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Tuesday, May 28, 2024
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Labour’s Health Reforms: Boldly Going Where It Might Not be Wise to Venture.

THERE IS NOTHING WRONG with being bold, the real trick is to be bold about the right things. Is “Health New Zealand” (HNZ) the right thing? Labour supporters are saying it is with a suspicious degree of vehemence. (The sort of vehemence usually reserved for the defence of a dear friend who has done something that we all know, deep down, is really, really stupid.)

Meanwhile, the National Party has promised to repeal the legislation setting up HNZ the moment it’s re-elected. For good measure, they’re labelling the proposed Maori Health Authority (MHA) “separatist”.

So, there you have it. This “bold” reformation of New Zealand’s health system will proceed without the slightest hint of bi-partisan consensus. Excellent.

What do I think of Labour’s proposed reform? From what I’ve been able to glean over the course of the past few hours, the whole exercise smacks of the sort of desperation that seizes people who know very well what the solution to the problem facing them is, but, having been told they cannot choose that solution, have opted to distract us with something so huge that our first instinct is to say: “Crikey! They’d hardly choose to do something this big if the odds of it succeeding weren’t exceptionally high.”

It’s a good trick – but is it the right trick?

Regretfully, I’m forced to say “No.”

What has been at the root of our health system’s problems for the past 30 years? Inadequate funding and a management regime intended to replicate the incentives and disciplines of the free market. As New Zealand’s population has aged, the demands upon its public health system have steadily increased. Unfortunately, this rising level of demand has coincided with the imposition of neoliberal economics. Accordingly, from the mid-1980s onwards, the necessary fiscal adjustments have been deemed impermissible by politicians and bureaucrats alike. Rather than raising taxes to fund New Zealand’s hard-pressed health system, successive governments have commanded those charged with running it do more and more with (in real terms) less and less.

Had Andrew Little and his colleagues announced this morning that, thanks to a major fiscal re-jig (to be announced later in the day by Finance Minister, Grant Robertson) there was to be a significant and permanent increase in Vote Health, then we would have been able to say that this government had indeed grasped the nettle of reform. If they’d also announced a return to the ratio of administrators to health professionals that prevailed in the early 1980s, then we could be certain that what we were witnessing was a wholesale repudiation of the neoliberal model in health delivery. That would have been “transformational” – with bells on.

Sadly, that is not what Little and his colleagues announced. Rather than more money, more professionals and fewer administrative overseers, this government has opted to construct a massive single bureaucracy out of its current collection of 20 smaller bureaucracies. There is no hint that this new HNZ bureaucracy will be run on anything other than neoliberal lines. The same determination to prevent “professional capture” of the health service will lead to exactly the same sort of bureaucratic interference that eliminated the outstanding professional leadership of the Canterbury District Health Board only a few months ago.

For good measure, the new health system has been shorn of all the pitiful vestiges of democratic accountability still clinging to the DHB model. How the new, improved, neoliberal bureaucrats of HNZ will be held to account is anybody’s guess.

“But what about the new Maori Health Authority?”, I hear you ask. “Surely this innovation is an unequivocally progressive advance?” We must certainly hope so, but even here the Labour Government’s proposals fill me with nagging doubts.

In this morning’s media release, the Minister announced that: “A new Māori Health Authority will have the power to commission health services, monitor the state of Māori health and develop policy.”

On its face, this sounds excellent. Indisputably, Maori and Pacifica New Zealanders fare much worse at the hands of their health system than Pakeha New Zealanders. A MHA run by Maori, for Maori, is surely more likely to produce better results than the present system, which insists on treating all patients “the same” – regardless of the very different (i.e. inferior) health outcomes its one-size-fits-all approach produces.

If, however, we unpick the Minister’s statement, it immediately becomes apparent that the MHA will not, itself, be the provider of Maori health services. These will be “commissioned” by the Authority: presumably from private Maori contractors. Exactly who these contractors will be is not spelled out. Urban Maori Authorities will almost certainly be involved, as will health providers established by Iwi. We may even see the rise of Maori health entrepreneurs: individuals keen to profit from the needs identified by the MHA’s “monitors”.

