I was interested to read that breast reduction surgery is available from Medicare in Australia. This made the news when women complained they were at the back of the queue, apparently some surgeons viewing it as a cosmetic issue.

That’s nonsense. Overly large breasts are a hellish problem and just as much an impediment to a physically comfortable life and thus needing surgery, as say hip surgery. But offering this operation in New Zealand (outside of the private sector) would be a pipe-dream, due to the appalling shortage of medical professionals here.

Successive New Zealand governments have been grossly negligent in failing to establish a third medical school and now we have a crisis, reflected by the doctors strike in protest at their huge work pressure.

Shane Reti, the Nats Health spokesman has promised to start immediately after the election, establishing a new medical school at Waikato university. ACT have endorsed this. But it will be many years before it starts pushing out doctors.

I have the answer. Pending New Zealand producing sufficient doctors and surgeons it would be a smart move to fly back-log surgery patients to say Thailand, and additionally, overall cheaper, even including airfares and accommodation.

A senior legal friend needing surgery, took his wife with him and had it done in Thailand, altogether at less cost than here. That included airfares and the necessary recuperation period, lying in the sun around the pool, the Thai private hospital essentially being a luxury hotel. Everyone’s a winner.

Cuba has pumped out armies of doctors, far in excess of its own requirements for decades now. This has been a huge boon for people and specially Americans needing surgery, and unwilling or unable to pay the notoriously high American medical fees.

I put this to a senior medical specialist male. He said it’s spot on but an attempt to do it would induce an uproar protest from our surgeons, worried about protecting their patch. They’d carry on about operations going wrong and an inability to follow up, which of course is rubbish and simply protecting their financial interests.

Regardless, the way round that is to relieve the burden on our medical situation and operation backlog by confining the Thai or Filipino ops’ to the more basic treatments.

This proposition is a damn sight more virtuous then the current situation in the west with its medical doctor and surgeon short-fall crises, pillaging the third world’s doctors with higher salaries.

Visit a British public hospital today and its odds on your doctor or surgeon will be Indian or African.

Paul Theroux wrote about this a year or so back. Theroux had been one of Kennedy’s young Peace Corp in the early 1960s. He was sent to Malawi which is why it became the setting for his early comic novels.

He understandably retained a sentiment for the country and reported how a decade or so back they built their first medical school. But every graduate they’d produced has promptly gone off to Britain, lured by significantly higher incomes.

When I read that I realised why when I was last in Malawi, I encountered many young newly graduated British GPs, presumably lured for the adventure after years of study.

It’s important to emphasis that the Thai, Cuban, Philippines, Spanish, Iranian, Turkish and such-like foreign medical fee-earning scenarios is not at the expense of the locals, rather they have deliberately produced surplus medicos as a foreign exchange earner, just as we produce milk, lamb and wool beyond our own requirements.

But typical of communist regimes, Cuba for example, grossly over-did it, so much so it resulting in them actually exporting doctors for optimistic political reasons, to African and Latino states and Venezuela in particular.

I witnessed this excess in the 1990s when following a rather amusing incident I drove a Cuban girlfriend to hospital in Havana to have her leg patched up. A GP could have handled this in 20 minutes but instead, I was invited to come into the operating theatre and witness 8 no less surgeons hover over her.

Afterwards I thanked them and said if they’d like I’d take them to the only decent restaurant then in the city, it only accepting payment in US dollars, this far beyond their means.

They promptly downed tools, told the nurse to cancel that afternoon’s operations and said let’s go now (it was around mid-day). We had a merry afternoon living it up as with the Soviet Union’s collapse, Cuba was then in a desperate situation, particularly with food shortages.

Those of you familiar with my comic novel “Full Circle” will recall how the key character exploited the post-Soviet massive surplus of tour ships Russia had built and were culturally unequipped to operate, in the hope of earning foreign exchange.

I come back to my base proposition though, namely we’re a trading nation and should not confine trade to material goods but extend it to services, such as surgery, where it makes economic sense.

Currently our private medical practitioners run essentially a monopoly and will protest.
We’ve been through that before in the 1980s when Roger Douglas, to all of our benefits, ended the existing monopolies with the anachronistic import licensing markets.

That’s not peculiar to the medical profession, rather practitioners in every activity thrive on thwarted competition.

