ACT is readying for an unprecedented challenge and opportunity. The party have reshuffled their list to organise their first grouping of MPs to ever go into a governing coalition. Of their 2020 crop, Damien Smith and James McDowall are retiring (no surprise, they never made an impression). Toni Severin has been bumped down to 14 (still sure to return) and Chris Bailie to 17 (near the edge).
Seymour, Van Velden, McKee, Chhour, Cameron and Court remain in the top ten. All have clear roles; you can read speculation on the Cabinet spots that might translate into here (paywalled). David leads, BVV is the young liberal for Tāmaki, Nicole the lifeline to the firearms community, Karen the compassionate state care reformer, Mark out amongst North Island farmers and Simon the toll road enthusiast.
Put a pin in the name Todd Stephenson. For now, let’s concentrate on two interviews with this ACT candidate. The Platform’s provides a useful starting point to discuss ACT’s lineup. Michael Laws amusingly states that “what strikes me [about the ACT list] is that it doesn’t strike me”, but ACT have still exhibited some of the tendency to look for big names. They have sniped former National MP Parmjeet Parmar and Federated Farmers president Andrew Hoggard for their top 10 - a statement move about ACT occupying ground National once did. ACT will fight hard for a Cabinet role for Hoggard in a ministry like Agriculture to deepen their blossoming relationship with rural voters.
Their other likely MPs fit Laws’ statement: Christine Young at 18, the amusingly named Rob Douglas (nephew of the big man) at 16, Ben Harvey at 15, Ash Parmar (no relation) at 13, Antonia Modkova at 12, fellow funny name Cameron Luxton at 11 and Laura Trask at 10. These are ordinary people, and a strong lineup: a Tauranga accountant turned martial arts kwan jang nim, a Hawkes’ Bay businessman, a Burnham army type, a repeatedly ramraided bottle store owner located, of course, in Hamilton East, a Bulgarian tech startup type in Manakau, a tradeperson who ran in the Tauranga byelection, and a “registered evacuation consultant”, which is the most Banks Peninsula job title ever.
ACT has the hottest party list in New Zealand. Think about it: they’re the fastest-growing party, the most effective operation and due for a key role in the next government. If you are on the right wing of politics and have the opportunity, you want to be key to this party. That shows in the calibre of people they are attracting from the private sector. They can fill out their lineup of potential MPs without the fringe sneaking in.
All of that places a premium on a high spot up the list. Getting that golden ticket means you are a) bound to enter Parliament even if ACT endure a massive scandal or other unforeseen polling collapse, b) clearly signalled as cabinet material and part of a future leadership team in a party bereft of clear successors, and c) being ranked ahead of all of these big names and impressive people, a big boon to ego and bigger to your reputation.
Todd Stephenson, who nobody has heard of before, is at #4. Above everybody we have just listed bar McKee and the leadership. What has earned him this spot? Maybe top ten South Island representation? Yeah, no - he just moved back from a life in Oz. A reward for his thirty years of loyalty to the party? That doesn’t sound right, considering how in his interview with Laws they celebrate that much of the party’s history was purged as deadweight.
His experience is in the pharmaceutical sector - perhaps he’s here to rework Pharmac (basically, the body that decides which drugs are publicly subsidised or not). Audrey Young speculates BVV might take on this task, but he seems like the most qualified candidate. This is all speculation, but the likeliest implication of Todd Stephenson’s high list placement is that he would be designated in a coalition agreement as point man on ACT’s reform programme for Pharmac, perhaps as Associate Health Minister.
What’s confusing is that Todd himself doesn’t particularly seem to know what he’s here to do. "As far as the issues I’m concerned about, I mean, again, um, I will do whatever, y'know, David thinks my skills can be deployed to, I mean, I'm interested in a wide range of issues, I’m obviously, I'm working in the health sector currently, but I have, y'know, obviously a bit of a legal background, so, again, I'm open to serving wherever David thinks appropriately, but, you know, deploying my skills for ACT to get things done, Michael." What? (Laws instantly follows this with his killer line.)
Stephenson’s interview with Jack Tame followed the example set above: an exemplar of a man constantly fidgeting, adjusting, blinking and stuttering. None of these are bad things. They are normal and human, but politics has unusual standards. In a field where appearing honest is rewarded and deceit is punished, he looks shifty. In a job that demands confidence, he’s nervous. Above all, politics demands a clarity of purpose, which is why they repeat the same messages a million times, and Stephenson’s message is muddled. Which leaves you baffled as to why they accepted this interview request in the first place.
Their earlier back and forth is unproductive. Tame questions whether he’s an opportunist, an accusation that is neither convincing, nor impactful if true. Tame points out the company he worked for charged extortionate rates for drugs. Stephenson deflects back onto Pharmac, not private companies, as the one deciding prices for New Zealanders.
This is obviously absurd - the more Pharmac has to pay for drugs, the fewer they can afford to subsidise - but as recent events have evinced, New Zealanders are uncomfortable with personal attack politics of the type we see in the US. Our revolving door between lobbying and politics is treated as a structural issue, not one of individual character. If a tobacco lobbyist can be National’s third-in-command, Stephenson will be fine.
What pricks my ears up are two points of discussion, from around 6 to 10 minutes in. The first is that Stephenson wants to add productivity as a consideration for Pharmac - certainly not their whole approach, he stresses, but it’d be a factor. Essentially, Pharmac would be likelier to fund drugs if they are for treatments which would help people return to work.