If Little had announced that HNZ would be commissioning private sector providers to supply the health needs of New Zealanders, then the Left would have condemned him roundly. Labour would stand accused of privatising the public health system. People would demand to know how the citizen’s right to publicly provided health care can possibly be reconciled with the pursuit of private profit. That no such outcry has greeted the Government’s decision to hand over the health care of New Zealand’s poorest and most vulnerable citizens to private entities – some of them quite likely profit-seeking businesses – is telling.

Is Labour of the view that Maori are incapable of exploiting Maori? Is it saying that the operating principles of capitalism cease to function when the capitalists’ skins are brown? That indigenous people, simply by virtue of being indigenous, possess moral qualities that render them incapable of wrongdoing and that, as a consequence, they must be permitted to operate freely, without the strict bureaucratic oversight deemed essential for businesses conducted by the descendants of settlers and immigrants? Surely not.

Labour might also like to answer how it could possibly be in the MHA’s interest to report anything other than a strong improvement in Maori health outcomes. Were it ever to report that in spite of its best efforts the general health of Maori New Zealanders, as compared to Pakeha, continues to decline, then one of the key rationales for its establishment would be seriously compromised. Is it reasonable to ask the MHA to be a judge in its own cause?

Readers may find these propositions jarring, but that will not stop them being advanced by Labour’s political opponents. Indeed, it is happening already. What’s more, if any of them turn out to be true, then Labour’s health reforms will stand revealed as the wrong sort of boldness. Jacinda’s government will have tricked itself.

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  1. I think you are spot on Chris. Under this big new model no one knows if this will fix anything. No one knows if Bob will get his colonoscopy quicker despite living in Blackball. No one knows if this will make it easier to access services. This is certainly transformational of the current system, but can someone tell us how this will get code red at the Dunedin A and E down from code black.
    This has the potential to be the most expensive restructural fizzer of all time. It sounds to me like buying a lotto ticket to fix your bladder infection. There is nothing obviously wrong with the current system other than you cant get into it.

    • Well well you people are NEVER satisfied, I read constant consistent criticism about the government not doing anything when they do something big you lot are still not happy. I also didn’t know that Chris Trotter was an expert on health matters . I think he should stick to his knitting because these days his columns are desperate and disappointing .

      • Gillian Evans: “….you people are NEVER satisfied…”

        Gillian, the DHB system is the correct configuration for NZ’s health needs. But it needs orders of magnitude more funding than it currently gets. And we could no doubt manage with slightly fewer DHBs than we now have. Amalgamation in, eg, Auckland and Wellington would perhaps make sense.

        But the government is proposing to can DHBs altogether, in favour of something like the UK’s NHS. Which doesn’t work, to the extent that the UK government has been looking to rejig it, so as to make it more closely resemble NZ’s model.

        If that isn’t the epitome of dumb decision making on our government’s part, I don’t know what is.

        “I also didn’t know that Chris Trotter was an expert on health matters.”

        What has that to do with anything? It’s a free country (for now): any of us is entitled to express our opinions on whatever the government decides to do.

        As it happens, I agree with everything Chris Trotter says about the DHB model. While I certainly wouldn’t classify myself as an expert on health matters, I did work for long years in the health sector. I lost count of the reorganisations to which we were subject.

        In my view, the health sector needs more reorganisation like it needs toothache. What it most certainly needs is MORE FUNDING. Bucket loads of it. And an end to the god-forsaken neoliberalism which has plagued it these many years.

        I note commentary on this blogsite to the effect that these reforms mark the death of neoliberalism. They most certainly do not: and that’s the problem. Death of neoliberalism? We should all get so lucky!

        By all means support the current government if you wish. But be clear-eyed about its weaknesses and its propensity for making dumb decisions. This is the dumbest so far, by a country mile.

  2. Why you must pay your family doctor and your dentist

    Subscribers only. Bad luck:
    The political economy of healthcare reform: why New Zealand has experienced 82 years of ineffectual reforms and what can be done about it
    ‘Universal healthcare, based on there being no cost for consumers, was partially realised in New Zealand in 1938, but an unresolved dispute with the medical profession meant that primary care remained privately provided.’

  3. I sadly think everything you say is correct. I hope everybody reads this and that the lefties don’t encourage Labour and Greens to proceed with another health restructure that is fatally flawed, and just a spin exercise, along these lines like they did with Kiwibuild, Healthy Homes, immigration Ponzi, etc.

