‘the health of the people is really the foundation upon which all their happiness and all their powers as a state depend’ - Benjamin Disraeli

By definition the public health system exists to meet the health care needs of the public. It is a government-administered, publicly-funded, universally-applied service. Or that, at least, is what most people imagine to be the case. The reality in 2006 is very different.

The cost of health care is very high, in part due to increases in the cost of the purchase of hi-tech diagnostic tools, advances in treatment options, the increasing cost of pharmaceuticals and also to the cost pressures of specialist recruitment and retention in a highly competitive global market. And the administrative cost of the health bureaucracy seems to suffer from the sort of exponential growth which must be the envy of many businesses.

The result is simply that health services in New Zealand have been rationed. Not all New Zealanders have access to health care in a timely, affordable manner. In fact we’ve been put on very short rations indeed. Those who can, take out private health insurance. Those who can’t, wait….and wait……and wait. More than 12,000 tax-paying New Zealanders have been either removed from their places on waiting lists around the country or been advised that they soon will be. Instead of patiently waiting to see a specialist, they are to return to their GPs. It seems that only those in the direst need are able to receive the attention they are entitled to. On the face of it, some elective surgery seems to be suited to lower priority status. But given only a little reflection it is clear that any need for surgery is a situation which must cause discomfort, inconvenience, reduced quality of life and may require additional care for the patient.

In addition to being cruel, it seems so short-sighted to leave patients until their level of acuity is high, and therefore more expensive, before giving them access to appropriate treatment. Some District Health Boards have accepted that they face a grim choice: balance the budget through finding efficiencies or cut services. Many DHBs have already cut all the fat from their systems but still believe they are under-funded for the services they provide. The DHB solution, despite being an unpopular one for elected representatives to choose, is to cut services.

Democrats for social credit  believe that one of the most obvious flaws in the funding of the health system is the practice of government borrowing money from overseas banks and on-lending it through the Ministry of Health to DHBs. These borrowed funds are subject to the usual market interest rates which inflate the repayment figures making paying for capital expenditure such as the purchase of new equipment or the building of a new hospital an even more expensive component of the health budget. Our solution is for the government to borrow the money from our own Reserve Bank of New Zealand, without interest but with a small administration charge. In this way, the principal sum is repaid quickly and only once, not three times over as can be the case with interest-bearing debt. We propose that the health sector have access to cheaper money. It’s that simple.

Of course there are many aspects of the health sector which could benefit tremendously from a move to Reserve Bank funding options. The aged care facilities which were either closed down or handed over to the private sector could be re-established. Afterall, which part of “public health care” do our older people not belong in? They are members of the New Zealand public, their health determines their ability to participate in their communities, and many of them are in need of care. Yet they are excluded by virtue of cost of provision of the care they need.

The government has devised any number of “strategies”, many of which come with a “toolkit”, aimed at prevention or targeting specific groups or populations. That’s all great, on paper, but is not going to benefit too many souls if in the final analysis the cry is “we can’t afford it”. We can afford it, all of it, if the political will to explore the Reserve Bank funding option exists.

A cynic might wonder whether the DHB structure was actually established to create a buffer between the government and the people on the health issue. Certainly the big dream of democratically elected representatives making good health provision decisions on behalf of local people seems to be fading as the impact of financial constraints is realised.   What we need to remember is that the buck stops with the government. That is where the decisions about funding allocations originate. The government decides from whom the money needed shall be borrowed.

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