Political tokenism comes in many shapes and sizes, but the $98 million boost in elective surgery is a cynical example of it.
The pre-Budget package breaks down to $48 million for elective orthopaedic surgery over four years – plus the re-announcement of an election campaign pledge to spend a further $50 million upon (a) a range of general surgeries (some of which will be orthopaedic surgery) and (b) a number of community-based early intervention teams.
The tokenism is obvious. Split that money between 20 DHBs over the course of three or four years and it won’t go very far at all – not in a context where the ageing of a growing population has for several years been pushing more and more people into the categories in need. As general surgeon Philip Bagshaw of the Canterbury Charity Hospital Trust told RNZ this morning, the rate of increase in elective surgery has been declining since 2008 :
We’re falling behind all the time. We’re not even catching up with the unmet need. We’re falling behind year on year. So this amount of money will not even address the rate of decline. Its as simple as that.
In his view, the government is pursuing false economies, and imposing them on DHBs. As Bagshaw added :
The important thing to realize is that we should be investing in elective care of this kind. Because in fact, its
the cheapest way of going about doing it. If you treat people early with most conditions, you actually avoid complications, and avoid a lot of the very costly issues which occur down the line…The notion that if you don’t treat them they’ll go away, is completely wrong. They come back. And when they come back they come back with problems which are very expensive.
There is a widespread perception that health funding is a bottomless pit, and that whatever the government provides will never be enough. In fact, the vision of a health budget expanding faster than the economy’s ability to sustain it is a fiction. The Association of Medical Specialists pointed this out in detail in a must-read research paper last August :
Between 2009/10 and 2014/15, Vote Health’s nominal operational expenditure increased by $1.8 billion, while nominal GDP increased by an estimated $48 billion. The increase in health expenditure has not made the country less able to afford health services. The country is actually wealthier.
Even so, Vote Health’s operational budgets have been falling as a proportion of GDP over recent years – an intentional policy flagged by Treasury two years ago in a document dated June 2012, which shows Vote Health operating funding was projected to drop from an estimated 6.5 % of GDP in 2010 to less than 6% in 2014.
This downwards trend in the ratio of health spending is something Scoop will update on Budget Day in a couple of weeks time. What we have is an intentional shrinkage of the relative spend on Vote Health, even as the need for preventative care is on the rise within a growing and ageing population. Unmet need is rife, and the government has little interest in measuring it, let alone in addressing it. Token gestures like the one announced yesterday are intended to disguise the fact that the ratio of spending on health relative to GDP by this government has been going backwards – with further deterioration being projected over the remainder of this decade.
Cuts in services, and cuts to the quality of those services, will be the inevitable outcome – a situation due, in part, to the government’s budget-balancing mania.
Ben E. King RIP
In the past two weeks, two soul music greats have died : Percy Sledge and Ben E. King. Ben E. King’s hit run began with his lead vocal on “There Goes My Baby” – a strikingly odd track ( the record company executives hated it, and felt it had been mastered at the wrong speed) that introduced string sections and the influential Brazilian baion rhythm to US r& b. The baion was also used by arranger Stan Applebaum on King’s “Save The Last Dance For Me” and “Spanish Harlem” epics, and Burt Bacharach later embraced it as well.
“Stand By Me” was King’s masterpiece though – a throwaway track that was cut during the spare time at the end of a recording session. It is perfect on all counts : the simple, arresting intro, King’s impassioned vocal and the creative string arrangement, also by Applebaum. While “Stand By Me” is often described as an adaptation of an old spiritual, King’s rewrite is so different as to deserve being regarded as an original. Here’s the spiritual by the Soul Stirrers. Despite what Youtube says, this is Johnny Taylor in the lead vocal, not Sam Cooke :
While King’s classics are all readily available, I’ve always had a soft spot for this lesser known 1970 track “Don’t Let Me Down…”