My Identity Crisis

Who me? A Politician?

After about a week of sleepless nights, I recently agreed to stand (in New Zealand. you “stand” for office) as a Green Party candidate for Taranaki District Health Board (DHB). Does this mean I’m a politician now? I sure hope not. For most of my life “politician” has been one of the vilest words in my vocabulary – one I associate with sociopathy, criminality, and moral bankruptcy. Is a candidate for public office automatically a politician? Or is there some invisible ethical boundary most political leaders cross that transforms them into politicians.

The First National Health Service in the World

For readers unacquainted with New Zealand, our National Health Service, established in 1938, was the very first. Funded through tax-payer dollars, our health system is similar to the British National Health Service, in that hospital doctors and nurses are government employees. One important difference is that primary care remains in the private sector. Kiwis pay most of the cost of a GP visit themselves. Although the government subsidizes GP care for seniors and other disadvantaged groups, cost remains a significant barrier for many low and middle income Kiwis.

This, in turn, means New Zealand has an abysmal record in treating chronic conditions like high blood pressure and diabetes and delivering preventive health services. A recent University of Otago Study revealed that low income Kiwis die 6-9 years younger than other New Zealanders. In my mind, a national disgrace.

Taranaki’s Health Care Mess

I’m standing on a platform of increasing transparency and accountability over major service cuts that are occurring under our current National-led (conservative) government. Like many “provincial” (i.e. rural) areas in New Zealand, Taranaki has a chronic GP shortage – made worse by recent budget cuts. Moreover at present even middle income Taranaki residents have difficulty getting “elective” services, such a joint replacements, through the public system. Pressure from the New Zealand government to reduce long waiting lists means that many patients with degenerative hip disease can’t even get on a waiting list. In other words, unless they can pay $25,000 to have their hip surgery done in a private hospital, it won’t happen.

Efficiency Adjustments: Austerity Cuts in Sheep’s Clothing

The New Zealand NHS is divided into twenty health districts, each supposedly governed by a District Health Board. Increasingly, however, the Ministry of Health is centralizing all the really major decisions over health care delivery, reducing the DHB role to that of a rubber stamp.

Our current government, which has laid off thousands of public service workers, made a campaign promise that they wouldn’t cut health care or education. Thus they play this elaborate shell game called “efficiency adjustments.” What it amounts to is a scheme to magically erase the cost of inflation, population growth, and caring for older, sicker patients from the health budget. In 2012, they allocated $111 million less than the twenty DHB’s needed to continue existing services.

Because DHBs aren’t allowed to run deficits, they have no choice but to cut staff, decrease GP subsidies, and prioritize cheaper, less complicated surgeries. Here in Taranaki, they started by laying off clerical workers and administrators, shifting this paperwork load to doctors and nurses. In 2013, the DHB has begun to cut clinical staff positions. As doctors and nurses are still expected to care for the same number of patients, this is an ominous development which greatly increases the risk of medical errors.

Crossing the Line

If there is an invisible line, it must be the one a candidate crosses when he or she makes a campaign promise they can’t possibly keep. This is what worries me as I get up to give my stump speech. With Taranaki DHB having so little authority over health service delivery, I sometimes worry what I can keep.

I tell people I’m standing on a platform of increasing transparency and accountability over all budget and service cuts. I know I can keep the first part of this promise. I’m starting a watchdog-type blog on my new website and will take great joy in exposing National “efficiency adjustments” for what they really are: austerity cuts. Delivering on accountability (i.e. forcing the government to respond to what the public wants) will be more difficult. I am prepared to stick my neck out and be an extremely forceful advocate for the residents of Taranaki. I really worry, though. Will this be enough?