The Durable Goals
Finding What New Zealand Actually Agrees On
NZ2050 Thought Experiment Series | July 2026
Executive Summary
New Zealand does not have a policy problem. It has a continuity problem. Successive governments have broadly agreed on what good health outcomes look like and fought bitterly about how to achieve them. The consequence is a politics of reversal: each incoming government dismantles what the last one built, rebuilds it differently, and hands the wreckage to the next. Nothing compounds. Nothing lasts.
Strip the mechanism away from any major health policy debate and three things emerge: a surprising amount of shared ground between parties, five measurable outcome goals that no incoming government need reject, and a clear case for the institutional architecture to protect them. Health is the worked example here, because the evidence base is strong and the cross-party consensus on destinations is clear even as the fights over methods remain bitter. The same methodology applies across every topic in the NZ2050 series.
The five health outcome goals that emerge from this analysis are externally benchmarked, independently measurable, and deliberately silent on mechanism. On youth suicide, New Zealand is the worst performer of 36 OECD and EU countries. On medicines access, New Zealand spends 4.9 percent of its health budget on pharmaceuticals against an OECD average of 13.3 percent, and Australia funds 142 medicines that New Zealand does not. On cancer treatment timeliness, a 90 percent within-31-days target already commands cross-party support. The gaps are documented. The goals write themselves.
What requires deliberate design is the institutional architecture. The Zero Carbon Act, passed unanimously in 2019, was being gutted by simple parliamentary majority by November 2025. Statutory goals without supermajority protection are insufficient. New Zealand already has the tool: Section 268 of the Electoral Act 1993 entrenches six provisions against change by simple majority, requiring either 75 percent of Parliament or a public referendum. The same mechanism can protect a national health goal set. This is not constitutional innovation; it is applying an existing instrument to a new problem.
The Problem: A Politics of Perpetual Reversal
Not every policy reversal is a mistake. Sometimes a new government genuinely has a better idea, and the previous one built the wrong thing. The problem is structural, not partisan: when the goal lives inside a party’s platform, it inherits that party’s electoral fragility. Good policy rarely survives three years.
In 2022, the Labour government established Te Aka Whai Ora, the Māori Health Authority, as a co-governance body alongside Health New Zealand. By June 2024, the incoming National-led government had disestablished it entirely, returning functions to Health New Zealand. The political fight was real and the values disagreement genuine. The practical cost was not just institutional disruption: it was the staff who were left uncertain for months, the programmes that stalled, and the trust that contracted.
Three Waters tells a similar story. Labour spent what the incoming government characterised as $1.3 billion constructing a water services reform programme, with $63 million going to consultants. The National-led government scrapped it in early 2024. Whatever its merits or flaws, the programme never had time to prove itself. The water infrastructure problem it was designed to address has not gone away.
The most instructive case is the Zero Carbon Act. It was crafted over a year of negotiation between the Greens’ James Shaw and National’s Todd Muller, passed unanimously through Parliament in 2019, and established an independent Climate Change Commission with legally binding emissions budgets. The bipartisan consensus was treated as the law’s great strength. Cross-party commitment was supposed to guarantee continuity across political cycles.
By November 2025, the National-led coalition had announced sweeping reforms: removing the Climate Change Commission’s role in advising on emissions reduction plans, allowing ministers to amend those plans at any time without public consultation, and decoupling the emissions trading scheme from New Zealand’s Paris Agreement commitments. A law passed unanimously by Parliament six years earlier was being hollowed out by a government controlling 61 seats.
The Zero Carbon Act case matters because it was the model. If a unanimously enacted law with an independent commission and legally binding budgets can be gutted by simple majority, no statutory goal set is safe without additional protection. That structural gap is what the rest of this piece addresses.
Why This Is Not Inevitable
The policy reversal pattern is common. It is not universal. Comparable democracies have managed to build cross-party goal sets that outlast governments. Three models are worth examining.
