Sunday 9 November 2014

Cooking The Medical Books: Citizens suffer in stoical silence so National can keep taxes low.

Suffering In Silence: The Government and its cash-strapped DHBs are relying upon the decency and stoicism of the average citizen to get them off the fiscal hook.
FUDGING THE FIGURES is what governments do when effective policy solutions are ruled off the table. According to Radio NZ News: “New research shows nearly 40 percent of patients who need hip and knee operations in at least two district health boards are not getting them because of budget restrictions. The study, published in The New Zealand Medical Journal, which looked at Northland and Hawke's Bay, found the drive to cut wait times has left 36 percent of patients with moderate to severe pain and disability untreated.”
Clearly, the now retired National Party Health Minister, Tony Ryall, was unable to persuade his fellow “Brat Packer”, Bill English, to appropriate sufficient funds to keep our public health service up to the job of actually serving the public.
One doesn’t imagine that English, an essentially decent politician, was very happy about this. But with his colleagues demanding lower taxes for the wealthiest New Zealanders (and some modest covering reductions for the rest of us) he was left with little choice. It would require a Labour-led government of more than usual fortitude and radicalism to institute the fiscal reforms necessary to ready the New Zealand health system for the influx of ageing Baby Boomers steadily falling prey to all the ills that flesh is heir to.
Tony Ryall’s response to his increasingly underfunded health system was, however, ethically extremely radical. According to the study published in The New Zealand Medical Journal, he simply invisiblised upwards of a third of New Zealanders in need of non-urgent surgical interventions.
Chairman of the Canterbury Charity Hospital Trust, Christchurch surgeon, Philip Bagshaw, told Radio NZ that focusing on the length of time people were waiting, rather than the length of the waiting lists themselves, was “a great way of hiding the scale of the problem”.
“It’s become smoke and mirrors”, said Mr Bagshaw. “They’ve created a self-fulfilling prophecy, so they say the waiting list is only six or four months, but that’s because they only allow that many people onto the waiting list.”
Smoke and mirrors it may have been, but the practice permitted Tony Ryall to boast that the time spent waiting for elective surgery was steadily decreasing. According to Mr Bagshaw, haemorrhoids, cataracts, hernias and varicose veins – among a host of other debilitating conditions – are simply not being treated in the public system until such time as serious complications render them acute – and costly.
Allowing the condition of sufferers to deteriorate to the point where they are forced to seek emergency admission to public hospitals is, not surprisingly, a considerably more expensive proposition, long term, than providing treatment early. “Investing in health early on is not only humane but also makes good economic sense because to do things in a timely way is the cheapest way,” Mr Bagshaw confirmed. “If you deny people treatment ... they come back later with bigger complications and cost more money.”
As scams go, however, this is a particularly clever one, because, obviously, not all of those sufferers rendered invisible will end up undergoing emergency surgery. Most will simply go on suffering, unheard and untreated.
In other words, the Government and its cash-strapped DHBs are relying upon the decency and stoicism of the average citizen to get them off the fiscal hook. Their deeply cynical – but apparently accurate – expectation has been that the voters will evince little interest in how Mr Ryall’s miracle is being achieved, just so long as the waiting period for elective surgery keeps decreasing. And so it proved. On Election Day, most people accepted without demur that John Key’s government was managing our public health system with considerable skill.
So, it’s ‘all good’ for the Government? Well, not necessarily. As the Baby Boomers find themselves relying more and more on the public health system, they are bound to flex their still massive demographic muscles to ensure that sufficient funding is appropriated to meet their growing needs. With everything to fight for in terms of free medical care, there is nothing to suggest that the ageing Boomers will not emulate the exemplary levels of electoral participation demonstrated by older voters generally. In securing their self-interested health objectives, the Boomers will be aided by the short-sighted failure of so many young voters to participate in the electoral system.
The politicians of the future will respond to the medical demands of the Boomers in the way politicians always do when presented with a choice between serving the interests of citizens who vote and the needs of citizens who stay at home. If young New Zealanders want a viable public health system to still be in place when they reach their 60s and 70s, then they’d better start voting in the same proportions as their elders. Otherwise the health statistics being fudged will be their own.
This essay was originally posted on The Daily Blog of Saturday, 8 November 2014.


Guerilla Surgeon said...

It's interesting, my old thesis supervisor – (well my other thesis) did some research years ago and found that if provision was begun at that time for the ageing population then it could be quite easily managed. Of course being an academic he was perhaps a tad naive about politicians and short-term thinking.

Brendan McNeill said...


The public health system is a perfect metaphor to display all that’s dysfunctional with the modern socialist state. It promises something it can never deliver - universal free healthcare.

As you have correctly pointed out, it is not universal and as I would like to remind you, it’s not free either. Someone always pays. What is just about a system that taxes you your entire lifetime for health care you typically don’t need when you are young, and then fails to deliver it when you are old?

Our present system works very well if you have an emergency like a car accident or a heart attack. But if you go to your doctor suffering breathlessness, and it’s determined you need a quadruple bypass, then you could likely die on the waiting list.

