A Prescription for Shame

Why is Gareth Morgan on this whole health kick of late?  The other day I picked up one of the Journals I read, to again find another whole page advertisement from him.  This time not for Gareth Morgan Investments and his Kiwi Saver scheme but for Health Cheque and his Prescription for Change. The advertisement (alongside the huge photo of Gareth Morgan) reads as above.  Now, I don’t know if the years spent working in the health system has made me bitter and cynical but after reading that advert the first thing I thought was, “Oh, here we go”.

For those of you who are not aware, Gareth Morgan is a respected Economist and Investment Advisor here in New Zealand and a self made Millionaire.  He became a lot more of a household name after his son Sam Morgan's Trademe site/business (that Gareth helped him setup) got sold to Fairfax for $700 Million.  Gareth received $47 million of it, that he reportedly gave to charity.


I thought if this Journal has given a whole page advertisement to Gareth Morgan they must be endorsing his 'Prescription for Change' so I better at least have a look at what recommendations are being proposed and endorsed for our public health system.


The book he wrote, 'Health Cheque: the truth we should all know about NZ’s public health system' comes from research and numerous overseas literature reviews according to Gareth.  From the website all we can see is a lot of quotes from 'whomever', from 'wherever', answering 'whatever' questions they were asked on any given day.   I'm unsure how he gathered and correlated the information, or the questions that were asked.  Nor do I know if the huge limitations in this 'research' were acknowledged.  After all, we could all answer the questions differently depending on the day at work.  I have not been able to get a copy on the book myself to read but MacDoctor has reviewed and blogged about it and concludes much of what I suspected.  Interestingly enough, Geoff Simmons (co-author) posts in the comments on that blog.  It is well worth a read.


The first of many assumptions Gareth makes in his video presentation is that Clinicians, namely doctors, don't tell their patients the risks or cost/benefit factors of procedures.  He believes if we start doing this more (at least the limitations and possible adverse effects part of a procedure) we would get a 40% reduction in procedures as people will be too petrified to have the treatment.  I guess he is not familiar with the legislation around informed consent huh?


While there are just too many topics from 'A Prescription of Change' to explore in this blog, I have included a few highlights from his website/videos to see if I'm the only one that is left thinking WTF!!  I would be interested hearing what you all make of these true pearls of wisdom from him.

For 'Prioritising Care' (as us PC lot call it)....or 'Rationing' (as Gareth calls it):

“40% of visits to GP’s result in no diagnosable condition.  But if you don’t give the person a placebo, all hell breaks loose.  And they call you malpractice and all sorts of things and go off down the road to another one.  So he gives them a sugar pill”.  REALLY?????

“Incentivising primary caregivers, GP’s in other words, to manage conditions and prevent chronic developments as opposed to paying them per intervention.  Now GP’s are under a delusion, they think they are entrepreneurial.  Jesus, half their money comes from taxpayers.  They have got no right to be entrepreneurial.  They should all be on salaries and totally accountable for the spend of that money.  And you can get an enormous benefit if you are incentivising to keep people away from the surgery rather than increasing the count of them coming through.  Certainly given that 30% of visits are from hypochondriacs.”  DELUSIONAL GP's?  30%??  HOW WILL THIS SOLVE OUR NATIONAL GP STORAGE GARETH AND IMPROVE MAORI & PACIFIC ISLANDERS HEALTH OUTCOMES WHEN THEY DON'T OFTEN HAVE OR USE A GP?  OR IMPROVE OUR CHILD HEALTH STATS? 

“When researching our 2009 book Health Cheque, Geoff Simmons and I were told by numerous professionals inside the system that on a daily basis they are put under undue pressure from patients and their agents (family members, MPs, lobby groups) and the disturbing reality is that the squeaky wheel gets the oil. The typical scenario is when the patient's people threaten to go to their MP, go to the media and so on unless they get the service they think they deserve, then the system is abused.
Blackmail of busy health professionals like this is offensive but sadly is common, resulting in those with the loudest advocates getting served in front of others, just so the professionals can move on and attend to others. It is wrong, it is unfair but it is the reality - the needs of those without access to strident advocates are being trampled under as the loud lambast their way to the front.”  PMSL.... YIP BECAUSE BLACKMAIL IS COMMON AS WE ARE ALL SPINELESS TWITS?  WTF? 

“What's fair? We'd all like to think that those with greatest need are fixed first, but sadly it is not that simple. In a world where all needs cannot be met, society has to decide what "greatest need" is. How do you decide between a 92-year-old and a 10-year-old in need of the same knee operation? Personally they both have equal need so that gets you nowhere, and the limited resources mean you have to make the choice. The 92-year-old has paid more taxes, the 10-year-old has more taxes to contribute, so that doesn't help decide either.
But we must make a decision, we must decide who it will be. This is the reality facing society and the reality several generations of politicians have run away from. The answer is very clear but we must have the courage to declare and stick to it. The 10-year-old gets the nod because from this point of time society will benefit more from them being fixed - they have far more quality-adjusted life-years to contribute to society than the 92-year-old has. From society's perspective it's a no-brainer investment.”  NICE, JUST COMPARE APPLES AND ORANGES WHY DON'T YOU.  HOW MANY OVER 90 YEAR OLDS OR KIDS EVER HAVE KNEE SURGERY?  TRY COMPARING THE 50 YEAR OLD WITH THE 55 YEAR OLD?  OR THE TWO PEOPLE ACC REJECTED AND WHOS INJURIES HAVE WORSENED IN THE LAST YEAR?  OH AND NICE WAY TO DEAL WITH THE AGING POPULATION.  JUST LET THE BUGGERS SUFFER BECAUSE THEY HAVE NO WORTH NOW DESPITE THOSE MANY YEARS OF BEING A TAXPAYER.

Oh, that is just the tip of the iceberg and we haven't even touched on his 'stigmatising' of obese people as one of a number of public health strategies to deal with obesity.  All based on the fact that it worked so well for smoking.  But one does have to wonder why someone who states he and his friends go overseas for their healthcare needs and is not a health professional himself feels the need to make 'A Prescription for Change' in the first place?  Is he posturing for a career in Politics, or are we going to see him selling Health & Medical Insurance in the near future?  Regardless of his motives, I don't wish to see his face on the pages of my Professional Journal.  Will they next be selling advertising to Brian Tamaki?