The Sunday Long Read

The Slow Death Of Our Public Health System 8/12/24

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The Slow Death Of Our Public Health System

My Scottish mother had a saying – “You never miss the water ‘til the well runs dry.” In other words, we often take for granted things that are precious until they become scarce or disappear altogether. Our public health system is one such well.

There was a time when we believed that everyone has the right to free public health care and while I’m pretty sure that most of us still cling to that principle, we are told by the current coalition government we can’t afford a quality free public health system and for some years now we have been witnessing the construction of a two-tier health system where the rich quickly receive the very best treatment available, and the poor don’t.

Why? Because the low tax ideology of the neoliberal economic system, under which we live, promotes the selfishness of individual rights and downplays the duty of care we should have for each other.

Skin In The Game

Let me admit, if it is not already clear, that I’m a staunch advocate of free public health and medical care. For a start it has kept me alive to write this piece, and it has kept you alive to read it. So we both have skin in this game.

I’ve written elsewhere that I was the first member of my family to be born in a hospital. That was in 1948, the year the NHS began in the UK. We lived in Edinburgh in the slum area down by the docks, and every member of my family before me had been born in their parent’s bed, the sheets of which may, or may not have been washed that month, because it was in the days before washing machines became a household item.

My mother told me that my dad’s father died in agony from bowel cancer in our tenement flat, because we were poor, and going into hospital was expensive. However, when I was born and got whooping cough and measles, pretty much at the same time, in the first few months of my life, the nurses and doctors at the Western General Hospital gave me expert care – so here I am, still causing trouble.

Some Key Dates

So, how did we get to the point where we don’t have enough doctors and nurses, and a government talking about privatising some (but I am sure they would prefer all) of the hospital system? If we wind back the public health clock a few key dates stand out.

• 1847: Auckland Hospital became the first public hospital in New Zealand, followed by Wellington Hospital. So just 7 years after the signing of the Treaty Of Waitangi we embraced the idea of free medical care for all in time of need.

• 1900: The Public Health Act established a Department of Public Health staffed by full-time government officers with expertise in public health.

• 1938: The First Labour Government passed the Social Security Act setting up a universal and free public health service, making New Zealand one of the first countries in the world to ensure that everyone had access to free medical services. The system was funded through taxation and embodied the principle that health is a fundamental right.

• 1945-The post-war period further bolstered the system with investments in hospital infrastructure, primary care, and public health campaigns. Notable achievements included the control of infectious diseases such as polio and tuberculosis, improvements in mother and child health, and advancements in medical technology. These efforts were underpinned by a strong public service ethos and a belief in the value of collective welfare.

• 1984 – the Fourth Labour Government adopted neoliberalism as the country’s economic ideology. The mantra became “user pays”. Or, to put it another way, if you can’t pay you can’t use. But don’t worry, Roger Douglas assured us, the rich might get richer but some of that wealth will trickle down to the poor so everything will be fine.

• 1990’s - But it wasn’t fine. Wealth trickled up not down as consecutive National and Labour led governments put neoliberalism on steroids, reduced taxes and slashed services run by the government in the public good – such as our electricity network and yes, hospitals.

The emphasis on market efficiency, cost-cutting, and privatisation across the public sector led to the introduction of user charges for some healthcare services and a focus on managerialism within hospital administrations, which fragmented the system. The creation of competitive Crown Health Enterprises (CHEs) replaced the integrated public hospital boards, shifting the focus from public service to financial performance. These changes undermined the universal nature of the system, particularly for Māori and Pasifika, creating huge disparities in health outcomes and a post code distribution of health care with rural and remote areas struggling to access timely and adequate care.

It got to the point that Kiwis with money started buying private health insurance, a process that has steadily gained momentum, until today we are starting to see again the re-emergence of the philosophy that excluded my grandfather from hospital but allowed the wealthy to get immediate and expert medical attention.

