National’s Health Discussion paper

September 27th, 2007 at 9:18 am by David Farrar

released yesterday its discussion paper on health.  Some key points are:

  • Greater involvement by doctors, nurses and other health professionals in the public health system’s planning and operation
  • Relocating some hospital services to Integrated Family Health Centres, which would provide a fuller range of services closer to patients
  • Use of public-private partnerships to boost elective surgery availability and cut waiting lists
  • Investigate bonding and student-loan write-offs to boost the health workforce

The full paper is 51 pages long.

Understandably some of the media focus has been the statement during the press conference that National does not plan to continue to cap GP fees.  I’ll touch on the process and the substance of this.

The political management has been a bit sloppy to not have this explicit in the discussion document or at least the accompanying material.   Any release of decisions or thinking should be done in a controlled structured way, not done because a journalist happens to ask the right question. This combined with the publicity over the policy to allow minority private ownership stakes in some SOEs makes it an untidy few days.  Again not that the substance is wrong (in fact it is good to see differences between Labour and National) but that it looks like policy is being revealed grudgingly.  The SOE stuff has been public for months and months and any questions on policy should always refer to the fact that this is not new.  MPs should have at hand that this was released publicly on x date by y, is on the website at z etc etc.

Anyway onto the substance of should GP fees be capped, and Tony Ryall answered this well:

“We think the Government’s price control affects the long-term viability of general practice. So people can have the price control, but they might not have a GP. That’s the reason we’ve indicated for a long time that we just don’t think they should have this.”

He said National would have a much more “trusting relationship and a relationship of mutual respect” with doctors, who had undertaken to pass on subsidies when they signed up for them.

And then John Key said:

National leader John Key also said fees would be controlled by “the market”. Asked what would stop rural doctors increasing their fees given they faced little competition, Mr Key said “country GPs aren’t exactly known for being rip-off merchants”.

Labour’s imposing price controls on GPs has been part a 20 year battle by Helen Clark (she tried in the 1980s) to effectively nationalise GPs and make them de facto state employees.  We’d be like the UK National Health Service and I suggest anyone who trumpets that service should be forced to go and use it.

The reality is we have a huge GP shortage, especially in rural areas.  The thought of GPs making themselves filthy rich because they are the only GP in say Haast is a joke.  We have real problems getting GPs into rural areas, even with the massive influx of foreign trained GPs.

GPs income relative to other professionals has, if I recall correctly, massively shrunk in the last 20 years.  It used to be a top profession to aim for, with top remuneration, but now some LLB students are earning more than a GP, before the med student even finishes study.

Another reason the state should not price set for GPs is not all practices are the same.  They have different property costs, different staff costs, different mixtures of patients, different average times per consultation etc.

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166 Responses to “National’s Health Discussion paper”

  1. Inventory2 (10,269 comments) says:

    Ask your questions on this thread sonic!

    Personally, I have no problem with removing the cap on GP fees. The state has no role in restricting professionslas from earning an incoime commensurate with their qualifications, experience, and their desire to “make a difference” by working as GP’s – goodness knows, GP’s are in short enough supply as it is – let’s not make the “calling” any less attractive than it has already become.

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  2. Inventory2 (10,269 comments) says:

    whoops – typos! should be “professionals from earning an income”

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  3. sonic (2,818 comments) says:

    “a bit sloppy”

    Rather an understatement David. The Nats release a 44 page health policy document that, for some reason, fails to mention they are going to remove the cap on GP charges.

    Have you ever seen a more shifty bunch when they got rumbled?

    This all ties in to the “secret agenda” meme. Another example that behind Key’s image there is a hard right programme being concealed.

    Expect to hear lots more about that.

    Finally (for now) part of the deal that set the cap gave doctors large subsidies. Does National plan to remove these?

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  4. toms (299 comments) says:

    The interesting thing is that every time the edge of the carpet is pulled up and some National party policy is whispered – letting “market forces” set doctors fees, privatising ACC, selling off the SOE’s – its always a massive vote LOSER with the electorate. My prediction for 2008 is an increasingly irrelevant and vacuous John Key will simply try to say nothing, make bumper sticker cliche mum and apple pie statements, and talk about ‘tax cuts,” whilst Bill English will continue to snipe away from the side streets.

    [section deleted by DPF as involved children of MPs]

    The cracks in National are obvious despite all the papering over that has gone on, and that translates into the sort of appallingly bad political management we saw yesterday were John Key looked uncomfortable and poorly informed as mad dog Ryall answered all the questions, including questions about things National “forgot” to put in the document.

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  5. philu (13,393 comments) says:

    so.

    1)..flog off the states’ assets..

    2)..raise doctors’ fees..

    (what a ‘winning’ formula you are coming up with here.!..author..!..author..!.)

    what’s next..?

    nuke reactor..?..

    in aro valley..?

    phil(whoar.co.nz)

    [DPF: Well if we had one, that would be a fine place for it :-)]

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  6. slightlyrighty (2,471 comments) says:

    The usual suspects are jumping on this statement.

    Capped fees are all well and good if you have a doctor to go to. There is a huge GP shortage in this country with people in parts of wellington having to wait months to get on to a GP’s book. Some people in Kapiti are getting GP service in New Plymouth?

    GP’s are not state employees. They are a private enterprise and the only private enterprise that is limited by the government as to what they can charge.

    Many GP’s are retiring and not being replaced. I would assume that doctors are intelligent people. Would you want to set up a business that has no control over costs or income?

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  7. sonic (2,818 comments) says:

    On the substantive part of the policy. The whole ethos of modern health care stratehy is to encourage people to visit their GPs. Illnesses are cuaght early, Accident and Energency departments are spared visits from people with easily treated conditions, preventative care can be promoted and problems spotted earlier.

    The incredible out of touch nature of John Key was also on show yesterday when he said “it is a market” and that people could just go down the road and see another doctor if their GP charged too much.

    Health care is not like buying a tin of beans Mr Key.

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  8. Linda Reid (413 comments) says:

    The ‘market’ would supply far superior health care for the vast majority of people. It would make more financial sense for the government to buy health insurance for everyone rather than try to run hospitals – something this government in particular is astonishingly bad at doing.

    Health care is a fast developing field and the creaky mechanism of central government and district health boards are just able to innovate and deliver an adequate service.

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  9. Linda Reid (413 comments) says:

    Health care is a fast developing field and the creaky mechanism of central government and district health boards are just NOT able to innovate and deliver an adequate service.

    (Check before you post Linda.)

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  10. Tane (1,096 comments) says:

    <i>Labour’s imposing price controls on GPs has been part a 20 year battle by Helen Clark (she tried in the 1980s) to effectively nationalise GPs and make them de facto state employees. We’d be like the UK National Health Service and I suggest anyone who trumpets that service should be forced to go and use it.</i>

    And letting “the market” decide as John Key has suggested would send New Zealand down the path of the United States health system, where the poor don’t go to the doctor to get their illness seen to because they can’t afford it. Is that National’s vision for New Zealand’s health system?

    Left to its own devices, the market will not provide for those who can’t afford it. That’s one thing John Key and the National Party will never understand.

    [DPF: It is hard to accept but there is such a thing as a compromise between 100% public like in Canada and 100% pruivate like in the US. We have a hybrid model which seems to be better than both the extremes. GPs get some subsidies from the state but they are not employed by the state. But if you are worried about poor going to the doctor, then you should support my preference for targeting greater assistance to poorer familes rather than have universal subsidies for everyone no matter how wealthy.]

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  11. Lee C (4,516 comments) says:

    Regardless of the ideological issues at stake here, it does beg the question I once raised about the handling of the EFB, then the recent clumsy treatment of the SOE issue, now this, to convene the national press and not know the answers to basic questions – is this the hall mark of a party that can effectively lead a country?

    Point is, the National Party should stand up and be counted, and not come across like naughty schoolboys, otherwise, Labour will defeat them at the election simply on the basis of having more ‘street-smarts’.

    For goodness sake, National, grow up and get into the frikkin ring with the big boys…

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  12. david (2,552 comments) says:

    while it is a pleasant experience to “enjoy” cheaper doctors visits when reaching for the wallet there is a huge downside to the changes made over the past 9 years.

    I have seen waiting times at the surgery increase because allowed consultation times have been reduced but the doctor still takes whatever time is needed to do his job. The subsidies system demands that the GP cranks through his patients far faster. This has made them run almost perpetually late unless you can score an appointment first up in the morning or after lunch and has shifted the cost in unproductive time back on to the patient. At my charge-out rate I would rather pay more and be seen as scheduled than be sitting around in the waiting room with a bunch of sick people for half an hour.

    The GP is pressured to get his patient in and out in something like 10 minutes or less which mitigates against proper diagnosis and the sort of inquiry that migt reveal the early warning signs that is one of the trumpeted features of more frequent visits.

    My observation is that the GP now has to have a much larger list to be economically viable to the point where he relies totally on his computer notes rather than his knowledge of the patient which is contrary to my expectation of a sensible and consistent treatment regime – I have to tell him where we are up to.

    Summary
    The system is running the doctors rather than the doctors running the system..

    It might suit the likes of sonic to live in a command economy but there are others who value their freedom of choice and are seeing it eroded constantly.

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  13. Right of way is Way of Right (1,121 comments) says:

    I agree with Sonic…. partly, and for the first time in my life!!

    The focus on Primary Health care is on early intervention by GP’s. Great. Now National want to ensure there will be a GP to go to! The Labour Government have been trumpeting te wage rises for nursing staff at the same time as they cap GP fees! Not only that, but then the GP’s have to cope with the influx of people that have been removed from Labours reduced waiting lists!

    GP’s have rapidly become the safety valve for a massively under-resourced and overly beaurocratic health system. Any policy that increases the viability of becoming a GP is a damn good idea!

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  14. sonic (2,818 comments) says:

    Perhaps we could have two sorts of GP’s?

    One for wealthy people like Mr Key, and another set for poor people, sort of bargain basement health care.

    Just like the market you see.

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  15. Inventory2 (10,269 comments) says:

    sonic said “Perhaps we could have two sorts of GP’s?

    One for wealthy people like Mr Key, and another set for poor people, sort of bargain basement health care.”

    Do you mean doctors like the ones who have set up a charity hospital in Christchurch (entirely self-funded) to provide services to people who can’t access heathcare under a Labour government?

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  16. rickyjj (163 comments) says:

    As David points out, there are a lot of good reasons for dropping the cap.

    However “market” control will mean doctors fees will increase – under the cap they’re already allowed to decrease them if they wish – and National shouldn’t try and pretend that this won’t be the case.

