Since his sacking as Chair of Health New Zealand (Te Whatu Ora) Rob Campbell has taken to freelance writing like a duck to water with almost weekly columns in each of Newsroom, Stuff and NZ Herald.
His pieces are thoughtful and insightful. Many involve the health system but not all. Recognising the importance of achieving equity and the effects of inequity (and addressing them) are common themes.
Rob Campbell’s writings are thought-provoking and often, but not always, right
At the risk of giving him cardiac arrest I often agree with them (or at least many of his observations).
At the very least they are thought-provoking. This is definitely the case with his Newsroom column on 25 March:
Rob Campbell’s objective
Campbell’s objective is to challenge the “political parties on the left” (by implication Labour and the Greens today) preference for a “strong emphasis on universal services and benefits” which arose out of the development of Aotearoa New Zealand’s welfare state in the mid to late 1930s.
I have a different view of what being leftwing means. For example, I would describe Labour as social liberal and technocratic (and elitist as a consequence) rather than leftwing. I discussed this last year (30 April) in a Political Bytes post:
However, this difference is a side-issue. Unlike many critics of universalism, this business leader, economist and (back in the distant past) former union leader is not criticising support for universalism of public services and benefits from a right-wing perspective.
Campbell places universalism in the context of the overarching economic and social model of the time which “…envisaged a mixed economy with many core activities and assets publicly owned, and much private enterprise significantly regulated.”
But, as he correctly notes. it was also a “largely mono-cultural model”. The model has been:
…substantively shattered over the last half century by social changes driven by cultural and other identity expression, by regulatory, ownership, technology and economic structural shifts. This was a mix of progressive and regressive change which has created a whole new reality.
He observes, again correctly, that Aotearoa is now:
…in the midst of a further shift towards private interests (ie property rights) even further overriding social and community opportunities, costs, risks and responsibilities.
Rob Campbell is in effect giving a wake-up call to the ‘ political left’ which is struggling to respond to this cumulative transformation although he is not pessimistic. In his words: “It is not inevitable that this further shift prevails.”
From universalism to ‘neo-communities’
However, to ensure that inevitably is not the outcome the ‘political left’ should not seek to return to practices based on past “fragile” social and economic structures which, in his words:
They [reinstated practices] may be fixed and even appear certain but they anchor to a past that has gone. They will not survive in the new world. They will not be adopted and will not work if they are.
This is stated with absolute conviction. Campbell refers, by way of example, to the view that returning to the past would mean that social transfers or distributions should be made on a universal basis. But, he argues, too many changes now make this very difficult.
His advice is that the reaction to these changes should not be universal public services. Society has done too much damaged by becoming a “much more unequal society” and a “much more privatised economy”.
Further, his understanding of universalism is that it is based on centralism. That is, the belief that the ‘centre knows better’ and ‘one size fits all’.
His way forward is what he calls a “neo-community” response. That is, the empowerment of community groups, whose focus is on inequities in the economy and society, such as Iwi Māori Partnership Boards.
In his words:
They know far better than the centre what the most urgent needs are and can be relied on to be reasonable about those – they are not accustomed to generous treatment. The left should be relying on their innovation, making the best use of scarce resources.
Beginning with a critical swipe
On 28 March The Post published a very good paywalled article by lawyer and political advocate Max Harris arguing the importance of supporting universalism in response to the high profile school lunch failures.
Max Harris gives Rob Campbell a critical swipe
His article included a brief critical swipe at Campbell for, in his view, recommending abandoning universalism:
Despite its brevity (it was an aside in the context of an article on a related but much more specific issue) I agree with Harris’s critical swipe in principle. But a more nuanced consideration is required.
Where his argument falls down
Too many of those who express opinions publicly, including political leaders, tend to go straight to the answer without understanding the question. This cannot be said of Rob Campbell. A good part of his article raises questions that deserve to be raised.
But he falls down on the answer side of the equation, in my view at least, because he considers the question through a structural rather than relational lens. His lens is too narrow.
If universalism was about central government control over provision and delivery of public services, then he would be right. The culture that is incentivised by this approach is ‘command-and-control’ which guarantees poorer informed decision-making.
