Heart disease is a favourite tool used by the Grim Reaper across all ethnic groups; a timely reminder for all of us to lose a few kilos.
Lung cancer and diabetes are the preferred means by which Māori leave for the beyond, while breast and bowel cancer are popular in the Pākehā community.
Death by motor vehicle rates well among those cursed with an XY chromosome, while the double Xs show an inclination for strokes.
Why, dear reader, am I sharing this appalling data set as you lie in bed on this lazy Sunday? I’m glad you asked.
The Pharmaceutical Management Agency, better known as Pharmac, has $1.045 billion to spend each year on drugs.
It is widely regarded as a success. By deploying a single-buyer model, Pharmac can negotiate terms that we’d struggle to obtain if we acted individually.
I haven’t verified this, but it seems credible. Lives have been saved, and high-quality years added to uncounted Kiwis as a result of this success.
This rare example of an effective state agency is about to be sacrificed on the altar of equity.
The Government commissioned a report. Of course it did.
The interim report, published last year, states: “Pharmac starts with a utilitarian approach, in that it seeks to achieve the best use for society of available funding.” Utilitarian means obtaining the greatest possible outcome for the greatest number of people.
In the health system, this is measured using a Quality-Adjusted Life Year, or QALY. One QALY is a year of perfect health, a zero QALY means you are dead, or worse, a resident of Feilding.
Pharmac looks at its budget and decides how to spend its limited cash to get the best possible outcome for all residents of these shores. It does not look at the religion, the race, the gender or physical attractiveness of the human beings whose life is being enhanced.
This approach is being updated. In the future, if you have the right whakapapa, your medical well-being will count for more than that of the nurse who arrived from Manila last month and will be administering the medicine.
This interim report drives home the point: “Screening [for bowel cancer] is highly cost-effective compared to other healthcare interventions. But since the disease had a relatively lower incidence among Māori, this could increase inequity by focusing on a disease less common among those with the greatest health needs.”
The final report landed in June and recommends: “Pharmac needs to incorporate equity considerations in all stages of its assessment processes.”
Andrew Little is enthusiastic. “Pharmac will have a much greater focus on improving the health of Māori, Pacific peoples, disabled people and other groups who do not yet share equitably in the benefits Pharmac provides.”
Dr Bryce Wilkinson, in a report written for Wellington think-tank the NZ Initiative, does an outstanding job of unpicking exactly what is being proposed.
Pharmac has a capped budget and purchases drugs that do the maximum good for the maximum number. Forcing Pharmac to focus on increasing the QALY of one sector of society means it must cancel a medicine elsewhere.
Wilkinson writes: “To oblige Pharmac to fund medicines according to race or ethnicity is to propose that a unit of quality-adjusted life year for Māori is worth more than a unit for non-Māori, regardless of any other consideration.”
The argument is a little technical but easy to grasp with a simplified example.
Bowel cancer screening costs, say, $10 million and saves 100 lives. Five are Māori.
A diabetes drug costs $10 million and saves 50 lives. Ten are Māori.
Under the current rules Pharmac invests in bowel cancer screening. Under the proposed guidelines it chooses the diabetes drug.
Wilkinson goes further.
Part of the justification of these changes are claims of systemic racism, being laid by, amongst others, the yet-to-be-knighted Dr Ashley Bloomfield, who told the Waitangi Tribunal: “The impact of personal and institutional racism is significant on both the determinants of health and on access to and outcome from health care itself.”
Wilkinson issued several Official Information Act requests for the evidence of this “institutional racism”. He received a weak response and concluded that what the research shows is a link between self-reported experiences of racism and ill-health, and notes that this shows a correlation, but not that racism causes or is responsible for Māori and Pasifika health outcomes.
He is more restrained that I am willing to be. The cupboard is bare and the data self-evident.
Lung cancer and heart disease are, by and large, illnesses of choice. To assume that those who smoke or enjoy the delights of a diet light in vegetables are ignorant of the consequences of their decisions is to deny the agency of those individuals.
I know that carrying a spare tyre around my mid-riff comes with the cost of years not lived. I am aware that earning a living in the stress-filled existence of commerce comes with an increased risk of stroke and heart disease.
More men than women make these choices, and is part of the reason males spend less time between being born and buried than women do. That and a penchant for riding motorbikes, boxing, and other acts of recklessness that we do to impress females.
This lack of lived masculine years isn’t the result of sexism, and it isn’t a justification to junk screening for breast cancer in favour of compulsory prostate exams.
What is being proposed by Andrew Little and his minions is morally abhorrent. It is a paternalistic, white-man’s burden re-imagined for a modern era...
It is widely regarded as a success. By deploying a single-buyer model, Pharmac can negotiate terms that we’d struggle to obtain if we acted individually.
I haven’t verified this, but it seems credible. Lives have been saved, and high-quality years added to uncounted Kiwis as a result of this success.
This rare example of an effective state agency is about to be sacrificed on the altar of equity.
The Government commissioned a report. Of course it did.
The interim report, published last year, states: “Pharmac starts with a utilitarian approach, in that it seeks to achieve the best use for society of available funding.” Utilitarian means obtaining the greatest possible outcome for the greatest number of people.