    In my opinion we seem to have a problem with GPs not because of poor pay but because the medical profession is a monopoly and they are extremely strict with who they let into medical school. If they are going to go with market control then they should let anybody into medical school and let anybody who wants to call themselves a GP. Sure this will mean a lot of bad doctors but in a real market you should get the choice of going to a bad doctor for cheaper (like Dr Nick on the Simpsons!).

    The truth is that brains aren’t really so important for a GP. The job is far more about people skills, and any time they’re unsure of anything they refer you to a specialist. Most intelligent people don’t want to be GPs as it’s a pretty shitty job, and most people of any real talent already try and specialise… I don’t see how letting them charge another $20 an hour is going to change this.

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  17. krazykiwi (9,186 comments) says:

    Inventory2 – sonic doesn’t ‘mean’ anything.

    he’s just relentlessly working his ‘create fear about the absolute evil of wealth’ script.

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  18. sonic (2,818 comments) says:

    Exactly inventory. National could have a multi-tier system.

    Gold class GPs, for multi-millionaire market spivs. Top medica treatment, no need to mix with the proles in the waiting room.

    Silver class, for your middle class Kiwi Battler, Not the full bells and whistles like the above, but a decent service (serious illnesses extra)

    No frills Economy class, for the financially challenged. Doctor is not actually qualified and no actual medical treatmenst available, however you will be told that there is a lot of that going around, take two asprin and call me in the morning, just like the real thing.

    Pauper class. Charity hospitals. Great source of spare parts for Gold class customers.

    National’s vision of the future, brings a tear to the eye!

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  19. Lee C (4,516 comments) says:

    sonic said “Perhaps we could have two sorts of GP’s?

    One for wealthy people like Mr Key, and another set for poor people, sort of bargain basement health care.”

    It doesn’t matter, either way, sonic. I am sure that even in the politburo at the height of communism, the Party Members wouldn’t have to queue with the proles for their health care.

    What of the other ideas floated?

    “Greater involvement by doctors, nurses and other health professionals in the public health system’s planning and operation
    Relocating some hospital services to Integrated Family Health Centres, which would provide a fuller range of services closer to patients
    Use of public-private partnerships to boost elective surgery availability and cut waiting lists
    Investigate bonding and student-loan write-offs to boost the health workforce ”

    To they have any merit?

    My remarks about communist Russia are not designed to justify a two tier system, but rather to indicate it is probably pie in the sky to really think that equal healthcare is ever provided across the population.

    Personally I would endorse a state-owned and regulated free health care system for all. But Look at the shambles of the NHS in the uK. Even New Labour had to use private services to bale them out.

    Here in NZ people are flying to AUS to access care….

    I think some issues should not be reduced to an ideological argument, but should be worked out as to provide the best service for all. Health, education and constitutional issues for three.

    I work on the basis of:
    If I work all my life and pay my taxes, and then when my hips are knackered, can I get an op to fix it quickly and without disrupting the quality of my life too radically?

    If the answer is
    yes’ then my contribution has been justified.

    if it is ‘No’ then I have been screwed by the state, regardless of the colour of their brochures.

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  20. KevinOB (267 comments) says:

    I detect that Liabour have got there bully boys and girls out early in this pre-election tussle. I don’t dance with thugs but will trip them them up in the mud.

    As a mere patient and user I have no problems with my doctor having a decent income: I can see the commercial reality of the local practice. On an hourly rate they are not charging anymore than the specialist I paid $200 (GST inc) to see on Monday. Both have substantial costs to meet from their charges.

    What is wrong, is the forced delays in diagnosis. My next stage is an expected CT scan, which unless it is done in the next month, I will have to expedite by paying for myself. We have got to the situation, where even life threatening conditions are not being promptly dealt with, because of factory like patient processing and bureaucratic molasses. Planning has surpassed common sense. If you do not have a broken limb you can be a non-person.

    We don’t need any national health insurance to add another layer of costs but freedom for GP’s will allow services to develop. Our local practice has done that under the new PHO funding model and their fees have increased, but not unreasonably. There is evident increased efficiency, even test results come direct to their patient database from the lab. As a customer I prefer the better service. Those who say they cannot afford it need to look at their spending priorities.

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  21. dave (987 comments) says:

    Tony Ryalls excuse for omitting the fee cap removal is that the issue was not a major concern for most Kiwis – the fact that not getting the services was of more of a priority.

    Well, its of greater concern than the rest of the policy. No point having services if you cant access them because of cost.

    National over the past week has just declared its neo-liberal hand. Leave it to the market. Market failure doesnt exist.

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  22. Inventory2 (10,269 comments) says:

    sonic said “National’s vision of the future, brings a tear to the eye!”

    Yeah, started on Labour’s watch, despite an extra $5billion expenditure on health, with no discernable benefits (unless you’re a nurse or a member or the Service & Food Workers’ Union!).

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  23. Andrew Bannister (213 comments) says:

    but now some LLB students are earning more than a GP, before the med student even finishes study.

    I think that says more about the over-valued LLB student than it does about poor wages of GPs and physicians in general. GPs, on average, take home a reasonable income, given their training and skill level. Now I know people will argue that they can get more in the UK/Oz/pick a country, but so do most occupations. NZ incomes are just lower than some other countries. You take the good with the not-quite-as-good.

    As for the cap, I’m in two minds about it. I like the idea that there is a limit to how much a GP can charge. However, as DPF says, I also doubt that removing the cap will actually result in a huge increase. Not under our current health system. I think it would be a different story under a fully privatised system.

    Dentistry is a good comparative model of what I fear could happen. A BIG part of the population are experiencing serious health concerns (e.g. poor diet because they can’t eat properly) and suffering immensely, simply for lack of access to reasonable dental care. For a lot of people, dental care just isn’t an option. In extreme situations, extraction is sought as a last resort. This is far from ideal, and as Sonic has said, poor primary health care will cost billions in the future. That includes dental care. I think a fully privatised health system will be much the same.

    However, as DPF says, it’s about finding a balance. As much as I prefer to keep the cap there, I doubt that removing it will change all that much, at least in the immediate future.

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  24. Paul (1,315 comments) says:

    Key “country GPs aren’t exactly known for being rip-off merchants”

    No but according to you right-wingers, they are meant to be self actualising individuals, so the should be going for as much money as possible shouldn’t they?

    The policy is a crock of shit. From the very first versus of old Ruthenasian recidivism through to the end.

    From the document “Trusting health professionals”. Shame they don’t feel the same about the education sector. Teachers concerns are always swept away as unionist scare mongering.

    You know, personally I stand to do rather well out of a national govt, and although have voted left all my life, I was looking forward at least to some new directions and ideas. I mean you’ve been in opposition for how long and the three major policy (roads, SOEs and Health) in recent times, all belong in the very distant 1980s-1990s. Is there anyone in that party capable of coming up with inventive policy? Richard Worths alluding to Roman Roads as a transport policy inspiration is systematic of possibly the scariest potential govt for one hell of a long time. Why – because there are no new ideas!!!

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  25. Paul (1,315 comments) says:

    “I also doubt that removing the cap will actually result in a huge increase”

    Doesn’t anyone here have a memory? What the hell was the market rental reforms all about, getting more people into affordable housing, yeah like market forces helped with this one.

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  26. burt (8,206 comments) says:

    The issue of capping Dr’s fees just shows how stupid the left wing Govt is. Let’s get really basic about this then the lefties might have a chance of understanding the issue.

    Govt say they partially fund GP visits… I’ll assume we can all agree on this.

    Now where we seem to be speaking past each other is:

    The left think that if they can’t fund enough of the GP visit to meet their social policy objectives that it’s valid to cap the cost of a visit. Why is it hat the funding can’t be increased ?

    I thought all the rich bastards (according to 1999 income levels) were paying a few cents more to fix health (and education) and now we hear that the way to fix health is not to use the extra tax collected to ensure the partial funding is sufficient but rather cap the cost.

    Then you dim-bulbs on the left wonder why we have a GP shortage…

    You guys on the left need to open your eyes – Labour’s solution IS part of the problem. Either do what you say you do and fund enough of the GP costs to make a difference, let the DR’s charge what they need to charge to make it worth while staying in NZ.

    OR: Get the hell out of Govt and let some people with enough IQ to see that your policies are a failure fix the mess you have created.

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  27. francis (712 comments) says:

    An eye-opener, from NZ Doctor: http://www.national.org.nz/files/__0_0_15_August_07.pdf

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  28. John Dalley (394 comments) says:

    KevinOB
    Labour doesn’t need to. National have finally had to (start) lay out policy and the reality of politics will focus the blowtorch on their testicles.
    Watch John Key’s and National’s ratings start to slide from here to the election.

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  29. sonic (2,818 comments) says:

    Reading the comments I’m struck with wondement about the fact that if this is such a stonkingly good idea, why did National try so hard keep it quiet?

    I wonder what other fantastic policies have also slipped their minds?

    I think we should be told.

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  30. Lance (2,629 comments) says:

    I am reluctant to say this but it’s what I am thinking…
    Sonic…Toms et all..
    What a lot of communist bullshit you are crapping on about. Listen to yourselves, you are saying unless everyone is at one level they are bad people who look down on ordinary NZers. This sort of pure shit has been proved again and again to NOT WORK.
    People need goals or they aspire to mediocrity.

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  31. gd (2,286 comments) says:

    This very neatly illustrates the difference between the old paradigms of Left and Right that are now soooooo 20 th Century.

    The new paradigms are Freedom vs Control..

    On the Freedom side we have the Nats saying that they trust the medical profession will do the right ( no pun intended) and act in a balancesd way as regards delivering a profession service at a reasonable cost in order to derive a reasonable income.

    On the Control side we have the Socialists who say that the medical profession can not be trusted to not gouge rape and pillage the citizens so WE the Socialists must control them.

    Forget all the frothing IMHO this is the guts of this and every bother policy.

    Do you want Freedom OR do your want to nbe Controlled.

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  32. Andrew Bannister (213 comments) says:

    Paul, GPs and slum-lords are not in the same league.

    By the way, I’m a dirty lefty too.

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  33. sonic (2,818 comments) says:

    “People need goals or they aspire to mediocrity.”

    The goal of not dying in a ditch with no health care because they cannot afford to see a GP?

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  34. burt (8,206 comments) says:

    gd

    It’s almost more simple than that: The left say they are funding GP visits but because they don’t want to increase the funding to match the rising cost of health ( which they acknowledge ) they want to cap the Dr’s fees.

    Loosers – and their supporters can’t understand why with capped Dr’s fees we have a Dr shortage….

