Fiona Mackenzie: Need Public Healthcare? A name change may help.

At a recent speaking engagement, Sir Bob Jones said he had known Sir Tipene O’Regan before he was a Maori. Bob had apparently grown up with one Stephen O’Regan – a man who made the politically and financially rewarding decision to strengthen his Maori identity and change his name in middle age. 

Well, it may be time for all of us to start digging out an inner Polynesian. As the baby boomer bubble moves into old age and increasing demands are put on health resources, activist bureaucrats have announced plans for race-based financial control and preference in our public health system. Choosing to identify as a “Maori” or “Pacific Islander” may leapfrog you over other Kiwis.

Identity Becomes Health Issue

PHARMAC (the Government’s Pharmaceutical Management Agency) decides which medicines, vaccines and medical devices are to be purchased or subsidised by taxpayers. In 2013, the organisation sought submissions on a new set of decision-making criteria. That process is now complete. From 2015, PHARMAC will be making funding allocations based on four criteria, of which the first two appear entirely reasonable. They are:

• The impact on the person, the person’s family/whanau and wider society; and to the broader health system;

• The impact across the dimensions of need, health benefits, costs and savings, and suitability.  

But the next two raise the spectre of racism, along with the possibility of corruption inherent in any government treating its citizens unequally. These are: 

• The impact on the health of Maori as a separate factor to acknowledge our commitment to Te Tiriti o Waitangi and being a great Te Tiriti partner;

• The impact on broader groups of populations that are facing health disparities, including Pacific peoples.

The Thinking Behind It 

The Treaty of Waitangi makes no reference to taxpayer funds, healthcare or preferential Maori rights to future technological advancements in western medicine. However, PHARMAC seems to think otherwise, explaining how they are applying the (mythical and undefined) Principles of the Treaty in delivering preferential funding and treatment to those of Maori descent.

It’s somewhat absurd to suggest Queen Victoria’s granting of “the same rights and privileges of British subjects” to Maori could be interpreted as offering their descendants superior healthcare rights. But this seems to be PHARMAC’s intent.

PHARMAC describes its role in advancing tino rangatiratanga (which is interpreted by Maori supremacists as 'absolute sovereignty'). How can any democratic government organisation be promoting sovereignty for any part of the population over public funds and services?

Political Decision-making

PHARMAC’s bureaucrat-speak website appears to suggest that “Maori health” needs and allocations from taxes are to be decided upon by Maori organisations (with no mention of independence, science, reasonableness, let alone specialists, doctors or nurses). Such race-based privilege and control - for Maori by Maori - inevitably means discrimination against other public health patients.

There’s certainly nothing wrong with a health emphasis on conditions such as diabetes, respiratory disease, cardiovascular disease, mental health, arthritis and obesity. But none of these are Maori-only problems. Reducing the impact of these conditions across the entire population should surely be the aim.

Ignoring the Inputs

PHARMAC aims to “eliminate inequities and to ensure health outcomes between Maori and non-Maori are the same”.  If only it was that easy! From personal experience, there’s no chance of health outcomes being equalised within one family, let alone across a community or a country.

Good health is certainly not just about genetic makeup or cultural allegiance yet PHARMAC makes no mention of addressing personal lifestyle choices. Nutrition, exercise, drugs, alcohol, family size, education, budget priorities and personal values surely play a part, yet these inputs don’t get a mention. Instead, PHARMAC wants to allocate funds to broad racial groups (not individuals) they consider to be disadvantaged.

Not all Maori or Pacific Islanders are hard done by. Yet it’s now possible that Governor Generals, TV celebrities, lawyers or MPs of some Polynesian extraction may receive priority treatment over other Kiwis when arriving at the doctor’s, hospital or pharmacy.

And where is the reference to good science in this highly political move? A genetic analysis might find that many “Maori” have predominantly Caucasian bloodlines.

Science or Politics?

Well-informed Kiwis will be aware of the complexities associated with deciding how to optimise the health budget. Any community will have a range of health and disability issues, age-related concerns, and socio-economic constraints. No bloodlines can protect any group from all of these.

Imagine the fuss if our taxpayer-funded, public health system decided to prioritise treatment for New Zealanders of British or Asian descent. It’s an absurd idea, right? That is surely not the Kiwi way. We live, love, work and play together. Surely our ailments should be subject to the same assessment criteria in the healthcare system too.

Difficult as it may be, PHARMAC should not get caught up in political and non-health related judgments based on claims to cultural identity. Such blatant political game playing would make the system very vulnerable to corruption. It would be a sad day when having the right affiliations was a prerequisite to receiving public-funded health care in New Zealand.

To read further, please visit: www.pharmac.health.nz/news/notification-2014-11-24-decision-criteria-review/