The problem with ten-year private healthcare contracts

In a democracy, the people/tāngata support parties and policies and thus provide the resulting government with power. The advantage of a government with power, supported both by votes and taxes, is that it can take responsible actions on behalf of all and provide services efficiently—e.g., education, healthcare, border security—that are much harder, even impossible, for smaller units of the community to provide for themselves. This is the heart of the social contract.¹

Poorly functioning, neglectful or incompetent governments ignore the two-way nature of this arrangement: they accept the power from tāngata but do not use it for tāngata. Such governments begin to dismember the difficult services, perhaps believing that everything should pay for itself, even make a profit, or maybe just not wanting to do the hard maintenance work needed.

The particular advantage of dismembering healthcare is that there are some parts of hospital care that allow those in private business to make low-risk, large and rapid profits.² If the government is under the delusion that private healthcare is more efficient than public institutions in delivering hospital care, this just adds weight to the justification for their decision.³

Hence, the 10-year contracts the Aotearoa New Zealand Government is currently proposing.⁴

Other parts—the urgent cases, complex disease management, hospital care needing multidisciplinary teams, training specialists^5,6—are not easy to sell off as it is far harder to make the kind of profit that the routine can provide. So, these are necessarily kept in the public sphere. When they are poorly financed, they slowly decay. The health of tāngata goes downhill and the health/life expectancy gap between Māori (as well as Pacific people and the poor) and the rest of us continues to grow.⁷

As the healthcare system plummets towards the most expensive, least efficient and most unequal, it will begin to look more and more like the United States of America (USA), but will actually be worse, because there university-affiliated full-service hospitals provide medical training and do research.⁸ We have no comparable institutions in Aotearoa New Zealand. So, we will be expensive, inefficient and unequal and we will be even more dysfunctional than the USA.

The authors of this letter call for an uncomplicated government guarantee of free access to hospital healthcare for all of us as a collective moral imperative and an individual legal right. We ask all healthcare workers in Aotearoa New Zealand to join us in this call.