Wealth for health but no happiness?

Let’s get a few things straight about health ahead of this Budget. There will not be enough given to health – there will never be enough given to health. It’s the catch-22 of a free service that there’s no end to what citizens will expect to receive for free.

One only has to look at the competing demands that have filled column inches and airtime in the period where the Government is making the finishing touches on its first Budget – protests and complaints of underfunding and underpayment by midwives and nurses. And now, doctors are calling for the Government to abolish capital charges.

There is money that is expected to be made in this change of Government.

The Government’s own message has been treading a line of poverty and tradeoffs, while promising big-figure spends to ‘‘undo the damage’’. On the one hand, it claims massive infrastructure problems will cost billions to fix – a red herring as much of that expenditure will be coming out of the capital works budget and not Vote Health.

The health minister has also been vocal about increasing district health board (DHB) deficits, understaffing and the need to defer its election promise, for cheaper GP visits, because there’s not enough cash.

Meanwhile, a cool $1 billion has been handed to foreign affairs to expand and put weight behind the ambitious Pacific reset. It’s a worthy spend and, given the amount of revenue unexpectedly amassed in the past six months, the political equivalent to finding cash behind the couch.

If it was ever in doubt that Labour’s health ‘‘underfunding’’ figure was political, then it would pay to look up this year’s analysis on how much the Government will need to provide to avoid that mantle. Such data won’t be found, as this year Labour and the Council of Trade Unions (CTU) have conspicuously stopped publishing the data.

While in Opposition, Labour commissioned multiple years of research to claim that National had underfunded the health system by $1.7 billion, where separate CTU research put the figure closer to $1.4b.

That’s based on all areas of Vote Health but, at its core, the message was the underfunding of DHBs that were struggling to tread water and falling deeper into deficit.

Prime Minister Jacinda Ardern has hinted that there will be some surprises and there could even be something related to GP visits. It could be more targeted than its universal policy to lop $10 off all visits. The Government also campaigned on a policy to make all visits related to mental health free.There have been no hints as to whether that’s in line for funding this year.

But if it gives the expected big figure to DHBs then that poses some restrictions for headline grabbing allocations as well. Whatever the Government gives DHBs, it must give the same and then some the next year, and this is money for day-to-day operations. It cannot be overly ring-fenced for flashy initiatives.

But the Government has talked itself into a slight corner, whereby if it doesn’t deliver considerably more than National’s funding track, it will be accused of underfunding itself. Or worse, underfunding and hypocrisy.

Whatever the coalition Government gives DHBs, it must give the same and then some the next year, and this is money for day-to-day operations.