Upton-on-line returns after a brief time in Washington wherehe learnt about the distinction between ‘dimpled’ and‘pregnant’ chads (he rather favoured the ‘swinging’variety); and The Hague, where he was able to dispensebonhomie and bandages to Pete Hodgson and the team who werestoutly (and rightly) defending unrestricted emissiontrading. After all this cosmic excitement the New ZealandPublic Health & Disability Bill seemed a bitanaemic.

Jeunesse Dore [sic]

Upton-on-line returnedfrom the manicured civilities of Western Europe on the daythat The Australian’s correspondent, Christopher Dore, wasreturning to his kennel in Sydney. His parting cloque was arather well-written little piece that appeared in TheDominion in abridged form.

(Having checked the original inThe Australian, upton-on-line was initially mystified by thenature of the abridgement until he realised that the Dom hadtactfully omitted a single line reference to a feat byWinston Peters that had exceeded even that old master’sdizziest moments. Readers of The Australian got theunexpurgated (and probably actionable) fantasyversion).

Mr Dore’s affecting account of the maniccondition to which he succumbed in Wellington was valuableon two counts. First, his disclosure contained material ofreal clinical significance. It has long been known thatjournalists exhibit group allegiances. It had beensuspected – but not confirmed – that these allegiances didnot necessarily extend across tribal boundaries.

It is nowclear that J.ockerensis exhibits a strong immunologicalreaction when exposed to foreign prejudices. Even morerevealing is the potentially life-threatening risk editorstake if they allow journalists to go on an extendedassignment all by themselves. Long evenings with no-onelaughing at your jokes, abusing your favourite league clubor getting aroused every time someone says seeex (as inseeex-pack) are hard enough for ordinary people to handle. But for a journalist …

But the greater value of Mr Dore’scolic was this judgement:

“Kiwis who flee to Australiaaren’t running from a small country and its constraints;they’re escaping from each other. Running from the burdenof being a New Zealander.”

There’s more than an element oftruth in that observation. Having observed kiwis abroad -both in public and in private - these last two weeks, onehas to concede a certain force in the charge. It’s afunction of being a small – and claustrophobic society. Upton-on-line has had Maori New Zealanders explain why it’sa relief to escape to Sydney. But in truth it’s the samefor pakeha. There’s no prospect of anonymity in NewZealand. Everyone’s in the kitchen – and Mr Dore clearlyfound the steamy intimacy of it all a bit much.

NewZealanders do brood about their smallness and isolation. It’s a pathology that has intensified as we have stressedour ‘independence’. Ironically, we were probably leastself-conscious about our condition when we just regardedourselves as citizens of the Empire. The nation-buildingartists, politicians and historians who insisted that we“grew up” and developed our own sense of national awarenesshelped plunge us into what is becoming a permanentlyadolescent identity crisis.

It’s one thing to be (asAustralia is) a slightly self-important “middle power” whichis not only strategically important but rich enough andpopulous enough to be good-naturedly offensive to just abouteveryone. It’s entirely another to go it alone with fourmillion not terribly well-educated and not speciallyproductive people who keep assuring themselves that theystay here “for the lifestyle”.

Whether “getting on withlife”, as Mr Dore quaintly describes the daily activity ofAustralian residents, involves forgetting all about placeslike New Zealand is another matter. Upton-on-line isplanning a major ruminate on the curses and joys of NewZealandness next week, excerpts of which will form the basisof next week’s edition.

Dying for a Vote

HealthBoard Democracy

Dose: to be taken triennially as apurgative. Clinical indications: extremely low turn-outs. Adverse reactions: interest group capture, in-fighting,blaming the Minister for providing insufficient money andthe construction of visible monuments.

Contemplatingthe need for health care after next year’s local bodyelections? Don’t worry. It will be provided for you bydemocratically elected boards. It is almost worth delayingyour illness. Think of the reassurance you will get fromknowing that your surgeon’s scalpel is empowered by locallyelected worthies.

Upton-on-line makes no apology forcynicism on this front. A public health system funded fromtaxes is one thing. Handing it over to people, a majorityof whom have no responsibility for raising the funds thatare to be expended, is another. We’ve been through thisall before. No taxation without representation makes justas much sense in reverse: how is there going to be anyaccountability in a system where the boards (21 of them!)will say they haven’t been given enough money to do theirjob and the Minister will huff and puff and say she’s giventhem plenty?

For starters, board elections will have to befunded from existing health budgets. So there’s animmediate gripe for boards to fasten onto. The reality isthat human nature, as always, will out. There is noincentive on boards to do anything other than pass the buckto the Minister – and for her to pass it back.

To try tostiffen the resolve of boards, the Government is givingitself two chances to breathe down their necks. First, theMinister can appoint up to four extra board members (sevenwill be elected). Secondly, the Minister can appoint acreature new to the public sector firmament: a CrownMonitor. (One imagines this person carrying a little mace,wearing a little coronet and seeing that the whiteboard pensare all working).

The Monitor is there to (i) observe thedecision-making processes and the decisions of the board;(ii) assist the board in understanding the policies andwishes of the Government; and (iii) advise the Minister onany matters relating to the board’s performance.

It allhas a slightly Maoist feel to it. Incorrect thinking willbe reported by the Monitor to the Head Prefect foreducational correction. Right-thinking people will beappointed to see that local democracy is guided.

The basicquestion is this: who wants elected boards? How manypeople waiting for angioplasties or prostate surgery give afig about some alleged ‘democratic deficit’ down at thehospital. It’s quite different in education. People doseem to be genuinely interested in seeking to influence theway in which their children’s schools work. Buthospitals?

Why Stop There?

Ah, I can hear the Ministerchiding me, it’s much more than hospitals. District Health Boards will also be directing primary health care which ismuch more widely used. It is – and it currently operates in- a relatively free market in which people vote with theirfeet and find another doctor or midwife if they’re notsatisfied with the service. GPs have long placed much storeon the sanctity of their relationship with the patient andthe freedom to choose. (In other walks of life it’s calledcompetition.)

GPs and other primary health providers needelected boards and monitors like holes in their heads. They’ll probably start to take an interest in the ‘fairness’or otherwise of access to doctors. No doubt the CrownMonitor will explain to them that this problem has beenovercome in the education sector through zoning and luckydip ballots for out of zone places. Perhaps GP practicescould be zoned, with 10% of patient rolls balloted everythree years to inject a little ginger. Or perhaps, likeschool, GP practices could be precluded from charging anyfees if they want to accept public health dollars.

Mostreaders of upton-on-line will be too busy to offerthemselves for re-election. But fortunately for all of us,there are always people with the time to do so.

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or e-mailadrienne.frew@parliament.govt.nz

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