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6:00 am, July 1st, 2022 - 66 comments
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The current rise of populism challenges the way we think about people’s relationship to the economy.We seem to be entering an era of populism, in which leadership in a democracy is based on preferences of the population which do not seem entirely rational nor serving their longer interests. ...
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https://i.stuff.co.nz/national/politics/300626662/eu-and-new-zealand-secure-free-trade-agreement
Despite the local complaints that the PM shouldn't have gone, looks like her presence and Damien O'Connor's presence were critical to getting the deal over the line.
In addition to some good outcomes, it also includes climate enforcement, so a handy tool to convince the agricultural sector to reduce emissions.
How good it is I can't say yet, a lot to take in. But it's worth it just to watch the PM's haters react …
"We need a proper CEO to get a trade deal not a princess doing a photo-op what a wasted journey she'll never get …
oh shit, she has."
It does seem rather ironic based on some of the crap I read prior to the trip.
However I wonder if her critics have the capacity to understand irony. It usually seems to me that they are rather wedded to living in a misogynistic 19th century society.
Mind you I also consider they are such completely incompetent wannabe arse-lickers (Mike Hosking comes to mind) that they fail to understand that having skill in business has virtually no relevance to having skills in politics.
I've worked in and around both (I avoid becoming a politician or a manger) and I can't see much of transfer between the skills sets. My opinion is that being competent line manager is usually a detriment to becoming a politician. John Key was interesting when you look over his career. I get the impression that his business roles were more selling and politics than managerial.
I haven't time to do a full article on it, but structural theorists ought well have a crack at the reaggregation of the state since as of today we now have one single health entity.
In the late 1980s and early 1990s so many public services gained fresh legislation that assumed strong communitarian voice into prioritisation of many kinds of state service.
Primary and secondary education got Tomorrow's Schools and the formation of school boards with locally elected representatives.
Local government got the 1989 act that required all budgets to go to public consultation. Hundreds of tiny councils were joined into sub-regional blocs.
Regional government was professionalised and given specific tasks held over from Rabbit Boards and the like.
Health got the full regionalisation of health provision with the formation of mostly elected District Health Boards to reflect regionally specific delivery.
Polytechs were clumped together into regions to reflect industry specialisation and response.
Even the entire territorial ocean was divided up into policed and tradeable blocs of fish.
Maori were strongly regionalised through negotiating Treaty settlements through iwi, and professionalised as a result.
Government also generated regional growth strategies, encouraged with bounteous wheelbarrows of cash if the regions did the work.
This regionalised set of structures corresponded with a strong legislative underpinning within the new RMA that local voices could, if regionally collected , truly stop or alter the power of the big state and of big business – and that still remains the case.
The citizen empowered was at the heart of this. They were to stand and represent within public service structures.
Power and decisionmaking was supposed to be delegated down to the lowest appropriate level.
It is this government that has killed most of this communitarian citizen off in favour of centralised structures.
There is no current proof recentraliation will do good. It will of course take many, many years to measure any good in it. And we are a vastly different country to what we were 35 years ago.
There's certainly a pattern to what Labour are doing, but I'm not sure there's a logic.
If one is around for long enough in a business or other organisation – it's not uncommon to see an oscillation between centralisation and decentralisation, with each announced as exciting and original, and each aimed at solving the same set of problems. Which might suggest that neither the origin of, nor the solution to, those problems lies in the structures of the body tasked with solving them. But working on structure and culture is a technocratic and non-ideological thing to do – a comfortable place for centrists to play in.
It 's not enough to simply observe it as a generational binge-purge cycle.
It affects services delivered to us all, from cradle to grave.
"I think we've really cracked it this time…" – hope springs eternal.
At the start of Covid one of the main reported problems was that hospital systems could not talk to one another. It wasn’t supposed to be like that but 22 separate ideas on what computer system was needed ended up in an expensive farce for only 5 million people.
Just another neolib failure…..these 22 !! DHB’s act as self contained mini empires. Who ever thought that was a good idea ? !
Also when whistle blowers tried to alert of the above linked CRIMS..(and there are many more) they were told mind your own business !. Hey, just like always.
Geraint Martin……I certainly remember that name….and then he shuffled off to Te Papa. And after “fixing” things, then shuffled off from there…..
https://www.nzherald.co.nz/nz/te-papa-chief-executive-geraint-martin-quits-after-controversial-restructure/ROIIS65LEFTWHI6RFZGF4UFVNM/
Labour thought that they were a good idea at the time. The DHB came into being under Helen Clark.
