This article appeared in NZ Doctor Magazine on 4 June 2014.
Turn ACC into a national health insurance scheme, funded by levies that are written off against income tax.
You're not going to find that in UnitedFuture's election manifesto but it's the way party leader Peter Dunne is thinking. He says the last two governments have significantly increased health funding and that's relieved a lot of pressure points in the system.
"But it's a mighty big BandAid," Dunne told New Zealand Doctor. "At some point in the next five to 10 years, the BandAid is going to either snap or wear out, and governments will simply not be able to bridge the gap. We will be right back into the days when rationing decisions were very severe and very harsh, and pretty brutal." Dunne, an Associate Health Minister under Labour and National, isn't criticising the health system as it exists today.
The problem, as he sees it, is that it isn't going to get any better, and, unless some hard thinking is done and decisions taken, it's going to deteriorate.
"I think it's as good as it gets," he says. "It's almost like we're on planet good time and that will never change. Well, I'm afraid it will." So it's time to think outside the box, or boxes.
"If you take the most extreme choices, on the left it would be to nationalise everything and have a wholly taxpayer-funded public health system," he says. "At the other end of the spectrum, it's just sell off the whole lot. It's a private good, run it as a classic American system." Because neither of those are acceptable, New Zealand has a mixture of public and private.
"We don't lack the capability, it's all about resources," Dunne says. "I've been of the view for some time that a different funding base is going to be required, and it's going to come from an element of an insurance-based model." Dunne says health funding is an international problem, and, if New Zealand looks in the right place, it will be better off than most when it comes to long-term strategy.
"We've got the genesis of the solution right here, right now. We've had it for 40 years. It's called ACC. We have a no-fault accident insurance scheme. I think we should be thinking about how we progressively expand it effectively to be our national health insurance scheme." Dunne hasn't got as far as figuring out how it would actually run, or how much the levy would have to be.
"I'm not in a position to say 'here's the plan'. I'm simply saying this is the idea...you would have to work out what the appropriate levy was for the level of care that's necessary and then you would discount that off personal tax." The reasons Dunne fears for the future are manifold.
"We've got a medical workforce that's going to face huge challenges in terms of delivery of services, [and] technology and science is going to change things massively...there's already a huge splurge of medical breakthroughs.
"Increasingly, access to new procedures, new technologies, new medicines is going to intensify. People aren't going to be satisfied with 'that's too difficult, that's too expensive for us to do in New Zealand'; those arguments just aren't going to wash."
Dunne is currently Minister of Internal Affairs, and there's a part of his job that has brought home to him the way things are changing.
"I sign all the 100-year-old congratulatory messages, and I'm amazed. There's a pile about an inch thick every week, and a lot of them aren't just 100, they're 103,104. I signed one the other day for a woman who is turning 110 - it's actually happening, right now, and this trend is going to intensify." But having ideas about ways to deal with an ageing population and funding a health service of the future is one thing, persuading governments to do something about it is another.
As the leader of a minor party, Dunne has worked with Labour and National.
"They're as good and as bad as each other," he says. "I think the fact that they've both invested more in electives over the years, and both have invested more trying to deal with the pressure points, is a good thing. But they throw rocks at each other about that." Dunne says the approach he's taken with both of them, when he has had an idea he thinks should be progressed, has been to discuss it with officials and get it shaped up.
"Then probably talk to the ninth floor (the Prime Minister's office) and say 'this is what we want to do'. Then you get told 'this isn't going to fly' or 'ok, go on and do it'. Then I would talk to the Minister of Health." When Dunne looks back at what he has been able to achieve in coalition with the major parties, he sees the medicines strategy as a shining example of how a minor party can influence policy. He started it under Labour and finished it under National.
"The upshot was the Government put more money into Pharmac, we've had better funding decisions and we've now got 240,000 more people a year getting medicines than was the case previously." The Pharmaceutical Society made him an honorary member. There's a plaque on his office wall to prove it.
United Future's Health policy, which it's likely to take into the election without substantial change, focuses strongly on the need to ensure the system keeps up with demand. It says the medical workforce isn't planned in a sustainable manner and emphasises the need for good primary care.
The policy document lists seven key issues and 14 main policy points. It's easy to find - ask Google for United Future health policy, it's worth a read. A link to United Future's health policy can be found under 'Extra Coverage - Ballot 2014' on www.nzdoctor.co.nz
"It's almost like we're on planet good time and that will never change. Well, I'm afraid it will" - Peter Dunne