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 politicians 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 becomes apparent immediately 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.
This essay was originally posted on The Daily Blog of Thursday, 22 April 2021.