New Zealand has seen this eventuate in our public health system and, at an aspirational level at least, veering in this direction in local government. It is even occurring in the education curriculum with a didactic ‘one size fits all’ approach that denigrates meaning as a pedagogical tool.
Campbell argues that it has now become too complex for universalism of services and benefits to turn things around. He is wrong.
Take the public health system. It could be turned around by three critical things:
- devolving decision-making to the level where healthcare is overwhelmingly provided;
- addressing health workforce shortages; and
- empowering that same workforce to deal with complexity challenges and innovation.
Complexity is not the problem. Beginning with governments, poor leadership culture is. If leadership can first recognise these three things then addressing by strategic firmness can follow.
Subsidiarity and differentiation strengthen universalism
Universalism of public services and benefits requires the principle of subsidiarity to make it relational and therefore more effective. That is, things should be done locally (for example, in communities) except where it makes better sense for them to be done centrally.
Rob Campbell has counterposed community based activism to universalism. However they don’t have to be alternatives. In a relational based culture subsidiarity enables the blending of them together as interconnected ‘fellow travellers.
Insufficient consideration is given in his column to the extent that differentiation can, has, and should, exist within the universalism of public services and benefits. Universalism should not be narrowed down to ‘one size fits all’.
This also requires recognising that the means of provision and delivery that are consistent with underpinning values can also evolve over time. In other words, continuous quality improvement.
A compelling defence of universalism
Rosslyn Noonan puts it better than me
I can put this no better than former teachers union leader and chief human rights commissioner Rosslyn Noonan who, in a published reply to Rob Campbell, said:
Rob is right about the critical role of grassroots, community developed and led provision of basic services that should be appropriate and accessible to everyone. One size does not fit all. But we shouldn’t be equating universal to centrally developed and provided. That’s lazy thinking.
The issues are complex and the same approach will not work for all basic services . But a brief consideration of the universal right to free primary and secondary education is evidence of the possibility of rich diversity within universal provision, provision that is largely public not private, imperfect though it is.
Privileging a market model and private provision is the tragedy of early childhood education and care. And the dental market has miserably failed to cater for our children let alone the adult population.
I agree we have to start from where we are now, that we should be exploring how best to support diverse communities, iwi and hapu, but let’s never accept the right’s denigration of universal provision.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Political Bytes
My explanation is that since those with wealth are now able to control governments their lack of concern for the health of others has consistently underfunded health which has caused the current situation. The other factor is that feelings are considered more important than evidence so we have a lifestyle that makes people sick but since those with wealth are profiting from people’s poor choices that is unlikely to change also. This does sound like a blame the victim explanation which is not my intention as most people’s choices are conditioned within a society shaped by those who control it.
Re @ Bonnie.
” My explanation is that since those with wealth are now able to control governments…”
That depends on one’s definition of ‘wealth’.
In a democracy [wealth] is found in the vote surely Shirley? ( Leslie Neilson.RIP.)
If wealth ISN’T found in the vote then what do we have as a politic balancing our democracy? I can tell you. Those with wealth are now able to control governments. I read that somewhere..?
That ain’t a democracy and your vote means shit and you will eventually head down into a fearsome and ferocious carnivor rabbit hole of doom. As we can now see with 19 month waiting times for specialist medical treatment.
While voting is suspiciously still a casual affair yet enrolling is mandated we’re going to become so exploited by wealth gathering lunatic sociopathic narcissists we’ll be begging for a timely death just to avoid the terminal boredom of merely barely existing.
Mandate the vote. If you’re one of the rich and don’t like that idea, then go and live in North Korea.
Wikipedia
“Elections in North Korea are held every four-to-five years for the Supreme People’s Assembly (SPA), the country’s national legislature, and every four years for Local People’s Assemblies.[1][2] Each candidate is preselected by the North Korean government and there is no option to write in other candidates, meaning that voters may either submit the ballot unaltered as a “yes” vote or request a pen to cross out the name on the ballot. Critics argue that North Korean elections are show elections which lack competition and allow the government to claim a veneer of pseudo-democratic legitimacy.[3] A person’s vote is not kept anonymous, and those who cross off the name on a ballot are often subject to legal and professional consequences. According to official reports, turnout is near 100%.[1] “
In a free society (that is, one in which people are free to express contrary opinions) the open ballot is a boon to democracy. In an oppressive system people are reduced to expressing their opinions under cover of a pseudonym if at all. I will leave you to figure out to which category the Realm of New Zealand and Te Whakaminenga o Aotearoa respectively belong.
