When the Prime Minister sets out the four basic conditions his Government needs to meet to ensure its re-election it probably is not surprising that health is there along with jobs, education and personal safety.
The Prime Minister says that the things Kiwis care about include whether the health system is going to perform for them.
It is a very different philosophy from the 1990 – 96 National Governments where Health ministers, Simon Upton and Jenny Shipley, saw health as an area of spiralling out of control costs.
Mr Upton’s bizarre idea of calling hospitals “Crown Health Enterprises” summed up an approach which was all about efficiency and had little to do with the day to day politics of staying in power.
It is therefore perhaps appropriate that the current Health Minister, Jonathan Coleman, as a former GP signed up to the Hippocratic Oath which requires that physicians first do no harm.
Coleman has been a highly regarded but low profile Minister of Broadcasting, and Defence so far in the Key Government.
But now he is in the front line replacing the politically astute Tony Ryall in health.
And so far he hasn’t put a foot wrong.
Or at least he hasn’t put a foot wrong by the standards of Health Ministers who actually can do no right by some people as the Government faces a seemingly limitless demand for health services.
And there are some influential people in the background of the National Party who are watching Dr Coleman’s performance very closely.
He is on the smart political observers’ short list to replace Key in the leadership of the party.
He gave a taste of his potential at a recent press conference where he joined the Prime Minister to promote the Government’s anti-obesity policy.
Whereas Key indulges questioners and tolerates repetitive often irrelevant or trivial questions at his weekly media conference, Coleman was short sharp and to the point and firmly ended an argumentative line of questioning from Scoop’s Alistair Thompson, a perennial debater at press conferences.
Coleman is said to be close to the Prime Minister and his background as Auckland Grammar’s head prefect speaks to his leadership abilities – plus giving him a useful heavyweight network in the city.
And he is careful to define his role in health in terms of the Government’s overall priorities.
“No one is ever going to say stop spending dollars on health,” he says.
“But our focus has been on the quality of spending and if you look at overall fiscal strategy we’ve slowed the growth of public spending.”
So the growth is health spending is down now from 8 – 9% to around 2.5%.
He says there are ongoing efficiencies that continue to need to be made.
“It’s a matter of continually looking at what are the needs of the population you are serving and is the mix of services correctly configured and that will change over time.”
But he comes back all the time to the Government’s overall fiscal strategy.
“This is an ongoing process under any type of Government otherwise you are going to end up running huge deficits.
“So it has to feed into that overall fiscal strategy.
“There is a reason we are in surplus and that is because we’ve slowed the growth of public spending.”
He says his priority is access to services.
And he’s satisfied that he’s providing for that.
“I think we’ve got the system absolutely finely tuned to meet the demands of the population given the level of resourcing.”
So what about radical reforms – reducing the number of District Health Boards, for example?
“If you were designing the system from scratch you wouldn’t have 20 DHBs,” he says.
“What happens behind the scenes is important in terms of if you want to move resources from there to the frontline but just changing the letterhead is not going to improve access to services.
“So we don’t contemplate any change to the structure of the 20 DHBs because it would be a huge distraction.”
But part of the strategy for coping with the increasing demand resulting from both age and ethnic demographic change is to move more services out from the DHBs and into the community.
This is a controversial move with some GPs arguing it is simply cost shifting but Dr Coleman says if we want a sustainable health system it has to happen.
But he is emphatic that health funding will remain with the Government and rejects suggestions that the private health insurance industry could pick up more of the health tab.
“Those questions have been settled long ago so we’ve got a clear direction in health and it’s working and there is appetite that I’ve encountered to change the settings we are on.”
He says the public expects the Government to provide healthcare. And as far as he is concerned – though it might be assumed John Key thoroughly agrees with him – that that is that.
“In the end when it comes to going into that ballot box you ask how the government is delivering for me and my household.”
And he’s satisfied that he is providing a positive answer to that question.
It is that highly political response to his portfolio which is getting him more and more notice as one of the Ministers to watch in the Key government.
In a way he’s a foil to the westie populism of the other potential leader, Paula Bennett.
So how far does he want to go?
“I want to do the best possible job I can as Minister of Health.
“That’s what I can control, to a certain extent.
“But my view on politics is that you want to continue to make progress and I want to continue to make progress in my career.
“I heard a very interesting talk from Steve Hansen and he summed it up when you are playing rugby, and I make that analogy with politics that you don’t want to be looking at the scoreboard and looking ahead, you want to be focussed on getting the fundamentals right and focussing on what you are doing now.”
Press him on whether he wants to be Prime Minister and he repeats the mantra about focusing on his job but he admits he wouldn’t hang round if we was made a Minister outside Cabinet or sank down to the bottom of the Cabinet rankings.
Otherwise he wouldn’t mind being Minister of Finance or Foreign Affairs.
If McCully retires at the next election he could well take over that portfolio and then, who knows?