In the health system, this is measured using a Quality-Adjusted Life Year, or QALY. One QALY is a year of perfect health, a zero QALY means you are dead, or worse, a resident of Feilding.
Pharmac looks at its budget and decides how to spend its limited cash to get the best possible outcome for all residents of these shores. It does not look at the religion, the race, the gender or physical attractiveness of the human beings whose life is being enhanced.
This approach is being updated. In the future, if you have the right whakapapa, your medical well-being will count for more than that of the nurse who arrived from Manila last month and will be administering the medicine.
This interim report drives home the point: “Screening [for bowel cancer] is highly cost-effective compared to other healthcare interventions. But since the disease had a relatively lower incidence among Māori, this could increase inequity by focusing on a disease less common among those with the greatest health needs.”
The final report landed in June and recommends: “Pharmac needs to incorporate equity considerations in all stages of its assessment processes.”
Andrew Little is enthusiastic. “Pharmac will have a much greater focus on improving the health of Māori, Pacific peoples, disabled people and other groups who do not yet share equitably in the benefits Pharmac provides.”
Dr Bryce Wilkinson, in a report written for Wellington think-tank the NZ Initiative, does an outstanding job of unpicking exactly what is being proposed.
Pharmac has a capped budget and purchases drugs that do the maximum good for the maximum number. Forcing Pharmac to focus on increasing the QALY of one sector of society means it must cancel a medicine elsewhere.
Wilkinson writes: “To oblige Pharmac to fund medicines according to race or ethnicity is to propose that a unit of quality-adjusted life year for Māori is worth more than a unit for non-Māori, regardless of any other consideration.”
The argument is a little technical but easy to grasp with a simplified example.
Bowel cancer screening costs, say, $10 million and saves 100 lives. Five are Māori.
A diabetes drug costs $10 million and saves 50 lives. Ten are Māori.
Under the current rules Pharmac invests in bowel cancer screening. Under the proposed guidelines it chooses the diabetes drug.
Wilkinson goes further.
Part of the justification of these changes are claims of systemic racism, being laid by, amongst others, the yet-to-be-knighted Dr Ashley Bloomfield, who told the Waitangi Tribunal: “The impact of personal and institutional racism is significant on both the determinants of health and on access to and outcome from health care itself.”
Wilkinson issued several Official Information Act requests for the evidence of this “institutional racism”. He received a weak response and concluded that what the research shows is a link between self-reported experiences of racism and ill-health, and notes that this shows a correlation, but not that racism causes or is responsible for Māori and Pasifika health outcomes.
He is more restrained that I am willing to be. The cupboard is bare and the data self-evident.
Lung cancer and heart disease are, by and large, illnesses of choice. To assume that those who smoke or enjoy the delights of a diet light in vegetables are ignorant of the consequences of their decisions is to deny the agency of those individuals.
I know that carrying a spare tyre around my mid-riff comes with the cost of years not lived. I am aware that earning a living in the stress-filled existence of commerce comes with an increased risk of stroke and heart disease.
More men than women make these choices, and is part of the reason males spend less time between being born and buried than women do. That and a penchant for riding motorbikes, boxing, and other acts of recklessness that we do to impress females.
This lack of lived masculine years isn’t the result of sexism, and it isn’t a justification to junk screening for breast cancer in favour of compulsory prostate exams.
What is being proposed by Andrew Little and his minions is morally abhorrent. It is a paternalistic, white-man’s burden re-imagined for a modern era...
Damien Grant is an Auckland business owner, a member of the Taxpayers’ Union and a regular opinion contributor for Stuff, writing from a libertarian perspective. The full article is published HERE
6 comments:
Well put in layman's terms.
Once again the party that rails against racism is shown to be the MOST racist government we have ever had. Hypocrisy is what Ardern & Co specialise in.
A bunch of whities desperately needing to atone for their past perceived sins by discriminating against 83% of the country. Egged on by a small group of greedy, self-serving Maori whose eyes are bigger than dinner plates seeing all the moolah coming their whanau's way for nothing more than whingeing entitlement and claims of indigeneity.
What a bloody mess NZ is these days. A largely morally corrupt political elite, a craven and biased mainstream media and a population that just goes along.
Not even 17% are Maori, much less of our population. In the 60s to qualify for Maori housing loans and many other special benefits the applicant had to have 51% Maori blood to pass the requirements. Now New Zealand is full of white Maoris fighting to get their snouts in the trough. What percentage of Maori blood does Stephen OReagan ??? A disgrace to hard working NZ tax payers who have to foot the bill for these parasites. Kiwialan.
@ DeeM " and a population that just goes along"
Therein lies the most significant problem. Maori elite and the Maori Caucus are a relatively small part of the problem.
Who wouldn't keep demanding more and more knowing full well that the giver will acquiesce to demands for fear of being labelled racist.
Also knowing the general population wont do much to counter the demands even while they complain and moan to each other.
One wonders when we will wake up and say enough is enough.
One also fears that when that happens it may be too late.
Didn't look like this article made it into Stuff. Now there's a surprise.
This new policy seems very racist to me. I great number of heath problems are life style problems. If one becomes obese the naturally you will have more problems.
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