Source: ACT Party
The Haps
Why did the National Party roll out John Key to attack the Treaty Principles Bill? Free Press hears it was an attempt to dampen National Party members’ support for the Bill.
‘I’m not an ACT supporter but…she is a wonderful lady’ is the tone of many emails in support of Karen Chhour. The racialised attacks on Chhour in the wake of the Royal Commission led to ‘jump-the-shark’ moments for some opposition politicians and journalists. Free Press caught up with Chhour over the weekend, she is more resolute than ever.
Healthcare
(Public) spending on healthcare is $28 billion, or $5,300 per person, but nobody’s happy. It’s nearly the only department with extra money set aside for next year when there’s really no money. Perhaps it’s time to figure out what the real problem is and take the steps needed to solve it?
Sure, it didn’t help that the previous Government spent half a billion trying to restructure the entire system in the middle of a pandemic. Maybe one day Andrew Little will write a memoir explaining what they were thinking, but we can guess.
They started reforming because there were already big problems under the DHB model. Productivity growth was low to non-existent, morale was not much better. The balance between expensive hospital care and preventative primary care wasn’t right. The mix of pharmaceutical spending, i.e. investing in technology, and workers wasn’t right. The maintenance of hospital buildings means some buildings look like they belong in a Pacific island nation.
We don’t have time for Andrew to tell us why the solution didn’t work, because the system is in trouble now. The task befalling Minister Shane Reti and his Health NZ Commissioner Lester Levy is gargantuan. Both come with a track record. Reti is super bright, has spent years at Harvard, and devoted his whole life to medicine.
He maintains a practicing license to this day. Legend has it when he found out a school in his electorate had children without their MMR, he fundraised for the vaccine, went to the school, and offered free immunisations. He is also a profoundly decent human being.
We say all this partly because it’s true, but also because it sets up a titanic battle. Hopelessly sclerotic bureaucracy versus Super Minister. Can he fix it? If Shane Reti can’t do it, then probably nobody can.
What is there to fix? Constant disorganisation. We hear of pathology samples taking a month to process because of delays. Why? It turned out the lab fees hadn’t been changed for yonks. Nobody could afford to process the sample at the fees on offer.
We hear from highly paid surgeons who say that their list was cancelled because no anaesthetic technician showed up. The patients don’t like being operated on without anaesthetic. It’s not just the surgeon’s time, but the whole operating theatre that goes to waste. Time is money.
We now have the best Minister to fix these problems, but could there be too many? Health NZ, with a $28 billion budget and 65,000 staff, is by far the largest organisation in New Zealand. Air New Zealand has 10,000 and The Warehouse Group has 12,000, both businesses are arguably simpler than health. The risk is an endless game of whack-a-mole.
What other options are there, that could endure regardless of how good the Minister is? How about profit? The underlying reason health isn’t working is that nobody actually gets rewarded for making it efficient. If you were losing money every time a sample wasn’t analysed or a technician didn’t show up, you’d do something about it.
In Health, you just ask for more money, and Labour (especially) were always willing to give it. When they came to power, health spending was $16 billion, they nearly doubled it. Until there is a real incentive to invest when it will add to efficiency and cuts costs when there is waste, it will be difficult to make health work.
$5,300 is enough to buy every person private health insurance. Why shouldn’t you be able to opt out and buy a private policy? What if you could take your share out and spent it with NIB or Southern Cross?
What if they were required to accept any patient, and keep them for life if the patient chooses. What if they purchased services off an open market of private and state providers? What if certain services where competition is not possible, such as Starship’s Paediatric Intensive Care Unit, became regulated monopolies, required to serve patients from any insurer at the same price?
Most likely, motivated businesspeople would start solving the whack-a-mole problems that beset health. Investing in labour-saving technology, fixing bottle necks, and innovating. Healthcare would become vastly more efficient. The other way to ask the question is, what if privately managed systems like supermarkets had to wait for the right person to be elected and run them?
Radical? That is roughly the structure of healthcare in the likes of France and Switzerland. If Super Minister Reti cannot fix health the way it is structured today, perhaps it will be time to ask; how do they do it in Europe?