On the other hand mandated voting is not beneficial to democracy. In a genuine democracy people will be provided with reasons to vote, apart from the threat of jail time if they do not. If what you say is correct, mandated voting is at least the de facto rule in North Korea. That does not mean that we should adopt the same policy.
It seems like since forever that we get the best government that money can buy and the interest of most of the people is ignored. A number of those people don’t actually know what is good for them anyway so while I think that people should vote forcing them to vote is unlikely to have a happy ending.
It was fairly obvious that I was talking about financial wealth as we still have one vote/person however advertising or political policies are used to get people to vote against their best interests.
That is correct, Bonnie. The actions or inactions of government are only half of the problem. The actions or inactions of ordinary people, the general public, are the other half. That is not to blame the victim. It is to show us that in fact we don’t need to be victims, and that ultimately we control our own fate. That is a liberating truth.
Benefits can be either universal or discriminatory. Control can be either centralized or localized. The two factors should not be conflated. When the centre withdraws benefits, whether universal or discriminatory, the local actors, such as hapu and iwi, will respond by trying to fill the vacuum, usually in non-discriminatory ways, because such local authorities lack both the means and the will to discriminate.
That does not let the centre off the hook. It means that the centre (central government) no longer serves a good purpose and should be given short shrift by those at the periphery.
Give Rob Campbell his due. He is intelligent, he has a reasonably wide field of vision, and he sees dangers that are not apparent to other neo-liberals. But he is himself a die-hard neo-liberal. His latest attack on universalism is carried out with the neo-liberals’ favorite blunt instrument, TINA, “There Is No Alternative”. Of course there are alternatives. There always were and there always will be.
We must give Rob Campbell his due for sure. But he will be sensitive to tikanga, and true Kiwis who embrace a united country with bi-partisan approach, would also consider that there is a joint tikanga about health provision, and only different approaches consistent with the right practice for patients
I think our majority tikanga is that health care be mostly universal and sensitive to personal wishes and beliefs, and there be some add-ons through private where that is helpful and cost effective.
What a great lot of commenters. So good to have thoughtful.or even fiery polemic at times, but with some solid thinking behind and serious adult consideration likely.
My first response is thinking that this approach from Rob Campbell is an example of simplisttic 20th century thinking that, to our shame as people educated and anxious to keep up with new streams of communication and available information, shows we haven’t been asking searching questions and positing new ideas. These would be based on the fact that whatever we were thinking in post ww2 years, it has resulted in (I consider) a less than null result.
The most offensive thing about Campbell’s piece is the way he tries to drag Karl Marx into supporting his argument against universalism by advising “the left” to remember one of its “foundation calls”, “to each according to their need.” Campbell equates people’s needs with needy people, the very opposite of what Marx meant.
What Marx, and for that matter proto or millenarian communists stretching back centuries before him ( see the Book of Acts in the New Testament), meant by his famous quote was that all citizens of society have universal needs, for food, shelter, and the means to participate in cultural life, and that it is precisely because these needs are universal that their provision should be.
Campbell omitted the first part of Marx’s quote: “From each according to their ability.” In the communist society of the future everyone will be expected to, will want to, contribute to society through their labour in the way they best can. If they can’t work for some reason – old age, sickness, disability – they can expect their society to provide for them, no questions asked, as a basic right, not as means-tested charity.
Terry – I think that in our very near future we will see forcibly from events, and consideration about our growing numbers of aged, of which I am one, and that we all need to be contributing to the hive, whether we can only watch over the brood, fan the temperature down, or get honey and pollen etc.
There is no essential right to retire and stay at home or on cruise ships or even in our own gardens, or fill in time concentrating on being old as many in hospital waiting rooms seem to be, looking sad about it. Old people can be happy; change your ways, take a positive interest in the society that you live in which supports you – which will always be the way. You can’t save enough as a young person to be isolated and self-supporting when you are old, just because of inflation and also because of the low pay structure for many now enabled by government, and the longer period of existence that funds another ‘industry’ of rest and retirement homes.
