Video: health policy like you’ve never seen it

Written By: - Date published: 4:02 pm, September 16th, 2008 - 39 comments
Categories: health, humour, youtube - Tags:

Fair to say this is video is pretty much out there…

39 comments on “Video: health policy like you’ve never seen it ”

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  1. Anita 1
    16 September 2008 at 4:20 pm

    Risking an accusation of threadjacking…

    Key is standing with one hand in his pocket again. It’s something I really associate with him; jacket undone, one hand in his pocket, shirt collar cut so that it looks like his tie’s a little loose.

    What is it that his handlers are trying to construct? or combat?

    Why is casual and expensively subtly rumpled working for Key?

    Is it a conscious construction to make him more familiar, more like one-of-us?

  2. Benodic 2
    16 September 2008 at 4:23 pm

    What a strange video. Sometimes I think there should be age restrictions on the ability to make YouTube vids.

  3. John BT 3
    16 September 2008 at 4:59 pm

    Old news. Ask why a doubling of the health budget under Labour has not improved outcomes.

  4. Benodic 4
    16 September 2008 at 5:01 pm

    I’d rather ask for a source to back that statement. You could also try explaining what would have happened if Labour hadn’t kept up funding in a health system that swallows 7% of its budget in inflation every year.

  5. Phil 5
    16 September 2008 at 5:05 pm

    Anita – it’s a big step up from the ‘Don Brash Ensemble’ – Charcoal suit, white shirt, yellow tie.

    It says a lot about political observation that you immediately jump to “it must be part of a plan” rather than “it’s just his ‘thing’ “. We all have little manerisms and physical ‘default settings’.

  6. Anita 6
    16 September 2008 at 5:07 pm

    Phil,

    Well we know that Brash’s clothes and behaviour were very heavily managed, why wouldn’t Key’s be?

  7. Phil 7
    16 September 2008 at 5:10 pm

    swallows 7% of its budget in inflation every year.

    Erm… WTF?

  8. Phil 8
    16 September 2008 at 5:15 pm

    Anita,

    ‘Ensemble’ was a personal choice of Brash – this was before his time as leader of the Opp.

    It would be fair to speculate on Key being ‘managed’ in this respect if the attire has changed significantly (as Brash’s did). But from what I’ve seen, Key looks just like he did before.

  9. Steve Pierson 9
    16 September 2008 at 5:18 pm

    Phil. health sector inflation is a lot higher than the general economy, I seem to remember hearing 7% too. So, merely to tread water, the health budget needs to increase 7% in nominal terms.. but wait, there’s population growth of 1% a year too, plus the population is aging, so the health demand per person is increasing. So, you’re pretty large increases each year just to keep up.

    The flipside is that if health spending hadn’t doubled over the last 9 years, we would have much less healthcare capacity per person even as health demand per person is rising. we would have an even more underpaid medical workforce and serious shortages of staff, we would have far less money for medicine and medical equipment.

  10. Anita 10
    16 September 2008 at 5:20 pm

    Phil,

    Do you have some old images of Key? It’d be interesting to see whether Key-the-moneytrader, Key-the-MP, and Key-the-leader really do all look the same.

    My feeling was that there had been a change, but it’s gut feel not research 🙂

  11. Anita 11
    16 September 2008 at 5:32 pm

    SP,

    There’s an easy argument to be made that health costs increase at a steeper rate than inflation because they’re catching up for the cuts of the 90s. Have you tried plotting per capita health spend over the last 25 years? It might show a pretty red/blue trend, particularly if you could segment out the health costs and look at primary separately.

    A lot of the recent increases in costs have been trying to sort out woefully low health sector wages.

  12. naughtybynature 12
    16 September 2008 at 5:40 pm

    health sector inflation is a lot higher than the general economy, I seem to remember hearing 7% too. So, merely to tread water, the health budget needs to increase 7% in nominal terms.. but wait, there’s population growth of 1% a year too, plus the population is aging, so the health demand per person is increasing. So, you’re pretty large increases each year just to keep up.

    Isn’t it lucky then that during the 1990s the dismal National government intoduced funding streams for exactly these purposes .

  13. Steve Pierson 13
    16 September 2008 at 5:46 pm

    naughtybynature.. ‘funding streams’ … you mean user-pays that put basic healthcare out of the reach of ordinary Kiwis?

  14. naughtybynature 14
    16 September 2008 at 5:52 pm

    Steve nice red herring… Politics suits you; its all about spin.

    Read what I said. Do some real research and you will understand that it ain’t all black n’ white. But feel free to remain ignorant if you so wish. It gives me a good laugh.

