6 March 2014

Every now and then, and usually in hushed tones, the question is asked about how affordable our public health system will be in the future. Especially so as the baby boomers age, and demand more care, and the level of medical knowledge and technical skill continues to grow. And like ice-warnings delivered to the bridge of the Titanic, it is quickly dismissed. After all, thanks to the funding injections of the last two governments, elective surgery waiting lists are largely under control, and health is rarely the front page issue it used to be a decade or so ago. As all is sailing smoothly, why rock the boat?

While there is no immediate crisis, there is no immediate concern. The good ship Public Health is in good hands, sailing serenely on untroubled waters. Or so it seems, Captain Smith.

The one thing any long-term student of health politics quickly understands is that insatiable health demands always outstrip the conventional capacity to provide. So another funding crisis is at some point inevitable, and the application of traditional methods of response, such as the injection of more taxpayer funds, is becoming more and more constrained.

A game-changer is needed. Many governments, in Europe particularly, have already moved towards comprehensive insurance based health care provision. Holland and Spain are prominent examples, but they are by no means alone. Fine Gael, the current lead party of the Irish Government produced its own plan for a comprehensive health insurance scheme a few years ago. Given the similarities between Ireland’s and New Zealand’s economies and societies, Fine Gael’s scheme merits more than passing attention in our country.

And there are other examples, far closer to home, we ought to think about. The most visionary was Australia’s Whitlam Government in the early 1970s with its comprehensive Medicare programme which was never fully realised because of the near decade of  conservative governments after 1975. And New Zealand moved significantly in that direction at about the same time with the introduction of the comprehensive no-fault personal injury Accident Compensation scheme. While the Woodhouse principles on which ACC was founded have been compromised somewhat over the years, the essential framework remains intact.

The opportunity is thus there already to establish a comprehensive national health insurance scheme for all New Zealanders by building on and expanding the coverage provided by ACC.

This will not happen overnight, just as the shift to cradle to grave social security did not automatically follow the election of Michael Joseph Savage in 1935. It will take commitment and dedication, persistence and determination, and possibly a support party pushing for a government to investigate such a scheme as part of a confidence and supply agreement for the idea to get the traction it needs to take off. But as the days start to lengthen, the skies begin to grey, and the whiff of ice increases, the Captain Smiths on the bridge may just start to think this is a course adjustment worth making.