You need to go back earlier than that. This timeline is some help – though I can remember locally-elected hospital boards prior to 1983 where this timeline starts. In short, there is a long history of structural tinkering from both major parties. A quote from the piece:
The problem is that there are drawbacks to both centralisation and regionalisation.
If everything is centralised, services are integrated and consolidated but you lose the local representation, and then decisions like "oh, it's most efficient to have a single head trauma centre up here, 95% of patients will have helicopter access within ideal treatment times", and bugger the 5% who don't get treatment in time. The old "the numbers are so small it doesn't matter" problem.
But likewise, regionalisation gives so much local control that treatment can become a postcode lottery, and cooperations between areas is difficult.
And then governments see a big restructure as a great way to conceal (or promise to address) the systemic underfunding of the health sector that has existed for decades.
It was…………..Labour? Aaargh. And Helen Clark ? Noooooo.
Well if that was meant to be some shocking zinger for me….bad luck, lol.
As with every IDEA … fuckwits will pervert the intent. HENCE my comments about the Mini Empires.
And the fraudulent crims.
Yes Labour installed a healthcare system that is now considered to 'complicated for a nation of 5 million.
Maybe they should have thought about that when they invented that system? Btw, what was Andre Little doing during the Helen Clark years?
seriously, this is not even ment as a zinger, this is literally what happened during the life time of all of us.
but surely if you want to complain about healthcare – but not include the labour party and the parts it plays in mananing healthcare in this country – then just simply pretend that the 22 DHB are the best thing since sliced toast, and stop asking who thought it was a good Idea. Cause in the end you will always come back to the Labour Party and Helen Clark and her ministers at the time.
https://www.stuff.co.nz/national/health/300614631/cheat-sheet-how-new-zealands-health-system-is-changing
That became evident within months of the DHB's forming with quite a lot of previously integrated systems falling down.
As a user I really disliked the DHB system – if you have ever moved DHB's regions and had children under specialists it is a nightmare. More so if they actually get admitted in one DHB area who only have the responsibility to get your child "fit to travel to their own DHB". Having had a child discharged while still very unwell from one DHB and us having to drive frantically back to our own DHB as they turned bluer and bluer as their oxygen depleted and going immediately to our local DHB where they went straight into intensive care was a nightmare.
Trust me you never wanted to get admitted seriously unwell in the wrong DHB area.
As for BOT's having sat on these – once after a previous board full of lawyers and accountants set up ridiculous forward contracts for school maintenance amongst other things – my biggest observation is that local input has allowed the religious into state schools. This isn't unintended in my view and was always part of the plan in devolving centralised control. It isn't co-incidence the connection between the religious and the right and the notion of localism.
My wife works for a northern DHB. They have just introduced a new computer program that seriously effects her job. No training. Fiasco is one word. Another way of describing it is monumental cluster fuck.
Yes, a friend of mine moved from Auckland to Blenheim 4 years ago. She was really annoyed to find that several of the tests she had regularly in Auckland because of previous illnesses and family histories were not available at her new DHB because of their differing standards and policies relating to her age.
Agree. DoSmith
22 DHB's for 5 million people. 22 boards, levels of managers, finance, supply etc and all that branding.
National serve capital not people as this 'reform' had nothing to do with efficiency just more carving up the public asset to hopefully flog it off to mates.
why National?
blame N for defunding the DHB during their reign, but don't blame them for 20 of the 22 DHBs. That was grown on Labours compost pile. https://www.stuff.co.nz/national/explained/124915117/the-plan-to-get-rid-of-district-health-boards-and-centralise-healthcare-explained#:~:text=Sure
Yes Adrian, that computer linking is a biggie. They also developed their own silos. They overpaid Boards and Managers. Just to name a few wee problems.
“I know what the average Māori (person) will think and they’re not walking around every day thinking about the United Nations’ Declaration of Indigenous Peoples – they’re thinking about their housing, their health, their education.’’
https://www.newsroom.co.nz/jackson-not-comfortable-with-co-governance-draft
For all those critics of Pharmac and the current Government’s efforts in healthcare:
https://www.rnz.co.nz/news/political/470119/new-zealand-and-european-union-secure-historic-free-trade-deal
That's really good news, I am very pleased to see that the pharmaceutical industry's campaign against Pharmac hasn't weakened the Governments commitment to it.
