How Labour can fix health unclear

David Clark

Labour's David Clark was somewhat apologetic this week about vague answers he gave in an interview to the Otago Daily Times about his party’s health policy.

It is understandable the party will keep its health policy under wraps until  nearer the September general election. Although it largely failed to land big hits on National in the vexed portfolio, Labour has succeeded in making health funding an election issue.

It is unclear how Labour would restore the $1.7billion it says has been cut in recent years, while meeting new pressures, and running budget surpluses. It is trying to respond to the growing realisation that the part-privatisation of New Zealand healthcare has had unintended consequences. More than a quarter of adults cannot afford at least part of their primary health care, such as general practice visits, a study recently published in the New Zealand Medical Journal found.

Oral health, GP visits, and mental health are likely to receive funding increases  — and that is on top of the $1.7billion. A Labour-commissioned Infometrics assessment says $1.7billion was effectively cut from the health budget between 2010 and 2016 by not keeping up with increasing demand.

Labour’s given itself an out, saying the money would be refunded as fiscal conditions allow, which could mean anything. National’s argument is that Labour chucked money at the health sector and it has forced the sector to operate more efficiently.

Health spending as a proportion of the economy (gross domestic product) has fallen since National took office. National’s target-heavy approach to health means only those who meet an arbitrary threshold for, say, surgery are counted as waiting, meaning those who are missing out are hidden.

More fundamentally, a focus on a few big targets led to a somewhat flat-footed approach.

The surge in public interest in mental health which has gone largely unanswered is a good example.

Mental health has not had such a high profile since the 1996 Mason Report. 

National ignores calls for a review, but it would do well to rethink that.

The head of steam that has gathered in mental health is partly because of a cultural shift in society, where people feel more open about it.

General practice is another area quietly in crisis, and National is unwilling to tackle it.Health Minister Dr Jonathan Coleman walked away from the recommendations of a working party convened to look at reforming GP charges. He said it would be unpalatable to expect some patients to pay more in order for poorer people to pay less. 

Of course, the spectre of some patients paying more will also be politically unpalatable for Labour, so it will need to find more money overall for GP care. It remains unclear how keen Labour is for reform and upheaval in health. Annette King, Labour’s health spokeswoman before stepping out of the portfolio this year, was the architect of much of the existing health system. As health minister, Mrs King introduced district health boards in 2001, and that made it difficult for her to land hits on National when she was in Opposition.  Dr Clark has the advantage of being free of the baggage of the past.

One of the first things he will do as health minister, he tells the ODT, is call a summit of all the players in health.

In a Labour-led government, the Dunedin North MP is the only contender for the role because of the departure of the Green Party’s Kevin Hague and upcoming retirement of Mrs King.

Before Mr Hague’s surprise exit from politics, the former health board chief was expected to take the role in a Labour-Green government.

For his credentials, Dr Clark points to his Treasury social policy work, the tutelage of Mrs King, and a family tie to medicine.

His mother studied medicine while he was growing up, and it became part of his life.

Dr Clark says Labour will take a broader approach to health — and that means looking at the likes of poor rental housing stock as a health need.

"We need to have health in all policies.

"I would want to see the health lens put over all policies," he said.

It is a bit like National’s social investment in welfare but applying it to health.

New Zealand has appalling rates of diseases and hospital admissions with a "social gradient" — meaning poor people bear the brunt of them — like rheumatic fever. Changing that would mean saving money in the long term through having a more successful economy and less burdened hospital care system. But Labour has signed the Budget Responsibility Rules with the Green Party to try to inoculate itself  against charges it spends too much in government.

Meeting short-term financial goals is partly why — Labour also argues — New Zealand’s health service has been starved of funds.

Dr Clark insists Labour can be fiscally responsible while expanding health cover to more people.

"Labour’s track record on delivering what it promises is pretty good.

"In fact, sometimes I think we are a bit over-cautious because we don’t want to promise something we can’t deliver," he said.

This is not the first election in which Labour has talked about social inequalities in health, but its policy promises remained modest. It remains to be seen just how high a bar Labour is willing to set itself.

eileen.goodwin@odt.co.nz