Who knew that prescription fees would become such a litmus test of political morality? Earlier this year, Labour scrapped prescription fees, in order to make medicine more affordable to people struggling to stay healthy during a cost of living crisis. At the time, Health Minister Ayesha Verrall estimated the policy would cost $618.6 million in lost revenue, over the next four years.

National is now promising to re-impose prescription charges and says it will use the money to pay for the expensive new cancer drugs that Pharmac had previously decided it shouldn’t spend its limited budget on, not at least on any rational “greatest good for the greatest number” basis.

Labour has subsequently claimed that National will actually be using the prescription charges to help fund its socially regressive round of tax cuts. Not that advocating policies that generate further income inequality has ever been something that keeps the centre-right awake at night.

Priority policies

Ultimately, if National wants to be seen to be rushing to the bedside of cancer patients, it could simply postpone its tax cuts, and/or set aside its billion-dollar handouts to landlords. The underlying problem, of course, is the limited size of Pharmac’s budget. Labour won’t fund it adequately, and National’is insisting that any solution must be fiscally neutral. Meaning: one group of sick people will have to pay more to get their treatments, in order to pay for the treatment needs of another group of sick people with cancer. On this issue, there’s not a lot of generosity evident, on either side of the political fence.

There will be a couple of clear winners, though. Taking that $618 million and spending it on new treatments for relatively rare forms of cancer will deliver significant help to a small number of New Zealanders in desperate need. That’s great. Yet in the process, this will also be a gift to National’s friends in Big Pharma – who have long wanted Pharmac to dial back its spending on generics, which offer minimal, if any, profit margins, and buy more of its expensive new treatments.

Big Pharma’s prayers have been answered. The centre-right aims to use the revenue from prescription fees to buy more of Big Pharma’s pricey new products. It's an approach that could end up blowing out the medicines budget, while – as mentioned - making other vulnerable people pay more for the standard medicine they rely on. It's a form of trickle-up economics in action.

That’s the eternal problem with government spending. Despite what the Act Party claims...New Zealand is by global standards a relatively lightly taxed country with a minimum of regulatory red tape protections – and that’s one reason why we continue to top the global rankings of countries where it is easiest to set up and run a business.

The downside is that this has left successive governments without the tax revenue required to maintain adequate funding for some key social services, such as Pharmac. Within a limited budget, should the state be spending a lot more on the few in desperate need, or more on alleviating the pain and suffering of the greater number? ( Only by raising taxes and/or by foregoing tax cuts can you hope to do both.)

There will be costs involved, however, the state chooses to manage the status quo. On average, the new biologic wonder drug treatments cost $US30-50,000 a year per person, and that price tag can be up to $US500,000. (That four-year revenue flow of $618 million won’t go very far.) That being the case, a bi-partisan debate on how we can afford the selective purchase of these new treatments seems essential for a small country like New Zealand. To date though, it has been politically convenient to demonise Pharmac and heap all the blame on it.

Obviously, Big Pharma has a vested interest in stoking the demand for its new products by sick patients, at their most vulnerable. For equally obvious reasons, the pharmaceutical industry has also become skilled at marshaling the US legal system to block access to bio-similars, and to restrict the competition that might otherwise reduce the costs of these new wonder treatments.

FIFA Finance

In May 2024, FIFA will announce the host of the next FIFA Women’s Football World Cup, to be held in 2027. Four bids are on the table, although South Africa and Brazil probably don’t stand much chance. The two heavyweight contenders are (a) a joint bid by the football federations of Belgium, the Netherlands and Germany and (b) a joint United States/Mexico hosting bid. Chances are, the outcome will affect the power shift that’s becoming evident in women’s football, from the United States to Europe.

Viewership figures – which in turn dictate the advertising spend and the worth of the television rights – will be paramount. As we saw this year, the role of time zones is also crucial to how those figures pan out. TV audiences in the US in particular, had to cope with some brutal screening times during this year’s tournament. Looking ahead to May 2024, it's hard to see how the economic fundamentals of the US/Mexico bid can be credibly put together. After all, it can no longer be assumed that the US team would survive the group stage: and this deadly possibility has to be factored (somehow) into the audience projections and related advertising spend that will underpin the US/Mexico bid.

Europe rules

To be sure, the photo of Spain’s Ona Batlle consoling Engand’s Lucy Bronze in the aftermath of the final captured a lovely moment when humanity transcended sporting rivalry. Yet as Guardian sports writer Jonathan Liew says, it is worth keeping in mind that Bronze and Batlle are also team-mates at the Barcelona football club, where eight of Spain’s current national team spend most of their playing time.

As Liew indicates, the FIFA tournament – and the success of Morocco, Nigeria, Japan (and even Haiti, which held England to a 1-nil scoreline during the group stage) can be seen as a tribute to the new and exciting global outreach of women’s football. Yet conversely, it could also be taken as evidence of the convergence of women’s football on Europe and its mega-clubs, which seem to be displacing the US (and its previous lure of university scholarships) as the epi-centre of women’s football.

In other words, what we’re seeing may not be so much the horizontal growth of women’s football in countries all around the globe, although that trend is a welcome fact of life. Instead, it may be more of an example of the vertical integration of the funds, coaching skills and elite sporting talent within surprisingly few locations in England, Spain, and France.

In charting that trend, some of Liew’s observations are striking. Until recently, as he says, Haiti’s ability might have been unknown beforehand. That’s not so much the case now, given that 14 of Haiti’s national squad play their football in France. Much the same applies to Colombia:

Colombia’s irresistible adaptability was forged not just at home but in Spain and the United States, where 14 of them have played. The Nigeria squad that ran England so close are employed on four continents... Three of the four semi-finalists were European (Spain, England and Sweden), and of Australia’s 23-player squad 19[of them] play their football in Europe..

And so it goes. Incredibly, as Liew points out, England is the host for most of the competitive year to 106 of the players who took part in the FIFA World Cup. Reportedly, 16 of Nigeria’s squad, and 13 of the Morocco squad also play in Europe. Fittingly in the light of this European hegemony, it was Spain and England that ended up contesting the FIFA Women’s Football World Cup final. Even most of Sweden’s best players compete within [Spain’s] Liga F or [England’s] WSL.

No one begrudges the career opportunities and rewards that these wonderful athletes have now suddenly found to be within their grasp. No doubt their exploits on the pitch will inspire young girls everywhere to take up football. But New Zealand for example, will find it increasingly hard to compete on the world stage if our elite players can’t make their way into the English/European clubs and competitions into which global talent is being sucked, and where excellence in the game is being forged.

As with everything – from Pharmac to women’s football – the extent of state funding will be crucial. As Liew concludes, the magnetic pull that Europe is currently exerting will have serious drawbacks if national governments don’t step up:

Spanish investment may currently have fringe benefits for the Colombian national team, but it is a poor substitute for genuine investment in Colombian academies, Colombian schools and Colombian grassroots facilities. In the long run it is easy to glimpse a future in which European football essentially becomes the only show in town, in the same way America once was: warping the global market, helping itself to the pick of the world’s best players, and becoming progressively stronger as a result.

Across the Tasman, the success of the Matildas has induced the Albanese government to pour an extra $200 million into women’s sport. That kind of grassroots funding is going to be crucial for national success – even if also serves to locate the raw talent that the European super clubs and leagues then swoop upon, upskill and monetise.

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