On Health Narrowly Conceived, And Ukraine's Latest Impasse

Scoop

a day ago

Imagine an assessment of public health delivery that -for starters – ignored the adequacy of current funding and staffing levels, or the extent of unmet need. Imagine if this evaluation also omits the short term/long term implications of the privatisation of health services and the adequacy of the current training, recruitment, retention, and upskilling needs in health care.
If you want an overview of Te Whatu Ora and its operational environment that basically ignores all of the above factors, then you're in luck. Because Lester Levy, the Health NZ Commissioner, has written a self justifying editorial about Te Whatu Ora in the NZ Medical Journal that judges the organisation's success purely on whether it is adhering to the financial constraints placed on it by government.
In Levy Land, things are going great:
Between July 2024 and May 2025, the monthly deficit fell by 85 per cent, and by the end of the financial year the organisation was under budget. The organisation is now on a credible path to break even by 2026/2027.'
Entirely omitted from the analysis is the human cost involved in achieving that turnaround. There is little in the way of concession, even on narrow economic terms, that those finances may be looking better now partly because the (under-estimated) initial costs of centralisation are now behind Te Whatu Ora, and the benefits of scrapping the multiple levels of DHB bureaucracy are now starting to kick in.
Ah, but to attribute such gains to Te Whatu Ora itself would be to fail in what seems to have been the prime purposes of Levy's editorial. These include: touting the improvements since he came on board as commissioner, putting a positive spin on the austerity measures the government has imposed, and making the narrative in public health more about the state of the books than the state of the patients.
Talking of whom, I'm not sure that many people standing and waiting 17 or 24 hours for care in crowded EDs - or who are struggling to access a GP - will be overjoyed to hear that Te Whatu Ora is now living within the means allocated to it. I think they'd prefer a public health system funded adequately and properly staffed. That's not my department, says Professor Levy.
Footnote: BTW, 'Not my department' is a phrase that may ring a bell with fans of the political satirist Tom Lehrer, who died a few weeks ago at the age of 97. From a concert in the 1960s, here is Lehrer's classic song about a bright guy who isn't overly concerned about the moral context, or who his latest paymaster may be:
Cutting Ukraine Adrift
In a Werewolf exclusive, here's a clandestine recording of the recent Putin/ Trump summit meeting in Alaska, on Ukraine.
Putin: Nyet.
Trump: What's your golf handicap these days?
That seems to have been the gist of the Alaska meeting, with Trump simply serving as the megaphone for transmitting Putin's demands back to Ukraine, and to the rest of Europe. Surprisingly, the subsequent White House meeting between Trump, Volodymyr Zelensky and a few European leaders has raised the unlikely prospect of the US providing a security guarantee to Ukraine if (somehow) Zelensky can meet Putin's demand to gift the Kremlin with about 20% of Ukraine's sovereign territory as a reward for his invasions in 2014, and 2022.
In whatever shape it is offered – from a signed pledge on paper, to US boots on the ground - you can be sure that any US security guarantee will be highly conditional. The likely condition will be concessions to Putin on territory – not merely the Crimea, but the entire Donbass region on Ukraine's eastern border with Russia.
In essence, Zelensky is being made an offer that he has to refuse, and everyone else knows it, Trump included. The likely upshot of the Washington talks will be that Zelensky will be painted into a corner where he – and not Putin – get portrayed as being the intransigent obstacle to peace. Indeed, even if Zelensky did make land concessions – and he would be forced to resign if he did – this would only bring ' peace' until Putin wanted more.
Putin's other demand is that Ukraine must never become part of NATO. Yet ironically, any meaningful security guarantee by the Americans would have to look very much like the premise of collective defensive ( set out in Article Five of the Washington Treaty) central to NATO's very existence. Article Five says that any military attack on a NATO member is to be regarded as an attack on all of them. So any meaningful US pledge to defend Ukraine would lock the US into a military conflict with Russia, in the event of any further aggression by the Kremlin.
It is unlikely that Trump would make such a commitment. With reason, Trump is probably gambling that Zelensky will refuse to make the requisite land concessions to Putin. Similarly Zelensky is trying to avoid being typecast as a barrier to peace, so is pressing Trump for a security guarantee he knows Trump will probably not make. Putin meanwhile, is ruling out any NATO security force being deployed in Ukraine, just in case anyone thinks that might be a Plan B if the Americans won't put boots on the ground. It looks very much like what used to be called (offensively) a 'Mexican stand-off.' It may take a while to unravel.
Putin's Mentor
In his role as a Russian proxy, Trump has always been willing to cede Europe to Putin, while the US focusses on its conflict with China. In that respect, they've been like Mafia chieftains carving up the territory. When face to face in Alaska, it would have been more surprising if Trump had stood up to Putin, and imposed the conditional threat of severe economic sanctions if Putin failed to table a viable compromise. Not a chance. Essentially, what Ukraine is facing is a demand to surrender that's being relayed via a good cop (Trump)/bad cop (Putin) routine.
