A Doctor’s political perspective on Healthcare

Doctor and patient

Guest Post:

Disclaimer: I am an experienced doctor who has worked in primary and tertiary care settings here in New Zealand and abroad. I write on the condition of anonymity not because I fear WhaleOil readers (I do not), but because I do not wish to expose my professional reputation or my family to the vitriolic attacks and defamation that comes from the hard Left when they find someone who does not have the “politically correct” opinion. When I was at medical school people used to joke that I would end up as the Minister for Health one day, but I gave politics a miss for the sake of my family (and because I probably couldn’t handle attacks from the SJWs!)

Firstly, let me outline my political position as it pertains to healthcare. I believe that the best healthcare in the world is achieved in liberal democracies with Universal Healthcare but ONLY when the government is conservative. Let me explain – in the United States, the medical system is fantastic for that 70-80 % who can afford medical insurance but it completely lets down the bottom 20-30% who are uninsured. This leads to significant social issues including prolonged unemployment and increased crime among people with mental health issues, and an overburdening of publicly funded emergency rooms. So I do not support a hard right conservative approach to healthcare, as it is too uncaring and has numerous adverse outcomes for the general population.

By contrast, Universal Healthcare in socialist systems or even in liberal democracies with left-wing governments (see the N.H.S., owing to generations of Labour governments) is a bureaucratic mess where money is simply “thrown at the problem” of health, leading to overworked underpaid medical staff and poor outcomes. In short, billions of dollars are wasted. Yes, there are medical doctors who vote Labour or Green, and this probably comes from their compassionate natures and the commonly held belief that Labour is the “caring” party and National are the “mean heartless conservatives”, but this is a terrible misconception and entirely wrong.

In summary, my position is that the “ideal” healthcare system is universal coverage in a liberal democracy like New Zealand, provided the government is conservative. In other words, New Zealand under the National Party. Why you ask? Good question. Under the National government, the amount spent on healthcare has increased every year as a percentage of nominal G.D.P. and per person, but it is also being spent more wisely. The government has a singular focus on outcomes and cost-benefit ratios.

Case in point is throat swabs for strep throat to prevent rheumatic fever. Say you take throat swabs of 100,000 Maori and P.I. children and treat those with strep throat with penicillin at a total cost of, say, $20 million. You end up saving hundreds of millions of dollars because you have prevented 500-1000 kids from developing rheumatic heart disease which would, over future decades, incur a massive healthcare burden due to open heart surgeries, heart transplants, early deaths etc. So these are the kinds of evidence-based programs the National Party has been promoting to improve New Zealander’s health. They don’t win votes and they aren’t easily transcribed into a “soundbite”, but they make New Zealand a healthier place. The Labour leader can say “Better Healthcare for all” until she’s blue in the face, it sounds lovely, but National has actually effected changes that DELIVER better healthcare for all.

Compare that directly with the Labour Party who would simply throw billions of dollars at healthcare and give the bureaucrats free rein to spend and spend and spend without any actual benefit to population health. When I was a junior doctor in a major tertiary hospital under the Clarke/Cullen regime, the hospital had a “project management department” which employed (I kid you not) no less than FIFTY “project managers”. FIFTY. What did these people do? What, exactly, was their purpose? How did they improve the health of the population? Nobody knows. National have systematically been stripping the bureaucracy and trying to force D.H.B.s to meet clear performance targets in terms of outcomes eg. surgeries performed, patients treated and discharged, reduced death rates, reduced waiting times, reduced waiting times in emergency departments etc. Have the results been perfect? No. Are there still major problems with our healthcare? Undoubtedly, yes. But voters really need to think twice before giving the A.T.M. back to the Labour Party to throw billions at the health bureaucrats.

And just so you don’t think I’m biased, it has been found that¬†much of the money spent on general practice does not produce good outcomes for patients. We have even more obese patients with diabetes and poor health outcomes than ever before. Not doctors fault, you might say, but there is evidence that general practice isn’t doing a good job of creating better outcomes for these patients. This is very confronting for me as a doctor to think that perhaps I’m not making much of a difference – but good on National for asking the tough questions and getting us to confront our weaknesses as a profession.

Basically, we are being told across the healthcare sector: “if you want money from the government, prove that you produce better outcomes for patients”. I think this is brilliant, even if it potentially leads to reduced funding for things like “counselling in high schools” (because here’s a scary fact, school counselling does not reduce suicide rates). Another example of where the Labour leader has a policy that sounds nice but won’t make one iota of difference.

Are there failings in National’s approach? Yes. Training doctors have been a shortfall in this country for decades across multiple governments. Compare Australia, for a start. A country of 24 million people with 22 medical schools (basically one med school per million people). New Zealand has two med schools for five million people. We shouldn’t be talking about Waikato med school versus a Rural Otago/Auckland med school outpost – those two SHOULD ALREADY EXIST and we should be about to build our fifth medical school in Wellington. Instead, we languish on two med schools. No wonder we import a thousand overseas trained doctors a year.

