Down on the Farm: A couple of Kiwi conundrums
In 1980, New Zealand farmers were amongst the most highly-subsidized in the world. A complex system of price supports, tariffs and government payments kept things at a fairly even keel.
However, when New Zealand's competitive edge in agriculture began to slip in the late 1970s, even the farmers saw the writing on the wall and began to question the system.
After a thorough debate, the most radical solution was agreed upon: Tariffs, subsidies and government payments were eliminated. The New Zealand farm program ended cold turkey in 1983.
After a six-year period of adjustment, farmland prices began to rise again in 1990. Since that time, New Zealand has been an agricultural poster child, competing on the world market and galloping to new heights of profitability. In fact, a higher percentage of New Zealanders work on farms today than did thirty years ago. And just as many people live in New Zealand's rural areas as lived there in 1920.
In another example of the Kiwi willingness to tackle big problems, New Zealand decided to do something about lawsuits. With broad public support, the parliament simply banned most of them.
To provide compensation for accident victims and the like, the government formed Accident Compensation Corporation (ACC).
If you trip and break your arm outside the supermarket, you go to the ACC. They have a big book which tells them what broken arms are worth. You get a check and move forward with your life.
In the 1980s, the ACC was expanded to include all medical malpractice claims. If the doctor screws up, you don't sue the doctor. No, you take your claim to the ACC and they give you a settlement.
I went to New Zealand to study their nursing home system. I came home with observations which could fill a book, but one thing in particular puzzled me.
As I walked through the halls of various homes, there was a sense given off by staff and administrators that the residents were wards of an institution.
Even the gushy promotional literature for some of the nicer nursing homes couched their amenities in authoritarian terms: "With staff approval, you may be able to bring along some of your cherished belongings!"
A nursing home inspector told me that she has trouble finding out about abuses because, "Even the families of older people won't report problems for fear of reprisal."
There have been abuses uncovered by the Kiwi press, things similar to what you'd hear about in the States. However, after a public penance ritual by the administrators, and maybe a little discussion in Parliament, things settle down and the incident is forgotten.
As my trip drew to a close, it was the attitude of the eldercare system towards the people it serves that troubled me most. The consumers, that is the older Kiwis themselves, lack any of the swagger you find in American consumers. Most wouldn't even meet your gaze in the hall.
In this country, consumers generally don't put up with any baloney, particularly if we are paying for a service. We sometimes get obnoxious. In health care, if we really get mistreated, we go to court and raise a ruckus. The court case drags the dirty laundry onto the evening news, and a large settlement can throw the finances of a hospital out of joint.
It took me a while to put two and two together: One problem with the New Zealand system may be that they solved one of their biggest problems.
Lawsuits don't happen, but is care in New Zealand improved by the savings in dollars that would otherwise go to malpractice insurance?
I really wonder.
Perhaps because no individual doctor, hospital or nursing home faces possible financial loss for mistreatment or malpractice, health care staff move about with more authoritarian swagger than you see here, at least in the rural Midwest.
The wrong people feel the fear.
The thought occurred to me that a big lawsuit on the front pages for a couple of weeks might do more to improve the attitude towards New Zealand's institutionalized elderly than any tweak of policy.
And I am reminded that a big solution such as the banning of lawsuits, even when it seems to work, can create new problems.