Labour’s Health Reforms: Boldly Going Where It Might Not Be Wise To Venture.

Breaking Bold: Andrew Little's reform of the health sector 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.” But, are they?

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.

Moving The Centre

Centre Of Attention: In Stanley Kubrick's science-fiction masterpiece, 2001: A Space Odyssey, the mysterious black monoliths serve as catalysts for change. Political scientists attribute similar transformational powers to the political centre. In reality, the political centre is a malleable and constantly shifting phenomenon; its allegiances determined by the exogenous political pressures exerted from either side.

THE CENTRE FILLS the politician’s sky like the monoliths in Stanley Kubrick’s 2001: A Space Odyssey. In much the same way as his mysterious black stele are credited with being the prime motivators of human enlightenment and progress, the political centre is deemed to be the fount of all moderation and wisdom. Without it’s decisive intervention, say the pundits, electoral victory is impossible.

 

In reality, the political centre is the most malleable of all electoral clay: capable of being shaped and moulded into practically any shape its sculptors can conceive.

 

The voters who congregate at the extremes of the political spectrum have needs and interests that are clear, permanent and compelling. But the needs and interests of those in the centre are tied inextricably to those of the rich and the poor, and are, consequently, nothing like so constant. Accordingly, those who mass in the centre tend to oscillate wildly between the two extremes: their manic swings to left and right corresponding to the strength of the latter’s economic appeal.

 

Consider the role of the manager. Forty years ago the number of people in managerial positions was relatively small. Then along came the neoliberal revolution and the number of managers in the economy exploded.

 

As New Zealand society was restructured along “free market” lines, those workers lucky enough to keep their jobs were expected to work longer and harder for less. All those new managers were hired to make sure that they did.

 

Like the commissars of Stalin’s Soviet Union, the new managers’ prime mission was to protect and defend the revolution. In fact, their livelihoods depended on its survival.

 

Now, which way do you suppose that new managerial strata voted? For the neoliberal revolution’s friends – or its enemies?

 

The same political dynamic is at work among those who contract for services formerly supplied by the state.

 

By drastically reducing the size of the civil service and contracting out a great many of the services formerly provided in-house, the neoliberals did not, in fact, save a great deal of taxpayers’ money. On the contrary, one American study revealed that the cost of services provided by private contractors was, on average, a third higher than the cost of those same services when supplied by a public provider.

 

But, saving money was never the true objective of those responsible for contracting out public services. Neoliberalism’s purpose was to destroy the ethos of public service altogether and replace it with the ethos of individual enrichment by way of profit-taking.

 

A state that is able to provide its citizens with services that are efficient and cost-effective is a state those same citizens might learn to value and support. Even worse, it might come to be seen as a system worth extending into areas of the economy still dominated by the quest for private gain.

 

The whole point of neoliberalism was – and is – to prevent that from happening.

 

Like the new breed of managers, thousands of new contractors found their own futures and the future of the neoliberal revolution inextricably intertwined.

 

They, too, know on which side their ballot papers are buttered.

 

Now consider what might happen to the people in the centre if the neoliberal revolution was overthrown.

 

Imagine a political party which promised to reduce expenditure on taxpayer funded services by 33 percent – by taking the provision of those services back in-house.

 

Imagine a government which, instead of following economic policies that led to the sacking of thousands of low-paid workers, encouraged the creation of a new kind of workplace. One in which the skills and creativity of the whole workforce was brought to the task of lifting productivity. Such workplaces would have little further need for managers of the neoliberal variety.

 

Managers’ socially useful skills would not, however, go to waste if a reforming government invited them to become an integral part of the social entrepreneurialism it was pledged to unleash.

 

All across New Zealand (and in Christchurch particularly) there is a huge amount of work to be done repairing damaged lives and damaged communities.

 

In her valedictory speech to Parliament, Lianne Dalziel talked about building a “resilient society”. That is a construction job to which the skills of these former managers could readily be applied. Deploying taxpayer resources to foster not dependence but resilience is a public enterprise to which most New Zealanders will gladly contribute.

 

The political centre currently cleaves to the right because the neoliberal order, so ruthlessly imposed over the last 30 years, makes it worth their while to do so.

 

All that is required to shift their allegiance is the effective presentation of a social and economic manifesto that makes it worth their while to do something else.

 

Kubrick’s monoliths were significant not for what they made us do, but for the possibilities they allowed us to see.

 

This essay was originally published in The Press of Tuesday, 24 September 2013.