Yeah an insidious part of that campaign was the "but Australia pays for it" neglecting to point out that Australia pays for more high cost medicines in part because they (the government) pay much less of basic medical care costs for which you are expected to pay a higher price or have insurance.
NZ puts much more money proportionally into basic health care.
'NZ puts much more money proportionally into basic health care.'
Nonsense, spending per capita on health in Australia is above 5k US per annum in NZ it is barely 4k.
Didn't say they spent less per capita.
You are, if you have a decent income for instance expected to have medical insurance. If you don't you get levied on your income. Even with Medicare you pay quite a bit more for your doctor and prescriptions than here. It is a clear government policy.
This reduces the cost to the government for basic health care and frees up money to be spent on expensive medicines.
NZ doesn't spend enough per capita is definitely a problem though.
Proportionally was related to basic care vs costly new medicines. not Aus to NZ on a population basis. I can see why that was confusing in how I wrote it.
you reckon these guys will be paid better or worse after renegotiating their old contracts with the old/new owner?
https://www.stuff.co.nz/national/health/300614631/cheat-sheet-how-new-zealands-health-system-is-changing
If I had to take a punt better.
I have posted this previously but I remember being at a DHB meeting where their accountant got up and spoke about his disgust at reducing the hours of care for elderly to save costs. He made the point that many of the staff will still do the extra work needed and that they, the managers new this. He had calculated his estimate of the "free hours" each year they would get and it ran into millions. Not a single DHB manager disputed his claims and they proceeded uncaringly with the cuts. In my experience most DHB managers had previously worked to wreck the system in the UK and were now here wrecking ours.
Mental Health spending is another area they have consciously done things like reduce bed numbers despite staff opposition. to doing so. The neglect of dental health for low income and disabled is another area where they have reduced their effort year on year. These things were all management decisions that had everything to do with costs not to do with local health needs.
Reversing this stuff can't be done without spending more money and that has to include responding to the supply and demand staff shortages.
Time will tell.
"There's been a carve out for New Zealand medicines and Pharmac, as patent requirements sought by the EU would have made medicines here more expensive by hundreds of millions of dollars a year – "
This smells like spin and nonsense, PHARMAC are very very slow at funding new medicines and we only spend around a billion a tear on pharmaceuticals. Existing product prices wouldn't increase as they are subject to funding agreements.
This smells like lazy reckons and sour grapes, which is ironic. Pharmac is the funder and Medsafe is the regulator and these are very different roles that both require proper evidence-based decision-making and that takes time. Who said anything about existing product prices? And if you make assertions about funding agreements set in stone then you need to back that up, which won’t be an easy task for you as they are confidential. So, pull the other one.
it is a fact that vote health spends in the order of 1 billion a year on pharmaceuticals per the pharmaceutical schedule via retail pharmacy and via in hospital usage – this is publicly available information.
The majority of pharmaceuticals that have lost intellectual property (IP) protection are supplied within a tender system the prices are contracted and visible and again this is publicly available information.
The pharmaceuticals that are protected by IP are subject to many and varied contracts between the manufacturer and PHARMAC and again the prices are contracted (along with rebates that are confidential). Prices for these pharmaceuticals do not go up – certainly not since the arrival of PHARMAC some decades ago.
Therefore we are left with the newer products which PHARMAC has yet to fund – as you will be aware there is a rather large number of these and they are remarkably slow at funding newer agents despite the new funds that have been made available to them.
To suggest that patent extensions and the like would have added 'hundreds of millions of dollars' to the pharmaceutical costs in nz annually is a nonsense unless one expects a large proportion of the newer agents are suddenly due to come off patent and would be subject to longer patent terms and that there are cheaper generics available and that this situation repeats itself on an annual basis.
Again we spend just over a billion a year funding pharmaceuticals – the ‘hundreds of millions a year ‘ throwaway comment is simply not credible.
The only one who’s not credible here is you because you still haven’t provided any support for your reckons, just more reckons and throw away comments, which for all I know you’ve made up from scratch. I can easily do your homework for you, e.g., link to Pharmac’s tender outcomes, but I didn’t make your reckons. If you want I can park you in Pre-Mod until you have put up something with a bit of substance or change your nom de plume to something more fitting for the quality of your comments here. In particular, you have not countered the claim by the Government as per my original quote.
Fill you boots bud.
https://pharmac.govt.nz/medicine-funding-and-supply/the-funding-process/medicines-and-medical-devices-contract-negotiation/
As I have previously said the claim by the government is hyperbolic nonsense for a total pharmaceutical budget in NZ that is just over a billion dollars per annum and where new patent protected medicines are 'drip fed' to the medical community.