    Other things to note,

    “As New Zealand’s population has aged, the demands upon its public health system have steadily increased. Unfortunately, this rising level of demand has coincided with the imposition of neoliberal economics.”

    The woke and neoliberals have increased the amount of foreign pensioners in NZ via a targeted immigration policy to destroy the social welfare system in NZ. Now new Asian pensioners numbers are predicted to be greater than Maori and Pacific Island pensioners combined. This is not an accident but a deliberate tactic to destroy our free health care and pensions and warned about it a decade ago. https://www.scoop.co.nz/stories/PO1110/S00572/grey-power-warns-of-impact-of-high-immigration-rates.htm pensioners have high health needs and even the Natz eventually stopped it (Labour restarted it as another woke policy) https://www.rnz.co.nz/news/political/315435/migrants'-parents-cost-nz-'tens-of-millions‘ and of course once a pensioner gets into NZ they can marry other pensioners…https://www.rnz.co.nz/news/national/376220/10k-11-days-and-one-failed-deportation

    Our immigration policy, encourages the most high health needs people to come to NZ in massive numbers aka people having babies (like students or temp workers) and pensioners as their core groups to focus on. Those demographics are highest cost of health care for our health system, aka people in their first and last years of life.

    Many NZ maternal deaths avoidable – study
    https://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=10812793 Birthing unit in Ōpōtiki reopened but not staffed overnight

    The NZ government via their ministry have outsourced NZ visas applications and processing to India and China. Most of the people coming to NZ do not, and are not, capable of earning high incomes, they are people without income like foreign students who can work here, have kids and bring relatives into NZ , or in the lower bracket of skills and earning and need government top ups, but also entitled to bring more family members with them. Many visa holders in NZ are also turning to cash labour or becoming overstayers which is further destroying wages in NZ and putting more burden on all services across NZ.

    The scam has been going for well over a decade now, and instead of stopping the visas altogether, Labour is allowing them to continue.

    The neoliberals and woke who are now also in Labour and Greens, are determined to remove the ‘socialist’ free health and pensions in NZ while pretending to do the opposite.

  4. Definitely right-wing lead by Judith and David seemore feel bullied but let’s put it like thus. Would all these people fighting public health go and front there policy, speak to the people about it face to face. Probably not. I mean who is bullying who???

    Okay let’s say it another way. Let’s say we give this maori health authority billions of dollars. What damage will that cause to Judith Collins and seemores physical health?

  5. It would certainly be a miracle if Labour has had a Road to Damascus experience and overnight changed the entire direction of their ideology, while retaining it all other areas. It’s great maori finally get some headway towards any kind of system thats suits them. There is another explanation for these “reforms” which is far less cheering, and if that turns out to be the case, then National will keep them regardless of what they say now.

  6. Oh boy, I did not see it from that point of view Chris. There I thought getting rid of these weirdly ‘elected’ ‘political type’ health boards was a good thing. Let’s hope this works out because if it doesn’t, it can probably never be fixed again – by anyone.
    As for the MHA, I am still waiting for someone, anyone here, maybe you can, to explain to me in medically technical terms, how Maori are different from us other ‘pakeha’ humans that they need their very own health authority. I can’t see any other benefit here other than a political one. If it’s cultural, then what about a chinese health authority and a german one. Help me here Chris.

  7. Thank you Chris (and Ian Powell) for spotlighting the truth of this announcement through the fog of hype and cheerleading.

    • Like mine, theirs is just an opinion. Just because you agree doesn’t make it the “truth”.
      3 of the 5 experts endorsed a seperate Maori Health service. Whom is speaking the “truth”??, the 3 or the other 2?

      • The lack of any announcement of increased funding is a fact, not a statement of opinion.
        I refuse to cheerlead after years of bitter disappointment and disillusionment.
        The refusal of the self-proclaimed Party of the Workers to repudiate neoliberalism is a betrayal, plain & simple.
        TINA….yeah, right.

