Lees-Galloway Iain: New Zealand Public Health and Disability Amendment Bill — Third Reading 
Lees-Galloway Iain: New Zealand Public Health and Disability Amendment Bill — Third Reading 
[Volume:667;Page:14566] 
IAIN LEES-GALLOWAY (Labour—Palmerston North) 
: 
 It is a pleasure to speak in support of the New Zealand Public Health and Disability Amendment Bill. Dr Hutchison alluded to the fact that it appears that all parties will support the third reading of this bill but I would like to address the concern Dr Hutchison raised about some of the material that Opposition members are covering and why we have spoken so forthrightly against some of the myths that the Government is creating about the health system. 
The Minister and Dr Hutchison spoke at length about value for money and about productivity and indeed this bill supports shared procurement and is an attempt to reduce costs in the health system. It is a good thing; it has noble objectives and the Opposition supports it. However it is based on the premise that New Zealand’s public health system costs too much has too much bureaucracy and is inefficient and unresponsive. Indeed all the Government’s spin Dr Hutchison’s speech and the Minister’s speech are all based on that premise. Much as we support any moves to make the public health system more responsive and more efficient we must dispel this ridiculous myth that the Government is espousing. 
In my second reading speech on this bill I offered up the amount of money spent per capita on health care in New Zealand as a way of measuring how New Zealand ranks internationally in terms of the total cost of health care and New Zealand ranks very well by that measure. It spends less per capita than Australia the United Kingdom Canada Germany and of course the United States of America where costs really have blown out due to that country’s total reliance on private providers and multinational health insurers and due to the influence of the lobbyists from the pharmaceutical industry. The United States of America is a country that needs to take a serious account of cost blow-outs in the health care system. 
There are however a number of other measures by which we might look at how New Zealand compares internationally. Life expectancy is one measure. Not only do we compare very very well in terms of life expectancy but when we measure life expectancy against how much we spend per person we see that we do even better. If we look at the cost of purchasing pharmaceuticals we see that New Zealand just about outranks every other country in the world thanks to Pharmac. The use of technology and information technology is another area where we do very very well internationally. I bet most people in New Zealand will be surprised by this one: satisfaction rates amongst primary-care physicians in New Zealand are absolutely astronomical in comparison with those of many overseas jurisdictions. 
The New Zealand health system does very very well yet this Government seems to insist on pushing the message—and it does so through this bill; it has built a burning platform—that the health system is in absolute crisis. Yet when we look at it in real terms we see that there is a lot of good to be said about our health system but— 
Michael Woodhouse 
: Ruth says there is nothing right and Iain says there is nothing wrong. 
IAIN LEES-GALLOWAY 
: —there are places where we can improve. My friend Mr Woodhouse is getting a little bit concerned but I ask him not to worry because I am getting there. There are areas where we can improve. But this bill is just tinkering; it is small stuff. The real savings in health care are to be found in tackling the really big issues—the things that really cost our system. 
Diabetes is one area where we do appallingly internationally. Youth suicide is probably one of our biggest shames internationally. Cardiovascular disease and diseases related to alcohol abuse to tobacco use and to the abuse of other drugs are all things that cost our system. If the Government was serious about cutting costs it would not be dilly-dallying with this bill. Instead it would have a serious strategy to take on those things—a strategy for wellness in New Zealand. 
All those issues affect those who are most deprived in a far more destructive way than they affect those who are least deprived. So the single biggest thing that this Government could do if it was serious about reducing costs in the health system would be to have a serious strategy to reduce inequalities. What have we actually seen? We have seen tax cuts that increase inequalities. We have seen an increase in GST that affects those who spend the majority of their income on the basics in a far greater and more destructive way than it affects those who have more disposable income. 
This Government is actively increasing those disparities and it is undermining the good work that our physicians our nurses and our specialists are trying to do to clean up the mess left at the bottom of the cliff. This Government has no strategy for prevention. It does not care for prevention and it does not care for reducing inequalities. We can see this in the jack-up of the Horn report. The Horn report begrudgingly mentions the previous Government’s strategies for prevention and the effect they have had. It states: “New Zealand’s relatively strong commitment to prevention and public health has helped improve life expectancy delayed the onset of disability associated with chronic disease and reduced inequalities.” 
Hon Steve Chadwick 
: 9 years of Labour. 
IAIN LEES-GALLOWAY 
: Yes 9 years of Labour and the Horn report had to admit that that was the outcome of the Labour Government’s strategies. It goes on to state: “Opinion is divided however on the much narrower question”—the much narrower question—“of the extent to which further spending in this area at the expense of more immediate health needs might help reduce future health costs or improve the country’s economic performance thus making future health spending more affordable.” That narrow focus is what this Government is focused on. 
Hon Steve Chadwick 
: Sleight of hand. 
IAIN LEES-GALLOWAY 
: It is sleight of hand; it is smoke and mirrors. The Government is not interested in the big picture. It is not interested in where our health system might get to in 2020 or 2030 or in improving outcomes for our children. It is interested in the very narrow focus of the here and now. 
Do members know what? I am prepared to concede that that politically this bill makes some sense for National. People who habitually vote for the National Party do not tend—I am talking about tendencies here—to suffer from social deprivation. They do not suffer from the effects of low income. They do not suffer from diseases such as diabetes cardiovascular disease and everything else. They certainly do not tend to suffer from rheumatic fever. So politically a focus on the here and now and on the health system’s ability to respond to people who are fundamentally well makes sense for National. If National was truly interested in all people in New Zealand and if it really had a strategy that encompassed the whole community in New Zealand then it would not be faffing around with this bill and it would not be faffing around with the kinds of recommendations from the Horn report. Instead it would be focused on a true preventive public health strategy—and do members know what? That is what Australia is doing. 
We are very focused on the catch-up with Australia on trying to close the wage gap and on catching up economically with Australia. The Government is failing abysmally on that as well. Australia’s big priorities are obesity tobacco and alcohol. Australia has not come up with just a few bullet points and a catchy slogan. On each of those issues it has an overview a road map of how to get to its final goal and technical papers that deal with the guts and the details. Australians have a plan and they know where they want to be in 2020. The Labor Government in Australia has a real strategy for encompassing everybody in the community and for wellness in the whole community. 
The Opposition supports the objectives of this bill. It certainly does no harm so we are happy to see it pass through the House. But there is a problem with our health system: it is not what the Government is offering in terms of problems; it is how the Government treats those who are most deprived and most vulnerable in our community. This bill does not address that problem and it is about time we had a Government that was prepared to put up something that does.