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  35. tim barclay (886 comments) says:

    GPs are the only part of the Health Service where you can see some-one promptly. I understand with the NHS system in the UK you can wait several days to get to see one. But if you carry on with Helen Clark’s system in the longer term there will be problems getting this essential service especially in some parts of the country. If Tony Ryall cannot sell this he does not deserve to be in politics and so far so good, it looks like he can. So the debate will be around the narrow issue of capping fees and what they will do for this service. Bring it on Labour Party.

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  36. Paul (1,315 comments) says:

    Andrew,

    I prefer pinko-commie-bastard. But dirty leftie works.

    But why are so many of these “it’s a good policy you just don’t know it yet” cries reminiscent of the the 4th National govt that so divided the country.

    Roads, SOEs and now Health, it’s all 90s policy regurgitated. The best thing about these policies is the fact they do finally manage to separate National from Labour on the fence. Too many politicians had splinters from that fence.

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  37. burt (8,206 comments) says:

    Paul

    It’s a good policy if it slows or stops all our DR’s from moving to another country where they are not forced to make a loss running their practice.

    How long do the left plan to ignore the fact that their policy of underfunding and capping fees to compensate for that underfunding is what is causing the Dr shortage ?

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  38. Paul (1,315 comments) says:

    Tim

    is this selling… I really don’t want my kids going anywhere near your version of marketing 101.

    “Anger at Nat plan to boost GP fees
    By DAN EATON – The Press
    Public health groups are angry at National Party plans to remove caps on doctors’ fees if it wins next year’s election”

    Not sure how this goes with the statement from the policy that “Trusting health professionals” is one of the goals, if these professionals are already up in arms.

    But true we haven’t heard from the ‘Harley street’ mob yet, they’re at the pub with their accountants.

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  39. milo (525 comments) says:

    Labour is incoherent on this. Price controls on GPs, but no price controls on electricity. So answer me this – why are price controls okay on GPs but not on electricity? After all, we have had a doulbing in electricity prices, and this is in effect a very regressive tax on the poorest sections of New Zealand society?

    Anybody?

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  40. burt (8,206 comments) says:

    Paul

    You speak like a good Labour supporter.

    GP’s earn more than a person on a benefit therefore they should be denigrated.

    If you guys on the left really believed that the funding level Labour have put in place was valid and that the cap on fees is valid – then why are the Govt not employing GP’s ?

    Let me suggest a reason why: The GP’s would look at what the Govt will pay them – look at what they can earn outside of NZ and book a flight the next day. I know it – you know it as well now stop being blind and supporting the Labour position simply because it’s the Labour position.

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  41. Inventory2 (10,269 comments) says:

    Paul put up the headline:

    ““Anger at Nat plan to boost GP fees
    By DAN EATON – The Press
    Public health groups are angry at National Party plans to remove caps on doctors’ fees if it wins next year’s election”

    But didn’t go further – who’s angry; which “public health groups”? Read on…

    “Union and Community Health, which has two Christchurch clinics catering to lower-income Pacific Islanders and Maori, said removing fee caps would be “catastrophic” and increase the “gap between the well and unwell” in New Zealand.

    “I would say without a doubt the fees would go up,” general manager Genelle Gordon said.

    “And, as usual, the people most affected by that will be those on lower incomes or fixed incomes – the very people who already have the worst health disparities, worst health stats.”

    Health Care Aotearoa, which has 57 clinics nationwide and charges a flat fee of $10 a consultation, said National’s health policy was shocking.

    “I’m really concerned,” said national co-ordinator Petra van den Munckhof.”

    Union and Community Health – gee, wonder who told them to be angry!

    Tell the whole story Paul!

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  42. Inventory2 (10,269 comments) says:

    Francis – thanks for the link; an eye-opener indeed!

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  43. frederico (72 comments) says:

    rickyjj said

    “The truth is that brains aren’t really so important for a GP. The job is far more about people skills, and any time they’re unsure of anything they refer you to a specialist. Most intelligent people don’t want to be GPs as it’s a pretty shitty job, and most people of any real talent already try and specialise…”

    What a load of rubbish. This highlights the complete ignorance of those who want to control doctors.

    To be a GP you must be able to understand and predict complex drug interactions. Their patients are on a huge range of diverse medications. This requires a thorough knowledge of pharmacology to a post graduate level. To obtain this you need to be educated in honours level physiology and biochemistry. This is just one example. They do this whilst,counselling the pregnant teen, evaluating a potentional meningocoocal rash and screening for cancer risks. Everyday. You just dont see it.

    This is all about control, not health.

    If you nationalise GP’s, you will see the biggest flight of white coasts west no doubt. David is right, go to the UK and see what a GP provides there compared with NZ.

    If this is about preventitive health, why not but a cap on supermarkets price for healthy foods. Make them apply to a board to increase the cost. Makes sense. if healthy food is cheaper that will solve the poverty/health trap and people wont “die in the streets”

    Why, because its economic nonsense. Same applies to the GP situation.

    The NZMA supports this policy and for very good reason too.

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  44. Pascal (1,969 comments) says:

    Sonic: The goal of not dying in a ditch with no health care because they cannot afford to see a GP?

    We waited four hours after an A&E clinic sent us to the hospital with suspected meningitis in a 10 or 11 month old infant. This is under the brilliant Labour subsidised Healthcare that is understaffed and has everyone striking for better pay.

    To be honest, I would rather pay a little bit more so I know that my family does not have to risk dying because of some idiotic political agenda.

    Now in the world of realism, what will your

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  45. Pascal (1,969 comments) says:

    (stupid keyboard)

    What will your average GP do? Charge $599.99 per visit? Or keep roughly in-line, maybe $5 or $10 more here and there. Think sensible, talk policy and try to see how the system can be improved.

    Because the current system is broken. It needs to be fixed.

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  46. GerryandthePM (328 comments) says:

    Australia=freedom, New Zealand=control.

    Anyone notice which way the traffic is going?

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  47. Andrew Bannister (213 comments) says:

    Loosers – and their supporters can’t understand why with capped Dr’s fees we have a Dr shortage….

    Burt, Dr shortages have nothing to do with fee caps. All countries have Dr shortages. Shortages exist because the medical profession is a well-controlled monopoly. There are many people who would make perfectly good GPs, but never make the cut at med-school. Not because they are no good, but because training is heavily restricted. Training and licensing restrictions maintain scarcity, and the rest is Economics 101. No amount of money is going to change that. That is why the government has to be involved.

    Paul, pinko-commie-bastard is good also.

    I don’t think you can compare sectors like that. The primary motivation for people who go into medicine, is generally not money. I may be wrong, but my guess is that property investing is purely motivated by money. I can’t possibly see what other motivation there would be. So when you are comparing Dr fees with market rent, I think you are comparing apples with oranges. Having said that, I do think that Dr fees should be monitored and regulated if necessary. Again, I’m in two minds about the cap.

    I actually think the whole issue about the cap is a storm in a teacup. Still, elections tend to be won and lost over storms in teacups.

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  48. Thomas Stephen (12 comments) says:

    How many joint replacements were canceled in Wellington today?

    Answer 8

    Why. Lack of beds. Surgeon paid, theatre staff paid. theatre available

    Lack of beds means not funded. What a waste Hodgson, are you in charge of this shambles.

    Oh but its oK, Labour have set up a quango to tell independent doctors how to run their business.

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  49. casual watcher (289 comments) says:

    It seems that some people here would prefer that discussion papers and logical thought should not exist, there is only one way and we should be bloody grateful for what we are delivered. What these dickheads do not realise is that some intelligent life does still exist in this country and it is reflected in the polls. Hopefully enough of that intelligence is also present in the National party and they stand up and capitalise more effectively than they are at the moment.

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  50. Paul (1,315 comments) says:

    Burt

    “You speak like a good Labour supporter.” Burt you belittle me. Green at the very least. There isn’t a party left enough for me to take my vote serious.

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  51. Calculus (74 comments) says:

    The state provides free medical care for the poor, the beneificaries and according to Act half the peolple who can afford it anyway.

    The nub of this argument is that the state will always provide for the poor and John Key couldn’t be a better person to preserve this after having been broyught up in poor circumstances but the left and the trolls who are spewing well today hold to their bigoted view that the rich should always have their wealth removed and given back to the poor.

    The policys of Helengrad that would make Stalin proud.

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  52. Swampy (191 comments) says:

    The battle by Labour to control doctors fees has gone on a lot longer. They first tried 1938 and got a huge row then

    Just for Sonic. well we actually did have this before Labour came along and spent huge sums of money on cheaper doctors fees for wealthy people as well as poor people

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  53. Andrew Bannister (213 comments) says:

    Frederico, with all due respect to GPs, you over-estimate the skill of a GP. You talk about complex drug interactions, but most assessments are formulaic. GPs don’t sit down and work out all the possible drug interactions. Instead, they will say, “here take this, but before you do, do you take any other drugs?” If yes, they pick up the New Ethicals, do a quick check, and if no flags are raised, they go ahead with the prescription. That’s all they can possibly do.

    You are confusing a GP with a specialist. And specialists don’t work alone.

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  54. Paul (1,315 comments) says:

    “Australia=freedom”

    Are you fucking joking, this is one of the dumbest most moronic statements I have ever read on a blog.

    Anyone asked the aboriginal people (or most minorities for that matter) about their freedoms.

    Muldoon said it best (hope I got the author correct), when Kiwis leave for OZ the IQ of both countries goes up.

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  55. Lee C (4,516 comments) says:

    Pascal, the slaient question amny Labour supporters will now want to ask is:
    How much do you earn?

    If it is under $60,000 then it will be National’s fault you can’t get a decent service, because they were in power about ten years ago. And because there is no cash available to encourage the profession.

    (To spend the any of the surplus would be ‘inflationary’ you see)

    If it’s over $60,000 you should stop being selfish because obviously you are middle class and don’t deserve a decent service at the expense of ‘the poor’.

    (to spend any of the surplus would be simply rewarding the priviledged and punishing ‘the poor’ as well as encouraging Doctors to ‘rort’ the system)

    That’s the real world to which you refer…

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  56. frederico (72 comments) says:

    Andrew Bannister, with all due respect, I suspect I am more qualified to comment on this than you

    MB ChB (Otago), FRACS

    But thanks for highlighting Labours attitude to GPs. Ignorance and disrespect.

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  57. Swampy (191 comments) says:

    Tane Says:
    September 27th, 2007 at 10:02 am

    And letting “the market” decide as John Key has suggested would send New Zealand down the path of the United States health system, where the poor don’t go to the doctor to get their illness seen to because they can’t afford it. Is that National’s vision for New Zealand’s health system?

    Left to its own devices, the market will not provide for those who can’t afford it. That’s one thing John Key and the National Party will never understand.

