Little bit apples and oranges

I went and saw a preview screening of Michael Moore's new doco - Sicko. Its all about health services in the US and how crap they are. It made me think of a couple of things.

Moore really annoys me at times through his generalisations and see-no-evil approach to European countries - and Canada. Yes the NHS is great, and is held in very high regard in Britain - but its not perfect. Same with Canada, in fact they have they much the same issues we have here - long waiting lists etc, staff retention issues, but yes it is a pretty good system.

Then there is France, one of the most subsidised countries in the world. Economically, France has underperformed in the last 20-30 years - arguably because of the heavy state involvement in the economy (their farmers are still subsidised at pre 1980s NZ levels). The French are now largely reliant on Govt subsidies. So its apples and oranges to compare the US health system with these countries, they are all structured differently and all have their own issues.

In saying that, the US system is an absolute disgrace. It is based on the good old Tory myth that there is no such thing as bad luck - if something goes wrong in your life, its because you fucked up (hence no need for a safety net - you should have worked harder).

At the very least the state should provide free emergency health services. What kind of country bills someone for ambulatory and emergency department care related to a car accident??

I was pleased that Moore chose to travel to Cuba as well. The most maligned country in the world, just happens to have the some of the best health and education services in the world. In fact for the large part NZ's Primary Health care Strategy and PHOs are based on Cuba's approach. Essentially its about cheap/free primary care (doctors/nurses visits) - catching illnesses early rather than putting prohibitive costs between patients and care (meaning illnesses get worse/need surgery etc etc).

But the policies of the US were the model for the Bolger National government in the 1990s - user pays. Which is the second thought I had. Tony Ryall has made no secret of National's plans to re-privatise ACC (despite it being a failure the first time). So who will be surprised if ACC providers start denying people coverage on the basis of some fine-print clause in your agreement?

While we may not always get it right with health care, there are fundamentals that need to be upheld. As the US shows us, most people will choose to make their basic ends meet (power bills/mortgages/food for your kids) before putting money into health insurance on the off chance they will one day need it. This is why the state MUST provide coverage.

I don't believe for a second that National has changed their spots on health care, and Sicko, for all its flaws is a timely reminder of what will be at stake in 2008. Go and see Sicko, take Moore's comparisons with other countries for what they are, but reflect on what sort of country we want here. National, like the US, will use health as a revenue gathering machine to make up for their cuts to taxation. Health should be solely about making people better, not making a buck. Unfortunately this is again the choice we will be facing in 2008.