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John MacDonald: Is compulsory health insurance the answer?

Author
John MacDonald,
Publish Date
Wed, 7 Aug 2024, 12:57pm
Photo / File
Photo / File

John MacDonald: Is compulsory health insurance the answer?

Author
John MacDonald,
Publish Date
Wed, 7 Aug 2024, 12:57pm

So the guy running the hospital system says it could go broke within just a few months and we’re going to just keep on doing things the way we have forever, are we? 

That would be nuts. Which is why I think we’d be much better off if we just required people to have health insurance. 

The public system which Dr Lester Levy —who is the Commissioner appointed by the Government to run Health NZ instead of the Board— says its spending $1.4 billion more than it should. 

His job is to get on top of that and get the place running as the Government wants it to be running by Christmas. Which is a pipedream, especially if anyone thinks that amount of money can be saved, services can be maintained —if not improved— and that we can do it under the current funding model. 

Which is where Singapore comes into the conversation, and where I think we should be looking for a solution for this health funding mess. Because what other solutions are there? I can’t think of any. You might, but I can’t. 

Former politician Richard Prebble has written an interesting piece in the NZ Herald today, where he says that maybe Singapore has the best approach when it comes to paying for healthcare. 

Over there, everyone pretty much pays universal health insurance. They have a scheme which is mandatory for all citizens and permanent residents which provides cover for life, for hospital bills and outpatient treatments. 

As well as that, they have a compulsory medical savings scheme which people can use on other healthcare expenses for their families. 

So think KiwiSaver, but it’s a health fund instead of a retirement fund, that comes out of your wage or your salary and you can call on it when you need it. And just like KiwiSaver, employers are required to top it up, as well. 

And what this approach means is that the Government in Singapore doesn’t have to spend as much of its budget on the health system, unlike us here in New Zealand, where health is the biggest single item in the Government’s annual budget. 

Percentage-wise: in Singapore, the Government or taxpayers cover just a quarter of healthcare costs. The rest are covered through these insurance schemes they have operating over there. 

In New Zealand, it’s around 85 percent. 

In his NZ Herald article today, Richard Prebble reckons politicians here wouldn’t have the guts to push for the same thing here. But I say, why not? 

Unless you can come up with a better solution, I think compulsory health insurance is the only solution. 

The only solution if we don’t want to keep hearing the talk we’ve been hearing from the Health NZ Commissioner in the past 24 hours. 

Talk like this from Dr Levy: ““For us, this is not a marathon, it’s a sprint. We have to move really quickly to secure our financial position as quickly as possible in order to overcome this particular cash-flow issue that is hanging over us.” 

And he’s got the job of sorting this out before Christmas. Which, in dollar terms, means somehow cutting spending by tens of millions of dollars per month. 

How on earth do you do that without cutting services and making people wait longer for treatment? 

The answer to that, is you can’t. It’s impossible. 

Which is why I’m saying that, if the model is broken —as it very clearly is— then we need to do things differently. And, for me, compulsory medical insurance is the answer. It could be done through existing medical insurance outfits - or it could be a government-run scheme like they have in Singapore. 

But, either way, we have to get over this idea of doing things the way we’ve always done them if we are really serious about sustainably funding health services in this country. 

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