Perhaps a challenge for you – provide an example of a pharmaceutical funded by the government in NZ that has had an increase in price increase over the last decade which could support the government's statement.
I'm not sure where the statement from the government originated, I very much doubt it was from PHARMAC or any healthcare professionals – maybe from the health ministers spin doctors ? They do appear to be coming up with a load of codswallop on a daily basis at present.
So, you cannot or don’t want to back up your own comment, just digging in and doubling down.
It really is a stupid move to put the onus back on somebody who challenges you to provide support for your reckons. You make the claims, you back it up.
Noted for future reference.
The government spin-meisters made the claims – they should back them up.
I clearly explained why their claims were absurd hyperbole, that you are unable or unwilling to comprehend what I point out is hardly my problem.
That is a big win. "Today is a good day for Kiwis"
The main outcome of the new health structure – at least in the short/medium term – is going to be the rationalisation and centralisation of elective surgery and other procedures. New Zealanders are going to have to be prepared to travel for advanced healthcare to just a few centres. It makes sense to have excellent care in one city rather than very good care in six.
Maori health has now been given the rope it has been demanding, we will see if they hang themselves or haul up Maori health outcomes with it. The ball is in their court.
Or the difference between specialist service and no service at all: https://thestandard.org.nz/mother-nature-gives-groundswell-nz-the-middle-finger/#comment-1804112.
To keep up with medical innovations and to be involved in clinical trials a close relationship with [the 2] medical schools is a huge advantage if not a prerequisite. The latter need to have a bigger presence and footprint in the heartland of NZ.
Otago Medical School are very present in Dunedin and Christchurch so it's mainly the North Island that needs to catch up.
Which is what used to happen previously to rationalise spare capacity e.g. Taumarunui during the off-ski season used to do lots of hip replacement operations.
People didn't mind travelling for serious stuff. What happened is people in place like Taumarunui now had to travel for hours for normal every day stuff. For those communities that used to have local hospitals medical travel has ben a way of life ever since the DHB system was set up.
Many of those rural hospitals also were close to high Maori population areas in the NI at least.
Thank you for your comments.
Healthcare is everything from the everyday stuff such as GP visits (incl. Pharmacy) and taking & dropping off samples to full-on hospital care (incl. A&E) with all the more specialised services plus all the wrap-around services (incl. radiology service, for example). It is huge.
Patients need community for well-being and healing (and for palliative & ‘pastoral’ care). This has been brought up again during the pandemic and all isolations that people had to endure. This can be very hard on people who are scared, confused, unwell, or in pain (mentally or physically). For example, elderly people are confined to their rooms even today when there are any positive cases in their rest-home and it is bloody hard on them (and on staff and relatives).
"Medical tourism" was great for Taumarunui. Some one I knew whose mother had her hip done there spent the best part of a week contributing to the local economy. They drove their Mum down, and then spent several nights in a very nice motel while she recovered from the surgery and was OK to be driven back home.
The US Supreme Court has ruled that federal action on climate change is against the constitution:
https://www.politico.com/news/2022/06/30/supreme-court-handcuffs-biden-on-major-climate-rule-00043423
The Senate filibuster prevented their attempt at regulation and the Supreme Court ruling preempts any further attempts. The descent of US empire has accelerated this week. Sadly this will have ramifications for us all.
Its part of a Fascist coup in the USA with the aim of cementing white minority rule. The United States is one Democratic president serious about taking on Fascism – or one election clearly rigged by voter suppression and Gerrymanders – away from serious and escalating civil violence.
It gets worse:
https://www.npr.org/2022/06/30/1107648753/supreme-court-north-carolina-redistricting-independent-state-legislature-theory
Is it potentially possible for Biden to alter the number of Supreme Court Judges. Then stack it with human beings?
FDR was able to leverage that threat to ensure the enactment of the New Deal, so it is potentially possible. I don't see it as likely given the current impotent response of the Democratic party. AOC however raises the justifiable impeachment of at least two of the Justices:
https://www.theguardian.com/us-news/2022/jun/27/alexandria-ocasio-cortez-supreme-court-justices-impeach-kavanaugh-gorsuch-thomas
Biden can't do much as President but as the Constitution is silent on the size of the Supreme Court, the size is set by Congress via legislation.
It's a family thing.
