by James Robb
A fake debate on access to healthcare opened in June, with the National and Act parties claiming that the government was giving privileged access to health services to Māori and Pasifika people. Their target was a policy adopted by Te Whatu Ora Health New Zealand that a patient’s ethnicity should be a factor to consider when placing them on a surgical waiting list (along with other factors that include time already spent waiting and urban or rural residency). National Party Health spokesman Shane Reti said “race should have no place in surgical priorities.” Act leader David Seymour added, “This is the Government actively promoting racial discrimination in the health system”. The Labour and Green parties and Te Pati Māori support the policy, although the Labour Prime Minister Hipkins left it to Health Minister Ayesha Verrall to defend it on her own, and halted any extension of the policy. “The reformed health system seeks to address inequities for Māori and Pacific people who historically have a lower life expectancy and poor health outcomes,” Verrall said.
Not a single voice on either side of the argument made the most important and obvious point: if hospital and other health care services were adequately meeting everyone’s needs in a timely way, there would be no waiting lists for surgical operations, and therefore no possibility for anyone to ‘jump the queue.’ Clearly, none of these parties have any intention of getting rid of waiting lists in health care: they were all engaged in demagogy and vote-gathering, nothing more. Their debate leads to a dead end.
Rebuild the public health system!
Workers Now demands the rebuilding of the free hospital and health care system as the only truly effective means of ensuring equality of access to health care. Free public hospitals were a demand raised by the workers’ movement a century ago; the current system of free hospitals was set up by the Labour government elected in 1935, with hospitals paid for by taxation and administered by elected Hospital Boards. The aim was to make health care available to all, and not restricted to those wealthy enough to pay doctors’ fees or buy health insurance. This was a colossal gain for the working class, acting in the interests of all the oppressed and exploited.
The free hospital system was extended throughout the years of capitalist prosperity, expanding to include compensation for all accidents in the 1970s. Since that time, however, it has come under continuous attack, both directly and indirectly. The most direct attack was the attempt in the 1990s to introduce fees for nights spent in hospital, and the corporatisation of the hospital boards, which were now to be run as if they were businesses. The attempt to force people to pay for hospital visits was defeated by protests by health workers and the broader labour movement, and by a mass refusal to pay. But the other, more indirect changes were forced through, resulting in a sharp deterioration of access to health care for working people. Especially hard hit were those living in rural areas and smaller towns, after many local hospitals were shut down by the corporatised health boards in the name of efficiency.
As the free public hospitals were run down and waiting lists for surgical operations grew, an industry of private health care businesses sprang up, providing the same services – sometimes with the very same specialist doctors! – but for payment. These businesses are built on the agonising decision faced by many patients needing surgery: languish for months or years on the surgical waiting list, or ‘go private’ and pay an astronomical figure to get the operation done immediately. Even patients in severe pain, or with conditions like cancer, where timely treatment can make the difference between life and death, face this terrible decision. The health insurance industry mushroomed, as another layer of capitalists sought to gain a profit from this situation.
Without the waiting lists, this entire profit-gouging business would wither and die – because why would anyone pay for an operation if you could get it free? That is why the capitalist parties, which put the profits of these businesses before the health needs of the population, will never move to abolish the waiting lists.Most workers can afford neither health insurance nor the cost of paying for surgical operations from their own savings. This fact is the chief source of unequal access to health care – workers can not afford to ‘go private’. As long as there are waiting lists for free health care alongside a private health industry for those who can afford it, that inequality will remain.
There are no academic studies of unequal class access to health care. Capitalist society doesn’t recognise class, and aside from data on incomes and occupations of patients – which are at best inaccurate indicators of class – doesn’t even collect data on it. But they do keep data on ethnicity, and since Māori and Pasifika peoples are overwhelmingly working class, the class inequality appears in the form of a well-documented and much-studied difference in health outcomes for Māori and Pasifika peoples.
This class fact, an inevitable consequence of the operation of capitalist market forces in the health system, largely explains the unequal access to health care for Māori and Pasifika peoples. But not entirely. The New Zealand state was founded upon the dispossession and marginalisation of Māori, and national oppression of Māori remains embedded in its structure. While surgeons and other medical practitioners claim to be making decisions based purely on medical criteria, in practice their decisions collectively reflect this institutional racism. Māori suffer disproportionately high rates of heart disease, for example, yet receive a disproportionately low share of heart surgery. A similar situation applies to women: conditions only suffered by women, such as endometriosis, are constantly neglected in the health system.
Such discrimination in the provision of health services can tear the working class apart. So long as the waiting lists remain, therefore, Workers Now supports measures of positive discrimination in favour of Māori and women to partly correct this imbalance. Such measures are in the interests of the entire working class.
Workers Now stands for …
· Abolish the waiting lists for surgery and all health care! Rebuild the free hospital system with funding sufficient to ensure that all patients’ needs for care are met in a timely way.
· Open the borders to health care workers, with rights to residency and citizenship, and raise their salaries, in order to fill the hospital vacancies and end the overwork among health professionals
· Full training without fees for doctors, nurses, and all skilled health professionals, conditional on their employment in the state health system, wherever the need is greatest.
· Support positive discrimination in favour of Māori and women in access to health care, as long as the waiting lists remain, and to all professional training in health care.
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