Presumably, people in these situations are facing considerable but not severe health difficulties if going back to work is an attainable goal so long as they can get their drugs funded. The corollary would then be that there is less funding for drugs for people who cannot return to work, e.g those with relevant disabilities, bed-ridden by chronic illness etc. That seems very concerning. I can’t see a way to win the argument that any return on investment to the country would outweigh the human cost of such a policy. Left-wing parties love to pounce on any hint of profit motives entering public healthcare bodies. Pharmac absolutely is such a body even if it does not provide healthcare directly.
The second point to come out of this interview is that he has no plan. Pressed on what ACT will do, if they are promising to improve Pharmac’s access to “new, more advanced” drugs and have also pledged no increase to funding, he starts out by saying ACT will create more tax money by growing the economy. Cool story, still none of that money is going to Pharmac. Not a solution. His ideas are, instead, “have a strategy”, “have a plan”, “timing”, “improving the process”, and we get to “removing older medicines” - which is, of course, robbing Douglas to pay Paul.
The worldview that Stephenson sets out where Pharmac’s people are getting together and deciding to fund obsolete medicines that are either non-functional or strictly outclassed seems unreasonable. If they are wasting money, ACT’s actual plan on their website (an independent review of Pharmac to improve transparency and accountability) will surely put a stop to that.
We are still left with the question of how ACT will upgrade Pharmac quality across the board, rather than just stripping out rubbish and taking the easy wins there. For instance, when parties promise to strip out the waste and bloat from government bureaucracy, that’s a largely separate pledge to making them run more efficiently. One is about the internal allocation of funding, the other about reconstructing their processes. It’s the difference between setting out to clean the clutter off your floor, and to organise everything better. One is a lot easier than the other.
Nothing in anything ACT has published or Todd Stephenson has said explains how ACT will actually improve efficiency or decision making for Pharmac. That is, of course, unless your view of efficiency is economic efficiency over patient life value. That’s one of those pretty fringe, economically hard-right views identified with the past of ACT - the sort of mentality that Stephenson himself tells Laws they have moved past. ACT policies propose various levels of privatisation in some sectors like education and roads. They are welcome to try but let’s not kid ourselves here: privatisation and profit motives in provision of services are controversial both politically and in their outcomes.
My immediate advice to ACT would be to have Seymour and Todd Stephenson sit down for an interview together with a media outlet, such as a return to Q&A. (From what I’ve heard, Todd is a quick study and already sounds better on the radio.) David, make it clear why you chose to put this guy so high up. Prep to have Todd draw on his expertise and clearly explain what it is he is actually going to do: what is the plan, what is the strategy. Otherwise, people are voting on blind faith, and we saw how that went in 2017 when Phil Twyford was trusted to get Kiwibuild done.
You have six more weeks of airtime in an election you are winning. Use these precious days get free attention for your policy programmes, before people move on and the business of government goes behind closed doors. ACT are clearly unafraid to openly discuss their agenda, and credit to them for that. Pair that resolve with competence here, now.
Without this clarity, ACT are going into coalition negotiations with a whole lot of murkiness about a core part of their reform program. If there actually is no such reform plan with Stephenson in mind, that leaves a big question mark at the heart of their party. ACT already lacks a clear achiever outside Seymour. There are lots of impressive ordinary people who ACT brings forwards from across the country, but none of them are leaving an impression that ACT has goliaths in the halls of Wellington besides David. Anything short of making Stephenson shine will be the next three years’ single biggest contribution to that narrative. He is the one rookie you are passing the ball to. He has simply got to run with it.
What concerns me, here, now, is that Stephenson’s explanations place clear value on new, more advanced drugs being developed. You could of course go straight for the obvious here and say this guy’s job was to promote new, more advanced drugs from Big Pharma. Now he’s moving to a new job in which his role will remain to promote new, more advanced drugs from Big Pharma.
There is clear personal bias in judgement from somebody whose experience in life is closely tied to the virtue of the development of new, more advanced drugs, because they can be marketed and sold for more. That is valuable in the business world. That is bad for Pharmac when they have to pay more. Maybe there’s proportionate value added, or maybe Big Pharma is a reasonably oligopolistic market notorious for price gouging and sponsoring junk science. That should be enough to have you concerned too, but there’s another angle to consider here.
Bear with me for a moment and dive all the way back to the start of politics podcast Gone By Lunchtime, entitled “Episode 2: Pharmac, the flag and the Auckland shambles”. Go to 9:07. What you will find is that the territory Todd Stephenson is staking out scrapes perilously close to the “gross hypocrisy of the Labour Party”!
In that era, heartbreaking stories of medical trials and tribulations for afflicted patients would rise in the media. Opposition politicians would pounce for political points and demand Pharmac fund new, more advanced drugs for them. These people’s suffering and need is very real, and just as it was exploited by politicians interfering in Pharmac’s decision making, it was exploited by the Big Pharma PR people who were getting these stories in the news in the first place.
If Pharmac were to kowtow to every request for somebody pushing new, more advanced drugs because they bought into the necessary assumption that they were automatically better, they were making suboptimal decisions leaving more humans in suffering and need. There is a place for cold, dispassionate analysis in the allocation of lifesaving and life changing medicine. It’s not the Rogernome kind weighing economic value against health value. We have seen from COVID that the two go hand in hand.
Whether the drugs are new or old, however much they cost: Pharmac’s mission should be to shut out the noise and figure out, with the funding they have to work with, what is the combination of drugs that will do the most for New Zealanders? Put in terms of a market: where is the equilibrium that will maximise utility without being distorted by policy interventions? That is the transparent, accountable Pharmac that we should all hope ACT will be able to create. That is the world which ACT’s #4 undermines by placing headlines over healing. Prove me wrong, Todd.
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