World Review: Poor Health Wanganui (1995)

From the August 1995 issue of the Socialist Standard

One can’t help but notice the supreme irony surrounding the name of the Wanganui area Crown Health Enterprise (CHE)—Good Health Wanganui. Good Health Wanganui is in very bad health having just had the hard word that it has too high a level of service compared to other CHEs around the country and therefore will have its funding slashed. Two hundred and forty-six jobs will be lost from the beleaguered CHE along with 30 percent reduction in some surgery over the next three years in order to "break even". The Dominion (13 June) reported:

“‘Other services would also be downgraded because the Government believed the crown health enterprise had been providing more services than necessary’, chief executive Ron Janes said yesterday.

'The situation is utterly disappointing,’ Mr Janes said. To have the spare capacity to be able to help those in need and not use it is bad enough. But to also shed that capacity so it will not be there when future policies show more vision is worse.’"

Janes must have been rapped over the knuckles for telling the truth as his first statement was followed later with a less critical statement, after a phone call from the CHE Minister Paul East's office.

The Dominion continues in the same article:

“The salaried Medical Specialists Association said more cuts were pending, with plans to contract out support services such as x-rays, pharmacy and laboratories, while references to reducing the cost of continuing care for the elderly to market level and promptly discharging new mothers were ominous."

On the same day, the Evening Post carried a report that the

"Hutt Valley Health CHE will have to severely cut back or close several services over the next two years because of proposed funding cuts.

The cuts are coming because the Government had told CHE it will stop funding to cover deficits by 1997. That means hospitals will have to make do with funds provided by RHAs (Regional Health Authorities). CHEs say those funds are inadequate to meet growing demand for services."

Since the dose of "free market" restructuring given to the old Area Health Boards by the National government, things have been going from bad to worse. Now after being split into autonomous competing companies, Crown Health Enterprises are run on strict business lines, where running out of budget is a final thing. CHEs contract out various services such as catering and cleaning but still must survive on the vote of money from the state via RHAs. CHEs are in direct competition for resources and supplies.

Recently the CHE in Lower Hutt ran out of budget for operating theatres three-quarters of the way through the year. The remaining three months without money meant an idle theatre but still a large and growing waiting list for operations. That’s not to say that the waiting lists were much smaller under the previous regime, but that restricted state funding has become more obvious.

Getting the chop

Various CHEs have been in the media recently for turfing patients—mainly elderly—out on the street in the wintry dead of night in the interest of cold-blooded efficiency. Also patients have been abruptly discharged supposedly because there is nothing seriously wrong with them, despite protestations and then promptly dropping dead. Funding restrictions have meant that the over-70s are no longer receiving certain operations such as knee replacements and in one very highly publicised case a man who needed kidney dialysis was refused and left to die. Doctors are forced to make life-and-death decisions because of the absence of sufficient funds, and the elderly are the first to get the chop, in keeping with the system that sees workers as economic units, rather than as human beings. Elderly workers are regarded as having too many miles on the clock and are too expensive to maintain.

Have no doubt in your mind that the capitalists’ idea of the perfect worker is one who remains healthy all their working life, works hard to the day they are put on the scrapheap and promptly drops dead thereby releasing the capitalist class from having to fund their hospital repairs and pay for their dotage. This is not necessarily because the capitalists are heartless cruel people but because the logic of a competitive system of society which has a fundamental need to accumulate capital at all costs for survival.

The Returned Services Association (RSA), well-known as being a bastion of conservatism recently criticised the government’s treatment of the aged citing as examples:

• There had been no catch-up in pensions for the elderly despite a thaw after the three-year freeze. Meanwhile, the cost of living had risen markedly, leaving many senior citizens on or below the poverty line.
• Medical and elective surgical treatment for many had been put on hold as waiting lists grew longer, with operating theatres closed for part of the year as funding allocations were used up. Asset-testing meant assets were required to be used to pay for full-time care in rest homes often causing the long-saved-for family home to be sold-up and unable to be passed to the next generation.

It is interesting in this connection to note that the old much debated topic of Euthanasia has popped up again with a private member’s bill named "Death with Dignity” being introduced in the New Zealand parliament and recently the Northern Territories of Australia passing a bill allowing voluntary Euthanasia under certain circumstances.

No doubt a few wealthy members of society like the thought of workers topping themselves to eliminate the expensive care needed to attend to the terminally-sick. Undeniably, there are certain aspects of Euthanasia that are humane, but in a system of society like capitalism, it is open to abuse, to service those who would benefit from reduced state expenditure.

The Evening Post (1 June) reported that:

"the government has told public hospitals to increase profit by restricting surgery and other services, says the Medical Association.

Chairman Dennis Pezaro said a letter from the Ministers of Health, Crown Health Enterprises and Finance to country's 23 CHEs showed the health reforms were a 'sham'. . . . This means hospitals must not do more operations than they have been paid for . . . Since die health reforms, surgical waiting lists have increased by about 30 percent to 80,000 despite hospitals increasing the number of operations."

According to Health Minister, Jenny Shipley:

"the reason for the instructions was to prevent the problem with the previous area health board system, where hospitals ran up large debts doing uncontraced non-urgent work and then sent the bill to the taxpayer."

So why does the government show so much concern to "the taxpayer” while at the same time is practically oblivious to the needs of many workers in desperate financial situations, the unemployed, the sick, and families struggling to survive on low income? The answer is both simple and complex. Complex because of the mythology surrounding capitalism; simple because the answer is that it is in effect the capitalist class that ultimately pays the burden of taxes, including PAYE and GST. which are a charge on profit, rent and interest for the services provided by the state.

Obviously, the less tax charged by the state, the more profit left over for reinvestment and consumption by the owners of capital, or allowing them to remain competitive in the face of competition in depressed markets. You didn’t really think that you were going to benefit from promised tax cuts did you? There are a hundred ways of skinning a cat, and the claw-back of the extra take-home pay is relatively easy in times of high unemployment (look how easy it was to make the public servants put up with many years of no pay increase while inflation reduced what they could buy with their frozen wages).

In New Zealand, health represents over 10 percent of total government expenditure, and is the second largest single government expense next to social welfare (25 percent); which is why both are under attack. This is happening worldwide; governments around the world are attacking social welfare, trying to reduce the infrastructural costs to capital, in order to remain competitive in an ever more competitive market. Is this a spiralling effect? Yes. But of course reducing expenditure can have negative effects when taken too far, as needed workers become unproductive because of ill-health, broken marriages, poverty-driven social disintegration, crime etc.—but just how bad can it get? Do you want to wait around and find out? Or do you want to do something about it while you can? It’s a choice between roll-over-and-die, or stand-up-and-be-counted—counted for your active support for free access; no money, voluntary labour; no employment, democratic administration; no government.

Dave Tildesley,

World Socialist Party of New Zealand