  15. Anita 15
    16 September 2008 at 5:54 pm

    naughtybynature,

    Isn’t it lucky then that during the 1990s the dismal National government intoduced funding streams for exactly these purposes .

    Huh? What? Where?

    Seriously but, I have no idea what you’re talking about, but I’m fascinated because targetted funding streams and guaranteed increases to meet demand would be an awesome thing.

    Do you have more detail so I can go and read to my geeky little heart’s content?

  16. Steve Pierson 16
    16 September 2008 at 5:59 pm

    naughty, i did read what you read… are you not talking about user pays? maybe you would be so kind as to elucidate.

  17. naughtybynature 17
    16 September 2008 at 6:58 pm

    Steve you referred to funding for cost and demographic pressures. National introduced funding for these in the middle to late 1990s.

    Anita have a look on the Ministry of Health’s website. There should be something there.

  18. Anita 18
    16 September 2008 at 7:09 pm

    naughtbynature,

    Anita have a look on the Ministry of Health’s website. There should be something there

    Yeah, I already did that and I couldn’t. I also looked through the 2008-2009 estimates and nada. Nor could I find anything in the 1999 and 1998 National budget speeches and fiscal reports (the estimates aren’t on the Treasury site any more, but what is left is pretty thorough).

    Presumably you had a source in mind when you said it, where should I be looking?

  19. naughtybynature 19
    16 September 2008 at 7:45 pm

    Yes I had sources in mind…

    From Budget 2008 p. 10
    A significant proportion of the new allocations are used to maintain existing services by enabling the
    sector to manage the impact of price pressures as well as demographic and technological change. This
    funding, known as the forecast funding track (FFT) and demographics, amounts to some $496 million of
    the $750 million allocation in Budget 2008, with the balance of the funding used for various new
    initiatives.

    http://www.treasury.govt.nz/budget/2008/ise/v6/ise08-v6-pia-health.pdf

    Budget 2000 – p. 12
    • $159 million to maintain existing services overall and implementing service
    improvements to increase health gain
    • $99.691 million to reflect demographic pressures

    http://www.treasury.govt.nz/budget/2000/estimates/est00health.pdf

    Can’t obtain earlier budgets online.

    Happy digging.

  20. Steve Pierson 20
    16 September 2008 at 7:55 pm

    so, yeah, the lion’s share of the health funding increase since 1999 has been to keep up with demographic pressures and inflation

  21. Anita 21
    16 September 2008 at 8:35 pm

    naughtybynature,

    Way back up there you said that the National Government of the 1990s

    intoduced funding streams for exactly these purposes

    What you have shown evidence of is a completely normal practice for every government I’m aware of of increasing budgets to take into account demographic (and other) shifts in service requirements, and of identifying those clearly in the budget documents (although obviously the budget documents were different before the PFA).

    So nothing you have shown demonstrates either “introduced” or “funding streams”.

    It also doesn’t show whether the increases were, in fact, adequate to keep up with those demographic shifts.

    Care to try again?

  22. Draco TB 22
    16 September 2008 at 8:38 pm

    But, NBN, where’s your source that proves what you said about what National did in the 1990s?

  23. Anita 23
    16 September 2008 at 8:39 pm

    Oh, and I forgot to say, everything you’ve given us is from a Labour led government. If you’re sure about your claim that National in the 1990s introduced funding streams, you probably need to look at what National did in the 1990s 🙂

  24. naughtybynature 24
    16 September 2008 at 9:02 pm

    Partisan blah blah blah. National this, Labour that.

    Want the references? OIA them because in the era of open government that’s what you have to do.

    But by all means continue the partisan bickering it’s rather amusing.

    Good luck.

  25. naughtybynature 25
    16 September 2008 at 9:11 pm

    Actually here you go:

    In 1996-97, automatic adjustments to funding were introduced for Vote: Health, initially only for demographic changes. In 1997, Cabinet agreed to a health funding package to maintain the existing level of health and disability services. Included in this package was the “sustainable funding path’, which was an adjustment to the Vote to allow for the effects of inflation, technology, and improvements in efficiency, and to allow for some new initiatives. In 1999, funding was agreed for 2000-01. Subsequently, a funding increase was also announced for 2001-02. In December 2001, the

    http://www.oag.govt.nz/2006/health/part2.htm

    I love it when I’m right. Mind you it happens so frequently the thrill is becoming less and less.

    There you go partisan hacks. Pick it to bits and tell me why the Right is so terrible and the Left so grand.

  26. Steve Pierson 26
    16 September 2008 at 9:40 pm

    but, naughty, National was getting the money for that from part-charges.. you know, user pays.