People do.

How about we have an honest system that costs taxpayers less. A public system that provides emergency treatment only, and we make it clear that you need private insurance for everything elective. Make health insurance tax-free for those earning under $100K if you want to keep socialism alive. Arrangements can be made for beneficiaries.

Such a system would deliver better outcomes for everyone.

Jigsaw said...

What a biased account! Under that last Labour government people were being sent to Australia for operations-remember? I have had several brushes with the health system in the last few years and can only say its improved enormously in the last few years-far more focussed with definite goals. I am sure that there is never enough money spent but the figures relating to innoculations etc speak for themselves. I watched in the last parliament as time and again Annette King tried to attack Tony Ryall- to little effect. The fact that health hardly featured in the election campaign is a tribute to Ryall's work.

Guerilla Surgeon said...

I had some great experiences of healthcare under labour. And under National. But one person's experiences don't count. One of the first precepts of scientific investigation.

J Bloggs said...

As someone who has worked on the Orthpedic wards at a regional hospital I can can assure you that the number one reason hip operations are delayed is because the Orthopedic sugeons (of which there is a limited number in any regional hospital) usually start each week absolutely knackered after spending the weekend fixing up the injuries from:

a) Drunk drivers
b) Soccer players
c) Rugby players
(& d)olk folk who got drunk, fell over and fractured their hip - but they tend to be more regular arrivals across the week, rather than a big clump)

It is not an uncommon for the ortho ward to be 3/4's empty on Friday evening and filled to overflowing come Monday morning - and the poor old hip replacement gets bumped til later in the week, then bumped again because of next weekend's rush, and again & again & again....

You want to get hip replacements done quicker in the provences - stop the bloody drunk drivers!

pat said...

curious thing about statistics....the outcomes they can produce are only limited by the imagination of the group gathering and interpreting them.
A few points to consider , publicly (or socailised) health care has consistently been shown to be the least expensive method of delivery even ignoring the additional benefits of a universal public system .
As western governments are increasingly placing tighter and tighter limits on public spending the pressures on the private funding of these necessities grows at an alarming rate, something has to give.
Those on low incomes, benefits and national super are increasingly paying larger and larger portions of their meagre incomes for such luxuries as rent (housing),rates, health care....and the baby boom demographic bulge is due to hit retirement age compounding the problem.
What happens to a country and its services and infrastructure when a substantial segment of that society can simply not pay for the aforementioned items?
Think its not your problem? basic economics will tell you if you reduce the number paying the cost will increase for those who still can to the point where no one can afford to pay and the service/infrastructure will simply disappear.
Being melodramatic? ask the Mayor of Clutha DC, hes living with a microcosm of it as we speak.

Davo Stevens said...

Bloggsey has got it right, the biggest single drain on our Health System is car accidents. Some 40,000 a year I'm told that take up valuable space and surgeon's time.

Car crashes are covered by ACC so they could be done in the private Health System. Just taht ACC won't cover the cost privately so the public hospitals take up the load.

Brendan: Has it occurred to you that our Public Hospitals are funded by insurance? Use your head mate, the insurance is included in out taxes.

Our system is much better than the US one where if you don't have insurance you die, end of story.

Also in a private system the insurance companies pick and choose what they will cover. As many have found out to their cost!! And some insurance companies change the cover without informing the client which is much worse.

Jamie said...

The people can't take more taxes Trotter,

We are getting squeezed from every angle,

Hell a pack of durries dam well costs an arm and a leg before you even get em out of the packet...

If we must raise taxes then how about this...

Regulate, and
Taxate the illicit drugs market if the Government is broke...


Because I don't see much incentive in working hard and getting ahead when all you end up doin is paying taxes to an un-efficient Govt who pisses it up against a wall,
I could do that myself...

David said...

Bill English essentially decent?
Is that the same Bill English who compared long term beneficiaries to crack addicts and in Masterton last August said of Labour and the Greens "They hate livestock almost as much as they hate people."

Robert said...

My answer to Guerilla Surgeon, is that a number of times in history, eg the 1945 British Labour Governments introduction of the NHS, it was argued that earlier intervention by doctors would reduce health costs, by treating the 'illness' earlier in term. The result was actually spectacular increases in health spending with more potential patients arriving for treatment and higher and higher expectations of services on demand and maintenance of jobs in expanding health industries.Free services usually result in demand ratcheting up and worse service for most. Certain groups of free riders benefit of course, in economic lingo.
Today populations are better fed and live in greater comfort and theoretically demand for health services should decrease, but don't
Outside of AE and accident and collapse care, Modern medicine and Psychiatry probably reduce peoples lives and happiness. Increasingly medicine is a militant effort at social intervention and engineering.
My favored health service would just allow people to choose and buy their own medicine and control the dose themselves. NZ medicine is just another employment creating racket.
In NZ's third world areas and poor white areas health is doubtlessly getting worse, but that reflects poor genes and self destructive lives of epic scale. More than most in NZ, we simply haven't allowed evolution to run its course.

