Dialogue: We need dedicated health funding

By JOHN ROUGHAN

When the health service awoke from a post-election slumber and gave a grunt in the direction of its new feeder, Annette King, last year, she was ready with an idea.

Turning to the rest of us, who blindly provide the fodder, she said: what about a dedicated tax? Now that is an idea that occurs to anyone who has watched successive governments wrestle with the beast.

As things are, the politics of health are impossible. There is literally no limit to the curative or comforting services the industry can sell us. And no limit to our desire for them, so long as the Government can be pressed to pay.

There is no price signal, as the economists say, to make me stop and ask: do I really need this?

When doctors warn of dire consequences unless their specialty is better fed, when radiation technicians strike for higher pay and district health boards go into deficit, public opinion says give 'em what they need. Goodness knows, we've given the Government plenty of money.

It spends a fifth of the money on health services. Isn't that enough? That's the question underlying the whole recurring headache. Custodians of the public purse, conscious of all other demands on it, and professionals, whose first duty is to patients, have quite different answers.

But only taxpayers really have a right to answer it.

Perhaps they could, if they consciously paid into a fund that could not be raided for anything else. Maybe. We are not about to find out.

When the beast really started to bellow this week, Mrs King no longer had a daring idea. She said a three-year programme will be announced on Monday which will heave more money at the monster.

Whatever happened to her dedicated tax? My guess is that at first mention she received a glare from the head of the cabinet table and hastily dropped the subject.

Dedicated taxes are anathema to governments, particularly governments from the left, because they reduce the pool for general redistribution. The Treasury resists them, too, because they leave less to shuffle around the Budget.

For all that, Michael Cullen has just set up a dedicated fund for superannuation, over the objections of the Greens and many in the Coalition who would prefer that the money was spent on health among other things.

So why not a fund for health? The only better way to find out whether people think something is worth buying is to slap at least a partial charge on it for those who can afford to pay. But we've been through that.

The next best test is to pay a proportion of income into a fund which is highly sensitive to the range of services we want and how much it can ask of us. Many of us do now. It is called health insurance.

In present circumstances it is a bit parasitic. It leaves the urgent, difficult work to the public hospitals and shamelessly exploits their waiting lists for routine operations.

It also sends you letters when you are fit and healthy telling you what a good deal it has for you. But it is hard to find a deal that promises the same premiums when you are more likely to use it. The appeal of insurance was to smooth out lifetime fluctuations in earnings and risks, I would have thought.

For all that, private insurance presents its customers with some idea of health costs, exerts a little discipline on surgeons' charges and tries to encourage efficient use of the services.

A public health fund could do likewise. In fact, just such a fund already does so for a proportion of public health care. It is known as ACC. Why not a Public Health Corporation with an annual allocation of taxation to provide all the treatments and preventative programmes that the electorate is willing to pay for? There is one reason we are unlikely to see it.

Most health professionals, especially those in public administration, do not really want voters deciding what should be provided. For all their appeals to public sentiment when it suits, they believe they know the public interest better.

And when you look at the popular priorities of the Auckland children's hospital, the "Starship", you might agree.

This week the Starship publicised the use it is making of $1.7 million raised this year in an appeal supported by Lucy Lawless, Temuera Morrison and others.

The money will be used to duplicate neurosurgery facilities that are evidently available at Auckland Hospital on the same site. The Starship's acquisition will avoid the need for children to be wheeled through a tunnel to the main hospital.

Dr Andrew Law, clinical director of the Starship neurosurgery unit, said he was amazed at public support for the fundraising. "It's one of those things that make you pleased to live in this country," he said.

Meanwhile, cancer patients are being sent to Australia for radiation therapy.

Comparisons of health needs are always invidious, but somebody has to make them. If the public was given the whole picture, and personally felt the cost, all sorts of perverse spending and self-serving politics might give way to some healthy democracy.