Dirty Little Secret
Forget John Key and the H-fee. Don’t both with Winston’s Helicopter antics. The real dirty little secret of the election campaign is that people are suffering and even dying every day because of government ideology. Don’t believe me? Take a look at the comment of David “I’m in Charge” Cunliffe on the news that 10% of elective surgery is being done by private clinics in the Auckland area.
““The ratio of public to private is about as high now as I am comfortable with. The last thing we need is for private medicine to suck any more capacity out of the public system.””
And this reported remark in the same article:
“Labour paints National’s health policy as offering work to its friends in the private sector.”
This makes me angry, because hidden in these remarks is an attitude that places ideology above patient care. Let me explain:
There is excess capacity in the private health system. There is also an ability in the private health system to provide even more excess capacity at relatively short notice. Most surgical clinics have been constructed to allow rapid expansion of wards and theatres, particularly if resource consents are streamlined.
There are thousands of people on elective surgical waiting lists who are waiting many months to years for operations. Most of them could have already had their operations if the private sector was allowed to properly partner with DHBs. Currently, most private sector “public” operations are done under limited contract – often 1 or 2 surgical sessions at a time. There is absolutely no incentive for the private hospital system to “flex up” as the huge demand is being dealt with in a piecemeal fashion.
This is bad enough for Mrs. Smith who has waited three years for her hip operation and can barely walk. It is life-threatening to those who need cardiac surgery or radiotherapy. I am certain that, if Saturday sees the return of a Labour government, the brand new radiotherapy clinic in Auckland will have a few patients sent to it by the DHBs – the ones who have waited well beyond a safe waiting time. There will, however, be no concerted plan negotiated between the DHBs and the new clinic to maximise this new resource, because Mr. Cunliffe is apparently nearly out of his comfort zone.
This means, to put it baldly, people will die because of his ideology.
I hear objections to using private health care occasionally from my colleagues. Their objection is that, if you move these patients out of the public system, hospital doctors will eventually have insufficient variety of work to maintain their skill sets (“I’m in charge” Cunliffe puts it as “sucking capacity out of the public system – a nonsense phrase, if I have ever heard one). Apart from the dubious ethics of essentially denying people timely care in order to maintain a doctor’s skills (or non-existent theoretical hospital capacity), this objection does not hold water. Most of the surgery dealt with by the private clinics is low complexity. Private clinics usually lack ICU beds and so cannot deal with the very complex. What maintains your skills better – 10 routine hip replacements or three complex revisions? Removing a dozen easy appendixes or a couple of complex appendix masses?
Not only does the more gratifying, complex surgery gravitate towards the public system, but so do the more difficult medical cases. Emergency departments do not suffer patient drought caused by nearby A&M clinics, they just lose a little of their non-urgent caseload. The same effect of increasing complexity spans all hospital departments.
Besides, many of the surgeons who are “losing out” on less complex surgery are actually the ones who are doing that same surgery in their private capacity. ‘s good deal, if you can get it… (see the comments below for a nasty illustration of this)
So let’s stop this whining about privatising medicine and use all of our resources, both private and public, to get the medical care that people need. National’s thoughts on this are very promising, particularly the multiyear funding guarantee which will enable both public and private resources to expand capacity with confidence. Yet another reason to vote for the three-headed hydra. 
I note that the Herald uses the word “Elite” meaning “private”. I realise this is probably due to space constraints in their headline, but it is hugely insulting to those people who are having to mortgage or sell their homes in order to get the surgery they desperately need. I think we need to get past the place where we see private medicine as the domain of the wealthy and see it as a normal and valuable part of the entire health system.
I draw your attention to the byline of this blog. When politics is driven by ideology, people get hurt. National did it in the 90s, Labour are doing it right now. A dirty little secret indeed.
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Nov 4 08 5:59 pm
This is a long standing problem. Way back when Jenny Shipley was Minister of Health my father, an ex-serviceman, was seriously ill. We were not well informed about the extent of his condition, which turned out to be multiple issues related to age. His specialist advised an operation which turned out to be a side issue, but which was played up as a risk that should be dealt with promptly.
As it happened, the operation could not be done in the public hospital, but the specialist could do it now privately for around $10,000.
I took the time to check about access to the public hospital. It turned out the same specialist was the person who decided who could have this kind of operation in the public hospital. He declined my father’s case.
He was engaged in a blatant money making racket.
My father died of other issues soon after.
I complained with an explanatory letter to Jenny Shipley, who responded with a nonsense bureaucratic reply showing no empathy or concern at all.
I was pleased to see her government kicked out a few years later. She remains unforgiven by us.
So this idiocy you speak of goes back a long way, and across parties.