Ireland: Sláintecare
Ireland’s Sláintecare emerged in 2017 from an all-party parliamentary committee with a clear mandate: design a ten-year health plan that no incoming government would dismantle. The destination, a single-tier, universal, publicly funded system, was agreed at the goal level. The mechanisms were left to be worked through in implementation. By May 2025, Ireland’s government had published Sláintecare 2025+, an evolution of the framework into a new implementation phase. The six new HSE Health Regions that commenced in March 2024 are a structural consequence of the plan. Emergency department trolley numbers fell 11 percent, despite overall presentation numbers rising. The original report is eight years old and still the operating framework.
No incoming Irish government has campaigned on dismantling universal healthcare as a goal. The reason Sláintecare has survived is the same distinction this piece argues for: the goal was stated at the outcome level, and the mechanism was not. A new government can fund universal healthcare differently, reorganise delivery, or adjust the pace, without abandoning the goal. The goal gives each government something to own rather than something to repeal.
New Zealand: The Zero Carbon Act
The Zero Carbon Act was the closest domestic example of the same thinking. Its November 2025 dismantling demonstrates the limit of the model when not protected by a supermajority threshold. Statutory obligation and an independent commission are necessary but not sufficient. A government with a majority can remove both.
Sweden: The Fiscal Policy Council
Sweden’s government operates under surplus targets and expenditure ceilings that have survived multiple government changes. The mechanism is an independent Fiscal Policy Council that publishes annual assessments of whether the government is complying. The political cost of visible non-compliance, publicly documented by a credible independent body, is higher than the political cost of the mechanism debate beneath. Institutional transparency makes reversal legible as a choice rather than a routine policy adjustment.
The common features across all three models: outcome-defined goals, independent tracking, and a political cost for visible deviation. New Zealand needs all three, plus a fourth: a supermajority threshold for statutory goals, applying the existing Electoral Act mechanism to a new domain.
The Discipline: How to Tell an Outcome from a Smuggled Mechanism
The central argument is simple: define goals at the outcome level and stay silent on mechanism. Applying it is harder than it sounds. Two failure modes undermine well-intentioned goal-setting.
The first is vagueness. A goal so high-level that everyone signs it and nothing is measurable. “All New Zealanders deserve quality healthcare” is not a goal. It is a sentiment. A government achieving nothing can claim it is pursuing quality healthcare. Vague goals produce no accountability because no one can demonstrate non-compliance.
The second failure mode is more dangerous: smuggling. A goal that looks like an outcome but quietly encodes a mechanism, losing one side the moment they notice. “Reduce emergency department waits through nationally mandated targets” sounds like an outcome goal. The destination, shorter waits, is genuinely shared. But the method, mandated targets with quarterly public reporting by region, is National’s preferred mechanism. Labour and the Greens approach access through funding levels and staffing ratios. Encoding the mechanism in the language of the goal makes it impossible for any government to pursue the destination by a different route without first publicly rejecting the goal. The goal becomes a political liability rather than a shared foundation.
The test for genuine outcome neutrality: if two parties with diametrically opposed views on mechanism can both accept the goal as stated, it passes. If either side sees their preferred method encoded in the wording, it fails.
International benchmarks are particularly useful for writing mechanism-neutral goals. They are externally validated and hard to characterise as partisan. “Reach the OECD top quartile on cancer treatment timeliness” does not specify whether to get there through more oncologists, faster diagnostic pathways, increased Pharmac funding for cancer medicines, or productivity gains in existing services. It describes an endpoint any mechanism can pursue.
One honest caveat: not every goal that looks neutral is neutral. An equity-gap goal, the health outcomes gap between Māori and non-Māori for example, is a measurable outcome. It is also politically loaded in New Zealand in a way that a general wait-times goal is not. The mechanism fight and the values disagreement are different things: mechanism fights can be resolved by a shared goal; genuine values disagreements cannot. Part of the analytical work in each domain is separating what is truly a mechanism fight from what is a real disagreement about ends.
Applied: What NZ Parties Actually Agree On in Health
The research picture for health is clearer than the political noise suggests. New Zealand ranks fourth of ten comparable countries in the Commonwealth Fund’s 2024 Mirror, Mirror report, first on care process and third on health outcomes. By the OECD’s amenable mortality measures, New Zealand performs above average on both preventable and treatable mortality. The system is not failing by international comparison overall. It has specific, documentable gaps.