For some, it may be consoling to treat Trump as stupid. Yet as he pillages America (a) for his own enrichment and (b) to fuel his unquenchable vanity, the strategising of Russia and China stands in stark and scary contrast. For decades, Western neo-liberals have been preaching the inherent inefficiency of the state, but China has proved the exact opposite. China's state-funded efforts are already delivering it technological superiority on the global stage.
Similarly with Russia, it is striking is see how consistent Putin's actions are with the plans set out long ago by his ideological mentor, the Russian hyper-nationalist Alexander Dugin. Dugin's 600 page manifesto The Foundations of Geopolitics: The Geopolitical Future of Russia was published almost 30 years ago, back in 1997. A good backgrounder on Dugin is available here:
In eight parts [Dugin] establishes the strategies of Russia's adversaries, devises his own, and provides bold steps to regain Russia's position of dominance lost at the end of the Cold War. The most trenchant of these recommendations include the invasion of Georgia, the annexation of Ukraine, the separation of Britain from the rest of Europe, and the sowing of divisive seeds in the United States, each of which should sound quite familiar.
Georgia got invaded in 2008, Ukraine in 2014 and 2022, and in between Britain left the EU. NATO is being weakened and Russian cyber-attacks have been one source of division among many in the United States, a dis-integration process helped along by Putin's fanboy in the White House. (In France, any future ascent to power by Marine Le Pen would give Putin another crucial ally, in the heart of western Europe.) And oh yes, Ukraine did feature prominently in Dugin's calculations, over a quarter of a century ago:
Dugin grew in relative fame after the Ukraine conflict began [in 2014], as this was his most efficacious recommendation. As he explained, 'Ukraine, as an independent state with some territorial ambitions, poses a huge danger to the whole of Eurasia, and without solving the Ukrainian problem, it makes no sense to talk about continental geopolitics.'
Historically, Ukraine was a significant economic hub on land, and much of Russia's natural gas exports used to travel through it into Europe. Now, the Nord Stream 1 pipeline runs under the Baltic Sea straight into Germany, the Turkstream pipeline crosses the Black Sea into Turkey and goes from there into south-eastern Europe, while the Yamal- Europe pipeline runs into Germany via Belarus and Poland. For all its posturing, Europe still has a heavy energy reliance on Russia.
Dugin could see this one coming, too. At the time that Dugin was writing in the mid 1990s the annexing of Ukraine was a key part of his wider vision of making Europe more dependent on Russia for its energy needs, and less reliant on the energy reserves in the Middle East over which the US and Europe still exerted some degree of neo-colonial control.
In other words, there has been a long-term blueprint for Putin's actions and ambitions in Europe and elsewhere. Putin's 5,000 word essay that famously mis-represented the history of Ukraine – and basically denied its right to exist - was published barely six months before the 2022 invasion. It could have been written by Dugin.
In sum, Putin cannot be patronised any longer as just a reactionary kleptocrat trying to shore up Russia's fading ambitions on the world stage. During the Cold War, Russia controlled an empire in eastern Europe. Putin will turn 73 in October, and he seems intent on restoring as much of that empire as possible before he departs the scene. The current US President appears to have no interest in restraining these revived imperial ambitions.
Footnote: Of late, calls have been made for Trump to impose tough economic sanctions on Putin over Ukraine. Unfortunately, that horse may have bolted. For the past 15 years, Russia has been insulating itself against the effect of US-led economic sanctions.
In 2022, the US. Germany, France and the UK finally buckled to pressure and agreed to suspend from the international banking system [aka SWIFT] a number of banks on an already sanctioned list of Russian banks. The reason for this selective exercise? Once again, it comes back to Europe's energy problem.
Before the Ukraine invasion, the likes of Germany, Italy, and France would pay Russia for their energy fixes through the SWIFT banking system. Cutting off Russia's access overnight to SWIFT (and thus to their own imports of Russian energy) would have sent petrol and heating costs through the roof across Europe. These costs remain a politically sensitive issue during the northern winter. Its not accidental that the West's sanctions on Russia over Ukraine have leaked like a sieve.
In the interim, Russia hasn't been standing still. Since 2022 Russia has built itself an effective alternative transaction system to SWIFT, and has rapidly decoupled from its reliance on the US greenback as its currency for international transactions. (It is also developing a domestic alternative to the Internet.) Meanwhile, Europe's dependency on Russia as a cheap energy source has reduced only somewhat:
Germany joined France, Belgium, and Spain as key importers of Russian LNG in 2024, a new study reveals. German energy company SEFE, federally-owned by the government, imported 58 shipments from Yamal LNG into the EU port of Dunkirk, a 650 percent increase over 2023. Some of this Russian LNG finds its way into Germany counter to its government's assurances that it does not import Russian gas.
So when Zelensky went to the White House with his European friends, he would be well aware that his country's fate may be an over-riding priority for Ukraine, but it isn't for anyone else at the briefing.
Songs for Zelensky
Zelensky has his critics at home and abroad,but his resilience under fire has been remarkable. Having to flatter and politely cajole Trump in the face of Trump's inherent dishonesty would be bad for anyone's blood pressure. Endurance. Patience. Hope for better times to come. Here's great gospel song that celebrates those qualities:
And while you do stuff for others, here's a soulful reminder to look after yourself: