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Opinion: Slowly, inexorably and irrevocably we are losing confidence in the public health system, and nothing tells the story of this loss of faith than the number of people taking out private health insurance.
We’ll get to the numbers shortly but let me dwell a moment on the cultural journey.
I’m Gen X – a child of the 70s. I grew up in a household where the public health system was revered.
It was a point of pride and a key difference from the American culture that was beamed into our homes via the Pye television sets of the day: Americans can’t get health care unless they pay for it! In New Zealand, we would tell each other, with our strong egalitarian values, private health insurance isn’t even a thing.
Confidence in the health system in our household was bolstered by the fact my father, a professor of endocrinology in Christchurch, had spent his life working in the sector.
He’s 90 now - and still working, researching, writing, hiking and biking - so I hope I have inherited some of his genes and his ongoing curiosity and quest for knowledge. My two older brothers and I grew up thinking – knowing – that the public health sector was strong and there was no need for private health insurance.
I have type 1 diabetes now – diagnosed in 2018 – and an insurance broker told me a couple of years back that I’d be unlikely to get health insurance no matter what I paid in premiums.
I’m okay with that. I don’t have health insurance.
My health insurance is my lifestyle. I don’t drink alcohol. To keep my blood sugar low I avoid all carbohydrates and prepare almost every meal I eat. I run most days and am probably healthier than before my diagnosis.
I’ll cross my fingers and hope the public system can accommodate me if things turn dark. But I am increasingly an outlier.
New Zealanders seem to have looked at the state of the public health sector and voted with their open wallets. Nearly 1.5 million of us now have private health insurance.
The recent surge has been striking. Between 2022 and 2023 a quarter of a million Kiwis newly signed up for private health insurance. In 2022 32% us had health insurance. Now it’s 37%. We pay nearly $2 billion in premiums a year, up from $1.4 billion in 2019.
Perhaps most tellingly this year more than 40% of senior doctors in public hospitals supported a vote for private health insurance to be included in a union claim on employment conditions.
That wasn’t the majority needed for inclusion in the claim but if close to half of doctors in the public system want private health insurance that’s a strong indication of where we sit.
It’s hard to see this trend reversing.
We seem to believe we can be both a low-tax country and have first-world public services – or at least politicians keep trying to square that circle. Neither side of the aisle has the courage to raise the age of entitlement to superannuation so the silver tsunami is gathering and will crash to shore leaving too few workers to pay for too many retirees.
Our pitiful spend on medicines is the butt of jokes, even by the minister for Pharmac. “We’ve been sort of the Romania of the Medicines World Cup for quite some time, and people have had to put up with it,” David Seymour said recently. He pumped more money into Pharmac but that was largely playing catch-up and making good on National’s election promises.
The health budget is under severe scrutiny. Health New Zealand now reports a $1.7 billion deficit. The government is blaming financial mismanagement. Maybe there were inefficiencies but we’ve hardly had a culture of extravagance.
We seem to believe we can be both a low-tax country and have first-world public services...
The biggest crime uncovered so far seems to be that it hired 3000 nurses above the budget. We’ve been complaining of nursing shortages for years so is it too many nurses or just not enough money?
Aside from financial woes recent media stories include people dying waiting in ED, queues at dawn to see the GP and people marching in their tens of thousands in Dunedin in protest at cutbacks to the South’s promised new hospital.
In countries where public health care is guaranteed few people have private health insurance. In Britain where the NHS is a national treasure – although a troubled one – only 11% have private health insurance.
If the clamour for private health care continues New Zealand is on track for a majority opting for private cover. At that point do the expectations of the public health system slide and the services slip even further?
We used to put a premium on the public health system. Now we are paying premiums to avoid it.
Guyon Espiner is an investigative journalist and presenter at RNZ, who hosts TV and radio interview show 30 with Guyon Espiner. He writes a fortnightly column for listener.co.nz
