The new health system rises, the NZMA sinks

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The demise of the NZMA raises questions about the importance of interest groups in health policy and in democratic processes more generally.

In the 1990s, when I was a graduate student, I was a teaching assistant in a single course devoted to the subject of interest groups and politics. For some time, there had been a lively debate among political scientists about whether or not interest groups had a productive role to play in shaping democratic policy. Some have argued that interest groups serve an essential function in a democracy as channels through which public input helps shape political decisions between elections. Most of those who argued that were American political scientists trying to explain to the rest of the world what really made American democracy great.

However, other political scientists of the time noted that political decisions were often shaped by a close political community, which included government agencies working closely with key sectoral interest groups.

Membership in these political communities generally excluded other groups with an “interest” in politics. Sometimes these arrangements were more about developing stable processes to manage foreseeable conflicts.

Readers who lived in New Zealand, Australia or the UK in the 1970s will recall that this was how industrial relations policy was organised.

These ‘corporatist’ arrangements were also common in health policy, particularly in northern European countries, and typically involved ministries of health and medical associations; it is rare for another association to be at the center of these arrangements. The counterpart was that the privileged interest groups were there to guarantee the support of their members.

Rudolf Klein, the most discerning British observer of health policy at the end of the 20th century, called these arrangements between government and the profession “double bed politics”, conjuring up the image of an old married couple who may not like living together but knows they can’t live without each other.

Critics from the political left viewed these types of arrangements as elitist and undemocratic. Right-wing critics have argued more about the economic consequences of a state too comfortable with “rent-seeking” interests.

When the neoliberal revolution took hold in the 1980s, corporatist relations between government and interest groups were the first to face the firing squad.

But even in countries less influenced by neoliberalism, such as the Netherlands, corporatism in health policy was quietly reduced in the 1990s. Nevertheless, these countries did not totally abandon the use of groups of professional interests as “policy insiders”.

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