The gap that is worst by any international comparison is youth suicide. New Zealand has the highest child and youth suicide rate of 36 OECD and EU countries, according to UNICEF data. The rate for female youth is the highest of any comparable country; for males, the fifth highest. No party argues this is acceptable. National, Labour, the Greens, ACT and NZ First have all made mental health commitments in successive parliaments. The destination is shared. The method is contested.
The medicines gap is the next most striking failure. New Zealand spends 4.9 percent of its health budget on pharmaceuticals; the OECD average is 13.3 percent. Australia’s Pharmaceutical Benefits Scheme funds 142 medicines that Pharmac does not, 38 percent of them cancer medicines. By July 2026, ACT had published a costed policy to close the medicines gap with Australia, describing it as an “achievable path.” Labour and the Greens have long supported increased Pharmac funding. The destination is shared. The debates are about pace, funding mechanism, and whether the problem is Pharmac’s structure or its budget.
On cancer treatment timeliness, 85.9 percent of New Zealand patients received cancer management within 31 days of a decision to treat as of the December 2024 quarter, against the government’s stated 2030 target of 90 percent, down from 87.7 percent in 2019/20. National reintroduced timeliness targets as explicit health system measures in 2024. Labour and the Greens have historically supported timeliness benchmarking in cancer care. The 90 percent target is mechanism-neutral: it measures an outcome and leaves the question of how to achieve it to each government.
On access and wait times, 73 percent of New Zealanders reported in 2024 that wait times for doctors’ appointments were too long, up from 66 percent the year before and above the Commonwealth Fund’s comparable-country average of 67 percent. All parties accept the current experience is unacceptable. All parties propose different mechanisms for addressing it.
Where the consensus genuinely breaks down: anything touching the structural design of Māori health services, reflecting a real disagreement about both mechanisms and values; and the universal-versus-targeted question on free services such as GP visits and prescriptions, reflecting a genuine philosophical divide about the state’s role. Both are worth debating. Neither can produce a mechanism-neutral outcome goal that survives a change of government.
The five health outcome goals that pass the test are:
Goal 1: Reduce New Zealand’s youth (under-25) suicide rate from worst in the OECD to below the OECD median within 10 years.
Goal 2: Increase pharmaceutical spending as a share of the total health budget from 4.9 percent to the OECD average within 10 years.
Goal 3: Achieve 90 percent of cancer patients receiving treatment within 31 days of a decision to treat by 2030, rising to 95 percent by 2035.
Goal 4: Reduce the proportion of New Zealanders reporting an unmet health need from within the highest international quartile to below the OECD median within 10 years.
Goal 5: Reduce the proportion of New Zealanders reporting unacceptably long wait times from 73 percent (2024) to below the Commonwealth Fund comparable-country average of 67 percent within five years.
Each of these can be tracked against an external benchmark. Each is mechanism-neutral. Each would be accepted by a government of any composition as a legitimate destination. Together they constitute a goal set that could survive an election.
The Consensus Catalogue: Applied Across the NZ2050 Backlog
Health is the first entry in a running exercise. The same methodology, strip the mechanism, identify the shared destination, test for smuggling, benchmark against external comparators, will be applied to each major topic in the NZ2050 series. Each topic generates its own goal set. The full catalogue, once complete, becomes an executive summary of what New Zealand actually agrees on across every major policy domain: not a political platform, but a document showing where the country already has a mandate that goes beyond any single coalition.
On energy, both major parties support New Zealand’s 100 percent renewable electricity target. The mechanism, timeline, technology mix, and the role of gas as a transition fuel, is contested. The destination is not. A candidate goal: 100 percent renewable electricity generation, tracked against the grid mix annually with a 2035 target date.
On housing, all parties accept that home ownership rates for younger New Zealanders are declining and that a shortage exists. The mechanism, density mandates, RMA reform, government build programmes, foreign ownership rules, is the perennial fight. A candidate goal: restore first-home ownership rates for under-40s to within 10 percent of the OECD median within 15 years.
On infrastructure, there is consensus that New Zealand underinvests relative to need and relative to comparable countries. The mechanism is contested. A candidate goal: bring New Zealand’s infrastructure investment as a share of GDP to within 10 percent of the Australian average within 10 years.
On education, international PISA rankings show New Zealand’s results declining and outcomes unequal. The mechanism, curriculum settings, school structures, teacher pay, charter versus state, is the perennial fight. A candidate goal: return New Zealand to the OECD top quartile on PISA reading and mathematics within 10 years.
The pattern is consistent across every domain: the destination is shared and the road is disputed. The NZ2050 series has been mapping the destinations. The political alignment framework makes the pattern explicit and builds a durable foundation beneath it.
The Institutional Question: Who Keeps the Goals?
A list of agreed goals with no keeper does not survive contact with a new government. The mechanism fight will eventually consume the goal if there is no independent institution to defend it. But institutions can be restructured, commissions can be defunded, and statutory obligations can be repealed. The Zero Carbon Act had all three and it was gutted in weeks by a government with 61 seats. The institutional architecture of the goal set must be harder to reverse than the goals themselves.
The Supermajority Threshold
New Zealand already has the mechanism. Section 268 of the Electoral Act 1993 entrenches six provisions against change by simple majority: the term of Parliament, the voting age, the method of voting, the formation of the Representation Commission, the drawing-up of electoral districts, and related provisions. Changing any of them requires either 75 percent of members of Parliament or more than 50 percent of voters at a referendum. The precedent has operated since the Electoral Act 1956, when National’s Sydney Holland secured cross-party support to protect basic electoral law from the vicissitudes of simple majorities.
A supermajority requirement of 75 percent applied to a statutory health goal set would mean that in most parliaments, reversal requires the support of at least the largest government party and the largest opposition party. That is a very different political calculation than a simple repeal bill. Dismantling the goals would require a public argument about why the destination itself was wrong, not just why a new mechanism was preferred. As the Zero Carbon Act demonstrated, a law without this protection can be hollowed out quietly. A law with it cannot.
There are legitimate constitutional debates about whether outcome goals are the right kind of provision to entrench. Those debates are worth having. But the principle is established in New Zealand law: some things are too important to reverse by simple majority. The case for applying that principle to national health outcome goals built on evidence and tested against the smuggling test is at least as strong as the case for protecting the voting age.
The Supporting Layers
Three additional institutional layers sit beneath the supermajority threshold, each adding friction to the reversal impulse. An independent commission, modelled on the Climate Change Commission before its November 2025 reform, would track progress against the goal set, publish annual assessments, and advise the government on required policy adjustments. The government would be required to respond publicly to recommendations it rejected. The political cost of visible non-compliance rises when a credible independent body makes it legible.
A permanent cross-party select committee provides a parliamentary forum for reviewing progress. No executive power, but a standing public record that makes backsliding visible and requires explanation from any government that chooses it. Ireland’s experience with Sláintecare shows that a parliamentary process, even without legal enforcement, creates political ownership that is difficult to abandon.
Statutory obligations embed the goals in legislation and require any incoming government to either comply or explicitly repeal. Repeal is on the record; it requires a parliamentary vote; it is harder to do quietly than a ministerial direction.
The architecture worth building: supermajority-entrenched statutory goals, tracked by an independent commission, reviewed by a permanent parliamentary committee. Each layer is independently insufficient. Together they make reversal a deliberate, public, contested act rather than an administrative convenience.
Scale-Up Scenarios
The scale of what New Zealand gains from policy continuity depends on how much institutional protection the goal set receives.
The case for Tier 3 is not that it is easy. A supermajority threshold requires more genuine cross-party support to enact than a simple majority law. But the threshold is achievable for a goal set that passes the smuggling test: goals defined in outcome terms that no party could credibly reject. The political cost of publicly refusing to support “reducing child suicide to below the OECD median” is higher than the political cost of proposing a different mechanism for achieving it.
What This Does to the NZ2050 Backlog
The NZ2050 series has been mapping first-principles policy in each domain: what a coherent health system would look like designed from scratch, what a mining framework built for 2050 would prioritise, what genuine innovation investment at three to four percent of GDP could produce. Each piece describes a destination worth reaching.