    What you don’t understand Mr Tane is the market is providing even under this Labour government. In my city there are and have been a number of low cost healthcare providers for people on Community Services Card the system that existed before Labour embarked on its massively expensive tax churn spending on cheaper GP visits for wealthy people

    And in my city there is a group of medical pros disillusions with the Labour Goverments failure to resource hospitals to carry out the most basic surgery that improves peoples quality of life that they set up a charity hospital

    You see these people are not suckered by Labours claims of setting up the health boards as more accountable, the health boards are just a whitewash system

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  58. Inventory2 (10,269 comments) says:

    Lee – it’s all National’s fault! I mean, get real man, they’ve only been in for eight years (I know, it seems like a lifetime, but it’s really only eight years), and you couldn’t possibly expect them to have fixed up all the stuff-ups made by successive governments in a mere eight years. After all, they had an agenda to unleash on us first, didn’t they!

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  59. krazykiwi (9,186 comments) says:

    thomas stephen – not good at all. This is an issue of resource distribution. We clearly need to establish a review team to investigate the performance of hospital management and establish a set a key performance metrics to track the case-mix costs of various classes of procedure. In due course this review panel will make recommendations almost certainly about the harmonisation of resources with anticipate demand. It is likely that this recommendation will call for additional management systems, processes and staff to code with the newly increased process load. Oh and those 8 will still be waiting…

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  60. Inventory2 (10,269 comments) says:

    frederico – that must be the BEST put-down in Kiwiblob’s history! Super shot that!!

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  61. Inventory2 (10,269 comments) says:

    whoops – another typo – KiwibloG

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  62. GerryandthePM (328 comments) says:

    Try New Zealand=freedom, Australia=control.

    Umm. Gee. Not sure. Can’t decide. Better not guess. Don’t want to appear dumb. Or moronic. Umm. Pass. Too hard. Better keep my high IQ intact.

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  63. Robert Owen (236 comments) says:

    So Fredrico We do not cap prices in Super arkets but we also don’t subside
    supermarket food either.
    Si if I understand correctly, you want to remove caps and have no subsidy ?

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  64. gd (2,286 comments) says:

    Lets go back to the good old days crica early 1980s

    Controls on rents (stops bastard landlords over charging the poor)

    Controls on interest rates and the supply of loan money (yes for all you young ones I used to get an allocation of credit from the Gumint on the 1st of each month and if I lent it all out before the of the month then tough)

    Controls on the price of a litre of milk ( stop the greedy bastard farmers an Fonterra ripping the poor )

    Controls on thge minimum cash deposit required to buy a new or used motor vehicle.

    Why not. Whats any different from those things to the price one pays a doctor.

    Well Im waiting you Control Freaks.

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  65. burt (8,206 comments) says:

    Andrew bannister

    Shortages exist because the medical profession is a well-controlled monopoly.

    Yes it is under Labour – You know as well as I do that only the policies of envy (Left wing policies) insist that health must be provided through Govt monopolies.

    I agree – it’s a monopoly and it’s hopeless. As designed and implemented by the Labour Govt.

    Public funding and public provision can be entirely separate things and then the monopoly would not exists. Once again Labour policy creates it’s own problems and how do Labour plan to solve it… Cap the fees that Dr’s can charge so they close up shop and leave the country. Well done – NOT!

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  66. krazykiwi (9,186 comments) says:

    you’re right gd, this has nothing to do with health – it’s a manifestation of an ideology.

    the socialist left wants big govt to micro-manage our lives (ensures survival of the political elite) while the capitalist right want free market (ensures survival of the most wealthy).

    both would try to control the masses, only using different instruments. For the record I believe labour is further left than most NZers are aware and that national is not as right as labour keep painting them.

    back on topic, does anyone know how many GPs are subject to price controls, i.e. is it mandatory or only so if one wants govt subsidisation. If the latter, what is the spilt bewteen GPs who are in/out of the scheme?

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  67. burt (8,206 comments) says:

    Robert Owen

    I don’t think there is much argument here about the concept of social policy initatives to make Dr’s affordable for people who can’t pay the cost themselves.

    The debate is really about should that affordability be achieved by increasing social policy funding or should it be achieved by restricting what Dr’s can charge.

    Increasing funding is what a Govt concerned about providing access to Dr’s for poor people would do – capping fees is policies of envy stuff that drives the Dr’s out of the country.

    Win win VS Loose loose

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  68. Swampy (191 comments) says:

    milo Says:
    September 27th, 2007 at 11:56 am

    Labour is incoherent on this. Price controls on GPs, but no price controls on electricity. So answer me this – why are price controls okay on GPs but not on electricity? After all, we have had a doulbing in electricity prices, and this is in effect a very regressive tax on the poorest sections of New Zealand society?

    Anybody?

    Sure, Electricity is a huge cash cow for this goverment which just took nearly a billion dollars in a dividend from Meridian Energy

    You dont see any evidence of hand wringing by the goverment over electricity prices do you

    They just justified the increase that will come from the climate change by saying the companies need the extra revenue to fund new generation

    But in fact the govermment owns a majority of the generators and takes big dividends out of them

    and they have been chargging more and more for new generation already

    Lets face it without electricity price differentials for differnet classes of people Labour wont do anything about electricyt pricing because the socialists see it as the way of wacking the big businesses which they just love doing, look how they have carved up Telecom and are squeezing other big business where they can

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  69. Lance (2,629 comments) says:

    Hey
    I have a great idea.
    To stop doctors leaving in droves to Australia etc due to Labour party capped fees etc, why not make it illegal for them to have passports?… AND they cannot work in any other area except General Practice.

    That was easy… New Zealand the way you want it ;-)

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  70. Swampy (191 comments) says:

    Inventory2 Says:
    September 27th, 2007 at 11:57 am

    “Union and Community Health, which has two Christchurch clinics catering to lower-income Pacific Islanders and Maori, said removing fee caps would be “catastrophic” and increase the “gap between the well and unwell” in New Zealand.

    “I would say without a doubt the fees would go up,” general manager Genelle Gordon said.

    Gee, I guess even Union and community Healths GPs will have to put fees up as well then

    LOL

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  71. Minnie (98 comments) says:

    The whole issue is about whether central government should control a traditionally strong profession or not. The Minister at present controls appointments to the Medical Council (the regulatory body), and the Govt at present regulates the business of medicine through formulaic price control.

    The problem is the profession is increasingly disenchanted and disempowered. When that happens there is little or no chance of it being flexible and able to respond to changing health problems and changing demand.

    It also has a lower incentive to act in the public interest.

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  72. Bogusnews (473 comments) says:

    Two things fascinate about the whole health issue.

    First is that the numbers we are talking about are so big that it’s very easy to become fixated by them. Over 200K (before they started slashing 000’s off to hide the numbers) on the waiting list, up from 100K when National was in power, 4000 dying in the last 12 months waiting for treatment, an extra $6Bil being spent on health for no return etc.

    But it’s not about numbers. It really is about sick people who desperately want to get well, Doctors who desperately want to heal them, and a mess made by labour that systematically stymies every attempt.

    The second thing that fascinates me is why the journos are treating anything this government says about health like it was the two stone tablets that moses brought down from the mount. Given Labours appalling track record in health, who are they to criticise any other policy? Why aren’t the journos asking them some tough questions?

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  73. burt (8,206 comments) says:

    Swampy

    Good Labour supporters are not smart enough to notice the joke in the statement by Union & Community Health that you have pointed out.

    It is funny that they are so dim.

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  74. Swampy (191 comments) says:

    Andrew Bannister Says:
    September 27th, 2007 at 12:23 pm

    Burt, Dr shortages have nothing to do with fee caps. All countries have Dr shortages. Shortages exist because the medical profession is a well-controlled monopoly. There are many people who would make perfectly good GPs, but never make the cut at med-school. Not because they are no good, but because training is heavily restricted. Training and licensing restrictions maintain scarcity, and the rest is Economics 101. No amount of money is going to change that. That is why the government has to be involved.

    Ah, who put that monopoly in place and regulates it? the goverment of course
    But saying because only the goverment regulats GPs training means they have to control the fees absolute crap
    The goverment regulates large sections of the economy but does not fix prices of most goods and services

    As we’ve seen the goverment has not put price caps on many many things that it has even more control over

    The only reason there is a price cap is Hodson wants to get political kudos from it
    And because Labour has tried since 1938 to control GP fees

    Every service where the goverment controls the prices fails to keep up with demand or return a reasonable price
    So called Free schooling being most obvious
    Schools have to raise ever more money every year in so called “donations” to pay their costs

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  75. sonic (2,818 comments) says:

    I see the National party diehards have decided that political principle (the principle that Doctors should all get as rich as possible) is worth sacrificing any chance of getting elected.

    It’s rather noble of you all, one might even say brave.

    Bravo Nats, principle before power, well done

    (P.S 3 more years.)

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  76. burt (8,206 comments) says:

    sonic

    I would rather NZ Dr’s got rich ( earned over $60K ???) in NZ.

    But keep missing the point – you are good at it.

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  77. Lee C (4,516 comments) says:

    To paraphrase Orwell -‘If I were to start a revolution, the first ones I would execute are those with clean fingernails’

    Regardless of the economic rationales used for regulating the GPs, is there not a faint whiff of the political establishment seeking to undermine and demoralise a part of society that is its natural enemy – ie those who earn good salaries, are educated and show a tendency to think for themselves?

    It’s like a mirror-image of Thatcher’s assault on the unions in the 80’s undertaken for economic and ideological reasons, but with little reference to the good that such organisations are capable of.

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  78. sonic (2,818 comments) says:

    I’m looking forward to the billboard.

    A picture of a scowling Helen Clark above the words, “cheaper medical sevices” alongside a smiling John Key with the slogan “Make the b@stards pay more”

    Thats two policies in a week, both have proved to be about as popular as Anthrax.

    Whats next I wonder

    “Vote John Key, and we’ll kick you all in the balls:

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  79. Lee C (4,516 comments) says:

    HOw about

    Vote Helen Clark: Reduce waiting lists. (by redefining them)
    Vote Helen Clark: Reduce unemployment (by putting them on the Sickness Benefit)
    Vote Helen Clark: Reduce hip replacement Ops (by kicking your legs out from under you)
    Vote Helen Clark: Raise Carbon tax (from all those Australia-bound Aeroplanes)
    Vote Helen Clark: Keep her fat pay-check coming for a few months after the election until she resigns for a job in the UN.

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  80. Andrew Bannister (213 comments) says:

    Frederico, come down to Dunedin hospital. I’ll show you round.

