and in health care
planning. Some of these issues are addresses in pages on this web
Moving from exposure, to understanding, to resolving:- To accommodate the move from what was primarily a whistleblowing site documenting corporate behaviour and government ineptitude the site was restructured in April 2000. A few pages were removed and many more added. It was essentially a patch job filling in gaps and adding large amounts of information.
I had long wanted to write pages specifically analysing aspects of corporate behaviour common to all corporations to show how the system worked. Graeme Samuel's speech to the world bank provided the stimulus and a focus around which to write a series of pages describing corporate behaviour rather than specific companies. Some of these pages were included in April 2000. They need editing and some rewriting. This is planned for 2004.
There was limited value in simply describing bad behaviour. To do something about it we need to understand what is happening and use the understandings to help us plan something better. Introducing theory is always difficult as it requires effort to understand and often puts people off. I felt it was important to do so.
I have therefore developed some theoretical concepts to explain what is happening. An optional introductory page dives straight into theory. A number of pages are frankly theoretical and theoretical threads of understanding run through the other pages analysing corporate behaviour. Hopefully this strategy will make it easier to understand and relate to what is actually happening. It is still possible to learn a great deal about what is happening by skipping the theory.
The final page (except for the update section) uses the insights and the theory to suggest ways in which we can move ahead to build a better health system. For the less theoretical the final paragraph offers a KISS (Keep it simple stupid) description. These pages were added (October 2000) but will be reviewed 2004.
Future directions:- A number of pages are still empty and there are many gaps. The overview pages need to be better coordinated. The final structure will I hope consist of three levels. A top level of broad summaries and pages giving access to specific areas of interest. A middle level comprising the body of the material - information about corporations, descriptions of conduct, analyses and theory. A deeper level consisting of references, abstracts, quotes, extracts, links and copies of original material to support the other documents and help researchers. This has been done in aged car, recent Tenet Healthcare pages, HealthSouth pages, managed care pages, Mayne Nickless pages, much of the Australian material, and Citigroup material. I do not intend to revisit the other older material.
This site is assuming the character of a book - an Internet book which is very different to a real book. It does not follow a path but contains threads of logic to follow. It is something to explore rather than read. It will eventually be possible to enter it in multiple ways, as a whistleblower following the path of exposure, exploring the theory, examining the conduct of individual services and corporations, looking at the analyses of corporate behaviour or following the criticism of Graeme Samuel's speech. Crosslinking will provide paths from one thread to another. To facilitate this a site Map has now been developed.
Objectives:- For the general user the site should provide easy access to short reviews of the major events and problems. It should provide brief analysis of the process at work. It aims to provide an alternate dissenting points of view.
For the researcher it should provide more depth with pages leading to detailed information and references to original documents. Where possible digitised versions of original documents should be made available.
Pages also tell the story of my attempts to blow the whistle on health care corporations and on political behaviour in Australia - challenging establishment dogma and promoting dissent. This may be useful to others promoting dissenting points of view, seeking to blow the whistle or studying these activities.
In 2005 and 2006 many pages on Australian hospitals were added to fill gaps in coverage. Sections on pathology and radiology were included, and other pages updated. Following a series of scandals in aged care in Australia a large number of aged care pages were added to the site. In 2007 material was added to address the purchase of Australia's largest nursing home operator bya Citigroup private equity subsidiary. In 2007 major updates with a number of new pages were added for Tenet Healthcare and HealthSouth. The outcome and revelations from the major scandals both were involved in in 2003 are now included.
Coming to an end:- After 15 years I feel that I have done enough and that the lessons are crystal clear. Putting on more material will not add significantly to this. I therefore plan to round off the site during 2007 and then move on.