Budget Cuts and Bleeding Stupidity

The COVID-19 pandemic exposed both the strengths and vulnerabilities of our health system in workforce capacity, infrastructure, and mental health services. These challenges underscored the urgent need for systemic reform so in 2022, the Sixth Labour Government consolidated the 20 District Health Boards into a single national health entity, Health New Zealand (Te Whatu Ora), and created the Māori Health Authority (Te Aka Whai Ora). The aim was to reduce inequities, streamline healthcare delivery, and address the historical underrepresentation of Māori perspectives in health policy.

As our population ages so the demand for healthcare services, particularly in hospitals, is growing, and while our public health system is still relatively comprehensive, it is constrained by budget limitations. But quite where to draw the bottom line on the health budget is the matter facing us right now.

So now we come to the current National Act NZ First coalition government and Health Minister Dr Shane Reti, who has declared the problem with our troubled health system is that the last Labour led government allowed Health New Zealand - Whanau Ora, to “blow their budget”. He promptly fired the Board and put Commissioner Lester Levy in place to make the severe cuts he deems necessary. In an ACT- driven moment, it was also decided it was unfair that Māori and Pasifika peoples got special attention on the basis of race and axed the Māori Health Authority.

None of the content of that last paragraph is justified. The problem is not that areas of our health system are running over budget it’s that consecutive governments since the 1980’s have UNDER FUNDED our health system .

That’s why, for example we now have a shortage of doctors and nurses and why there are waiting lists for elective surgeries, such as hip replacements or cataract operations.

It is a fact that Māori and Pasifika peoples have had the poorest outcomes from our health system and pretending otherwise will cause unnecessary suffering and deaths.

So… what?

The first thing to realise is that we are not a poor country. Internationally we have a AA+ credit rating . So our government could borrow, at very low rates of interest, to build a new hospitals, raise salaries for doctors and nurses and embrace new technologies and medicines to keep our citizens healthy. But the current coalition government won’t do that, because they have a myopic, self-centred, view of the purpose of an economy.

The government has failed to learn the fundamental lesson of the Covid epidemic that most illnesses are caused by the person-to-person transfer of nasty bugs. So putting human compassion aside for a moment, it’s in the self- interest of the wealthy to look after the well-being of the poor, because next time they get into a taxi and the driver coughs then they might also get whatever is ailing that driver.

They don’t seem to understand the relationship between public health and productivity. People who get sick can’t work so productivity goes down. If a child get sick and a working parent has to stay home to look after them, productivity again goes down. So spending money on public health is not a waste of tax payer money, it is actually an insurance that the economy will not be stalled by some preventable epidemic and tax payer dollars will keep being generated.

But you don’t see that kind of social accounting in neoliberal driven governments. What you see is a concerted effort by ‘the haves’ to take far more from society than they give through sanctioned tax avoidance schemes such as milking the property market to deliver untaxed wealth on property, as our Prime Minister has gleefully done twice this year with a third property now on the market.

The eminent American jurist Oliver Wendell Holmes Jr is credited with the saying that taxes are the price we pay for civilization. So if you are finding it really difficult to get an appointment with a GP, or your local hospital needs repair or a completely new one built, then look to the way neoliberal governments allow the few to hoard untax wealth at the expense of the well-being of the many,

1948 was certainly a very good year! Not only did the NHS save my life but the United Nations passed the Universal Declaration of Human Rights which New Zealand not only signed, but our then Prime Minister, Peter Frazier, helped craft – especially Article 25 which states

1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including foods, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

2. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

While the language of that Article reflects the age in which it was written, never -the- less there is a common good principle embodied in it that we signed up to as a nation but we are not honouring, because we have adopted an economic system that promotes the selfishness of the few over the well-being of the many,

The time is long overdue when we need to reaffirm Article 25 and reform our tax system, so that the top 1% pay their fair share in order that we can take our ailing health system off life support and restore it to being the vibrant functioning social entity we once had, to ease our pain, cure our ills, and wherever possible help to keep us from getting sick.

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