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  81. Inventory2 (10,269 comments) says:

    Or

    Helen Clark: Paintings forged, elections stolen, Ministers sacked, Brethren persecuted – you name it, she’ll do it (if the taxpayer funding is right)

    Or

    Helen Clark: Faster than a speeding motocade

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  82. sonic (2,818 comments) says:

    The worst thing from the Nats point of view is not only the way this came out, the secret agenda etc (what else are they not telling us) It is who this hits. As others have pointed out the very people this hits is not the very poor, who will get subsidised. It is “middle New Zealand” who will find that when they get sick will have to pay through the nose.

    Still look on the bright side, you’ll get another three years of foaming at the mouth about the actions of a Labour led government.

    So not all bad eh?

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  83. Andrew Bannister (213 comments) says:

    Burt: Yes it is under Labour

    It is under any government.

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  84. Swampy (191 comments) says:

    krazykiwi Says:
    September 27th, 2007 at 1:14 pm

    For the record I believe labour is further left than most NZers are aware and that national is not as right as labour keep painting them.

    Yes the unions are now running Labours reelection campaign. That is why the media is treating Labours utterances as the two stone tablets as someone else said, the media true to form being mostly left wing and union members has failed utterly to give any reasonable scrutiny of the Electoral Finance Bill

    and I just heard on the news Labour has appointed two more lackeys to the Electricity Commision, another dead wood bureacracy that just wastes money and does nothing LOL

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  85. pdq (82 comments) says:

    I’m not sure who said this first, but it will assist in understanding the comments made on this thread.

    Socialists only see three types of people: heroes, bastards and losers. They, of course, are the heroes and see it as their job to control the bastards and look after the losers.

    They don’t like it when they can’t control the “bastards” or someone else takes an interest in the “losers”, or for that matter, they are no longer poll as the “heros”.

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  86. frederico (72 comments) says:

    # Andrew Bannister Says:
    September 27th, 2007 at 1:57 pm

    Frederico, come down to Dunedin hospital. I’ll show you round.

    Thanks for the kind offer Andrew, but I know my way around Dunedin Hospital

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  87. Andrew W (1,629 comments) says:

    Sonic: “Bravo Nats, principle before power, well done”

    A clear admission that Sonic thinks Labour puts power before principle.

    I have to agree with him on that one, so we can expect the economy to be destroyed, along with free speech, in labour’s quest to stay in power.

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  88. Thomas Stephen (12 comments) says:

    “new research shows that doctors’ fees have not fallen as much as they were expected to, despite massive increases in Government subsidies.

    Independent researchers at Victoria University have been tracking reforms that have seen a total of $2.2 billion in Government funding over seven years to lower the cost of seeing the doctor for all age groups.

    The group’s latest report issued today, covering the period until mid 2005, says fees have fallen and people are making many more visits to the doctor.

    But fees for children under age six – who did not get extra subsidies – have risen over the period, and fees for some other groups who did get extra funding, fell by very little.

    Research Centre head Dr Jackie Cumming says independent scrutiny of fee rises should continue.

    The National Party said Wednesday that it would do away with a Government controls on GP fees.

    The Medical Association says GPs have always seen a review process as unnecessary.

    Copyright © 2007 Radio New Zealand”

    Ever had the feeling you’ve been had?

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  89. Lee C (4,516 comments) says:

    With thanks to C.R. this superb quote sums up a few of our erstwhile bloggers: I will think of it every time I see the words ‘secret agenda’

    “Time to dust off my copy of Richard Hofstadter’s classic essay The Paranoid Style in American Politics…

    The enemy is clearly delineated: he is a perfect model of malice, a kind of amoral superman—sinister, ubiquitous, powerful, cruel, sensual, luxury-loving. Unlike the rest of us, the enemy is not caught in the toils of the vast mechanism of history, himself a victim of his past, his desires, his limitations. He wills, indeed he manufactures, the mechanism of history, or tries to deflect the normal course of history in an evil way. He makes crises, starts runs on banks, causes depressions, manufactures disasters, and then enjoys and profits from the misery he has produced. The paranoid’s interpretation of history is distinctly personal: decisive events are not taken as part of the stream of history, but as the consequences of someone’s will. Very often the enemy is held to possess some especially effective source of power: he controls the press; he has unlimited funds; he has a new secret for influencing the mind (brainwashing); he has a special technique for seduction (the Catholic confessional).”

    ring any bells?

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  90. sonic (2,818 comments) says:

    Well Andrew the Labour party has, for good or ill, ditched some of it’s ideas and moved to the centre ground of NZ politics.

    National however still has it’s shibboleths'; private is always better than public, the market is always right, charity is better than public service provision, etc etc etc.

    The problem, for you, is that the world has moved on.

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  91. Swampy (191 comments) says:

    Lee C Says:
    September 27th, 2007 at 1:54 pm

    HOw about

    Vote Helen Clark: Reduce waiting lists. (by redefining them)

    This started 1996 when Jenny Shipley brought in the Booking System, at there was actually some honesty about the shortages. Annette King the labour spokeswoman railed against it

    So what does Annette king do in 1999? She puts in the government controlled health boards and then persuades the DHBs she now controls to disguise the waiting lists usually by not giving people any dates at all

    That policy has the sisterhoods manipulativeness stamped all over it, the art of spin and hiding the truth from public gaze and that is Annete Kings legacy, huge political gain for the government from shutting down debate about the health system by manipulation and deceit

    then Annette got “promoted” and Pete who is not as “clever” because he is not in the sisterhood gets the DHBs to be honest and tell people whether they are going to get treated in a reasonable time frame and so the truth of hiding people on the waiting list comes out

    With very little comment on Annette Kings record incidentally, Hodgson has taken all the fall out for that but he himself is now responsible for putting in the control of GP fees so he may yet get some mileage out of that

    And the moral of the story is? we always knew there is not much talent in the labour party except for covering up and now with the unions running the re eelction campaign there is obviously even less

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  92. Andrew Bannister (213 comments) says:

    Frederico, I don’t want to turn this into a slinging match, but it seems unlikely that someone with an MB ChB (Otago), FRAC, would be writing this:

    I suppose due to acute boredom with my job and a strange desire to find the truth I have come to this. I doubt anyone will read my inane ramblings…

    I’ll leave it at that.

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  93. Danyl Mclauchlan (1,066 comments) says:

    National leader John Key also said fees would be controlled by “the market”.

    And the invisible hand of the market will make sure visiting your GP is nice and cheap. You know – like the dentist!

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  94. Andrew W (1,629 comments) says:

    Sonic, Labour definitely moved right after Muldoon took a hard left, but ever since it’s been going further and further left, I agree with those here who argue that Key’s success in the poles is a result of his own centerist politics. the Nats are having to at least appear left to get elected.

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  95. Thomas Stephen (12 comments) says:

    Andrew,

    That was written when I was finishing a fellowship in Perth earlier this year. No im back.

    Look up Phillips, Orthopaedic, on the Medical Council website on find a registered doctor on the medical council website

    I suggest you apolgise for calling me a liar.

    Oh and guess why im not working today?

    Ill leave it at that.

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  96. philu (13,393 comments) says:

    inventory 2 said..

    “..that must be the BEST put-down in Kiwiblob’s history!..”

    i like ‘kiwiblob’..

    phil(whoar.co.nz)

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  97. frederico (72 comments) says:

    Got my logins mixed up there andrew. Different computer.

    Anyway, I think that other name fits aye?

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  98. Lee C (4,516 comments) says:

    I would suggest that the Labour Party has been sucked into the worst excesses of olde-world capitalist corporatism. It has occupied the centre, but slipped to the right, and that National is becoming the ‘new’ left of the spectrum. It appears ready to debate, argue, expand and meet in the middle.

    Labour have replaced the ‘rule by right’ old guard of capitalists with a new orthodoxy that employs the state to do all the same things – crowd out opposition, set and maintain media agendas, marginalise those who disagree, and lately, actually attempt to change the law to restrict free association and expressions of ideas.

    The idea that the world has moved on is as a relevent descriptor for Labour’s stasis as it is as a descriptor of your fixation with the past.

    That is the thing what I try to allude to every day on here, but detractors are always too busy detecting some kind of sinister ‘right wing’ agenda, when in fact it is they who have slipped to the right and are too brainwashed to see it.

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  99. Andrew Bannister (213 comments) says:

    Frederico, Thomas Stephen, or Mr Philips (difficult to know who you really are) I appologise most sincerely and from the bottom of my heart for calling you a liar, if you were not lying.

    Only you will know if you deserve that appology.

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  100. Andrew Bannister (213 comments) says:

    And those would be apologies with just one p.

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  101. frederico (72 comments) says:

    Thanks Andrew, sarcasm lowest form of wit aye.

    You are right though, the anonymity thing is bollocks. Ill be posting as Fred Phillips now.

    The reason I’m not working and wound up today??

    My operating list was canceled. Funny that

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  102. David Baigent (172 comments) says:

    sonic Says:
    “The problem, for you, is that the world has moved on.”

    No I think that is a typo sonic.
    You meant.. “The problem, for you, is that the voter has moved on.”

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  103. Andrew Bannister (213 comments) says:

    Fredrico, the apology is sincere, if deserved. No sarcasm.

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  104. sonic (2,818 comments) says:

    Are you telling us David that people’s key concern at the moment is that they are not paying enough to go to the doctor?

    The voters are screaming out to pay higher charges? are moved to rage by the pictures of the starving doctors we see on our TV screens every night?

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  105. Andrew W (1,629 comments) says:

    Sonic, There are lots of things I buy that I would like to be cheaper (OK, everything I buy I would like to be cheaper) I accept that I pay a fair price (unless I’m stupid). What I pay is what the market demands, do you accept the market as an efficient price mechanism or not? what alternative do you offer? Price fixing? If so you really need to study the history of countries whose governments buck the market, you could start with Zimbabwe, then look at the USSR.

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  106. burt (8,206 comments) says:

    sonic

    Now I get it, Labour want to stop Dr’s earning a reasonable living so they leave the country…. Then it can spend the health budget on administrators rather than Dr’s.

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  107. Andrew Bannister (213 comments) says:

    Ha, this is funny. Frederico, your blog seems to have disappeared. Is that because your age on that says you are 34, and yet Fred Phillips, orthopaedic surgeon, is in his 50s? Or is it because lots of other things on that blog make it blatantly clear that you are in fact, not Fred Phillips, orthopaedic surgeon.

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  108. David Farrar (1,883 comments) says:

    You don’t need to limit the apology by saying, if deserved. I can verify Mr Phillips as a surgeon.

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  109. Fred Phillips (72 comments) says:

    Andrew

    There are 2 Fred Phillips.

    Check again. and see…….MB ChB Otago 1996, FRACS Ortho 2005

    I am FTS Phillips

    not FJPhillips

    The other is the old man

    I deleted the blog as I suppose i have to be respectable now.

    Apology again please.

