The crunch paragraph in the ministerial health review group’s report is on page 8: it recommends another review in three years.
The group says that “working within the current legislative framework allows much earlier action” to meet the challenges. But it “runs the risk of not going far enough fast enough”. So, review the review.
The “challenges” can be met short-term by way of the clinical and administrative reshuffles it suggests, but not long-term. The risk for under-40s is that their needs will not be met 20 or 30 years down the track — just as national superannuation is at risk.
This is not a newly recognised risk. Early in his term as Finance Minister Michael Cullen said pointedly in a budget speech that health spending was rising faster than gross domestic product (GDP) and that could not go on forever.
The review group says: “Since 1995 growth in health spending has exceeded growth in national income by 30 per cent.” This country now spends a higher share of GDP on health services than the OECD average. And still there is a gap between demand and supply.
The group says, as Cullen did: “Clearly, this is not sustainable longer-term.” It quotes forecasts of a near doubling of health spending above inflation over the next 20 years.
The baby-boomers are about to start “retiring”, with long lives on average stretching ahead and consequentially higher costs of maintaining them.
And researchers and engineers are devising ever more complex and expensive interventions to treat ever more hard-to-treat ailments. They are also devising ways to do things more cheaply but cost rises outweigh cost falls. This may reverse at some point but that is unlikely for some decades.
So, the group says, “new models of care” will be required.
It proposes, in effect, a resurrection of the 1990s health funding agency abolished in 2000 as ideologically incorrect just as it was getting to grips with costs and services. That essentially returns to the 1980s philosophy of separating policy from funding, which has had a chequered history.
It wants services more clinician-led. It wants more of the cooperation across the arbitrary district health board and clinical boundaries which was started some time back. It wants the ailing primary health organisation (PHO) system cured so PHOs deliver on their intended purpose of coordinating the health care of their enrolled populations and focus on keeping people well instead of just fixing them when they are sick. (An early notion of PHOs “budget-holding” total care didn’t make it into the final report.)
That bumps into an elephant in the health room: lifestyle choices which push up eventual health care needs. For example, kids, especially poor kids, eat bad food. (So do many adults.) That is a recipe for being ill later.
The government canned one attempt to address that — a ban on junk food in school tuckshops — as a “nanny state” imposition on free choice. That sounded good on the hustings but at some point a serious health minister will have to contemplate serious preventative measures. An optional prime ministerial run round a footy paddock won’t suffice. The review group limply calls for “continued emphasis on helping people to take greater responsibility” for their own health.
Tomorrow’s taxpayers have an interest in prevention now.
That turns the light on a large elephant the report in its published form skirts: who will pay and how they will pay.
Already, those who can afford it take out insurance to pay for their “elective” surgery (only medicos think a sane person “elects” to have surgery). Thus, in addition to paying tax to run the state health system, they pay privately because the system cannot provide.
For the next five or 10 years the review group’s limited adjustments may well allow us to avert our gaze from the who-and-how-to-pay elephant. In that it has served its government accurately.
Ministers adamantly believe that voters’ expectation of “free” services paid out of taxes is embedded in this country’s culture.
But if you are under 40 do you believe that the government will still be providing “free” all the health services you need when you get to 65? Or to 80? Do you think the (proportionately fewer) taxpayers of 2035 will cheerfully pay more and more tax for your cohort’s care as you decay? (Along with cheerfully paying more tax for your pension?) Might they not instead, as Labour’s Ruth Dyson says the group mused in an early version, insist you work past 65?
Or do you (under 40) think it might help to have, say, a state-sponsored system that enables you to build up entitlements so that you can make up the difference between tax-funded services and your needs? (Along with a state-sponsored system to build up a pension?)
Oops. That forgets governments think in three-year chunks. The review group went outside its terms of reference with its implied suggestion of more innovative thinking in a review in three years. Such thinking can be risky.