Guerilla Surgeon said...

On the contrary Robert, the NHS spent more money because people were actually getting health care that previously couldn't afford it. The alternative was to leave hundreds of thousands of people with basically no access to healthcare apart from charity. And charity hasn't worked since at least the fourteenth century :-). And let's face it, jobs in the health sector can be quite well paid, and those people pay taxes, and spend their money on goods and services. All of which helps the economy. Your last few sentences make absolutely no sense. Not in the sense that I can't understand them, but allowing people to buy and control their doses of drugs is ridiculous. I suspect it would result in a huge increase in costs as people suffer side-effects and overdose. The idea of "poor genes" in the sense that you use it, puts you firmly in the eugenic camp, and shows you know nothing about biology sorry :-).

Davo Stevens said...

Agreed Surgeon, the utter stupidity of some people still amazes me at times.

Self-medicating? Think of the chaos! Our coppers are busy enough without having to deal with people who have dosed up and then go berserk.

We can do well without the Eugenics/racial comments as well. There is no place in our society for either.

manfred said...

The point is, Brendan, our public health care system does work. It takes the pressure off and provides an actual large quantity of surgeries and treatment for people who can't afford it. You are arguing to take that away.

Let me repeat myself; mass amounts of free high quality care gets delivered to NZers.

You are arguing to take that away.

You sound like a wealthy individual who is out of touch.

Most Kiwis are extraordinarily grateful when they receive their free health care.

It is only under the leadership of a right wing government, that the health system starts to fail in part. And this is because of underfunding.

My mother recently received top notch public treatment for a condition that was non surgical. She and my family would have been up shit creek without a paddle if she had had to pay for it.

So did my grandmother.

The system you are proposing would throw hundred of thousands of people into debt slavery or worse, as it has done in the states.

For that, Brendan, I ask you to go fuck yourself.

Robert M said...

Gurellia surgeon, my idea that the public make their own choice of drugs and dose of pharmacuticals including anti depressants and so called anti psychotics is certainly no more senseless than the widespread view held by many professors and even politicians that all illegal drugs be legalised and sold to the hoi polli. If you legalise or decrimalise pot or weed, the public have no idea how strong the dose is or what it cut or mixed with and much modern skunk is mindblowingly strong. Same probably with Vodka. Psychiatrists dont take the drugs the pescribe and I maintain that most patients over 18 will better determine what will help or lift them.
The British said the NZ idea that anyone could go to university over 21 would never work, but in many ways it did, and the only logical approach to the medical problem is to legalise all illegal and legal pharmacuticals and offer them to public. It would no more criminal than the NZ legislation that released chinese synthetics onto the NZ market

Guerilla Surgeon said...

Robert – You are correct I think, but I wasn't suggesting that we legalise all drugs. I think we should definitely watch the experiment in the U.S. with marijuana though. Self-medication is probably not a good thing. Most modern drugs are quite strong, because they actually do stuff. So dosage needs to be reasonably rigidly controlled, as does prescription. Interesting idea. Approaching a straw man argument however. :-)

Victor said...

Hi Brendan

I fear that private health insurance is a perfect metaphor for much that's dysfunctional about the market.

People often pay for their insurance over many years, starting when they're comparatively, young, healthy and earning reasonable amounts of money.

But as they get older, their health issues increase and their incomes may well decline (even if their capital increases through home ownership). And, it's at that very point that their premiums get pushed up way beyond what many find affordable.

And so, despite the fact that they've invested thousands of dollars in insurance policies down the years, they are often no longer able to afford the premiums and their policies lapse, just when they're most needed.

A further problem is that the elderly often find themselves having to cope with a gradual worsening of a "pre-existing condition", which will, of course, be the subject of an exclusion on their policy, should they retain it.

My understanding is that insurance companies in some countries are able to hold down the cost of premiums for older citizens. But our small population would tend to prevent this happening in New Zealand, even if there was a will to make it happen.

In other words, we have a pure, unadulterated case of "market failure".

Victor said...


"In securing their self-interested health objectives, the Boomers will be aided by the short-sighted failure of so many young voters to participate in the electoral system."

Just to make sure I understand what you've written; by "self-interested health objectives", do you mean things like wanting an unbearable pain to stop?

If so, how exactly is it in the interests of young voters to keep that pain going?

Could you please specify?

Jigsaw said...

So some unnamed person, sometime ago might have done a thesis that may have said that if we had s done a certain series of things at the time we might have been in a different position right now.....really, how incredible scientific! beats personal experience every time obviously!

Guerilla Surgeon said...

That unnamed person was interviewed on national radio, so it is a checkable fact.And I never said it was a thesis. Just some research. It may well have been published in an academic journal. But it was a while ago as I said. But on the whole I don't publish the names of people I know on this blog. Who knows what vitriolic attacks they might be exposed to.

Jigsaw said...

Indeed who knows what vitriolic attack and from whom......