Posts Tagged ‘Health’

Preventing the success that we celebrate

datePosted on 13:41, August 25th, 2009 by Anita

On the 1st of April this year I got a nice cheery tax cut because, according to our National ACT government, people like me on the top tax bracket are the hardest working and most deserving. As a private sector worker earning a good wage, paying my mortgage with some to spare, and barely noticing the recession I suspect they’d say I was exactly what success looks like to them.

Oddly, though, under the current policies of this government I’d probably still be on the sickness benefit able to work only 5-10 hours in a good week.

Not so long ago, due to health and crime circumstances beyond my control, that’s exactly where I was. Getting me back on my, “successful”, feet was a combined effort of systems, organisations and people; a genuine welfare system. I was fortunate to receive good welfare support from the benefit system, counselling through ACC’s sensitive claims, awesome care from the public health system, support from a state sector with a commitment to equity and workplace reintegration for people with chronic illness and disability, an open accessible education system, and a first class public transport system. Not to mention the variety of public servants in a wide range of organisations with the time and mandate to help me through.

How many of those systems will survive the current policies? How many face cuts that make the services useless or impractical? How many of those good people have been made redundant by the state sector cuts? Or overloaded by work from their departed colleagues? Or operating under new “guidelines”?

National and ACT may laud people like me who succeed in their eyes, but they’re taking away the small pieces of  support that make our success possible.

So the next time you see the politics of envy rhetoric, think of me: given a tax cut I didn’t need and wishing that every cent had been put into the services that we all rely on when things go wrong.

National are, true to prediction, privatising health provision. Also true to prediction they are doing so in a way that gives all the wins to the private sector and keeps all the financial risk for the taxpayer. Private providers may look low cost, but that’s only because they transfer huge amounts of cost to the public sector in terms of both management and back-stop services.

To give an example of a well known issue with private providers, every hip operation has a low very chance of complications leading to the patient spending time in an ICU.

When we cost public provision of a hip op we cost in a part of the cost of public ICU services. When we cost private provision we don’t, but we have to pay for the public ICU costs on top of the private hip op charge. That’s the first issue with the private provider efficiency – they rely on expensive back stop services being provided by the public sector. So we screw the costing model so that the private provider can make a profit off every hip op that goes well, and the public system ensures them against additional costs for the unavoidable not-so-good outcomes. Privatise the profit, socialise the loss!

The second is that there is additional cost in transferring a patient with complications from a private provider to a public ICU – we’re not only screwing the cost model to the benefit of private providers, but we’re actually incurring extra costs to do so.

Third problem? No matter who actually does the surgery “bureaucrats” are required to manage the provision, the eligibility, the bookings, the payments, etc. If one region uses eight small private providers then while each provider might look cheap and light on management there’s going be a team somewhere in the public system making sure that all the patients are allocated and treated, that the contracts are negotiated and the bills are paid and so on. Again, more inefficient that a single large provider responsible for both allocation and provision, again designed to make the private sector look lean and efficient, and the public sector bloated with bureaucrats.

Why, when so many other countries have proved that private healthcare provision is neither cheaper nor more effective thanpublic provision, when our largely private primary health provision is failing to meet demand, and when it is obvious that the private sector would only involve itself in healthcare so it could turn tax dollars into a tidy profit, is National pushing on with privatisation?

Part of the answer is ideological blindness, but part is also the make up of National and its closest friends. The links between National and the private healthcare lobby go back decades. In recent times the fundraising, personal and lobbying ties between National and the Private Hospitals Association are well documented in The Hollow Men, and a quick glance through the list of current National MPs shows just how entwined they remain, from Michael Woodhouse (ex-President of the NZ Private Surgical Hospitals Association), to Jonathan Coleman (a consultant in the medical sector) the list of Nats with personal interests in the profiteering of the private healthcare sector is deep and long.

Between ideology purity and self interest it looks like we’re on a long journey to inefficient expensive and ineffective privatised healthcare courtesy of Tony Ryall, John Key, and friends.

[This borrows from a comment I made on this thread at The Standard. Marty G has some great analysis on just how much of the current National spin about healthcare costs is … just spin]

What do they mean by private healthcare provision?

datePosted on 06:00, January 23rd, 2009 by Anita

In a number of threads people have brought up the idea that our existing publicly provided health system is fundamentally flawed and should be replaced by a privately provided healthcare system. Every time I read that argument I want to make a single (bold face) point:

The vast majority of our healthcare is provided by private providers.

The vast majority.

Take me for example, I see my GP (private provider), I have blood tests (private provider), scans (usually a private provider), take medication (private provider) and see a number of specialists (my main one is public but occasionally other public or private specialists). All except the specialists are private providers at least partly funded by the government.  One specialist is a public provider entirely publicly funded.

The only surgery I ever had was in a private hospital fully funded by the government.

So why, if the current health system is so broken, does anyone think that private provision is the answer?

I can see three possible reasons National and Act are arguing for “private health provision”:

  1. Transfer the last of the public money to the private sector to create private sector profits for shareholders.
  2. They don’t mean “private provision” they mean “private funding”, they actually want to cut the government spend and rely on individuals funding their own healthcare. Advantageous for the wealthy (who already have health insurance and would benefit from the tax cuts), disastrous for the poor who can’t afford private cover or care and don’t get tax cuts from the Nats.
  3. Ideological blindness.

Two are awfully cynical and the other requires a level of stupidity I don’t believe they have, any other offers?

Act says: solve everything by privatising everything

datePosted on 09:38, January 14th, 2009 by Anita

Roger Douglas was on Morning Report this morning, once again banging on about how we should privatise more stuff to save ourselves. I was interested to hear him complaining that National led government isn’t doing what he said they should, given that they clearly are. They have plans for

  • privatising more health provision
  • private prisons
  • increased funding to private schools
  • private competition in work accident insurance
  • privatisation of many local government services
  • private provision of social welfare services

Exactly what is Douglas concerned National is unwilling to privatise?