As sure as night follows day, any proposed rise in the cost of healthcare in this country will be condemned. So criticism of announced price rises for prescriptions, from $3 to $5 as of January 1 next year, should not come as a surprise.
It will, say critics, hit hardest those people who can least afford it. While the additional $2 for those who are in the middle and higher income brackets will barely be noticed, for those who have no money in their pockets in the first place, this increase will impose additional hardship.
Those critics have a point, but it is not necessarily the definitive, nor the final, argument in the debate. Any spending in health, or conversely, suggested cuts, are naturally enough the subject of close scrutiny. But they should be placed in context.
Good "health" is considered an inalienable right in developed societies. When you have enough to eat, a good job, comfortable housing, satisfying leisure activities and a pension scheme, maintaining a health "warrant of fitness" to enjoy all of it assumes inflated importance.
In fact, it might be argued expectations - whether access to drugs, surgery, hip replacements, specialist diagnoses, targeted medical care - in themselves constitute a modern "syndrome". Unfortunately, with the increasing sophistication of medical, pharmaceutical and surgical innovation, meeting its symptoms comes at a high price.
Health budgets have become bottomless fiscal pits and a headache for any government attempting to balance its books.
This Government has made no secret of its intention to run a second "zero" Budget, the details of which will be released next week. And while there is rightly some disquiet at the most needy - likely also to be those who are in poor housing, low-paid jobs or in the benefit sector - being hit the hardest by the prescription rises, they are not necessarily without recourse, either through Work and Income or primary healthcare organisations.
Further, the rises are capped at 20 prescriptions per family: the maximum extra amount any single family might pay in a year is $40 - less than half the average monthly cost of a satellite television subscription, the equivalent of about three packets of 20 cigarettes, or a couple of dozen bottles of beer. Rather than be considered luxuries, these too have come to be considered inalienable rights by a majority of the population.
So a degree of reality must be brought to bear in the discussion.
The price rises are expected to save up to $20 million in the first year, and $40 million a year after that. Further, at least some of this money will be reinvested in the health budget to fund the $101 million worth of new initiatives, over four years, also announced this week.
These include $48 million to increase elective operations by at least 4000 each year; $16 million on IT systems to speed up access to important diagnostic tests such as MRI scans, CT scans and colonoscopies; $4 million for a national register of heart patients; and $33 million for better and faster services for cancer patients.
The rises are the first in 20 years and in times of fiscal hardship and need for public spending restraint, the mooted price increases do not seem overly severe - especially if those most in need can access assistance.
In an ideal world, prescriptions for the needy would be free.
In an ideal world, the cost to parents caring for severely disabled children would also be recognised and addressed. In fact, the Court of Appeal has just thrown out an appeal by the Ministry of Health against an earlier decision which agreed with this proposition.
On merit, few might argue against it: caring for the disadvantaged is demanding work; it requires commitment and compassion - not to mention emotional stamina. But, again, the real world of budgets and costs intrudes. What must be given up in the health budget to fund the court's apparent directive? Given the high financial stakes, it would not be inconceivable were the Ministry of Health to seek a final adjudication on the matter in the Supreme Court.