We oldies are needed in amongst the throng as never before, and get the best help and smiles when we kindly put ourselves out a bit.
I’m picking that by Acts you mean 2:44-45 where all things were held in common and all needs met although it’s a pity that you missed the story in the rest of the books where Jesus sets up a kingdom that lasts forever. Communism has the same problem as capitalism in that it is unable to change our hearts as only a spiritual new birth can achieve that. That is why government force ends up being used to achieve the leaders desire in any man made system. Only the response of love to the love and forgiveness we receive is able to transform us to live in harmony for eternity. Mt 25:31-46 is an easy way to see if someone is a genuine Christian as the sad reality is that most who claim the name are destined for destruction.
Yes indeed Acts 2:44-45. Also 4:32-35: “And the multitude of them that believed were of one heart and of one soul: neither said any of them that ought of the things which he possessed was his own; but they had all things common. And with great power gave the apostles witness of the resurrection of the Lord Jesus: and great grace was upon them all. Neither was there any among them that lacked: for as many were possessors of lands or houses sold them, and brought the prices of the things that were sold And laid them down at the apostles’ feet: and distribution was made unto every man according as he had need.”
Such communist ideals and attempts to put them into practice are not uncommon throughout history, probably drawing upon humanity’s deep-seated collective memory of times before the rise of class society when we were all communists. The problem was that in societies like the communities in first-century Palestine that the Book of Acts describes, or seventeenth-century England where Gerrard Winstanley and his followers were active, the forces of production were too underdeveloped to provide the material wealth necessary to sustain the communist societies they aspired to. But nowadays the forces of production internationally are more than adequate to do so.
I said in my earlier comment “In the communist society of the future everyone will be expected to, will want to, contribute to society through their labour in the way they best can.” I could have added “without expecting, or wanting, undue material rewards for doing so.”
The tree of universalism was planted at the foundation of the welfare state and a couple of generations grew up under its shade. Then in 1984 neo-liberalism took to it with a two man saw, with Greed on one end and Resentment on the other. Greed, because some of us no longer wanted to go on paying the taxes which made possible universal benefits in health and education. Resentment, because those who had been forced to pay for higher education understandably did not feel they had any moral obligation to stay home and work for the good of their own country while receiving salaries that were lower than the international norm, and some did not even see why they should repay the debt they had incurred in gaining their degrees.
Those who stayed were so thoroughly imbued with the values of neo-liberalism, so convinced that they had fully “paid their own way” (not true in fact), and so resentful of their outstanding student loans that their only concern was to maximize their after-tax income by insistently demanding higher salaries and lower taxes and voting for the parties that would grant their wishes.
We should not blame these people. They are reacting as we should expect in the circumstances.
But there is nothing inevitable about the attitudes which prevail in neo-liberal New Zealand. They have been deliberately crafted through government social and economic policy. Successive colonialist administrations have set out to destroy the universalist principle because they know that it is critical to social cohesion and a united nation.
As private health provision extends further into the health sector, and private superannuation schemes become an essential element of retirement incomes, that same combination of Greed and Resentment will bring Universalism perilously close to toppling, and if it finally falls it will crush what little remains of a sense of social obligation within the current system.
Rob Campbell’s solution is clear, albeit lacking in detail. Basically, he is saying that we must accept the way things have gone in the recent past as the way that things must go in the future. That means more privatisation, more inequality and more division. The state will either cease to provide social services at all, or will provide them on a discriminatory rather than universal basis. Thus, in the former case, the divisions in society will be clearly illuminated in a way that accentuates them. Anyone receiving free health, free education, affordable housing or government superannuation will be seen by themselves and others as losers rather than as equally valued members of society and they will be treated accordingly.
So far so orthodox-neo-liberal-ideology.
What really interests me is that Campbell recognises that this outcome will seriously undermine the social order, and he is proposing that non-government agencies step in to retrieve the situation. He argues that “Out there, among those left behind in the privatisation of our lives, there are any number of community activists and agencies both old and new. They are where the solutions are to be found”.
