A race-neutral approach to government health (and welfare) spending would give the same treatment to people in the same circumstances. It would ignore irrelevant matters such as race, ethnicity, religion, gender, or creed. Horizontal equity requires no less.
The government seeks instead to discriminate between people by assigning them to groups and treating some groups as a ‘priority’ population.
Its undemocratic juggernaut to divide New Zealanders on ethnic grounds took another step this week with the 3rd reading of the Pae Ora (Healthy Futures) Bill. That the Governor-General will assent is a given.
The Bill divides New Zealanders into two groups – those whose access to health services will presumably be determined by the new Māori Health Authority, and everyone else.
Astonishingly, section 59 of the Bill prevents the Minister from giving any non-partisan direction to the Māori Health Authority. The Minister may only give a direction that “relates to improving equity of access and outcomes for Māori”. And who will be the judge of that?
Government health bodies are to be Treaty savvy. They must understand Mātauranga Māori and “Māori perspectives of services”. Who will determine that? The Minister’s new Hauroa Māori Health Advisory Committee has pole position.
The Bill requires the system to strive “to eliminate health disparities, particularly for Māori”. This focus over-rides individual needs. It ignores individual variability within and across groups. It risks violating horizontal equity by favouring well-off Māori relative to worse off non-Māori.
Who is to distinguish Māori from non-Māori, and on what basis? The Bill is silent on this.
Moreover, no amount of spending on health care can eliminate health outcome disparities. Other factors such as lifestyle choices and socio-economic disparities are too important.
The inevitable ongoing failure to achieve elimination invites the new Māori Health Authority to call annually for ever-more funding per capita. Others will call ‘inadequate’ funding ‘racist’.
Such unsavoury assertions distract from the real issue – achieving better outcomes for those who are most struggling to provide for themselves, regardless of group politics.
Overall, the Bill presumes Wellington knows best. The Minister must impose a Charter, strategies, plans and directions for the entire public-funded health system. Every region will have a Wellington-imposed plan.
This is elitist. Wellington does not know best. People need choices, not plans.