The committee was reported to be drawing on a 2010 report commissioned by the public health system in Wales, which identified no fewer than 550 elective procedures that were deemed to be of relatively low priority. The top 25 procedures on that list currently cost around $640 million a year in public funding here, so savings of $30 million would equate to less than five per cent.
The Welsh report offered examples for potential savings including tonsilectomies, grommets, varicose veins, haemorrhoids, hysterectomies, Caesarean sections, circumcision, eyelid surgery and surgery to correct protruding ears.
The process of pursuing savings will presumably focus on the health benefits offered by those procedures. As noted, tonsilectomies are nowhere near as common as they once were, while circumcision is arguably more elective than necessary, and few could complain if surgery to correct protruding ears was to be declared cosmetic. Once upon a time protruding areas were taped to a newborn's head in the hope that they would stay there when the tapes were removed, but even if that's no longer done it would be hard to believe that significant savings are to be made in that particular field.
The others are more problematic. Surgery for varicose veins can be much more than cosmetic. The same goes for haemorrhoids and hysterectomies. And Caesarean sections are presumably performed only when necessary; if the celebrity practice of choosing that means of delivery by the 'too posh to push' fraternity has reached these shores then one would expect them to pay for it. The major concern would be grommets.
The Welsh report claimed that the benefit of grommets in terms of a child's ability to hear gradually decreases in the first year of insertion, and that harm is commonly done to the tympanic membrane. The writer doesn't know much about the tympanic membrane, but does know of children whose lives have been transformed by tiny pieces of plastic that can and do make a huge difference in terms of language development, and consequently to the ability to learn.
Grommets are not uncommonly needed by very young children at a time in their lives when they need to be developing language skills that will stand them in good stead as they grow. Language underpins all sorts of other forms of social and intellectual development, and children who miss the boat early can pay a very high price. No one seems to be suggesting, yet, that grommets should go altogether, although the process is a relatively simple one that can be and often is performed privately.
That applies to numerous other procedures that are still on the public surgical schedule, and for many people 'going private' is a realistic option, either by simply fronting with the cash or by purchasing health insurance. Five years ago the insertion of grommets was available privately in Whangarei for $2500, a sum that might be regarded as exorbitant given the time involved but not beyond the means of many people who do not wish to see their child struggling to develop language skills.
The problem is that for many people $2500 will be an insurmountable barrier. It is also reasonable to assume that many children who will miss out on grommets if they are not publicly funded will face other challenges that will further handicap their chances of competing with their peers on a level playing field.
Every day, it seems, decisions are made by civil servants and politicians who do not understand the financial pressures faced by many New Zealanders. Last year's decision to increase the maximum annual part-charge for 'fully-subsidised' prescription medicines from $60 to $100 was a good example of that.
An additional $40 a year would seem piffling to most, and there were (and are) reasonable grounds to increase the charge, but anecdotal evidence would have us believe that it is already deterring some people from filling their prescriptions, while others are leaving their pharmacist to carry the debt.
There might well be good reasons for shuffling some would-be public health patients to private practitioners, and goodness knows the need to ensure that every dollar taxpayers contribute to the public health service is spent wisely has never been greater, but decisions need to be made in recognition of the fact that the public system is some people's only option. Without that they have nothing, and while it might not be unreasonable to expect them to go through life with wingnut ears, procedures that will make a real difference to their quality of life, and to their future prospects, should be provided without question.
If there is a need to reduce, or at least hold public spending, and there is, the committee should be looking at the cost of administration (which Health Minister Tony Ryall has been doing, to his credit, for the last four years), and at the potential for charging those whose illegal actions help drain the budget.
For example, there is no valid reason why those who put themselves or others in hospital as the result of drink driving or violence should not pay the bill. It should not be acceptable that there is talk of depriving children of grommets (and even now there tends to be a long waiting list, in Northland if not elsewhere), while priority is given to drunk drivers and violent thugs. Every time a drunk driver rocks up to a hospital for urgent repairs waiting lists grow, and the financial pressure that is now becoming intolerable increases a little more.
It would be simple for the government to decree that the cost of treatment will be paid by the person whose illegal act gave rise to that cost, and for the proceeds of that to be returned to the public health service. There would be some justice in that.