Of course this is passing the buck, in a big way. Never mind. Will it work?
Campbell specifies only one of the “any number of community activists and agencies both old and new” which will take over the provision of social services from the state. That is “Iwi Māori Partnership Boards”. Fine. It sort of fits with the neo-liberal assumption, which goes right back to 1984, that only Maori suffer from the ravages of neo-liberalism, and thus a solution is only required for Maori. (In truth that assumption is based not on the supposed peculiar needs of Maori, but on the fact that only Maori have the organisational structures to fight back against neo-liberalism, and have amply demonstrated their willingness to do so)
So Campbell specifically mentions only “Iwi Māori Partnership Boards” among the supposed “any number” of agencies which he sanguinely supposes are ready to step up and take over the responsibilities of government. We can surmise that these other agencies will be mainly faith based (from the Salvation Army and Methodist Missions to Destiny Church), along with a number of secular philanthropic institutions such as Habitat for Humanity, food banks or charity hospitals.
Would these institutions be state funded? Presumably to some extent, but not fully funded, or what would be the point? If the state is going to fully fund social services through other agencies it needs a reason for doing so, such as corrupt purposes (channeling state funds to cronies) or reducing the costs to the state of providing such services.
If the services are not fully state funded, who will pick up the slack? Presumably compassionate, concerned citizens. Ah, but here is the rub. Campbell himself says “There will be tax resistance not only from the rich but from the many who have been forced to fund their participation in the privatised society and have adapted to it. On most pressing social issues at least half of the population have adapted, if only because they had to”. Will these same people who “resist paying taxes” because “they have been forced to fund their participation in the privatised society” be willing to freely give the same amount that they would have paid in tax to private agencies for the provision of social services to those who have signally failed to “adapt”? I would not count on it, and neither would any other rational observer.
So let’s continue to probe into how this might all work. Underfunded agencies take on the provision of social services in a privatised society. Conveniently, some of those agencies are Maori. On what basis do they provide assistance? Universal or discriminatory? There can be only one answer. These agencies will and could only provide services on a non-discriminatory basis. They do not have the means, the powers, or the will to decide who is and who is not deserving of help. A marae welcomes all comers. A Christian church does not sit in judgement on folks who seek their help. These “any number of agencies” will be non-discriminatory and universalist because in their very nature they cannot be otherwise.
So despite everything Rob Campbell says, in his neo-liberal utopia/dystopia or somewhere-in-between, the principle of universalism will be re-established, not by the state but by whoever and whatever steps into the social services role of the state.
You don’t have to be very smart to see where this would lead. When the state is spending more and more of its billions on military forces, surveillance systems, courts, police and prisons and hapu and iwi are providing food, energy, housing, health and education then the people will see that even if power is invested in the state, the true authority which comes from God resides with the hapu, iwi and all those others committed to the well-being of His people.
So one way or another, Rob Campbell’s demand that “The left must leave the past behind” is a prescription for revolution.
I think this is well travelled GF, and I note it is not the rather narrow path but the common one that the self-satisfied and indeed one may say, selfish. consider the best route. Unfortunately their minds are astray and the situation has been considered frequently in different modes, over centuries. To have it dished up again in this greasy, so-confident and apparently reasoned way, is like being served a bit of new sponge cake supposedly made with the old Edmonds ‘Sure to Rise’ recipe, but the baking powder was forgotten. One feels not only flat, but as if trodden on by hob-nailed boots.
Stick it where the sun don’t shine Rob. Those of us who care about our fellow Kiwis must rear up and defend ourselves from this easy-going continuation of decades of peculation* of our nation’s assets and opportunities,. We regard this with horror and need to watch we don’t mingle too much with this type of person and their thinking, as the effects on us will be worse than those conveyed by Covid.
I like this little note on the peculiarities of language reflecting those of the society.
* Latin suffers from an embarras de richesses of terms relating to misappropriation of public funds, …[peculate] derivative of the verb pecūlārī “to embezzle,” and itself a derivative of pecūlium “wealth in cattle, private property.”…
Word of the Day – peculate – Dictionary.com https://www.dictionary.com › peculate-2018-03-05