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Heather Roy's Diary - 21 July 2006

Heather Roy's Diary

Medical Treatment for Foreigners

There has been much discussion in the past week about the liver transplant received by Morein Karetau, a woman from Kiribati (formerly the Gilbert and Ellis Islands) who has been living illegally as an overstayer in West Auckland. Details of her case are vague but it appears that she presented to hospital for treatment seven months pregnant and with liver failure. Complete liver failure is fatal without a transplant although the progression of the disease can be slowed. The doctors involved in the case would have had no real choice but to treat her once she arrived, but the case highlighted the costs to our health boards of treating foreign visitors, both legal and illegal.

Waitemata District Health Board chief executive Dr Dwayne Crombie commented that foreign patient debts were particularly painful for Auckland DHBs, which bore the brunt of people sneaking in to New Zealand and incurring massive medical bills they had no hope of repaying. For example, the Sunday Star-Times recently reported a Tongan dialysis patient who successfully appealed against a removal order on the basis that he would pay $50 a week towards his hospital debts. His care costs Auckland Hospital $7320 a month, his debt is more than $291,000.

To make matters worse, many people who are working and paying taxes here are being denied residency because they suffer from problems of much lower severity than those of Ms Karetau.

The Auckland District Health Board has written off more than $7.55 million over the past three years and is owed $1.93m by foreigners. The Waitemata board is owed more than $750,000, and Counties Manukau is owed about $1.5m. Other health boards have similar problems but seem to be able to recover a higher proportion of the bills. This is probably because there are a higher proportion of illegal migrants in Auckland as opposed to tourists.

The question has to eventually arise of what treatment the DHBs are obliged to provide. Everyone with permanent residency is entitled to free hospital care if it is considered necessary. We have agreements with the British and Australian governments to provide free emergency care to each others' citizens. The ACC legislation covers all people within New Zealand so anyone who is visiting and injured here can apply. This was put in place because a visitor could be injured through no fault of their own but has no right to sue under ACC legislation. Everyone else should theoretically be paying their own way or be covered by medical insurance. Prudent visitors have travel insurance covering their health, but the quality of the policies is variable, and a proportion of people can't or won't pay. What should we do about it?

This should be an immigration policy matter rather than a health dilemma for doctors and hospital managers. An option that I favour is to make suitable health insurance a prerequisite for a visa to enter New Zealand. That would prevent health problems amongst tourists becoming a public expense but would make no difference to those who are here without a valid visa in the first place. There is, however, a solution to this too. In many cases the patients come from countries that are recipients of New Zealand aid - particularly Pacific Island nations. The costs incurred from the provision of healthcare within New Zealand relieves the patient's own country of the cost of caring for them. It would be perfectly legitimate for DHBs to be reimbursed from the aid budget of the relevant country. My own feeling is that this could be done as part of a much broader initiative for co-operation in health matters in the Pacific - but that merits a separate article.

The Remarkable Senator John McCain

US Senator John McCain has hit the headlines in New Zealand this week because of his support for a New Zealand-United States free trade agreement and because of our foreign minister's rude behaviour in Washington. However, John McCain is a remarkable man and I would like to say a little more about him before moving on to Winston Peters' latest tantrum.

John McCain comes from a family with an impressive military pedigree. Both his grandfather and father were Naval Admirals. He attended the elite naval academy at Annapolis where he came dangerously close to being expelled for untidiness and rebelliousness. He went on to train as a naval aviator and established an impressive reputation as a serving officer on board an aircraft carrier. In 1967 he was shot down over Vietnam and managed to eject from his aircraft which was, incidentally, a Skyhawk. During the ejection, he suffered several fractures which were intentionally set out of alignment by his communist captors. He suffered other tortures during his 6 year confinement, but what astonished me was that he was offered a trip home and declined it. The North Vietnamese realised that his father was the commander of the Pacific fleet and offered to repatriate him. McCain declined, saying that he would go back when the other men did. Compared to such things enduring Foreign Minister Peters interrupting a press conference must seem a trifling matter.

Irritable Foreign Minister Syndrome

Luckily Winston Peters' latest sulk went unreported in America but I wasn't surprised when the Australians noticed. I can't do any better than a quote from 'The Australian':

"The first visit to the United States by New Zealand's foreign minister Winston Peters got off to a rocky start when he told a US senator to stop speaking to journalists.

Prominent Republican senator and former US presidential candidate John McCain was talking to New Zealand media ahead of a meeting with the notoriously prickly Mr Peters.

Mr Peters interrupted a surprised Senator McCain while he was talking up the possibility of a free trade deal with New Zealand to say the journalists following his visit had exceeded the number of questions permitted.

"I want to call a halt to this press conference because we've got discussions and it was two questions they asked for," Mr Peters told Senator McCain.

The minister is sensitive about trade after criticism at home for refusing to discuss the issue with foreign counterparts because he does not hold the trade portfolio.

Unlike Australia, New Zealand has not been able to even begin talks for a free trade deal with the United States - a situation blamed on its anti-nuclear policy which has plagued US ties for two decades.

Before the interruption, Senator McCain had also said the US should resume military exercises with New Zealand.

Mr Peters' trip to Washington this week, for the first time as foreign minister, has been conducted under a cloak of secrecy. "

In Parliament yesterday I asked the following question of the Prime Minister:

"Is Winston Peters a better person for the job of Minister of Foreign Affairs than his predecessor, the Hon Phil Goff, or is Mr Peters' appointment simply the price that this country has to pay for the Prime Minister to keep her job as Prime Minister?"

Michael Cullen, answering on behalf of the Prime Minister, said "They are different but both excellent men in their very different ways". If this was meant to be a comparison of any sort it is truly an insult to Phil Goff - who would never have dreamt of behaving in this way, either outside of New Zealand or at home.

Mr Peters has embarrassed New Zealand and the Australian press hit the nail on the head.


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