Political cosyism behind 3rd medical school decision-making
On this occasion the new word was 'chumocracy' and 'cosyism': Chumocracy and cosyism.
He was referring to the work of Auckland University Professor of Economics Robert MacCulloch who was calling out 'soft corruption' by political and business elites in Aotearoa New Zealand.
His focus included government, banks, big business and the rightwing 'thinktank' New Zealand Initiative. Such was the strength and persistence of the hostile response from these elites that he felt sufficiently pressured to close his website.
The core of MacCulloch's argument is that New Zealand is run by a 'chumocracy' of elites who are connected by what he calls 'cosyism'.
Third medical school announcement
These were the words that I began to think about after absorbing the announcement by Health Minister Simeon Brown and Universities Minister Shane Reti early in the afternoon of 21 July that it was proceeding with the proposed third medical school at Waikato University: Official announcement.
Later that the same day I was interviewed about the decision on Radio New Zealand's The Panel where my main focus was on the poor process which was likely to lead to an eventual poor outcome: Medical school decision based on poor process.
Nearly two years earlier I had outlined my concerns about the Waikato University proposal in an article published by BusinessDesk (26 August 2023): Third medical school caution.
What is the third medical school
The new medical school is to provide a four-year medical degree for students who already are graduates with a non-medical degree to work as general practitioners (or as other rural doctors) in regional and rural areas. The medical degree at the existing two medical schools, Auckland and Otago, is five years.
The advocated expectation is that the proposed Waikato Medical School will be graduating 120 doctors a year once it is up and running.
With its opening scheduled for 2028 the first graduates should start working as general practitioners or other rural doctors at the earliest in 2037. This gap comprises both the time at the medical school and the time as resident (junior) doctors in training.
Last year the Ministry of Health commissioned a report which advised that that Waikato's teaching model would be similar to the model in Wollongong University, south of Sydney. Reportedly 45% of the latter's graduates become GPs of which around 30% proceeded to work in rural areas.
In 2017 the Auckland and Otago medical schools had proposed that they be allowed to jointly establish a new joint 'school of rural medicine'.
However, while the previous Labour-led government and Ministry of Health was favourably disposed to this initiative, progress was understandably impeded by the Covid-19 pandemic.
In a memo to then Health Minister Shane Reti in September last year, Treasury recommended that Auckland and Otago Medical Schools be asked to present a counter-factual argument to the Waikato proposal. However, it appears that no such invitation was made.
Analysis by the Integrity Institute
The best commentary I have seen on this decision has come from Bryce Edwards in another Integrity Briefing published the same day as the Government's announcement and after my The Panel interview (21 July): Costly case study in policy capture.
Edwards also drew upon the excellent investigative work of Radio New Zealand's Guyan Espinar.
Consistent with his above-mentioned piece on 'chumocracy' and 'cosyism' he describes the decision as:
… not, at its core, a decision about health policy. It is a decision about political power, influence, and the erosion of good process. This project serves as a textbook case study of policy capture, where the interests of a well-connected institution, amplified by high-powered lobbyists, have overridden expert advice, fiscal prudence, and superior alternatives.
Later in his piece he adds:
This lack of transparency and due process is antithetical to good governance. The entire Waikato med school saga has unfolded via secret contracts, private lobbying meetings, and politically wired relationships – all largely hidden from the public until journalists and watchdogs pried it into the light.
Backing this up Edwards draws upon many questionable process features including:
Waikato Vice-Chancellor Professor Neil Quigley working 'hand-in-glove' in 'partisan coordination' with Shane Reti before the last election and promising the proposed school would be 'a 'present' to a future National government'.
Waikato University helping pay for the National party's campaign announcement of the medical school plan (about $5,000).
Government officials seeing 'red flags' in the proposal including alarm bells ringing from Treasury, the Tertiary Education Commission and the Ministry of Education warning of bloated costs, duplication risks and logistical hurdles.
The use of two of the most well-connected lobbyists: initially former Labour senior adviser Neale Jones and more substantially former National cabinet minister Steven Joyce. Joyce's firm was paid about $1 million over three years by Waikato for 'consultancy' (le, leveraging his political influence).
Questionable procurement in the way Waikato University hired Joyce leading to a public 'scolding' by the Auditor-General John Ryan.
Ignoring the arguably better alternative of expanding the existing Auckland and Otago medical schools which were already running rural immersion schemes and satellite programs geared toward rural health.
Edwards does not hold back:
At its core, the Waikato medical school saga is an illustration of how not to make public policy. The process has failed every basic test of transparency, public accountability, and evidence-based decision-making. A public university and eager politicians cooked up a major spending initiative as a political favour, greased by lobbyists and implemented via dubious means.
The normal checks and balances – open procurement, independent policy analysis, genuine stakeholder consultation – were subverted or ignored. It's the kind of deal that breeds public cynicism in politics, the sense that big decisions are made on behalf of the powerful or the connected, not the public.
Further:
By greenlighting this project in July 2025, ministers have signalled that political paybacks matter more than prudent spending. They have effectively rewarded a campaign of lobbying and pressure that sidestepped the usual contest of ideas. That sets a horrible precedent. It tells every other vested interest: hire the right insiders, make the right donations or deals, and you too can get the government to write a big cheque, officials' advice be damned.
And:
The Waikato medical school greenlight might be a political win for a few, but it's a loss for New Zealand's standards of governance. It undermines confidence that our health investments are made wisely and fairly. And it should prompt some soul-searching in Wellington: if this is how we make big decisions now, what does that say about who really runs the country?
Unconvincing contrary views
There have been contrary analyses supporting the Government's decision which I find unconvincing.
Luke Malpass, Stuff Political, Business & Economics Editor and formerly holding a leadership role in the New Zealand Initiative expressed a negative view of current medical schools describing them emotively, but without substantiation, as a 'duopoly'.
Writing in The Post (22 July; paywalled) in a flaky critique he dismisses those critical of the process, presumably including Bryce Edwards, as 'weird': Flaky rather than investigative.
Two days later Waikato University ethics professor and philosopher Nick Algar wrote a paywalled opinion piece in The Post abstractly arguing that those critical of the Government's were guilty of 'sloppy thinking'.
This reminded me of the expression 'pot calling the kettle black': Sloppy thinking in the debate over Waikato medical school | The Post Sloppy analysis of 'sloppy thinking'.
He also reminded me of Oscar Wilde on philosophy although without the latter's famous and infamous wit: 'My philosophy? I'm always right and you are wrong.'
The last word
Let's leave the last word to the action of the Government in releasing its redacted 'cabinet business case' material at 6.45pm last Friday as reported by the Otago Daily Times the following day: Politically expedient timing of third medical school case.
This timing has been a common practice of successive governments recognising that this is the most difficult time for media scrutiny before it is taken over by other news.
If the difficult to substantiate claim of $50 million savings per year stood up to rigorous scrutiny it would have been released at a time convenient for media scrutiny. But 'chumocracy' and 'cosyism' necessitated otherwise.
Ian Powell
Otaihanga Second Opinion is a regular health systems blog in New Zealand.
Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.
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