National's $15.4b health plan mostly keeps services running, and sets nothing aside for GPs

Nicola Willis released National's fiscal plan on 12 October. It answers the question Chris Hipkins had been raising: how National would pay for its health promises. Most of the money goes to keeping the current system running.

National set aside $15.4 billion in extra health spending over four years, 1News reported (NZ Doctor put it at "just over $15.35 billion"), and said health made up 88% of its spending commitments. Of that, $14.6 billion covers rising costs from inflation, wages and population growth, based on Treasury's Pre-election Economic and Fiscal Update. That cost-pressure funding climbs to $5.94 billion by 2030/31.

That leaves roughly $800 million for anything new. The two items 1News listed are $604 million more for Pharmac's medicines budget and lowering the bowel screening age to 50.

Labour's plan puts its extra health funding at $15.5 billion, 1News reported. About $2.5 billion is for new policies, including three free GP visits a year and free prescriptions. The other $13 billion covers rising costs. National puts about $1.6 billion more than Labour into cost pressures.

Aid cuts pay for most of the Pharmac lift

B2B News reported that the Pharmac lift would be funded largely by a 10% cut to foreign aid outside the Pacific. By its arithmetic, the lift costs $151 million a year, while the aid cut saves $107.8 million a year. That leaves about $43 million a year to find elsewhere.

A further 2% efficiency cut across the Ministry of Foreign Affairs and Trade is meant to save $45.6 million, B2B reported. If that is an annual figure, it more than covers the $43 million gap. Across the full plan, 1News reported about $1 billion in spending reductions, including $431.2 million from foreign aid and $583 million from "stronger welfare expectations and case management".

Pharmac's 2026/27 medicines budget is $1.806 billion, according to B2B, so the lift adds a little over 8% a year. The fiscal plan doesn't say which medicines that would buy.

The aid cut has split the current coalition. Foreign Affairs Minister Winston Peters said "it is irresponsible for National to jeopardise the relationships we have in the very markets we need to grow our economy," B2B reported. ACT's David Seymour, who holds the Pharmac portfolio, called the policy "a great sign for the next coalition". Massey University associate professor Gerard Prinsen told B2B the cut was "a bad idea in terms of geopolitical and business interests".

Nothing named for general practice

National left about $7.5 billion of its operating allowance unallocated, 1News reported (Labour: $10.5 billion). National says the money would cover things such as teacher and police pay rounds and new investment; NZ Doctor reported the list also includes education, law and order and undefined "social services". GPs are not named.

General Practitioners Aotearoa spokesperson Dr Buzz Burrell told NZ Doctor that "it looks very unlikely any of this funding will go to fixing the GP crisis". He said general practice "may not survive another three years of underfunding". He also said National's health total was "even less than Labour".

GPA wants National to commit to more GPs, to pay GPs for all the hours they work, and to provide safer working conditions. "GPs don't strike," Burrell said. "We just work away, every day holding the health system together with duct tape, goodwill, and a heck of a lot of unpaid hours."

There's little room for that to change before the 7 November election. National set aside $25.2 million over four years for policies it hasn't announced yet, 1News reported. Labour set aside $968 million.

Labour finance spokesperson Barbara Edmonds called National's plan "more cuts, more chaos, and absolutely nothing for the cost of living". Willis, ruling out tax cuts, said "now is not the time". National says it still intends to return the books to surplus in 2028/29.

Correction: An earlier piece on this election thread described $604 million as a past Pharmac investment that had delivered 66 medicines. 1News and B2B News both report the $604 million as a new pledge in National's fiscal plan to lift Pharmac's medicines budget.