A slight change this week for Richard McGraths regular column – a brief critique of Gareth Morgan’s musings on what can be done to improve our health system . . .
Gareth Morgan recently seems to have appointed himself Minister of Health, perhaps to draw attention away from the abysmal performance of his company’s KiwiSaver fund.
He is flogging a book called Health Cheque, and on his website makes the observation that the public health budget is consuming vast amounts of taxpayer money. Is it, he asks, a sick puppy, or the victim of unrealistic expectations?
He investigates “why there is so much political instability around the organisation of health services,” and offers his own 14-item prescription for improving health care in New Zealand.
Dr Morgan persists in misnaming political manipulation of the health market as “reforms.” My understanding of reforms is that they should simplify things and peel away layers of regulation and bureaucracy. By that standard, mothing the National Party has done in the area of health care since their election in 2008 could be properly labelled “reforms.” At best they are a rearrangement of the current state-imposed system of DHBs, PHOs and other acronyms that health care providers have had to accommodate into their daily working lives. Any reform is (hopefully) yet to come.
So, what are Gareth Morgan’s 14 prescription items? In essence a rather disappointing collection of platitudes, one of which pays fleeting lip service to individual freedom, along with some patronising advice to health care providers and a heavy dose of PC bullshit and some rehashed socialism.
Let’s start with a bright moment. Number 14 on his list states: “Individuals are ultimately responsible for their own health.” Bravo, Gareth! But this comment should be placed at the top of the list, where it belongs - not tacked on the end as an afterthought and ignored.
Three of his 14 points focus on some of the services he thinks health providers should offer – doing simple treatments well in the interests of economic efficiency, explaining the pros and cons of specific treatments to patients, remembering the role of palliative care, and the notion of arranging advance directives.
Morgan states one aim of his prescription is to “stop the need for frequent cash injections into the public health system.” So what does he think the government should do? Get out of the way? Sadly, no.
Let’s do a “health check” on some of Gareth’s prescription items.
“Item one: There will never be enough money to fund all healthcare demands, which are growing faster than our ability to pay.”
He forgets to mention that in a free market the cost of products tends to drop and their quality improve (or both) over time. And as health services improve—driven not by governments but by free market innovation-- people's expectations of what can be achieved also rise, driving further discoveries and breakthroughs in order to try and match the demand of individual consumers.
Dr Morgan also collectivises demand, which is actually just the sum of this individual demand. He neglects to tell us that in many cases, people are willing and able to fund their own health care--and do so, despite being taxed to pay for the health needs of others as well.
“Item two: We spend enough on the health system, and there will be negligible benefits from additional public funding.”
He’s right there - too much is spent propping up the failed socialist model of health care. Funding should be withdrawn and redistributed back to those who were made to put money into it – the taxpayer. Not that he suggests doing this.
“Item three: The purpose of health system is longer, healthier lives for all.”
Bollocks. It’s about better health for me. And you. And anyone willing to invest in their health. As individuals. I don’t want people like Graeme Burton or David Benson-Pope to have a longer healthier life, thank you very much.
Other items drone on about limited budgets and the “greatest improvement in collective health and lifespan”, a “formal, evidence-based non-political process to oversee prioritisation of care”, more “prioritisation” of services and an emphasis on preventive and early intervention, especially for the underprivileged.
For prioritisation, read rationing. That’s how socialist systems work. The government (politicians and bureaucrats) decides who gets treatment. People such as the “rich pricks” who fund the system get no guarantee of care. In fact, no-one is guaranteed care. A number of my poorest patients have recently been denied health care at Wairarapa Hospital because, despite paying taxes all their lives, they are not considered sick enough.
That’s how socialised medicine works. It’s not a health insurance system where there is a contract to cover certain conditions. In fact, a lot of the time it’s a Ponzi scheme bordering on insolvency.
I won’t run through some of Gareth’s other points, as they assume a role for the coercive funding of health services and a politically-run state health sector that he wishes wasn’t so political. He assumes such a system is morally justifiable. Sorry, Gareth, but I can’t justify a die-while-you-wait medical care structure based on the ethics of Joseph Stalin. You seem to be able to sidestep that inconvenient little eight-hundred pound elephant with deftness and ease. I can’t.
The most egregious item in Gareth’s prescription is number 13, which basically states that the treatment of obesity-related and other problems may need to “parallel” that of smoking –which means reliance on bullying, bans and taxes. A new focus for Nanny State.
Gareth, you are truly a piece of slime if you believe this. Notwithstanding that the draconian disciples of dictatorship who want to ban smoking, drinking and all forms of pleasure model themselves on the people that ran Germany in the 1930s, can’t you see that one of the first things to be banned in the reign of terror which your health system would inevitably become is riding your beloved motorcycles, statistically a very unhealthy practice. One of my surgical colleagues calls motorcycle riding the fast track to the orthopaedic ward. Another calls them donorcycles. Gareth, you moron, don’t you see a prohibition on motorcycle riding would follow shortly after that on smokes, booze and fat people?
Perhaps then, to have the next and final item on the list suggest that individuals should be responsible for their own health is an Orwellian private joke, Gareth?
So what would I suggest instead? Obvious, really.
Here then is Dr McGrath’s prescription:
- Individuals are ultimately responsible for their own health.
- Health care is a commodity which can be traded.
- The fairest, and most efficient, means of transacting health care is in the private sector, in a deregulated free market.
- A transition from the state-run, politically vulnerable model of health care provision to the private deregulated model is possible.
- This transition can be achieved via a number of small steps whereby taxation is reduced, and personal wealth increased, allowing for personalised health plans pitched at different levels of affordability.