More racial discrimination looming in the health sector

FREE cervical screening will be rolled out from September this year.

Free, that is, to Maori and Pacific women (or to use Te Whatu Ora’s terminology, “people with a cervix”), those with a community services card, and those who have never been screened or not within the last five years.

Te Whatu Ora claims the new initiative is about improving access.

Yes, the rates of cervical screening are lower among Maori and Pacific but the same is true of Asian women. If targeting by race is to achieve equity, why omit Asian women from the free service? In any case, while NZ European women have the highest screening rate, in absolute numbers they still make up the largest group of non-screened.

Alternatively, if preferential treatment is simply to satisfy another new-found Treaty of Waitangi principle, why are Pacific women included?

In practice, Maori and Pacific women who can afford and have regularly used the screening service will be switched to the free programme while other ethnic groups will continue to pay. That’s certainly not equitable.

The truth is many women put off testing due to discomfit, inconvenience or fear of cancer. The new self-tests will hopefully remove some of these barriers, but they should either be free for all or a cost for all. Analysing their take-up will be confused by varying accessibility.

Making Maori and Pacific ethnicity a condition for free eligibility cannot be justified on any sound basis. A publicly funded health system can never guarantee equal outcomes, but it can do its utmost to offer equal opportunity.

Prime Minister Chris Hipkins recently took a step back when the public reacted adversely to the use of ethnicity to decide priority for surgery saying he would get the Health Minister to “make sure there’s no discrimination.”

But Te Whatu Ora just steamrolls on with exclusionary policies based on race. There is no other name for this approach than discrimination.

Exclusion by race

Here we go again. Part of the panacea for solving the health system crisis is the brand-new Community Pharmacy Minor Ailments Service. A free service to treat minor ailments like skin infections and diarrhoea will be provided by local pharmacies to ease the pressure on GPs.

This is of course a ‘borrowed’ idea. But probably a good one going by Scottish experience where a survey showed, “Positive perceptions and experiences of those using MAS [Minor Ailment Service]”. These services are available across UK countries but differ from New Zealand in one major respect.

They are not restricted by ethnicity.

According to Te Whatu Ora, In New Zealand “Māori and Pacific, children under the age of 14 and their whānau, and Community Service Card (CSC) holders will be able to get free consultation and receive funded treatment for certain minor ailments this winter.”

The majority of the population is excluded.

Was that clearly signalled?

Discussion about the service cropped up on a Wellington talk show earlier this week. The host described his experience taking a family member with a large stye into his local pharmacy. Apparently, the pharmacist told the family member to book a GP consultation and the patient had to take the remainder of the week off work awaiting doctor treatment.

Perhaps the family member was the wrong colour but the pharmacist didn’t want to point this out?

The government seems to have built an expectation that the service is for everyone. At least that’s the perception that emerges when you are reticent about revealing it is actually restricted to Maori, Pacific, the poor and children.

On Tuesday NewstalkZB Wellington led their news bulletins with versions of the following: “76 pharmacies across the district are signed up to a scheme allowing them to treat minor conditions and ease pressure on GPs and hospital services over the winter months.”

Media coverage in Stuff makes no mention of restrictions to the service.

As a consumer of mainstream media, the fact that the service is actually severely limited later came as a complete surprise.

This Labour government, riddled with communications specialists and purportedly the most “transparent and honest” ever, unfortunately has a memory like a sieve.

In the early 2000s Helen Clark was forced to run a massive damage-control strategy when her ‘Closing the Gaps’ policy eventually sunk into the collective consciousness. The public was justifiably angry and unaccepting that services were restricted by ethnicity. She had to change the focus and rebrand the spending initiatives ‘Reducing Inequalities.’ She understood that Labour voters would accept targeting help to the poorest and neediest. And while many Maori and Pacific people fall into this group, a good many do not.

But in 2023 they are making the same mistake all over again.

Let’s not beat about the bush. All non-Maori and non-Pacific people who don’t have a Community Services card and are older than 13 are excluded from the pharmacy service. Pity the poor pharmacist who has to break the news to the sick patient presenting but ineligible.

This is a dying administration desperately grasping at straws, neither thinking policies through nor even reflecting on past experience. For these reasons alone, they need to go.

The Plague of Entitlement

The subject on Kerre Woodham's morning talk show today was the cost of living and how dire some people's circumstances are becoming. A texter wrote in:

"Kerre, As a solo mum of two year-old twins I was recently offered a role for $96,000. I chose not to take it because the cost of living means I'd actually only be getting about a hundred extra dollars a week to what I am getting on the benefit. Something is very wrong with that scenario. Rent - and childcare if I work full-time - is $80,000 gross. So getting offered a job at $96,000 …  financially, this single mum is better staying on a benefit. And what does that tell you?"*

I am assuming the texter is saying that a well-paying job, but not paying enough to attract her off a benefit, is confirmation of the extremely elevated cost of living. The answer to her rhetorical question is implicit. We are expected to agree and sympathise.

I would answer her last question rather differently. What her text tells me is this:

1/ She has no sense of gratitude or shame that other people are working so she doesn't have to 

2/ She has no motivation to contribute to the economy

3/ She has no interest in 'cutting her cloth' to cope with the consequences of her personal decisions

4/ She has no apparent awareness that increasingly generous benefits are a factor fuelling inflation and the cost of living which she is currently so concerned about

Over twenty years ago now, I launched a petition to parliament asking for an inquiry into the DPB. A local newspaper wrote about the petition which provoked howls of outrage among beneficiaries. One lady took umbrage at my assertion that being raised on benefits was not good for children. She wrote to the editor saying her children had turned out fine. Indeed, her daughters were now raising their own children on the DPB! 

