Health Minister David Clark is due soon to announce plans for overhauling cancer care. This might not, it has been reported, include establishing a national cancer agency.
That could be the right decision. It is possible to recognise the need for change while keeping an open mind about the agency itself.
But however that plays out, the fundamentals for one part of the system, drug-buying agency Pharmac, should not change.
Drug availability is one of several parts to cancer treatment, and Pharmac is often criticised for its failure to fund expensive drugs that could prolong life for cancer sufferers. The media regularly runs reports about desperate individuals with advanced cancer and their plight. They seek drugs at prices utterly beyond their scope. About 500 people, in their anguish, have donation pages seeking help. Patients groups also advocate for the public purchase of the latest drugs, and Parliament has been petitioned several times in the past year about specific drugs.
In contrast to such genuine and acute emotion, Pharmac is painted as hard-hearted and cruel. Often the same drugs are funded by the State in other countries - including Australia or Britain. Statistics are pointed to showing New Zealand spends less ($1billion a year) on drugs per capita than any other nation in the OECD except Mexico.
Yet, Pharmac is the envy of many governments. It removes politics from this fraught arena and Pharmac drives bargains with the massive multi-national drug companies. It has saved the country literally billions of dollars.
Pharmac was created in 1993 in the face of spiralling drug costs. It has a fixed budget and funds new drugs by saving money elsewhere. Cheap generic alternatives are used where possible and brands are switched. New Zealand achieves extraordinary bang for its drug-spending buck.
Pharmac is also cautious about new drugs that lack sufficient clinical evidence for their effectiveness. On the occasion political pressure led National to fund Herceptin for 12 months instead of Pharmac's recommended nine weeks, it seems Pharmac was correct. The extension was a political bribe that might have made little difference to life expectancy.
Labour played politics with the matter in Opposition, and now National, too, is pursing populist lines. Once it was National extolling the necessity of Pharmac and it approach. Now, it has been Dr Clark's turn to be quoted as saying "We cannot have politicians second-guessing clinical experts."
Pharmac's hardline approach causes individual heartbreak and other problems. Its changes to a cheaper or different drug can disrupt patient health. It will fail at times to fund new medicines that will make a difference. And it will tend to be the wealthier and more resourceful who can find ways to fund or procure their own drugs.
Sadly, health funding - as a potentially bottomless pit - always will contain inequities and forms of rationing. After all, it is only the better off who can afford a private hip replacement before reaching a crippled state.
Pharmac is criticised for lack of transparency, its slow speed in approving new drugs and the lack of drug choice for clinicians. Much of this, however, is necessary as Pharmac haggles with the powerful drug companies.
Perhaps, nonetheless, there is scope for a little change around the edges. There is talk of a rapid access scheme so newer potential life-changing drugs can be funded. While such programmes in Britain and Europe were unsuccessful and wasteful, they have been modified and improved. A tightly controlled system might be possible - as long as the politicians stay out of it and Pharmac's position is protected.
It is time, too, for a lift in the Pharmac spending cap. That should allow more drugs to be funded and some more quickly - hopefully without compromising the difficult and, largely, effective task Pharmac has been undertaking.