  27. Anita 27
    16 September 2008 at 9:51 pm

    naughtybutnice,

    Thanks for that, I’ll enjoy having a proper look through it tomorrow.

    The pieces I’m most interested in (Disability and Mental Health funding) seem to have some interesting characteristics (for example the Mason funding doesn’t seem to even increase with inflation), but it’ll take a bit of going through to get there.

    It is interesting to see the origins of the Population-based Funding Formula in there, and the use of socioeconomic deprivation data, although at first glance I can’t see the weightings. Not to mention the idea that they considered some of the DHBs initially overfunded according to the model (?!). That model seems to be a 2001 introduction, and the report doesn’t seem to show the initial (1997) model for demographic funding, now I have a year and a name I’ll be able to have a proper dig around.

    So that’ll keep me entertained for a while 🙂

    As for partisan hackery, would it make you happy if I said that, in my opinion, both Labour and National led governments have been piss poor at addressing the health needs of the disabled and mentally ill? The fact that the demographic calculations take into account socio-economic factors (at least from 2001) which are both a cause and a consequence helps a little, but throwing money at the DHBs is not the same at actually working out a strategy and following through.

    Both disability and mental illness are challenging political issues, because they require an honest evaluation of our social structures, our social norms, our service provision models, and the roles of families and communities. That makes them a much tougher issue than either hip operations or cancer treatment.

  28. Anita 28
    16 September 2008 at 9:53 pm

    SP,

    but, naughty, National was getting the money for that from part-charges.. you know, user pays.

    Just as we are still paying under our current Labour led government.

  29. T-Rex 29
    16 September 2008 at 11:04 pm

    “Just as we are still paying under our current Labour led government.”

    A large number of us are actually getting it for free, now. What are the present charges for GP visits by age? I think last time i went I was still in the “That’ll be $50 please” bracket, but I know that the clock is ticking for essentially free visits across the board, and already for most age brackets.

  30. jbc 30
    17 September 2008 at 12:08 am

    I think last time i went I was still in the “That’ll be $50 please’ bracket

    I’ve escaped for less than that recently (short consult, no drugs dispensed) and I’m paying unsubsidized ‘market’ rates (because I’d rather not wait in a subsidised clinic).

    It’s a curious situation at present in NZ. You pay market rates for an electrician, plumber, or builder – but a doctor with years of experience and paying off a loan for medical school fees has their fee regulated by the government. It is no wonder that GP’s are in short supply.

    But you don’t choose to see a doctor I hear you say?

    I don’t choose to need a plumber or electrician either. It’s almost always when something is broken and needs immediate attention.

    If I recall correctly from my last call to a plumber/sparky in central Auckland: they wouldn’t pick up the phone for $50. $90 might get them out of their ute.

  31. jbc 31
    17 September 2008 at 1:21 am

    I think most people listening to the soundbites in the video have been led handheld to focus on the negative aspect of uncapped GP fees.

    As far as I can tell the policy is primarily about the income of doctors. Nothing else. You would need to look at it alongside the rest of the policy to see whether or not it was a crap idea. As it stand though, it’s a dogwhistle video: Increased fees! user pays! Shock!

    If the govt announced that they were going to ‘meet or exceed the market rates’ in order to get more doctors into hospital emergency wards then I suspect you would all be cheering.

    Why the beef with GPs? I think they are worth a lot more than spanner monkeys. It saddens me to think that my own doc (whom I have seen for 20 years – and is a genuine thoughtful, caring person) has to plead to a govt panel to lift his fee.

    Anyone who thinks that GPs are in the job for the money is mistaken.

    Captcha: self-denial. Plenty of that around.

  32. T-Rex 32
    17 September 2008 at 1:56 am

    jbc – agree with pretty much all of what you’ve written.

    It is tricky. I think fully subsidized healthcare is a good idea, because it helps to reduce the false economy of being sick and not getting treated to save money – long run saving to society at large because the person doesn’t go on to impose a much greater cost on the health system at a level which IS fully subsidised.

    But, as you reasonably point out, you can apply the same argument to electricians/plumbers/builders. A poorly insulated home is grossly uneconomic, including the likely health cost burden to society (hence my wholehearted support for the recent green party won initiative).

    I guess eventually it’s all a matter of shifting standards – “universal human rights” are weird like that. What was an unattainable luxury becomes a basic right 20 years later, especially in medicine.

    Hmmmmmmm.

    For what it’s worth, I think the way the DHB’s in NZ have treated doctors, particularly junior doctors, is abysmal. The result is hugely expensive and unsustainable.