This elicited a response I shall never forget and when in need of some sanity and solace I revisit it:

Here we are, a generation down the track, and it's not just the value of money that is subject to rampant inflation. So is the plague of entitlement.

*(NewstalkZB, Week on Demand, 30/6/23, 9:45am, at 6:00 in, https://www.newstalkzb.co.nz/on-demand/week-on-demand/)

What benefit incomes really look like

The Green Party has just issued its election year Ending Poverty Plan. Supportive media reports tend to fixate on basic benefit rates. But these are just one component of benefit incomes. When politicians seek votes to solve a ‘problem’ their interest is always in casting it in the worst possible light. The Greens would have you believe that benefit incomes are at a meagre, barely subsistence level.

Here is data to help you make your own mind up.

Because beneficiary circumstances are many and varied – they might be single; partnered; with or without childcare responsibilities; living with a disability; working part-time or seasonally; studying; living at home or paying a mortgage, etc. – there is considerable variation in incomes.

To this end the Ministry of Social Development developed a new data set that, “…outlines the full range of financial support main benefit clients receive, including their base benefit payment, supplementary assistance and other ad hoc grants, financial support from Inland Revenue, and any earnings.”

In April 2022 the first report from this dataset appeared. It covered around 378,000 adults receiving an income-tested main benefit.

For background, the complexity that has developed over decades is first described:

“People accessing support through the welfare system can access three different tiers of support:

• Tier one main benefit payments, which are intended to meet the general costs of living, for example Jobseeker Support, Sole Parent Support and Supported Living Payment.

• Tier two supplementary assistance for specific ongoing costs, such as those related to housing, health, and disability, for example the Accommodation Supplement and Working for Families tax credits.

• Tier three hardship assistance that helps people meet immediate and essential costs, which cannot be met from any other income or assets, and can be recoverable or non-recoverable, for example Special Needs Grants.”

Reflecting this complexity, the following graph from the report shows the “average composition of total income by family type before housing costs.” For example, a sole parent with two or more children receives, on average, just under $1,000 weekly before housing costs. This ‘family type’ comprised 50,614 parents with 135,545 children.

(See graph source for explanatory notes)

It is impossible to say what the equivalent income for a sole parent in work would be. Her Family Tax credits would remain, but all other assistance would be adjusted or disappear. Suffice to say $1,000 weekly (or $52,000 after tax annually) is probably not what most New Zealanders regard as ‘living in poverty’. (The childless, single beneficiary is another matter.) Typical New Zealand salaries are listed at this government website and a number fall in and around this vicinity.

Yes, housing is a substantial expense, but that is so whether the renter is a beneficiary or non-beneficiary. Those who live in state houses pay only income-related rents and are relatively better off.

The next graph, which depicts income change between 2021 and 2022, shows the same sole parent with two or more children receives on average $632 weekly after housing costs, up from $548 the year before:

Sticking with the same family-type (green line), the next graph shows how their after housing income rose between 2016 and 2022 from below $400 to $632 and labels each of the Labour government policy changes along the way, for instance, the introduction of the Winter Energy Payment (WEP) causes increases in the June-September period each year:

Extra protection for beneficiaries

The report also describes how benefit incomes have been inflation-proofed:

“From 2018, increases to main benefit payments compensated for rises in inflation and housing costs over time. Since 2018, inflation (excluding housing) increased by 12 percent, while total incomes across all family types grew by 59 percent on average (after housing costs). Overall, peoples’ total incomes after housing costs are, on average, 43 percent higher in real terms now than in 2018.”

And that the Accommodation Supplement rises with rents:

“…as people’s housing costs increase, the amount of support they can receive through the Accommodation Supplement also increases, up to a maximum amount. This mitigates the extent to which increases in housing costs affect total incomes.”

The data is already obsolete with benefits having been adjusted again for inflation (7.22%) on April 1, 2023 but an updated report is yet to be released.

None of the above information is provided as proof life on a benefit is easy.

What it does show is that for beneficiaries with children, incomes are close to those from unskilled work. This means leaving a benefit - which is secure, consistent and adequate – takes a degree of motivation and self-discipline. It gets harder to leave as the benefit rises, which is why the duration of dependency is also increasing.

For those who have grown up in beneficiary households, where low-income levels are ‘normal’, the attraction of work is further undermined.

In response to my last post about new child support pass-on laws effective July 1, which will further increase sole parent incomes by an average of $47 weekly, a couple of readers pointed out that assistance beyond that provided by Work and Income has also accelerated in recent years.

Free school lunches, free period products, foodbanks and social supermarkets, very cheap accommodation in the form of emergency housing, a proliferation of charity shops selling inexpensive household wares and clothing … the list goes on.

Yet the Green Party leaders continue to lambast society for tolerating such a dreadful level of ‘poverty’ which could be fixed overnight apparently if only more money was forcibly taken from the rich and given to the poor.

Undoubtedly there are people struggling. But a policy of ever-increasing income redistribution via the tax system has been in play in New Zealand for generations.

Shouldn’t such a good idea have worked by now?

Or will it continue to be ramped up to the point where there are too few productive, independent people left to fuel it all?

I find myself wondering if the Greens ever ask themselves these questions.

Then … I hope and pray that voters do.