Upton-on-line returns after a brief time in Washington where he learnt about the distinction between ‘dimpled’ and ‘pregnant’ chads (he rather favoured the ‘swinging’ variety); and The Hague, where he was able to dispense bonhomie and bandages to Pete Hodgson and the team who were stoutly (and rightly) defending unrestricted emission trading. After all this cosmic excitement the New Zealand Public Health & Disability Bill seemed a bit anaemic.

Jeunesse Dore [sic]

Upton-on-line returned from the manicured civilities of Western Europe on the day that The Australian’s correspondent, Christopher Dore, was returning to his kennel in Sydney. His parting cloque was a rather well-written little piece that appeared in The Dominion in abridged form.

(Having checked the original in The Australian, upton-on-line was initially mystified by the nature of the abridgement until he realised that the Dom had tactfully omitted a single line reference to a feat by Winston Peters that had exceeded even that old master’s dizziest moments. Readers of The Australian got the unexpurgated (and probably actionable) fantasy version).

Mr Dore’s affecting account of the manic condition to which he succumbed in Wellington was valuable on two counts. First, his disclosure contained material of real clinical significance. It has long been known that journalists exhibit group allegiances. It had been suspected – but not confirmed – that these allegiances did not necessarily extend across tribal boundaries.

It is now clear that J.ockerensis exhibits a strong immunological reaction when exposed to foreign prejudices. Even more revealing is the potentially life-threatening risk editors take if they allow journalists to go on an extended assignment all by themselves. Long evenings with no-one laughing at your jokes, abusing your favourite league club or getting aroused every time someone says seeex (as in seeex-pack) are hard enough for ordinary people to handle. But for a journalist …

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

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

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

New Zealanders do brood about their smallness and isolation. It’s a pathology that has intensified as we have stressed our ‘independence’. Ironically, we were probably least self-conscious about our condition when we just regarded ourselves as citizens of the Empire. The nation-building artists, politicians and historians who insisted that we “grew up” and developed our own sense of national awareness helped plunge us into what is becoming a permanently adolescent identity crisis.

It’s one thing to be (as Australia is) a slightly self-important “middle power” which is not only strategically important but rich enough and populous enough to be good-naturedly offensive to just about everyone. It’s entirely another to go it alone with four million not terribly well-educated and not specially productive people who keep assuring themselves that they stay here “for the lifestyle”.

Whether “getting on with life”, as Mr Dore quaintly describes the daily activity of Australian residents, involves forgetting all about places like New Zealand is another matter. Upton-on-line is planning a major ruminate on the curses and joys of New Zealandness next week, excerpts of which will form the basis of next week’s edition.

Dying for a Vote

Health Board Democracy

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

Contemplating the need for health care after next year’s local body elections? Don’t worry. It will be provided for you by democratically elected boards. It is almost worth delaying your illness. Think of the reassurance you will get from knowing that your surgeon’s scalpel is empowered by locally elected worthies.

Upton-on-line makes no apology for cynicism on this front. A public health system funded from taxes is one thing. Handing it over to people, a majority of whom have no responsibility for raising the funds that are to be expended, is another. We’ve been through this all before. No taxation without representation makes just as much sense in reverse: how is there going to be any accountability in a system where the boards (21 of them!) will say they haven’t been given enough money to do their job and the Minister will huff and puff and say she’s given them plenty?

For starters, board elections will have to be funded from existing health budgets. So there’s an immediate gripe for boards to fasten onto. The reality is that human nature, as always, will out. There is no incentive on boards to do anything other than pass the buck to the Minister – and for her to pass it back.

To try to stiffen the resolve of boards, the Government is giving itself two chances to breathe down their necks. First, the Minister can appoint up to four extra board members (seven will be elected). Secondly, the Minister can appoint a creature new to the public sector firmament: a Crown Monitor. (One imagines this person carrying a little mace, wearing a little coronet and seeing that the whiteboard pens are all working).

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

It all has a slightly Maoist feel to it. Incorrect thinking will be reported by the Monitor to the Head Prefect for educational correction. Right-thinking people will be appointed to see that local democracy is guided.

The basic question is this: who wants elected boards? How many people waiting for angioplasties or prostate surgery give a fig about some alleged ‘democratic deficit’ down at the hospital. It’s quite different in education. People do seem to be genuinely interested in seeking to influence the way in which their children’s schools work. But hospitals?

Why Stop There?

Ah, I can hear the Minister chiding me, it’s much more than hospitals. District Health Boards will also be directing primary health care which is much more widely used. It is – and it currently operates in - a relatively free market in which people vote with their feet and find another doctor or midwife if they’re not satisfied with the service. GPs have long placed much store on the sanctity of their relationship with the patient and the freedom to choose. (In other walks of life it’s called competition.)

GPs and other primary health providers need elected 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 Crown Monitor will explain to them that this problem has been overcome in the education sector through zoning and lucky dip ballots for out of zone places. Perhaps GP practices could be zoned, with 10% of patient rolls balloted every three years to inject a little ginger. Or perhaps, like school, GP practices could be precluded from charging any fees if they want to accept public health dollars.

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

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