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  110. Kevin Hicks, Auckland District Health Board Candidate (1,122 comments) says:

    Unfortunately many of the comments here demonstrate the politics of envy and tall poppy syndrome that we must overcome once and for all in this country, if we are to progress.

    Statements like “let GPs become as rich as hell” are just based on unfounded emotive prejudice. If any GPs or other health workers do become rich it certainly isn’t because of their income or working conditions in the health sector, but because they are intelligent hard working people who invest the small amount (comparatively) they do earn wisely.

    We are facing incredible problems in this country in sustaining our health service at first world levels because of the global market for well qualified health professionals. It is no use hiding our heads in the sand and pretending the problem doesn’t exist. We do not create the rules, we have to work within them or bend them a bit to suit us if we can.

    Recruitment and retention of our valued health workers (doctors, nurses and allied health professionals) is not just about wages and workplace conditions. It is about creating an environment that makes them feel they are part of a team and are providing a valuable service to a public that values their input. Nothing will put these dedicated professionals off faster than an adversarial and prejudiced system that is always seeking to take them down a peg just because certain politically motivated individual have managed to convince the public that they are non-caring fat cats.

    The sustainability of our health system is not helped also by the fact that we have had 15 or so years of good economic conditions but the money flowing into the country has been wasted when it could have been used for developing clean lean green industries so we could have afforded cutting edge health provision.

    In addition the health system is anything but free – we all pay for it – the taxpayer. Using the words “free health system” is just political deception. And remember these well paid doctors and other health professionals pay an awful lot of tax!

    The simple message is that if we want a first class health system we all have to be prepared to pay for it – we all have to work hard and do our bit – it is the responsibility, not the responsibility of some mythical bunch of health workers willing to endure any sort of wages and conditions and not the responsibility of any one government at the time who have proved themselves incapable of running a sustainable health system that is not incessantly on the verge of bankruptcy.

    Let me repeat it – if we want the expertise in this country we have to be prepared to work hard and pay for it. So I ask everyone to stop donging on doctors and nurses and creating an adversarial environment and actually start cherishing their contribution to our health and our economy.

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  111. grumpyoldhori (2,361 comments) says:

    Bricks are flying on this issue.

    Ok, even though I am of the labour tribe I agree
    with David that we should look at other systems
    to see which gives the best bang for the buck.

    Private hospitals being used, no problem, after
    all I had a private business that did some work
    on a public hospital.

    Be like the French with their national insurance
    system where all pay in, and the money is
    spent in both public and private hospitals?

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  112. Andrew Bannister (213 comments) says:

    Andrew W, health care is not a commodity like a new spa pool or a boogie board. The market model simply doesn’t work for health care. Not if you want a fair and descent health system. No I am not saying that the system we have today is perfect, but all things considered, it is pretty bloody good. Sure, some countries have better systems, but they are not market models, nor are they all the same.

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  113. Thomas Stephen (12 comments) says:

    Im posting this under Thomas Stephen as my comment under Fred Phillips is awaiting moderation.

    Andrew

    There are 2 Fred Phillips.

    Check again. and see…….MB ChB Otago 1996, FRACS Ortho 2005

    I am FTS Phillips

    not FJPhillips

    The other is the old man (actually 60)

    I deleted the blog as I suppose i have to be respectable now.

    get it TS (Thomas Stephen)

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  114. john (478 comments) says:

    today in New Zealand you can die without medical insurance , im not bullshitting , and ,(what will change)if you can get a doctor and be on his/her list ,you pay because you have gone to the doctor, because you are sick .You pay what they charge you or else go out and find a witch doctor. Helen might froth at the mouth and try to score points but her elk dont live in the real world, does helen and the other mps sit in the local doctors waiting room ,i doubt it, J

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  115. david (2,552 comments) says:

    Andrew Bannister and sonic appear to belong to the group who would have us treated by “barefoot doctors” in the Socialist Utopia of the Peoples Republic or Arteroha where the happy peasants are treated in their mud huts by smiling health workers, whistling while they treat the ill and infirmed for the good of mankind and half a pound of rice a day. Dream on guys

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  116. Rex Widerstrom (5,349 comments) says:

    (My company handled communications for the Royal NZ Collge of GPs for years, so I still mumble this stuff in my sleep)…

    The GP shortage has multiple causes of which income is only one. Not many new graduates wanting to live in rural areas no matter what the money is another (which is why small towns in Australia haven’t attracted GPs despite stumping up $250,000+ sign-on bonuses from their own funds). A preference amongst medical graduates to specialise in something more “glamorous” is another. The overwork of existing GPs making teaching placements scarce and leading to a catch-22… and so on.

    Lifitng the cap might alleviate the shortage. It won’t, by itself, fix it. And it will adversely affect access for the poor unless, as DPF suggests, targeted assistance is offered.

    Simply recognising the key role GPs play in primary care would help. From around 2000, and particularly from 2005 on, there has been a concerted effort to force a system of “nurse practitioners” through – effectively handing nurses diagnosing and prescribing duties presently reserved for doctors. Although thankfully the original idea of effectively rendering GPs unnecessary, pursued by a handful of ideologues in the Ministry, has been modified somewhat. And the changes to obstetrics, handing the role of primary carer (and budget holder) to midwives have forced thousands of GPs out of that role too.

    I can’t finish without responding to rickyjj’s comment above however:

    The truth is that brains aren’t really so important for a GP.

    So the eleven years a GP studies before practising – and then the lifelong compulsory Professional Development he or she undertakes – aren’t all that taxing? If you ever catch, say, meningitis and, not recognising the symptoms, visit your GP, let’s hope you don’t get one of the “dumb” ones. A quick-acting GP (assisted later by ambulance and hospital staff) saved the life of my youngest son. I’m glad that one had a few braincells.

    any time they’re unsure of anything they refer you to a specialist

    Given that doctors are amongst the most arrogant and self-assured professions (my regular mantra to the College was “possesion on a medical degree does not confer omnipotence”) it’s the good GPs who defer to their specialist colleagues when necessary.

    Most intelligent people don’t want to be GPs as it’s a pretty shitty job

    I am sure you have the results of some research to back up this sweeping generalisation, which my anecodtal observation of hundreds of doctors over the years seems to refute? The GPs I dealt with were almost universally intelligent, humane and were justifiably proud of the work they do.

    most people of any real talent already try and specialise

    Which is why all the medical malpractice stories we read in the newspapers, and which are dealt with by the Medical Council, are about GPs and not about specialists. Oh, wait…

    I don’t see how letting them charge another $20 an hour is going to change this

    On that, at least to a degree, we are in agreement.

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  117. Thomas Stephen (12 comments) says:

    I came on here today rightly or wrongly under a pseudonym because I am pissed off. There was not one but two Orthopaedic Lists cancelled today ibecause of funding issues. That 8 people who were geared up for major surgery but culled.

    I then find that several commentators think that you don’t need brains to be a GP. This is a lazy and disrespectful comment and I defended it only to find myself in a slanging match over my qualifications. For the record GP’s are some of the most intelligent erudite doctors I have met and they do an outstanding job and deserve appropriate remuneration.

    Im at the coalface andrew, and i don’t like what i see. Its time some people on the left of the political spectrum accepted this

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  118. david (2,552 comments) says:

    Well said TS, in the current environment it takes a brave man to take that sort of stand.

    Others must feel the way you do but fear that speaking out would have them casting frequent glances over their shoulders.

    Perhaps if you got Deborah Powell refocussed on health care instead of perpetuating ways for the system to be manipulated to personal financial advantage of doctors-in-training you might make progress but that would be a big ask and the system probably doesn’t have enough money in it for that.

    Something stinks when the DHB loses more the more funded ops they do. My surgeon reckoned that his DHB lost tens of thousands because it performed my bilateral TKR which was “funded” under Annette King’s big clear-the-waiting-list-spend-up before the 2005 election.

    Anyway back to the topic on GPs.
    Obviously there is:
    a) no simple answer
    b) ample evidence that the current system is flawed

    so it takes a small minded person who rails against any suggestion of change when the intention is to make improvements

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  119. Andrew W (1,629 comments) says:

    Andrew B: “Andrew W, health care is not a commodity like a new spa pool or a boogie board.”

    Or like food I guess, can’t live without food – hey, I know! All food should be free!

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  120. Andrew Bannister (213 comments) says:

    In that case, my sincerest apologies. I am not going to reveal who I am, because I have said too many things here, and on other sites, that are best not attributed to me. They are opinions that would raise some eyebrows, and while they might not get me in serious trouble, they won’t help me either.

    I stand by my comment I made about GPs though. I meant no disrespect and it wasn’t a lazy comment. It’s just that, in my honest opinion, the skills of a GP, while admirable, are not as complicated and difficult as you made out in you post. I never said GPs don’t need brains. They do. And yes, I know GPs who are intelligent and erudite doctors who do an outstanding job and deserve appropriate remuneration.

    I suppose I took offence when you assumed that you were more qualified to comment about the issue than I am. It is very easy for people to throw degrees and qualifications around, and that is what I thought was happening. I wonder, had you been in my shoes, might you have reacted the same way as I did. Maybe not.

    Again, my apologies for any offence I may have caused.

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  121. virginblogger (97 comments) says:

    sonic says “The problem, for you, is that the world has moved on.”
    I say the world has moved on and NZ has not.

    I agree with kevin that until we can accept success and discourage our tall poppy syndrome perpetuated by the left, that this country will not achieve its potential, and well qualified and necessary skilled professions will be crying out for people.

    The disparaging comments here about GP’s is deplorable. Gp’s on the whole do a good job in difficult circumstances with limited funding. For those of you who think GP’s don’t need brains, I hope they can find some when you need medical care.

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  122. Thomas Stephen (12 comments) says:

    Thank you Andrew,

    Well we will have to agree to disagree.

    I suppose one thing this has taught me is that anonymity aint what its cracked up to be.

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  123. Kevin Hicks, Auckland District Health Board Candidate (1,122 comments) says:

    There are several factors which make this not so much an underfunding issue as a mis-drected funding issue.

    A lot of the money that goes to healthboards is tagged for expenditure on feel good vote catching areas such as suncreen usage surveys, or healthy eating campaigns that end up taking the whole milk out of the tea rooms (the antismoking campaign does NOT come under this category).

    The other thing is that the government is competing hard out with the coalface for employees, so who whould want to stay in an emotionally draining job like a coalface health professional when you can push a mouse around that desk all day for the same pay.

    Thomas, i’m agast at that wastage. Even though your not in the ADHB area please could you feel free to contact me or get your colleagues to – either on my blog or by email kevin.hicks@aucklandhealth.org.nz, PO Box 10090, Auckland City Hospital, Grafton, Auckland.