  8. We have nothing to lose as the current health system is not working and we don’t know whether something will work until we try it. But we do know a new system is worth a try and we do know the current government was given a mandate to make changes and that is what they are trying to do. The people saying the Maori Health Authority is separatist need to get over themselves. This country was founded on separatism. All our laws, structures and systems are based on the western one cultural model espousing individualism. And it has been that one cultural dominant views and beliefs that has become so entrenched many can’t see past their own noses. The new Maori health authority will take years to set up, it is not something that can be done over night nor do we expect it to and of course it will have teething problems. The main issue for the new MHA will be money and how much authority they actually have. We know we have huge shortages of all medical experts, so this is an area we need to plan extensively for, starting with putting our money where our mouth is. I have heard the same old dribble mostly from those who sit in a place of privilege. I also believe similar changes need to happen in other government departments.

    • You see CIP I have problem with that – are we one country or not? Are we a team of 5 million or two teams? Should we be one country? Or two? Enlighten me.

      • If the current health system is described as not benefitting the most vulnerable ( Maori) then we’ve been living as two teams for hundreds of years.

        • Well bert and friends, this where the whole thing is weird….I bet, and correct me bert if you want…but I bet you there is not one vulnerable person (vulnerable could be anyone, but you can ok call it Maori if you want)…not one vulnerable who won’t have their broken arm fixed, or antibiotics not prescribed, or not taken to hospital when required, or refused a doctors visit, or not given any medical attention when called for. And medical professionals would never ever say ‘ Is the patient Maori, well in that case we won’t operate. Or, hey that’s a Maori kidney so we need a Maori surgeon.’
          So explain to me why a country like NZ, even though it has many different peoples and cultures, why does it need one system for all and then another special for just for Maori? The logic does not stack up. If you said it needs one specialist system just for diabetics or cancer sufferers (of any creed and colour) then it would stack up. All progressive countries in the world operate like that. Why not NZ? They way things are going, we may as well split the country in two.

          • I get that you are trying to be contrarian, I get that you are attempting to be edgy, but you can’t actually be this fucking stupid can you?

            Is that what YOU think Institutional Racism is? Honestly?

            Māori are the indigenous peple of this country. Within 100 years they were almost wiped out and lost 90% of their land. The impact of colonisation set in motion intergenerational poverty and a deep suspicion of all Government agencies.

            We see this in todays social stats.

            Māori medical experts have for decades been calling for a Māori by Māori health system that acknowledges those cultural differences but just because you lack any imagination outside the most base level examples of what you consider health services, they are all wrong and they should put up with a health system that doesnt actually work for them?

            Your audacity is breathtaking Jaspinda.

          • Here’s one, health related in a sense. A client of mine( mental health and Maori) was taken for $3000 from one of those mobile shops. This was for a mobile phone and a Konig TV. 300 % mark up. I emailed the mobile shop having sited the contract and explained that this client is a vulnerable person under mental health and deficit in cognitive decision making. Fortunately it was reversed. The fact his street(state home and predominantly Maori is all the evidence you need to know about how vulnerable Maori are.

          • jaspinda’s tainted opinions are typical of the dull parrot mindset who can only squawk ignorant hobsons pledge gibberish and they’ve had the reigns of our politics and our economy for more than 100 years. That’s why the great many are fucked and the very few are rich and our beautiful AO/NZ’s periously close to going down the shitter. [It] should be called the hoskings pledge. “Greed is good” and “I’m a money man. I’m to the right of roger douglas”

      • We are one country but we are not one people, two peoples signed the TOW. As of for the team of 5 million rhetoric, being a good and successful team requires all people to be treated fairly and all people to have equal opportunities and receive their fair share of the pie but that has not happened in our country and it never will unless we make the necessary changes. To say we should treat all people the same is wrong, cause people are not the same, far better to treat people fairly and according to their needs. Respect and dignity come to mind. One country ruled by one people for one people is not our country if you want that your in the wrong country jaspinda.

    • Our current Health system is the third most fiscally efficient in the world. We have an incredible health system run by incredible doctors and nurses and health care workers.

      What has happened is that our population has increased, but the funding per capital in nz has decreased for heath by both the National and Labour government.

      Governments in NZ have to increase their health spending on par with the amount of people in NZ for us to keep the same health standards – a health restructuring is not going to do that.

      • Wrong wrong wrong.

        Go and Google “WHO Paper 30″

        Go Google ” New Zealand Medicines landscape 2020″

        We have a 3rd world health system.

