What happened to the promise of public healthcare?
Eighty-eight years ago today, Michael Joseph Savage’s first Labour Government passed the Social Security Act 1938, helping establish the principle that access to healthcare should be a collective responsibility, not something determined by a person’s ability to pay.
On its anniversary, Kaitiaki Hauora’s Dr David Galler reflects on what that meant for Aotearoa New Zealand, what has changed since, and the choices we face about the future of our public health system.
By Dr David Galler, spokesperson for Kaitiaki Hauora
Tomorrow 14 September is the anniversary of the signing into law of Michael Joseph Savage's Social Security Act
Eighty-eight years ago on 14 September 1938, the Social Security Act was passed by the first Labour Government under Prime Minister Michael Joseph Savage. It was intended to provide protection against economic insecurity “from the cradle to the grave”. It was one of the most important pieces of social legislation in New Zealand’s history introducing pensions, welfare payments and establishing that access to healthcare was a collective responsibility of the state, rather than something that depended primarily on an individual’s ability to pay.
The Act established five broad categories of health benefit:
Medical benefits – a universal general-practitioner service, intended to be available without direct charge.
Pharmaceutical benefits – medicines supplied under arrangements funded by the state.
Hospital benefits – publicly funded hospital treatment.
Maternity benefits – including medical and nursing care around childbirth.
Supplementary benefits – allowing the government to extend the system to services such as laboratory and radiology, specialist care, dental and optical services, physiotherapy, ambulance services and home nursing.
Importantly, these were conceived as universal benefits for people ordinarily resident in NZ no matter their economic circumstances.
But it wasn’t plain sailing and the aspiration to create the world’s first truly national health service, free at the point of care, was dashed by doctors and their representatives from the British Medical Association, who argued that doctors should be able to charge patients directly. Their view prevailed, and it still does, explaining why we have a primary care system partially funded by the State and through direct co-payments by patients.
Despite that, the 1938 Act served to change the social contract around health, establishing health and healthcare as a social right which the community had a responsibility to ensure and comparable with public education in its availability and financing.
That was an ambitious and world leading concept back in 1938 and it has become the defining element of the first Labour government’s legacy.
Looking back, the 1938 Act was much more than a reorientation of services, it created a social purpose, marked by collective responsibility, universal entitlement, public financing and then the development of services to deliver that entitlement.
How times have changed and with that NZ has changed too, swept along by the turmoil of the 1970s and 80s, the influence of Reagan, Thatcher and Douglas, NZ has embraced neoliberalism with an enthusiasm that surpasses that of most other countries, shifting towards less public spending, user pays, a shrinking of the welfare state and the privatisation of state assets. Under this government that now explicitly includes health services.
So here we are 88 years on from the passing of that landmark legislation, two years shy of its centenary, with the world burning around us, we live in a land of plenty but with so many unable to afford food; with people dying in our emergency departments and others unable to access the care they need when they need it; people working two or more jobs yet still unable to afford rent; with so many of our young people seeing no future for themselves here and opting to move abroad, surely it’s time we ask whether we have got this right.