Friday, September 28, 2007

A closer look: National on health

On Wednesday, the National Party released the first glimpse of its health policy, a discussion paper [PDF] promising "Better, Sooner, More Convenient" health care. Much of the media coverage has focused on their duplicitous decision (not mentioned anywhere in the discussion paper) to remove the cap on doctor's co-payments and leave it all to the market - a decision which would have disastrous consequences and which they are now backtracking on. But what about the rest of the policy? Is there anything actually in there?

Not really, no. While there's a lot of noise about the size of waiting lists and what a mess the health system is at the moment, National isn't actually promising much in the way of changes - they explicitly disavow reform of the DHB system, for example, and promise to retain Labour's re-universalisation of primary health care (but see above). So overall, their key policy seems to be "we'll manage it better" (with tax cuts!). Whether this is believable given their previous mismanagement (or the deceit exposed by their policy announcement) remains to be seen.

That said, they do make a few suggestions. Unfortunately, they're not exactly encouraging. On waiting lists for elective (non-urgent) surgery, they talk up a storm about how waiting lists are too long and this is unacceptable. But their "solution" - paying surgical teams a bonus for every operation completed - fundamentally misses the point. Elective surgery waiting lists are not caused by lazy surgeons or inefficient DHBs in need of "incentives" - they are caused by central government not funding enough operations to meet the demand. But National explicitly disavows any solution involving more money, saying that this would simply lead to "cost inflation" and that any gains would only be temporary. The real reason, of course, is that it is money that could be spent on tax cuts.

It's a similar situation with A&E waiting times. Again, lots of noise, but at the end of it all their key "solution" is better management. Colour me underwhelmed. What's worse is that in this case they diagnose the problems - A&E wards clog up because there are no beds in ordinary wards to discharge patients to, and because of staff shortages. These are clear capacity constraints, and the obvious answer is to increase capacity to meet them. But that's anathema to cost-shy National, who instead prefer to think they can gain efficiencies by screwing overworked medical staff even harder - just as they did in the 90's.

Much is made of greater use of the private sector, through contracting out and public-private partnerships. But overseas this policy has been a disaster, with hospitals forced to cut back on services in order to meet profit targets. The financiers get rich, but the people stay sick. But then, that's the point - as with their privatisation kick, this policy is about looting the state and funnelling public money into the private pockets of their donors and cronies, not about actually solving problems in the health sector.

Finally, there's the suggestion of offloading more work onto GPs in order to free up capacity in tertiary care. This is what PHOs are supposed to be about, and its good if those GPs have the funds and powers to provide the necessary care to their patients. But I'm somewhat warier of their suggestion for performing surgery and such in "Family Health Centres"; while seemingly about merely co-locating GPs and specialists to make access easier, the capital investment required means that these new facilities are more likely to be built, owned and operated by large medical companies. In other words, what National is talking about is devolving an increasing portion of our health services to privately-owned and profit-making mini-hospitals - privatisation by stealth.

So overall, not a particularly impressive policy, and actively bad in many of the solutions it suggests. And it raises the same question as their aged-care policy at the beginning of the month: does National have a policy which isn't about looting the state to repay its donors? Or has our main opposition party devolved completely into kleptocracy?