    Also you could sign up to the NZHealthTalk/NZHealthWatch email list at:

    http://www.aucklandhealth.org.nz/HealthIssues.shtml
    or http://aucklandhealth.org.nz/mailman/listinfo/healthtalk_aucklandhealth.org.nz

    We need to get doctors and other health professionals talking about this.

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  124. Andrew Bannister (213 comments) says:

    I suppose one thing this has taught me is that anonymity aint what its cracked up to be.

    No, it’s a bit catch-22ish. Unfortunately, I have to use a nom de blog, because these are my personal views. I use my real name (not on kiwiblog as yet) when I am representing my employer. Maybe I’m a coward, but that’s the way it has to be.

    Sorry I outed you.

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  125. Thomas Stephen (12 comments) says:

    Good thing is I am representing my employer………………the New Zealand Taxpayer.

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  126. Kevin Hicks, Auckland District Health Board Candidate (1,122 comments) says:

    Andrew B that is the short sightedness of the whole NZ system that you encapsulate. The idea that you can train a monkey to do the job if you try hard enough and then flows the ability to social engineer because this or that profession “isn’t really that difficult”. so you can then select people for political vote catching reasons instead of on merit, and ….. down the OECD ladder we go.

    But it IS a difficult job – to do 11 years or so of HIGH POWERED training and then stick at a job where many of the cases are easy and self limiting, just so you can catch the cases that aren’t – and refer them – now that’s what I call difficult! I couldn’t do it.

    And to be a member of society where the laws of double indemnity dont apply! Most people who make a mistake in our society have to answer to one authority – the law, and some dont even answer to that. But if a doctor makes a mistake they also have to answer to the medical council and may well lose their job.

    Answer this – would you want to go to a well trained doctor or is the job so easy that you would be happy with a lesser trained person?

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  127. Robert Owen (236 comments) says:

    “Primary Health Care: NZers Pay Less, Use More”
    http://www.scoop.co.nz/stories/HL0709/S00479.htm

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  128. Kevin Hicks, Auckland District Health Board Candidate (1,122 comments) says:

    BTW same discussion is going on the greens frogblog – no prises for guessing who their donging on!

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  129. Kevin Hicks, Auckland District Health Board Candidate (1,122 comments) says:

    Do you think there is really any journalistic honesty in that headline robert?

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  130. insider (1,028 comments) says:

    ANdrew B

    I tend to have a jaundiced view that gps are witchdoctors and everything is all on the computer.

    but I also have a sibling who is a GP so know from discussions that the skill is not in the prescribing, it is in the diagnosis. And that can’t be done by a computer or as it will often require intuition and experience, and asking the right questions.

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  131. Robert Owen (236 comments) says:

    Whoops
    “Primary Health Care: NZers Pay Less, Use More”

    http://www.scoop.co.nz/stories/GE0709/S00114.htm

    Press Release: Victoria University of Wellington
    MEDIA RELEASE

    27 September 2007

    Primary Health Care Strategy: New Zealanders Pay Less, Use More Services

    Researchers have found that the Government’s Primary Health Care Strategy, introduced in 2001, is resulting in New Zealanders paying less for, and using more, primary health care services.

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  132. burt (8,206 comments) says:

    Robert Owen

    So is this justification for capping GP’s fees ? Primary health care is becomming more and more the centre piece of the health service and to make sure it’s successful we cap their fees.

    Policies of envy – given them more mork and make them charge less for it.

    Typical left wing policies – shoot themselves in the foot everytime and just can’t understand why it all turned pear shaped.

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  133. Robert Owen (236 comments) says:

    Well if more people are going to the doc as a result of Government policies
    How is that turning pear shaped ?

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  134. Robert Owen (236 comments) says:

    I quite like mork the cheaper the better

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  135. Andrew Bannister (213 comments) says:

    Kevin Hicks, I agree, I think our blame-mentality does not allow for mistakes, and that is a terrible thing. This is especially hard on the medical profession, but also groups like the police. The latest shooting incident has the potential to really harm the officer involved. You can bet you bottom dollar that people will be baying for blood, as they do when a physician makes a mistake. I’m not sure how long you have been reading kiwiblog for, but I have commented on that before.

    I never said that being a GP is an easy job. But it doesn’t require super-human abilities. It requires a decent knowledge of physiology, biochemistry and pharmacology, common sense, a good brain, a systematic approach to diagnostics, and a willingness to seek help when things are beyond your expertise. There are a lot of people (not monkeys) who would be capable of being GOOD GPs. However, limiting places at training level, ensures that demand will always be greater than supply. (It’s saying things like that, that will get me in the pooh). There are lots of people who come out of university with science degrees, and get a shitty job in a lab somewhere, because they didn’t make the cut at medschool. Not because they wouldn’t make good doctors, but because the competition for limited places is so high. I don’t think the false-rejection rate at medschool is justified on the grounds of safety and competency.

    Look, I never meant to attack GPs or any other physicians. As I keep saying, I don’t necessarily think the cap should stay. I also don’t think removing the cap will result in rocketing GP fees. But … I also think the GP shortage is partly created by the profession itself. I have heard some terrible stories about the Colleges from colleagues who came from overseas.

    All said, I don’t think our health system is as poor as some people make it out to be. With an aging population, the demand for medical care will keep increasing. Unfortunately the result of a good health system is that the demand for that very system will increase. And you can’t pin that on the Labour government.

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  136. burt (8,206 comments) says:

    Robert Owen

    I’ll tell you why more people are going to their GP – they have been sent back there after being ditched off a waiting list. Just the number of visits this hideous practice has caused would be enough to skew the figures.

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  137. burt (8,206 comments) says:

    Oh also as more people are spending longer on waiting lists than they were under the failed policies of the past – of course there are more GP visits. Sick people staying sick for longer = more Dr’s visits.

    Funny how the statistics that there have been more Dr’s visits under Labour can be made to look like a good thing… even funnier considering that the entire objective of primary healthcare is to make people healthier and hence have fewer Dr’s visits.

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  138. Thomas Stephen (12 comments) says:

    Burt as you well know,

    Statistics are like a mini skirt.

    What they reveal is interesting.

    But what they conceal is vital.

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  139. grumpyoldhori (2,361 comments) says:

    Andrew Bannister

    When was the last Doctor jailed for making an
    error of judgement?

    I know of another occupation where a person has been jailed for a couple of years for making an error of judgement.

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  140. burt (8,206 comments) says:

    There is a trend that cannot be ignored;

    Teacher shortage – Govt sets salary – 3-4% increase per annum.
    Police shortage – Govt sets salary – 3-4% increase per annum..
    Nursing shortage – Govt sets salary – 3-4% increase per annum..
    Dr shortage in hospitals – Govt sets salary – 3-4% increase per annum..
    GP shortage – Govt sets fee cap.

    But the lefties and their policies of envy will of course say this has nothing to do with it because all of these people are just greedy as many of them already earn massive amounts of money (some earn more than $60K).

    Meanwhile the MP’s sit back and collect their salaries complete with circa 9% increases every year and it’s just a coincidence that there is no shortage of people lining up to be MP’s.

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  141. Peak Oil Conspiracy (3,216 comments) says:

    Thomas Stephen:

    “Burt as you well know,
    Statistics are like a mini skirt.
    What they reveal is interesting.
    But what they conceal is vital”

    You’re not a gynaecologist by any chance?

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  142. Thomas Stephen (12 comments) says:

    POC

    Very funny.

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  143. burt (8,206 comments) says:

    Yes agree

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  144. Kevin Hicks, Auckland District Health Board Candidate (1,122 comments) says:

    Andrew Bannister,

    I certianly didnt mean to imply I thought you were in the same category as the hard ore anti doctor brigade.

    However, limiting places at training level, ensures that demand will always be greater than supply. (It’s saying things like that, that will get me in the pooh).

    There are many reasons why this is wrong. Firslty we train more doctors than we need – its just that they can find better wages and conditions overseas, in the MOH, insurance companies, directorships, software houses – etc – because there is a shortage of hard working intelligent creative people.

    Also you have to limit training so that the resources can be put into training quality rather than quantitiy and this is what is causing the whole system to come unglued at present because of the bums on seats polcies at universities.

    IMHO there will never be a solution to this problem until a party, coallition or government comes along with an integrated strategy of developing the economy so we can afford what we want and can afford to pay for theexpertise to get it. Until that hapens I just can’t really see a way through it. I have finally put my neame forward after decades of grisling from the sidelines to see if we can develop short term cost effective strategies while trying to get the public to accept that long term solution – if we want the benefits of a first world health (or education or welfare) system we need to work hard together – with each other not against each other – to pay for it.

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  145. KevinOB (267 comments) says:

    TS
    Without breaking confidences can you elaborate on who was responsible for the cancellation of the operations today. Whereabouts in the administration was the decision made and for what apparent and real reasons?

    GP’s may not get the respect they deserve because of their factory-like work conditions. They have a tough stressful job; we are fortunate to have any. Plainly we only have then because they put patient care ahead of their own personal fortunes. The ones my family sees are smart and caring; they have to know everything and yet not know too much; nerds would fail at the job. We need more of them as well as other frontline health professionals. Remove the cap it will make little difference to patients. Those who cannot afford it will be attended to anyway; most doctors are far too generous to deny service.

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  146. Thomas Stephen (12 comments) says:

    Kevin, speaking generally and not specifically wrt today

    Operations are canceled for a number of reasons. But the main reason is lack of beds.

    Lack of beds is not a reason per se. It should read a lack of nurses and anesthetists. I emphasize, not a lack of surgeons. Beds are plenty.

    The question why in the public service this exists is a whole new ball game. But suffice to say, the GP’s are the ones picking up the end result.

    Manager’s cancel lists Kevin. Sometimes with good reason, sometimes not.

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  147. burt (8,206 comments) says:

    Bidsta

    You start of saying “The state does not set GP fees. There is not a GP fee cap” then you go on to explain how the cap works and why the cap exists.

    Is this like Union & Community health saying they are angry that the capo might be removed but then go on to say they would raise their fees….

    “Union and Community Health, which has two Christchurch clinics catering to lower-income Pacific Islanders and Maori, said removing fee caps would be “catastrophic” and increase the “gap between the well and unwell” in New Zealand.

    “I would say without a doubt the fees would go up,” general manager Genelle Gordon said.

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  148. Dead Duck Dux (181 comments) says:

    Sloppy political management?! Tacking your colours to a rampant narcissist is an example of sloppy political management. Neglecting to include something as significant as removing controls on GP fees in your health fees is sloppy like a head-on collision is “sloppy” road safety.