Anne Gorsuch, a radical anti-environmental activist, was appointed by Ronald Reagan in 1981 to be the first female administrator of the Environmental Protection Agency. She worked hand-in-glove with Reagan’s controversial Secretary of the Interior James Watt to undermine federal environmental regulations.
Here is how The Washington Post described her controversial 22-month tenure as EPA administrator in her 2004 obituary. In 1983, after she and her first husband, David Gorsuch, divorced, she married Robert F. Burford, a rancher and head of the Bureau of Land Management.
https://m.dailykos.com/stories/2022/6/26/2106335/-Gorsuch-poised-to-accomplish-his-mother-s-mission-of-undermining-the-EPA-in-upcoming-SCOTUS-ruling
It must be exciting to be an American and to be there at this time.
A story in the news today highlights the debates going on past abortion, Jan 6, the economy, immigration, cost of living and so on.
"Texas educator group proposes referring to slavery as “involuntary relocation” in second grade curriculum."
https://www.texastribune.org/2022/06/30/texas-slavery-involuntary-relocation/
It seems likely some who have been very vocal about not accepting what happened, and telling things as they are, don't want to tell things as they were and certainly don't want them to be called what they were.
They’re heading towards repealing the13th Amendment .
Finland/NATO called his bluff. Poots backed down.
https://twitter.com/AFP/status/1542249958161670145
Sympathetic article in the Independent UK, about an barnyard castration clinic in the US, in the early 2000s.
https://www.independent.co.uk/news/world/americas/trans-history-underground-sugical-clinic-b2110589.html#comments-area
Interesting that it appears at this time, following a narrative framework that replicates the back alley abortion clinics and systems that were set up to aid women.
Sometimes, illegal abortion clinics were all about the money for those performing – so, there is no guarantee that the intention is altruistic in either case. But here it is assumed.
There are many factors to unpick here, but one noticeable lack is a failure to mention that there is a large number of people who have a castration sexual paraphilia, (which is not replicated in regards to abortion).
The current draft for the WPATH Standards of Care actually included a whole section on eunuchs, which was released late last year.
(The transgender messaging has long moved on from discomfort in one's sexed body, to body modification without need for distress, a fundamental difference that many choose to ignore.)
The eunuch community online, also expresses the desire to halt development for growing people, and offers up castration as a means to do so.
There really needs to be better scrutiny and discussion on these topics, rather than promotional puff pieces in the media.
Yes, Who benefits from the creation of a bunch of people with children's bodies and adult ages?
The conservative backlash against this insanity is going to be ugly and violent. Because these disturbed and amoral individuals have captured the narrative of oppression and the levers of power in “polite” society, the only tool that remains for normal people who want to protect women and children, is rough justice.
I do not endorse that prospect, but it is clearly happening right now in the US of A, with the growth of the Proud Boys and the irrational rulings of the Supreme Court.
So surgery is to be granted to someone who identifies as eunuch identity if they are in danger of self harm. Does it not occur to anyone that the person would have to be really disturbed to threaten or be at risk of self harm if they are not castrated. I have known quite a few suicidal people over the years and the treatment or support that is offered has never included give them what they want. It’s a bit like telling the ex partner of someone who is suicidal to go back to them to stop them suiciding.
Direct link to WPATH here: https://www.wpath.org/soc8
It's about Eunuchs being recognised and treated as a gender identity – and I think they may have pulled the draft off the site, which is hard to navigate if you are unfamiliar with it.
Here’s an archived .pdf copy of what was released:
https://drive.google.com/file/d/1IL9odleDVgbiGxt6v42dLFnU_SDfDXra/view
Tutorial for men on how to behave on twitter 😂
https://twitter.com/sbartemio/status/1542690958885564416
As opposed to in our BBQ culture presumably
"And a man can cook dinner on a fire pit, yet most women prefer the convenience of a gas stove."
Faaaarrrkkkk…
https://www.nzherald.co.nz/nz/vicious-hawkes-bay-prison-assault-mongrel-mob-inmate-stabs-guard-12-times-in-face-in-cowardly-shocking-attack/AYQUW5FK5C3QQNXUSPHRVSV7MM/
Sorry for you and your colleagues Puke. And of course for the poor guy who was stabbed. It must feel very close to the bone
Sorry for you and your colleagues Puck. And of course for the poor guy who was stabbed. It must feel very close to the bone
Luxon vs The Bible
Luxo: "i gots me 7 houses yo"
Luxo: "bottom feeders GTFO"
Luxo: "abortion = murder!!!11!1"