    There’s a huge amount of “envy politics” aimed at the medical profession I think, by both sides of the political spectrum and by the non-medical elements of the healthcare profession. Why should doctors earn so much? Well, how about because they went to med school for 6 years (and that’s just for the basic level) which, in addition to costing them around $100k, created an opportunity cost of probably around $200k. That’s $25k/annum just to service the cost of capital.

    Cheap answer (without the “poor people don’t get healthcare” approach National appears to advocate) – stop people getting sick. Vote Green.

    Anyone know green party policy on stem cell research?

  33. naughtybynature 33
    17 September 2008 at 7:39 am

    but, naughty, National was getting the money for that from part-charges.. you know, user pays.

    Care to prove that Steve?

    Or is assertionh enough for you?

  34. higherstandard 34
    17 September 2008 at 7:40 am

    “Cheap answer …. Stop people getting sick. Vote Green”

    I think you might be over promising just a tad my friend.

  35. T-rex 35
    17 September 2008 at 8:24 am

    NOT EVEN! IT’S TRUE! Jeanette’s tears cure cancer.

    You’re right. Sadly. Some of their efforts will HELP stop people getting sick I think. Shifting 10% of the healthcare budget into prevention seems like relatively sensible allocation, in principle at least.

    Why they have to call it an “annual wellness check” though… argh. ‘Wellness’.

    And: “ensure a health impact assessment is completed on all government policies and projects.” – On ALL? That sounds like exactly the same kind of suggestion that leads to health impacts being IGNORED, because they become so pervasive and generic and meaningless people stop taking them seriously.

    “Support improvements in the pay and working conditions of health professionals, including mandatory staff to patient ratios in order to ease nationwide recruitment and retention problems. ”

    Mandatory staff to patient ratios eh?

    That’ll be fun to arrange. So do you kick out patients, or do you force people to become doctors?

    —

    Sigh. At least they’re going in the right sort of direction. Would love to see their funding model. Don’t mistake me for a Green fanatic HS – I’m just busy lately so gross over simplification is attractive. I’m voting for them because they’ve got the right idea on energy and transport. And they actually act like mature, responsible adults (mostly). Doesn’t mean I don’t think some of them aree flaky hippies, and I definitely think some of their policy is idealistic unrealisable bullshit (at least as far as the meaningful short term is concerned).

    Aside from the lousy treatment of staff by the DHB’s I actually think our health system is pretty good. I just don’t think it’s going to stay pretty good, because the staff are going to leave.

  36. T-rex 36
    17 September 2008 at 8:29 am

    ” 4. Take a precautionary approach to electromagnetic radiation regarding its possible effects on human health, and set up an independent committee to review the limits set by the National Radiation Laboratory for EMF, in particular for dwellings and schools located near high voltage transmission lines.
    5. Minimise exposure to electromagnetic radiation especially for children and pregnant women.
    6. No new unshielded high voltage power lines or towers to be built within 300 metres of any residential homes and schools.
    7. Investigate how to deal with existing high voltage transmission lines located within 300 metres of any residential homes and schools.”

    Right.

    Green Party – Sometimes they get it, sometimes they don’t.

    I’d love to know where that 300m figure came from. Has anyone seen sue kedgley rolling a die lately?

  37. Anita 37
    17 September 2008 at 8:49 am

    T-Rex,

    A large number of us are actually getting it for free, now. What are the present charges for GP visits by age? I think last time i went I was still in the “That’ll be $50 please’ bracket, but I know that the clock is ticking for essentially free visits across the board, and already for most age brackets.

    Actually very few people are getting their primary health care for free. Here’s a handy report about the level of GP fees in the Waikato.

  38. Phil 38
    17 September 2008 at 10:21 am

    Steve,

    Waaay back up the thread.

    There is a specific cost-escalation index the MOH have. It’s called the Hospital Price Index, and measures changes in the cost of staffing and other ‘consumable’ inputs… it might also include a measure of capital expense, not 100% sure.

    I don’t recall this ever approaching 7%, or anything anywhere near that level. Happy to be proven wrong if anyone has the time to ask the MOH if it’s available to the general public.

  39. Draco T Bastard 39
    17 September 2008 at 2:42 pm

    If the govt announced that they were going to ‘meet or exceed the market rates’ in order to get more doctors into hospital emergency wards then I suspect you would all be cheering.

    I certainly would be especially if it was extended to include GPs as well. The problem with the market as far as health is concerned is that it doesn’t provide enough doctors to cover the entire population and it’s more expensive. I don’t have a problem with doctors being paid well. I do have a problem when people can’t afford to go see the doctor when they need to.

    Markets don’t work for everything and that’s something that National/ACT and their supporters don’t want to admit.