Revisiting Universalism

Wednesday, 2 April 2025, 7:35 pm
Opinion: Ian Powell

Since his sacking as Chair of Health New Zealand (Te Whatu Ora) Rob Campbell has taken to freelance writing like a duck to water with almost weekly columns in each of Newsroom, Stuff and NZ Herald.

His pieces are thoughtful and insightful. Many involve the health system but not all. Recognising the importance of achieving equity and the effects of inequity (and addressing them) are common themes.

At the risk of giving him cardiac arrest I often agree with them (or at least many of his observations).

At the very least they are thought-provoking. This is definitely the case with his Newsroom column on 25 March: https://newsroom.co.nz/2025/03/24/the-left-must-leave-the-past-behind/

Rob Campbell’s objective

Campbell’s objective is to challenge the “political parties on the left” (by implication Labour and the Greens today) preference for a “strong emphasis on universal services and benefits” which arose out of the development of Aotearoa New Zealand’s welfare state in the mid to late 1930s.

I have a different view of what being leftwing means. For example, I would describe Labour as social liberal and technocratic (and elitist as a consequence) rather than leftwing. I discussed this last year (30 April) in a Political Bytes post:

However, this difference is a side-issue. Unlike many critics of universalism, this business leader, economist and (back in the distant past) former union leader is not criticising support for universalism of public services and benefits from a right-wing perspective.

Campbell places universalism in the context of the overarching economic and social model of the time which “…envisaged a mixed economy with many core activities and assets publicly owned, and much private enterprise significantly regulated.”

But, as he correctly notes. it was also a “largely mono-cultural model”. The model has been:

…substantively shattered over the last half century by social changes driven by cultural and other identity expression, by regulatory, ownership, technology and economic structural shifts. This was a mix of progressive and regressive change which has created a whole new reality.

He observes, again correctly, that Aotearoa is now:

…in the midst of a further shift towards private interests (ie property rights) even further overriding social and community opportunities, costs, risks and responsibilities.

Rob Campbell is in effect giving a wake-up call to the ‘ political left’ which is struggling to respond to this cumulative transformation although he is not pessimistic. In his words: “It is not inevitable that this further shift prevails.”

From universalism to ‘neo-communities’

However, to ensure that inevitably is not the outcome the ‘political left’ should not seek to return to practices based on past  “fragile” social and economic structures which, in his words:

They [reinstated practices] may be fixed and even appear certain but they anchor to a past that has gone. They will not survive in the new world. They will not be adopted and will not work if they are.

This is stated with absolute conviction. Campbell refers, by way of example, to the view that returning to the past would mean that social transfers or distributions should be made on a universal basis. But, he argues, too many changes now make this very difficult.

His advice is that the reaction to these changes should not be universal public services. Society has done too much damaged by becoming a “much more unequal society” and a “much more privatised economy”.

Further, his understanding of universalism is that it is based on centralism. That is, the belief that the ‘centre knows better’ and ‘one size fits all’.

His way forward is what he calls a “neo-community”  response. That is, the empowerment of community groups, whose focus is on inequities in the economy and society, such as Iwi Māori Partnership Boards.

In his words:

They know far better than the centre what the most urgent needs are and can be relied on to be reasonable about those – they are not accustomed to generous treatment. The left should be relying on their innovation, making the best use of scarce resources.

Beginning with a critical swipe

On 28 March The Post published a very good paywalled article by lawyer and political advocate Max Harris arguing the importance of supporting universalism in response to the high profile school lunch failures.

His article included a brief critical swipe at Campbell for, in his view, recommending abandoning universalism:

https://www.thepost.co.nz/nz-news/360630582/school-lunch-failures-strengthen-case-universal-services

Despite its brevity (it was an aside in the context of an article on a related but much more specific issue) I agree with Harris’s critical swipe in principle. But a more nuanced consideration is required.

Where his argument falls down

Too many of those who express opinions publicly, including political leaders, tend to go straight to the answer without understanding the question. This cannot be said of Rob Campbell. A good part of his  article raises questions that deserve to be raised.

But he falls down on the answer side of the equation, in my view at least, because he considers the question through a structural rather than relational lens. His lens is too narrow.

If universalism was about central government control over provision and delivery of public services, then he would be right. The culture that is incentivised by this approach is ‘command-and-control’ which guarantees poorer informed decision-making.

New Zealand has seen this eventuate in our public health system and, at an aspirational level at least, veering in this direction in local government. It is even occurring in the education curriculum with a didactic ‘one size fits all’ approach that denigrates meaning as a pedagogical tool.

Campbell argues that it has now become too complex for universalism of services and benefits to turn things around. He is wrong.

Take the public health system. It could be turned around by three critical things:

• devolving decision-making to the level where healthcare is overwhelmingly provided;
• addressing health workforce shortages; and
• empowering that same workforce to deal with complexity challenges and innovation.

Complexity is not the problem. Beginning with governments, poor leadership culture is. If leadership can first recognise these three things then addressing by strategic firmness can follow.

Subsidiarity and differentiation strengthen universalism

Universalism of public services and benefits requires the principle of subsidiarity to make it relational and therefore more effective. That is, things should be done locally (for example, in communities) except where it makes better sense for them to be done centrally.

Rob Campbell has counterposed community based activism to universalism. However they don’t have to be alternatives. In a relational based culture subsidiarity enables the blending of them together as interconnected ‘fellow travellers.

Insufficient consideration is given in his column to the extent that differentiation can, has, and should, exist within the universalism of public services and benefits. Universalism should not be narrowed down to ‘one size fits all’.

This also requires recognising that the means of provision and delivery that are consistent with underpinning values can also evolve over time. In other words, continuous quality improvement.

A compelling defence of universalism

I can put this no better than former teachers union leader and chief human rights commissioner Rosslyn Noonan who, in a published reply to Rob Campbell, said:    

 Rob is right about the critical role of grassroots, community developed and led provision of basic services that should be appropriate and accessible to everyone. One size does not fit all. But we shouldn’t be equating universal to centrally developed and provided. That’s lazy thinking.

The issues are complex and the same approach will not work for all basic services . But a brief consideration of the universal right to free primary and secondary education is evidence of the possibility of rich diversity within universal provision, provision that is largely public not private, imperfect though it is.

Privileging a market model and private provision is the tragedy of early childhood education and care. And the dental market has miserably failed to cater for our children let alone the adult population.

I agree we have to start from where we are now, that we should be exploring how best to support diverse communities, iwi and hapu, but let’s never accept the right’s denigration of universal provision.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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