        As for fiscal efficiency that’s another matter.
        Most of the money is soaked up by the 20 dhb management structures and depending on which post code you are in as to what healthcare you get.

        NZ healthcare has been pushed into to many different silo’s for to damn long starting from Nationals Health reforms in 1993.

        So Andrews health reforms to build an UK style NHS is well overdue.
        Now lets reform Pharmac, Primary Health and Health welfare related benefits.

        PS there are rumours ACC is about to have a reform as well and if the three mentioned above and Acc reform happens I will be over the moon because as another opinion writer says they all need to happen.

        Our health care no matter how much money is thrown at it in it’s current form will remain 3rd world and it is time as Andrew Little realised the changes NEED TO HAPPEN.

        • @ Geoff, I question the WHO findings, because they have the US as 5 places higher than NZ! The US is one of the most expensive and inefficient places to get health care. WHO is probably measuring off different parameters.

          ( Also with Covid, WHO’s independence seems tainted as of late).

          About 5 years ago the commonwealth report had NZ as 3rd most efficient in health care (so could have dropped, but by so much?).

          The availability of health care is declining in NZ due to demand (even with Covid over 120,000 new people entered NZ) but that is not the fault of the health system but the fault of health funding in NZ and planning not keeping up with demand of immigration and the lack of planning for health care due to NZ immigration policy. Note NZ birth rates in NZ from Kiwis are flat. Noliberals want growth so are wanting to expand consumption in NZ, but that does not work with free services in NZ).

          Health efficiency is not the same as Health availability which is clearly declining in NZ due to more people in NZ but not at the same health spending ratio as before.

          I’ll see if I can find out where exactly we are, but due to extreme stuff ups like the census who knows how accurate NZ now is.

          I agree with Geoffs comments about getting rid of health care middle management and all the non medical parts (bought in by the Natz to pretend to make quasi money as part of the health system) but don’t think a massive restructure is going to bring money per capita spending increasing.

          Most people do not speak well of the NZ ministry of Health, they are a bunch of policy people and giving them more power, yikes!

  9. Yes bert your right but if we are one people how come one group of people got everything and the other people got fuck all.

  10. Getting rid of 20 DHB boards and management and paper shuffler across them all has got to be a saving of hundreds of millions.

    Cancelling contracts for PHO’s, Maori Hauhora, NGO’s and Contractors of the ‘Private Sector’ services too will be in the hundreds of millions of dollars. GP cartels and parasitical private practices who work for a DHB but outsource their services to their own private practices, again tens of millions of dollars.

    Savings, savings, savings! That’ll start a bidding war later on and then you dictate the terms and cost for those services.

    More bang for Bucks I reckon.

    Anaaru Little making his run at the PM-ship 2023!

    • @ Denny, Nope all you get are number crunchers and consultants who try to make numbers that don’t work, work. Why do you think most of the CHCH hospital executive team have resigned.

      Having number crunchers (who funny enough started the GFC so don’t seem too smart or practical) and more middle men trying to take costs out of a system that is already one of the most efficient in the world is not achievable anymore. What will happen is patients will die, and hospitals will lose dedicated staff.

      They need more money more patients aka per capita spending needs to rise in NZ.

  11. Well done Chris! This is an excellent analysis of the problem.

    To add two points:

    The current government has been spending like a sailor on shore leave. A hundred million dollars has been spent on ‘working groups’ that delivered essentially nothing. A hundred million and counting on propping up a dying media. Millions slipped under the table with no accountability to a wealthy Maori elite, plus a long list of other gross excesses I forget: How many dental appointments or elective surgeries could those have bought? So a first step for this government would be to stop the poor quality spending and redirect it to core areas: health, education and infrastructure.

    Changing tack, in the 1950’s and 60’s NZ was basically a two crop agrarian state that boomed only because of the temporary post war food shortage. The problem is that it mostly still is today. Sure we’ve added a few things like the wine industry and tourism (and lost wool) , but our trading partners have gone from post-war wastelands to (think Korea, Japan, China) to high tech manufacturing giants. Meanwhile we still subsist on hill farming sheep and selling milk powder, and this will not provide us with sufficient revenue to provide a first class medical system, no matter how it is structured. The core issue is that we’re poor.

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