The political alignment framework is the connective architecture. It is the mechanism by which any of those first-principles frameworks might actually compound across governments. The Conservation Endowment Fund from the mining piece requires statutory continuity to build its corpus over decades. The prevention-first health system requires 15 to 30 years to produce measurable improvements in population health. The innovation multiplier compounds with each successive research and development budget. None of these work in three-year cycles.
The political alignment framework is not a separate topic in the NZ2050 series. It is the chassis on which every other topic runs. The question of what New Zealand decides its future looks like is only half the design problem. The other half is how New Zealand ensures that decision survives long enough to find out if it worked.
Conclusion: The Compounding Cost of Reversal
Inaction has an opportunity cost. So does reversal. Every three-year cycle of build-and-dismantle carries a compound loss: the cost of the original investment, the transition cost, the institutional knowledge lost, the private investment that never arrived because the framework was not stable, and the years of the new approach before it too faces revision. That is not policy disagreement. It is policy destruction.
New Zealand has the evidence to support five durable health outcome goals. It has the institutional model in Ireland’s Sláintecare. It has the domestic precedent in the Zero Carbon Act, and the proof of what happens when that precedent is unprotected. And it has the legal mechanism in Section 268 of the Electoral Act: the right instrument, applied to the wrong domain for thirty years.
The November 2025 dismantling of the Zero Carbon Act is worth reading not only as a climate story, though it is that, but as a governance failure: proof that cross-party consensus and statutory obligation, without supermajority protection, are not enough. New Zealand spent six years building a bipartisan climate architecture and lost it in weeks. The health system cannot afford to learn that lesson twice.
A country that agrees on where it is going but cannot decide how to get there should protect the destination. The five health goals in this piece are that protection: externally benchmarked, mechanism-neutral, and designed to outlast any government willing to commit to them.
The question is whether New Zealand has the political maturity to apply the same logic it already uses for the voting age to the outcomes that determine whether its children live.
References
[1] Commonwealth Fund, Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System, October 2024. commonwealthfund.org
[2] OECD, Health at a Glance 2023: Avoidable Mortality (Preventable and Treatable). oecd.org
[3] UNICEF, Report Card 18: Child Wellbeing Rankings, 2024. unicef.org
[4] Irish Department of Health, Sláintecare 2025+: The Path to Universal Healthcare, May 2025. gov.ie
[5] Sláintecare Implementation Progress Report 2024. gov.ie
[6] New Zealand Ministry of Health, Health Targets, March 2024. health.govt.nz
[7] New Zealand Ministry of Health, Health and Independence Report 2024. health.govt.nz
[8] Medicines New Zealand and BMS, Access to Innovative Pharmaceutical Medicines in New Zealand, 2026. bms.com
[9] ACT Party, “ACT Sets Achievable Path to Close Medicines Gap with Australia,” July 2026. act.org.nz
[10] The Spinoff, “Zero Carbon Act Overhaul Signals End of Political Consensus on Climate Change,” 7 November 2025. thespinoff.co.nz
[11] The Conversation, “The Government’s Dismantling of Climate Laws Breaks Years of Cross-Party Agreement,” November 2025. theconversation.com
[12] RNZ, “How Jacinda Ardern’s ‘Groundbreaking’ Climate Law Has Become ‘a Shell’,” 2026. rnz.co.nz
[13] Electoral Act 1993 (NZ), Section 268: Restriction on Amendment or Repeal of Certain Provisions. legislation.govt.nz
[14] OECD, Society at a Glance 2024: Suicides. oecd.org
[15] Brian Easton, “How Well is the New Zealand Healthcare System Doing? An International Comparison,” March 2025. eastonbh.ac.nz
[16] Cardiovascular Drug Access in Australia and New Zealand: New PBS and PHARMAC Listings 2023-2025, ScienceDirect, 2026.
[17] RNZ, “New Zealand Has Highest Child Suicide Rate, a Survey of Wealthy Countries Shows,” 2024. rnz.co.nz