Over 200 years back Adam Smith recognised this behaviour and it’s why every western country today has strict anti-monopoly laws.

As said, it’s normal human behaviour. I certainly recall my delight back in the late 1960s when Rob Muldoon became Keith Holyoake’s Finance minister. Rob believed in private enterprise but not in the “invisible hand” reality of market economies and wanted to control supply.

About 1970 he announced a ban on all new industrial and commercial buildings. Henceforth developers would need to justify their need to be allowed to be build new ones. It was fantastic for us existing building owners as we watched rents double inside 12 months.

As I’ve said we should sensibly utilise nations promoting price competitive surgery as a foreign exchange earner, just as we do buying cars and computers from abroad because they’re cheaper than us making them here.



Like the idea of extending our thinking around trade to services abroad. In many internal markets, at 5m we are too small to enjoy the benefits of competition in increasingly niche markets. Even if we were 10m we’d be too small, so let’s not wait around.

The same applies to dentistry. If you need a couple of crowns, it is far cheaper to head to South east Asia and have a holiday thrown in for free.

Yes, dentistry..Some time ago, I had a new tooth,the old one was extracted, and a small rod put into the jaw bone to support the new tooth.An oral surgeon did this, the dentist did the new artificial tooth.Firstly the Oral Surgeon x-rayed me with a 360 degree machine to make sure I had the necessary bone density to take the small rod in lower jaw bone,then I had to wait a set period of days for extraction to heal before the rod was inserted to the correct torque.Only then did the dentist do their part.It cost over 7 thousand dollars total, including Oral Surgeon, their bill was almost 2 thousand dollars. At the time overseas operators were offering the entire service for around 500 dollars.I light heartily mentioned this to the Oral Surgeon, who said we can’t even buy the kit for that price ( the rod ,special drills, etc).I don’t know what the answer is to lower costs for these extremely expensive procedures.If it can be proven people’s discomfort and pain puts them at the mercy of health care elites, then something needs to be done.On the other hand those that have ability need to be encouraged, no one expects them to work for nothing.The Oral Surgeon was also a maxillofacial surgeon, it would have taken him years to qualify, and ongoing professional development courses to keep up with latest procedures.First World medical care has its price, there needs to be incentive for commercial laboratories to develop cutting edge procedures.A good example of this is the research being done on Tinnitus using electro wave length plugs to counter the incessant buzzing.This can be so problematic for sufferers, that in the Netherlands patients with this condition can apply for Uthanasia.I guess it’s how people prioritise, but looking after your health if you are able to, is the best investment you can make, better than tattoos even.

I’d extend the outsourcing services even further , and include the Department of Corrections in the equation . Any crim guilty of previous bodily harm or worse would wind up in a congested cess pit of a gaol cell in Indonesia . A far cheaper option than caring for them in Godzone and a good little earner for the Indonesians . There ya go , Chippy , I just achieved a 30 % decrease in our prison population . Thank me after the election .

Great idea Sir Bob.
NZ should also copy the Singapore health system whereby Govt funding follows the individual not the blackhole we call hospital/NZ Health. Each of us then gets to choose where we go to get treated. No more monopolies.
Sir Roger Douglas has espoused this for decades. The current line up at ACT don’t like it for unknown reasons

Bob – So much commonsense. Too much for NZ, that’s the tragedy. Fifteen years ago I burnt skin off both hands in a Thai yachting regatta. Went to a stunning ‘International hospital’, nurses in starched uniforms, a doctor in white, spotlessly clean. Skin cut off then two follow-up appointments with dressings each time. At the finish, the bill, US$60!

Sage advice from SRJ. I really like the fact that SRJ doesn’t have the same ultra conservative attitude that many successful professionals have.

The medical professionals complain about being defacto government employees but are the first to protest against any suggestions of opening up healthcare to allcomers. I currently reside in Australia and am constantly amazed at just how good the healthcare is via Medicare, but how resistant they are to some ideas floated about cancelling students debt if new docs work locally.

My brother has experienced the Thai and Malaysian medical systems with cardiac problems and swears by them. He was traveling around the world for 11 years on his yacht. He now reckons that if he had to wait for the NZ public system, he would happily pay for a trip to SE Asia for the required treatment.

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