The ACT Party won only 8.6% of the vote last year, so how come it seems to be driving about 75% of the government’s agenda? It helps ACT’s cause that Christopher Luxon is so incompetent, and such a pushover. Earlier this week, Luxon just couldn’t keep in his head the sales pitch he’d been given for a crackdown that was comprised almost entirely of ACT social welfare policies.

First, Luxon had no idea what the Jobseeker payment that he’s expecting people to live on actually is – and he then mistook the number of extra beneficiaries that the crackdown will generate for the number of extra WINZ staff hired to process the caseloads. Overall, there is no mandate for so much of this government’s programme. Many of the policies enacted this year were barely mentioned on the campaign trail, let alone endorsed by voters. Luxon’s stock defence is to say that they were part of the coalition agreements.

Sorry, but that doesn’t amount to a mandate. The coalition deals were done post-election, and they merely spell out how ACT, National and New Zealand First agreed among themselves to divvy up the policy spoils of power. While those agreements were being negotiated, Luxon was unable to rein in his junior partners, or just dis-interested in doing so. So, here we are. Parties with minimal support (ACT 8.6%, New Zealand First 6.08%) are setting the pace of change and dictating the lion’s share of the policy content of a government being led in name only by Christopher Luxon.

Add it up. ACT has dictated the new policy settings in social welfare, justice and sentencing, taxation, gun control, the resources to be diverted from state education into charter schools, and the future funding/operational methods of Pharmac. ACT has led the attacks on the public service and cheered on the job cuts. While everything else is being trimmed or dumped, ACT has won funding for its own new bureaucracy designed to strip away the few remaining regulatory protections for consumers and communities.

In league with New Zealand First, ACT has also been engaged in systematically erasing the gains made by Māori over the past 40 years, even though those gains enhanced the identity of this country and were of benefit to everyone living in it. Instead, the ACT/NZF campaign has sought to reinstate the old colonial meaning of the constitutional relationship between Māori and the Crown.

Neutering Pharmac

Overall, it has been pretty sad to watch the major party of the centre-right being taken over by a neoliberal cult. Former senior figures in National, like Philip Burdon, Katherine Rich, Chris Finlayson, Simon Power etc were products of a time when being a conservative stood for something. One wonders what they think of the party’s current decline.

This decay isn’t unique to the centre-right in New Zealand. In the US, the Republicans were once the party of Lincoln and Eisenhower, before being gutted by Donald Trump and his disciples. National is now in much the same place. An ACT party capable of winning only single digit levels of voter support, is pushing National into compliance on a daily basis. ACT has for instance taken it upon itself to tell Pharmac that it won’t get further funding to buy the medicines essential to all of us, unless Pharmac agrees to snuggle up in the same way that ACT has, to Big Pharma.

Meaning: Pharmac has been put on notice that it needs to take a less ‘adversarial” approach, and be more willing to take at face value the drug companies’ own in-house research data. Here‘s what ACT leader David Seymour told RNZ:

It's about starting to work more closely with the pharmaceutical companies," Seymour says. "They have good data from foreign trials of what their medicines are able to do for people, and then getting good at the kind of mathematical modelling so I can credibly go to the other ministers and say, 'look, here's the money that we think we can save based on good data'."

Just how these diktats co-exist with respect for Pharmac’s supposed “independence” is anyone’s guess. In essence, Seymour is making Pharmac an offer that it can’t refuse. In the past, things were quite different. Pharmac’s tough bargaining stance was seen to be the main line of defence that taxpayers had against price-gouging by the drug companies. In effect, ACT’s call to be more “collaborative” is code for pressuring Pharmac to buy more of the wildly expensive new biologics being developed, often for niche conditions. This would have the downside of leaving less of Pharmac’s limited budget left over to buy the generic medicines relied on by the general population, but which generate negligible profits for the drug companies.

The perils of in-house data

As mentioned above, Pharmac is being told to become more reliant on drug companies “for good data on what their medicines can do for people.” Within the medical profession, there has long been unease about the reliability of trials funded by drug companies into the safety and efficacy of their products. So much so that there is controversy over whether medical journals should even be publishing articles whose findings rely on trials funded by drug companies. (Commonly, the funder will also have the final say on the article’s content.)

The hesitancy is well founded. For example: drug companies continued to sell and promote SSRIs even though they knew – but did not widely disclose - that some of these anti-depressants were leading to suicidal ideation among some of the people taking them. Before SSRIs, there was a similar history of drug companies only gradually divulging the addictions related to prolonged use of benzodiazepines. More recently, question-marks have arisen over the continued efficacy of some of the expensive new biologics. It is an imprecise science. Sometimes drug companies themselves withdraw products for fear of litigation after unexpected bad consequences, or because the early reliance on positive trial results had been found to be misguided.

That being so, if Pharmac and Medsafe choose to (a) wait for corroboration from a more independent trial and approval process and/or await (b) extensive use data from other countries...then this is sensible and healthy scepticism, and it has served New Zealand patients pretty well in the past.

In the end, the problems of drug availability have not been caused by the mindset at Pharmac. There has been a lack of sufficient funding by a succession of governments ever since Pharmac was set up in 1993, on the expectation that it would deliver savings in the medicines budget. Which it did, to Big Pharma’s chagrin.

The subsequent shortfalls in availability of certain drugs (compared to Australia) has been the direct and inevitable result of this deliberate underfunding. It has not been caused by the negative attitudes in vogue at Pharmac, whose staff – like other workers in the public health system – have been systematically starved of the resources they need to do their jobs as well as they would have liked. Ultimately, it has been in the interests of the drug companies – and their ACT Party enabler – to portray sick patients as being the victims of Pharmac’s cruel indifference.

Footnote: ACT is calling for Pharmac to adopt a “whole of society” approach – which, apparently involves taking a more “productivity based” approach to the funding decisions it makes. Before the last election, the ACT website listed the reform of Pharmac as its number one health priority before concluding:

The final framework should link health technology and medicines assessment using a productivity perspective...

That term “productivity perspective” isn’t defined. Yet presumably, it was a signal by ACT that people who are more economically productive and whose work is more profitable to the economy should be seeing that reflected in the drug funding decisions made by Pharmac. Should for example, a $150k annual income be taken into consideration when deciding to fund a $300,000 treatment course in biologics – an investment that by the same logic, should not be made if the health benefits are being delivered only to someone on the average wage?

That seems to be exactly what ACT means by its “whole of society” approach. ACT MP Todd Stephenson said as much last year to Q&A’s Jack Tame:

When asked if that meant more economically productive people should be prioritised for treatment, Stephenson said: “Not necessarily, but when you’re looking at the value of these treatments, that should be taken into consideration.”

Welcome to the ACT-run public health system. Don’t forget to bring your EPTPOS card.

September song

The British singer/guitarist Nilufer Yanya has been dropping an impressive series of preview singles from her upcoming My Method Actor album due in mid September. This airy, jazzy track “Mutations” is her celebration of change being not necessarily dramatic but more often the byproduct of the small decisions that we make every day, and which end up being transformative:

A fortnight ago, I posted some terrific live recordings by the country singer Willi Carlisle, mostly of them being songs from his 2024 album Critterland. Well, here’s the track that first put Carlisle on the map, about four years ago :

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