Public Health Systems, 101

Frenetically Polishing the Brass

We understand that the New Zealand Treasury regards our public (and subsidised private) health system as a deep, dark fiscal black hole. It is the Minotaur in the room which the Treasury gnomes prefer to keep locked up and hidden in the dungeons. No matter how much tax payers' money is thrown at the beast, it voraciously demands more. There is simply not enough money or wealth to satiate the demand.

We believe there never will be. The more living standards rise, the greater the demand for health services. Whereas once we might have put up with a behemothic frame, when we become sufficiently well off, stomach stapling surgery becomes an option. Ah, you say, such things would never become part of the public health system--funded by tax payers. That kind of "cosmetic" thing would always remain in the domain of individual consumption, funded by personal assets. Not so. Widespread arguments are afoot asserting that "wellness" and "preventative" health prevents greater disease and expense in the future. But, of course, "wellness" is a plastic concept to be moulded to the fashions and foibles of the day.

As living standards rise, the affordable becomes first today's desirable, then, tomorrow's entitlement and demand right. So, rising living standards intensify demand for health services, which require more and more public spending.

Secondly, rising living standards increase longevity. The longer we live, the more health services we will require and utilise. The health expenditure required by an individual with a 90 year life span will be far greater than someone who lives to 45.

State funded health care systems are always sub-optimal and ultimately despotic. The more they succeed, the more quickly they break down. Health care requires trade-offs and choices. And the choices are usually intensely personal. Personal choices cannot easily be translated into a schedule of government rationed demand rights--which is inevitably what all public health systems end up becoming. Unable to fund everything, all public health systems must ration care, deciding to fund some things and not others. The socialist system takes money from citizens compulsorily via the taxation regime then it rations who will get care and under what conditions. Individual and family trade-offs are overridden. The horror of this system is that Big Brother makes decisions for you about your life, well being, and physical existence, and executes them with your money. If a society accepts that extension of government power, it will accept any and every subsequent extension. Civil freedom has lost any real meaning, lingering on as an empty formal concept. Decisions by bureaucrats ultimately control your life, liberty and the pursuit of happiness--and all the more so as you age and become relatively more infirm.

The inevitability of arbitrary rationing creates an unstoppable political force amongst the voting public to reduce the rationing and increase public health expenditures. How terrible, utterly terrible was the government's decision to stop funding the expensive herceptin drug treatments for breast cancer! How arbitrary! And it was. That is the point. How easy, then, for a political party to garner popularity by promising to restore herceptin treatment. In the grand scheme of things it is a small amount of money. Actually, in the grand scheme of things it makes the demand for more and more health spending incrementally relentless and unstoppable.

Public health systems end up being run by health sector unions--which, as we all know, are interested ultimately in the power of the union. If you believe in class warfare--and all modern unions do--union strength is the ultimate concern because only a strong union will be able to wage war. A state of war requires temporary, emergency suspension of freedoms and rights. Modern unions believe in a perpetual state of class war, which justifies sacrificing the perpetual needs and interests of those they represent in order to strengthen the union so that it can fight more effectively now and in the future. Because the state of class war is perpetual, the interests, freedoms and rights of union members and workers are perpetually subordinated the the "greater good". It is a situation which reflects a miniature Nineteen Eighty-Four--permanent war is promoted to justify the powers of the collective.

Union militance and control in public health systems results in constantly raising barriers to entry to competitor workers and employees. Only the "guild-members" can trade. This is usually couched as an argument to protect professional standards, qualifications and so forth. Secondly, union militance resists any health worker layoffs and redundancies of union members. Thirdly, unions engage in political propaganda and join campaigns to extend public health funding and expenditure--as opposed to increased subsidies for the private health sector. Any suggestion that a system of decentralised decision making of individuals with respect to health is a far more just and efficient distributor of health services than the government is regarded as blasphemous. The unions are not interested in public health per se, but union dominated and controlled public health, in which case "big is good". This becomes a militant driver of demand for more and more public spending.

Finally, public health systems are wasteful. They are bureaucratic rule-driven, plan controlled systems with all the attendant foibles and waste, since it is impossible for any central plan to oversee providentially the wondrous complexity of human society. Conventions like "bulk funding" help assuage this, but only until the next central directive. The Borg must have control; therefore, it must assimilate all. Bureaucrats and politicians--that is, government--cannot help having wondrous plans and schemes using other people's money. And, being government, it must execute plans--for that is what power is all about after all. And, worst of all, because it is health and well-being we are talking about, government functionaries and politicians feel good about spending money and executing plans in the health sector. Are they not beneficent? Are they not loving, kind and good to be working for your health, so assiduously, with your (and your neighbour's) money? Are they not gracious and kind?  This helps explain why any foolish politician who would want to restrict or reduce public health spending is immediately cast in the public sphere as a monster of unparalleled dimension.

Public health systems are a relatively recent historical invention. They will not survive. They will eventually collapse under their own weight and relentless demand driven costs. But we acknowledge they will not be replaced until fundamental changes occur in our society that are comprehensive throughout. The arrogance of demand-rights religion must be repented of. Individual and familial and household responsibilities must be re-asserted and held sacred again. A far greater role for charities and charitable institutions in the health sector must have come into existence. A universal conviction that bad things actually do happen in a fallen world which can only be mitigated, not removed entirely needs to come to pass.  Like sickness and death, for example.  These things will only happen with a change of national religion--with a society-wide return to the God of our fathers. Only then will the current grasping, suffocating despotic state wither away to far smaller legitimate competencies.

These changes are so comprehensive and fundamental they will require not decades but generations to accomplish. But, in the end, God's time is our time. In the meantime, the present system will go to Hell in its own way. Tactical nous meanwhile calls for us to do what we can to mitigate its worst excesses, rather than redeem the unredeemable. You don't polish brass on a sinking ship.