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  149. Bidsta (1 comment) says:

    Burt

    maybe it’s a matter of semantics, but ‘cap’ seems to imply something less flexible than what is effectively a negotiation between the government and GPs about the quid pro quo for the subsidy — with wiggle room if a practice can show the fees review committee that it needs to increase fees by more than the standard amount.

    In fact, I see Tony Ryall is now saying something similar:

    http://www.scoop.co.nz/stories/PA0709/S00476.htm

    I can’t speak for Union and Community Health, but maybe they were speculating on the national situation, rather than talking about their own fees?

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  150. burt (8,206 comments) says:

    Bidsta

    Thank you. I now understand the semantics of both the issue and your post that I was reacting to.

    The quip about Union & Community was actually just showing the hollowness of their own argument that removing the cap would (without a doubt) put fees up. I’m sure if you asked Union & Community if their fees would go up they would give a resounding “No”. I also can’t speak for Union & Community but I doubt they claim to be the only place with a commitment to provision of low cost health care to the needy. Christchurch also has a Charity Hospital which seems to blow the lefts ideological view that only the state can provide health care out the window.

    However I digress, Union & Community health might as well speak out quickly on this issue, if Labour pass the EFB they may be restricted from commenting on health policy for quite some time.

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  151. Fred (163 comments) says:

    Usual story, the “news” on TV fails to inform has a leftwing bias, and lacks any level of intelligent analysis. A quick scan of Kiwiblog reveals the usual suspects spouting fearmongering drivel countered by a good bunch of informative comments based on real life experiences. Not many have commented on whether they find their own visits cheap or expensive. In my experience a visit has never been less than $50 and averages around $75, for 10 to 15 minutes of consultation (then there is the prescription on top of that!). No one I know has said that a visit is cheap (and does this mean value for money?), so how do you get access to the cheap visits being touted by labour and why does it cost me so much? The last doctor I tried to visit had a big sign saying “no casuals”. WTF is a casual, if you walk through the door surely you are sick and want to see a doctor! How does a cap work when they refuse to even see you! Of course the doctor’s visit that saves lives is the one to that after hours clinic that’s open late in the evening or the small hours of the morning, and who cares what that costs, after you have exhausted all of your grandmother’s cures for your sick child’s ailments, at your wits end you are just thankful that you didn’t have to go to A&E, so you drive to that small after hours centre that you know is good through word of mouth, it doesn’t advertise, and its a fairly long drive. If that isn’t market forces in action then what is?

    The problem with GP health care is that if you are healthy you don’t get to see a doctor very often, there’s no “relationship” (needed, or established) and given that the average NZ’er moves fairly often, it’s hard to establish one. In these circumstances, it would be best to have one all encompassing consultation (say) once a year or even 10 years, at least an hour long, and involve the full battery of tests, a comprehensive health and fitness check.

    On the other hand if you are crook, but not bad enough to be admitted, and had to visit the doctor every week, then it wouldn’t matter whether the visits were $25 each (or whatever any cap is), it’s soon going to get unaffordable (especially if your problem affects your ability to work).

    Any centralised “price fixing” system is going to create distortions and is going to be inherently unfair. It’s going to be bureaucratic and costly to administer. I am certain that a market mechanism is going to be far more efficient than the system that we have at present. What I reckon would work is something like a voucher or coupon system giving 3, 4 or 5 free visits a year, determined by age and other factors (even up to 10 visits if you happen to have some sort of chronic condition) and these can be used individually or saved up (like an insurance) or to be used on an all encompassing check up. This way, I think a lot of people who might not bother to go to a doctor may decide that they would go at least once a year or so to get the big lecture on diet, exercise, smoking etc.

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  152. Reg (539 comments) says:

    I’ve got no problems with the Nats policy in principle, although their needs to be a safety net for the destitute and chronically ill so that no one ends up denied medical help due to poverty.
    But there is no reason why the middle class and wealthy can’t shoulder the cost of the odd trip to the Doctor.
    I remember a GP telling me once that the people who complain about them charging 5 dollars for them seeing their child don’t think anything of paying $150 for getting their cat fixed at the vet.
    Perhaps some of us just need to sought our priorities out.

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  153. Inventory2 (10,269 comments) says:

    Bidista said “For practices that are part of a PHO, there are regional fees review committees. If a GP practice wishes to raise its fees beyond an independently-assessed ‘reasonable increase’, it must justify this to the fees review committe.

    Why have such a system? ”

    One reason I can think of – it’s good for unemployment, to be employing so many more pen-pushers and bean-counters in the health service. Then when you’re the Minister of Social Development, you can get some non-entity of a backbencher (Jill Pettis springs to mind) to ask you what reports you have received about unemployment and job creation!

    Just like the ones in the article that Francis posted the link for earlier in this discussion – take the time to read it; it’s enlightening!

    http://www.national.org.nz/files/__0_0_15_August_07.pdf

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  154. Anthony (789 comments) says:

    A few weeks ago the Dom Post had an interview with a doctor from the UK who came to NZ. What he found different was that patients were a bit more demanding here. In the UK with the NHS some patients saw him just because they were a bit bored and wanted someone to talk to.

    A free system meant long waits and people going to the doctor unnecessarily. What a surprise!

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  155. PaulL (5,951 comments) says:

    So, Australia doesn’t have a cap. And subsidises GP visits. With additional subsidies for poor people.

    I realise that this would never work in a NZ context, clearly there is something different about NZ. Probably what would happen in NZ is that all the doctors would get rich, and fees would keep going up.

    What is it about NZ that we feel the need to try to invent unique policies, and then fear-monger about them. Most of the things we are talking about have been tried elsewhere in the world. We can look at how they worked, and form a judgement.

    The Australian system works just fine. No caps in sight. In fact, no caps in NZ just a few years ago, I don’t recall the world ending, poor people dying on the streets etc etc.

    And, in terms of price controls, what is it about economics that some on this blog cannot understand? Lower price, less supply. Higher price, more supply. Why don’t we set the cap to zero, then everyone’s GP visits would be free, and the govt would get a great deal. Any suggestions anyone?

    This is just another example of the government trying to get something without paying for it – another way of expropriating private property rights (in this case, the rights of doctors to their time).

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  156. philu (13,393 comments) says:

    mmmm..!!!…

    smell that (blue) rubber..!

    it’s a natty-u-turn..!

    phil(whoar.co.nz)

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  157. philu (13,393 comments) says:

    and from now on in..

    in national/’hollow-men’ circles/lore..’letting the cat out of the bag’..and ‘scaring’ us mug-punters ..

    ..with a glimpse of nationals’ ‘real agendas’ if elected..

    will be forever known as ‘doing a tony’..

    (and hey..!..that ‘if elected’ is looking more and more dodgy..eh..?

    now that everyone seems to have woken up as to what your ‘end-game’ is..

    ‘partial floats’..indeed..!..)

    won’t the next polls be ‘interesting’..?

    (as i said at the time..last weekend was a watershed one..and not in a good way..for national..

    and that appears to be how it is all unfolding..eh..?)

    phil(whoar.co.nz)

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  158. philu (13,393 comments) says:

    and now that the ‘honeymoon’ is well and truely ‘over’..

    do you think those natty ”we’re gonna win..!..we’re gonna win..!” onanists

    ..will now top ‘rubbing’..?

    phil(whoar.co.nz)

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  159. philu (13,393 comments) says:

    err..!..

    ‘stop rubbing’..

    phil(whoar.co.nz)

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  160. Thrash Cardiom (298 comments) says:

    With regard to Key’s comment about people being able to go to another doctor down the road if their current doctor raised their fees to high; In the rural district I live in you can’t do this. The GPs do not accept patients from other GPs in the district. I know this through attempting to get a person transferred from one local GP whose performance we were unhappy with to another local GP. Other people in the district have had the same experience.

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  161. Spam (588 comments) says:


    Andrew Bannister Says:

    September 27th, 2007 at 12:23 pm
    Burt, Dr shortages have nothing to do with fee caps. All countries have Dr shortages. Shortages exist because the medical profession is a well-controlled monopoly. There are many people who would make perfectly good GPs, but never make the cut at med-school. Not because they are no good, but because training is heavily restricted. Training and licensing restrictions maintain scarcity, and the rest is Economics 101. No amount of money is going to change that. That is why the government has to be involved.

    And the other part of economics 101: Create a free health system (Labour’s goal) you create infinite demand. Gee…. I wonder why there are waiting lists?

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  162. PaulL (5,951 comments) says:

    In Australia pretty much every GP visit is entitled to a Medicare refund. This comes either:
    – bulk-bill. If the GP doesn’t charge a “top-up” then the GP can just claim the schedule amount from the govt. A decent proportion of GPs do this
    – pay and claim back. If the GP charges other than the schedule rate, you pay the GP, and claim back the schedule rate from your local medicare office.

    That isn’t so different in terms of churn, so why the concern?

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  163. clintheine (1,570 comments) says:

    How ironic that the only qualified Doctor here has been told he is wrong by the usual cat calls from the left.

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  164. RossK (275 comments) says:

    DPF writes:

    “GPs income relative to other professionals has, if I recall correctly, massively shrunk in the last 20 years. It used to be a top profession to aim for, with top remuneration, but now some LLB students are earning more than a GP, before the med student even finishes study.”

    I am a lawyer and comments like this frustrate the hell out of me. For the record lawyers start off on appallingly low pay levels. Average salaries in Christchurch for the first three years working would be something like $30,000, $35,000, and $40,000. Probably $5k higher across the board in Wellington and maybe $8k higher in Auckland. A recent survey of lawyers (by Butterworths I believe) disclosed that one third of lawyers earn less than $70,000 per annum so if any of you were about to comment that they make it up later bear in mind that there is no guarantee of that.

    I think you would find that the mean or mode salaries for most professions, not just the medical profession, have dropped relative to the mean NZ income.

    Young doctors and dentists are just worse off than most because they have to cough up even more cash to get admitted to this supposedly lucrative profession. Personally I think medicine will be like most professions – when the bulk of the practitioners in their late 40’s, and their 50’s exit the profession service charges are going to skyrocket. Kiwis have gotten very used to having affordable professional services in all areas of life. Just as the dream of owning a house is rapidly disappearing (ironically disappearing most quickly for the younger of us who were conned into jumping on the higher education bandwagon) so too will widely affordable professional services disappear. Heck, maybe some of us who got conned into getting degrees will finally find them paying off after all (better late than never).

    As for saying you don’t need to be that intelligent to be a doctor. Get real! I don’t want no dumb doctor treating me thank you. Oh, and in my experience generally the people who spout on about “barriers to entry” and “professional monopolies” are the same people who would continue to use the most highly skilled and qualified practitioners even after the profession was thrown open to the masses. Most professions act as a subtle form of social welfare with the wealthy clients subsidising the poorer ones.

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