During a layover in Auckland on my way to OZ, I picked up a New Zealand Herald and read a commentary by one Gareth Morgan, an expert on the Kiwi health system. In “Best Treatment Goes to the Loudest,” Morgan complains that those able to push their weight around receive better care than others. From his column:
The way the limited resources of our public health system are allocated across those in need is increasingly ad hoc and unfair. Because of the lack of a coherent and consistent framework for allocating resources – across conditions, patients and regions – we have an ugly situation where the loudest get served first. Put bluntly, it’s an obscene abuse of universal health care.
The people who benefit most, says Morgan, are the aggressive and politically connected:
When researching our 2009 book Health Cheque, Geoff Simmons and I were told by numerous professionals inside the system that on a daily basis they are put under undue pressure from patients and their agents (family members, MPs, lobby groups) and the disturbing reality is that the squeaky wheel gets the oil. The typical scenario is when the patient’s people threaten to go to their MP, go to the media and so on unless they get the service they think they deserve, then the system is abused. Blackmail of busy health professionals like this is offensive but sadly is common, resulting in those with the loudest advocates getting served in front of others, just so the professionals can move on and attend to others.
Gee, imagine standing up for your loved ones in a system that wants them to deny care! But to a collectivist–and that term would surely apply to the New Zealand health care system as described by Morgan–that’s verboten. Patients should meekly accept the restrictions that the bureaucrats or doctors impose.
Unsurprisingly, those who get left behind tend to be politically weak and societally marginalized:
It is wrong, it is unfair but it is the reality – the needs of those without access to strident advocates are being trampled under as the loud lambast their way to the front. Hardly surprising that over-represented in those being neglected are Maori and Pacific Islanders, although in no way is it restricted to them.
This is what comes from centralized universal care–it is that in name only. Morgan goes on to urge:
The time is overdue to introduce transparency and objectivity into the process of allocating health services and ensuring the whole ethos of universal entitlement is being honoured. In order to do that, transparency over how the fixed health dollar is allocated is necessary and the process by which the allocation is made has to not just be seen by all to be objective, but has to actually be objective
That’s impossible, because rationing is inherently political, which is to say, it cannot be objective.
What Morgan really means is that it is objective to follow his views on who should be cut off, with the example he gives in this piece rationing the elderly based on societal benefit. But even that over simplifies. In rationing, it is not only the old versus the young, but also, MS patients, versus cancer patients, versus women demanding IVF, versus, perhaps one day, transgenders’ sex change operations (currently paid by the City of San Francisco for its workers, for example).
Health care rationing is medical descrimination by a polite name to let us sleep at night, and creates a system where coverage is a form of political patronage and pork. And in Morgan’s rather crassly utilitarian and it seemed to me, somewhat misanthroic piece, there is a warning for the USA. Under Obamacare’s cost/benefit panels there will be rationing. But it is not to late to learn from the travail of others and go in a different direction.