Labour wants to slash skilled migration – but they plan on throwing billions at healthcare and Labour don’t support the Waikato med school. Where will the doctors come from then, Labour? Especially when your free doctors’ visits lead to G.P.s being worked into the ground by patients presenting with pointless problems and the generation of G.P.s in their fifties and sixties start retiring en masse (again, see the N.H.S. for proof that free G.P. visits lead to doctor shortfalls and doctors being overworked). Labour can’t have it both ways. You can’t slash immigration and expect doctors to materialise out of thin air!

Another issue I take with Labour’s approach to healthcare is their not-so-secret plan to force us all to join unions. In New Zealand, there are two main doctors’ unions, one that represents junior doctors in hospitals and one that represents specialists. They are run by a man and woman with the same surname¬†who have had a monopoly on the unions for decades. I don’t recall as a junior doc ever getting the chance to vote for change in union leadership. It was always them. They still run the show, and I have been told that it is in their interests to allow negotiations to drag on for years without ever really securing significant improvements in pay or conditions for doctors (because that means they can start agitating for the next round of negotiations the very next day!) When I was a junior doc, salaries had not gone up with inflation for 6 years and conditions were the same as always. I understand things aren’t much better today. So if Labour forces EVERY doctor in New Zealand into a union, we’re all going to be stuck with these Lifer Union Masters who will exert even more influence and power over the situation than they already do.

When Labour was last in charge, doctors were fleeing New Zealand en masse for Australia and other greener pastures because Labour sees doctors as “rich pricks” who should be taxed and get paid too much. Because God forbid, they studied hard for years and trained for even more years and worked 60+ hour weeks for years to get to where they are, but no, they’re all privileged “rich pricks”.

In my graduating class at least 40% moved to Australia or the U.K., including myself. I only returned when National took power and the tax rate and working conditions had improved. Expect that if Labour get into power, especially if they have the pro-homeopath anti-doctor Greens for coalition partners, doctors will start climbing on aeroplanes again in large numbers. Good luck to Labour staffing our hospitals then, especially when they ban skilled migration.

Let me be clear – I love New Zealand and I truly love serving the people as a doctor. More than half of my patients are Maori, Pasifika and/or from underprivileged backgrounds. They are wonderful people and it is awesome to be on the frontline helping improve health outcomes for these people so that they have better opportunities in life. But this does not make me a bleeding heart liberal. I vote National because they are the only party who understand that while healthcare is a RIGHT it is ALSO a privilege and should be administered sensibly and according to the evidence, with an eye to the bottom line.

A good example is a drug like KEYTRUDA for melanoma which, when Pharmac refused to fund, the Left in the media went hysterical and accused John Key of murdering people. Here is how this works: American companies invent expensive drugs which are on a patent for 10 years, which means they can charge whatever they like. Said drug might reduce the risk of death of a certain cancer by, let’s say, 10%. That means you have to treat ten people to save one life, and the other nine die anyway. If one year of the drug costs $200,000, then you have to spend $2,000,000 to save one life (and the other nine die at a cost of $1.8 million). Pharmac might reason that there is an 11 year old drug (no longer on patent, so much cheaper because any company can make it) that costs $10,000 a year but saves one in forty people. So for $2,000,000 you can treat TWO HUNDRED patients and save FIVE lives.

Obviously, these sorts of arguments are always controversial and often upsetting, particularly to people who are going to lose their lives (or loved ones) to diseases which could be treated by expensive drugs. But when you have a limited health budget, Pharmac has to make tough choices and it does so by looking at the evidence and carefully weighing up whether the expense is worth it.

So in summary, as a doctor, I think there is only one party capable of running our healthcare system properly. National have a caring yet sensible attitude, where they demand that the healthcare system produce results for patients in a cost effective manner and cut services which do not yield good outcomes or are wasteful. They understand that doctors work hard and deserve to keep more of what they earn. Their policies make New Zealand a more attractive place for doctors to live and work. They could definitely improve on several fronts, particularly with regards to the training of patients and perhaps certain underfunded services like bowel cancer screening (although the evidence is still coming in to determine whether it actually saves lives).

On the other hand, all the left-wing parties (Labour first and foremost) simply wish to throw money at healthcare and their policies will lead to a burgeoning bureaucracy, an overworked under-staffed healthcare system, and the flight of health professionals to greener pastures overseas. ACT is probably too extreme, as their cuts would negatively impact on population health. Any party that wishes to limit immigration is only going to make health workforce shortages worse (we rely so heavily on U.K. and sub-continental doctors, Filipino nurses and other Asian healthcare workers).

This election is extremely consequential. National has made some remarkable strides forward across the past 9 years but they need at least another 3-6 years to see their reforms to completion. I strongly believe that a Labour-Greens or a Labour-NZ First coalition will set healthcare back a decade, and make long-term structural issues even worse than they were back when the Clark regime last dictated to all of us.

A vote for National is a vote for better healthcare, and you heard it from a doctor.

 


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