I hope these issues will be dealt with under John Key, who seems to be a more intelligent and caring person, but he will have to address some deeply entrenched rorts.
All these years later my extended family has not recovered a positive view of government, any government, after the way my father was treated after all his service to his country. The public health system was very different and much more trusted until this nonsense began around the 1980s.
We badly need a change, not just in Party, but in the personal attitude and responsibility of those in power. People like Cunliffe must go. Theirs is a bankrupt, cruel and inhuman ideology. But so was the approach taken by Shipley.
National’s policies look promising. I hope they are actioned.
Nov 4 08 10:51 pm
There are still specialists who “work the system” for their own benefit, rather than the patient’s benefit. They get away with it because the waiting lists are so long and because the public health system has no checks in place to stop this. Reduced waiting lists and independent acuity assessors would all but eliminate this dreadful behavior but, after nine years of populist health funding, Labour has no political will to do this.
I am hoping that the ideologically driven disaster of the 1990s has taught National that ideology is a poor substitute for practical common sense. I’m pretty sure Key gets this. Let’s hope Ryall does too.
Nov 5 08 9:28 am
Still Upset – What happened to your father is unacceptable, however one needs to understand how patients get ‘prioritised’ for surgery. It is not a simple situation where a particular surgeon chooses to do a case in public or not. There is a scoring system applied to each case, using acuity, the risk if surgery is not done, etc, imposed by the MOH, and policed by clerks. Those with the higher number get on the list and those below the threshold are off the list. Cases that do not make the threshold can be done in private if the patient wants to pay for his/her surgery, and the patient is free to choose who he/she wants. They most often choose the surgeon who knows their case and will not have to spend further time and money for yet more investigations. (Of interest, this treshold is coveniently ‘used’ by politicians to ‘shorten’ waiting lists – it is as simple as a directive to all DHB’s telling them that the bar has been raised – and thousands of patients disappear off the waiting list. Nice!)
There are huge restraints on the amount of surgery that can be done in public by availablity of resources such as beds, operating rooms, nursing staff, money to pay for drugs, surgical equipment and prostheses. All this ‘costs’ money, taxpayer money.
Private hospitals have a different dynamic as they ‘earn’ money by performing surgery, and so the more they do, the more they earn. This results in the capacity in private being much more flexible and change being much more dynamic. They also pay their nurses more, offer them better working conditions, etc, and therefore are resource ‘rich’; and they are more efficient (fewer dictats from the Ministry that have to be complied with) and have fewer complicated cases grid-locking their operating rooms.
Ideologically Labour has chosen a level at which to fund health care. In a private conversation the then Minister for Health, Hodgson, stated that NZ could afford to spend more money on Healthcare than they presently did, but that what was being spent had been determined as appropriate for a country such as ours. Unfortunately most of this spending is on bureaucracy and implementing wild-eyed, idealistic WHO programs more appropriate for 3rd world countries than for a developed Western society; than actually building new operating rooms and training and keeping nurses.
National seems to have identified some of the problems in Public Health and have indicated that they will make the necessary changes. I hope so.
Disclaimer – I am not a surgeon and I have no private health interests.
Nov 5 08 9:35 am
Thanks – I still can’t get my mind around how any decision making system can permit such conflicts of interest for so long. I have put it down in part to a touching faith in specialists being above human motivations of monetary greed, but at the end of the day such distortions and rorts are caused by a lack of transparency and exposure to real competitive markets.
Let’s hope a fresh approach learns from these past failures.
Nov 5 08 2:25 pm
It is not clear what you are referring to as conflict of interest. A surgeon working in both public and private? If they had to choose between one or the other, I think the majority would go for private and then public would be depleted. There can be no doubt that human nature plays its part – they earn better in private than in public with fewer hassles.
Or are you referring to an operation that can’t be done in public but can be done in private? Well that is the nature of politicised health care – our elected officials decide how the public system works and then use facts and figures they ‘cherry pick’ to get you to believe that only they can provide you with what you need.
Nov 7 08 9:51 am
OK Doctor. Are you in favour of a universal publicly funded healthcare system or not? Clear answers in plain English please.
Nov 7 08 12:00 pm
Millsy:
I prefer a public health service.
There is too much asymmetric information to safely privatize health and the incentives for complex cases are extremely difficult to manage. I don’t think it is worth the effort to privatize health.
This post, however, is about using private health resources to supplement shortages in public health. That is very different from “privatizing health”. I am very much in favour of it as a “quick fix” to an ailing system, poorly maintained by our current government.
Nov 7 08 9:23 pm
To be honest doctor, I really have no problem with using private capacity for elective surgery, the problem I have is no-one seems to come forth with an explanation of how such a move will work. I have to admit its easy to scream privitisation when details are rather vague.