Back in the day - wherever did that bizarre saying come from? - we used to talk about helping someone in our cute egalitarian society by giving them a benefit. A benefit is financial assistance in time of need. Simple. Or not, actually. A benefit now has a cosier name - an entitlement - which is "a right granted by law or contract". Big. Difference.

There has been a lot of talk of entitlements over the ACC-in-a-pickle problem. It's a freaking big pickle. A $5 billion pickle, actually. And the punters who have "entitlements" are no longer called claimants; they are clients, lest it might sound as though they are putting their paw out. The ACC public relations dude told me the Labour Government had asked for the jargon change - Labour understood the power of Neuro-linguistic Programming. The theory was that people had actually paid their premiums and so shouldn't feel they were getting summat for nothing. Dinky idea, but as we now know, the premiums do not cover the cost of the ACC scheme - so claimants are getting something for nothing. Actually.

In a country of four million people, perhaps we cannot afford to make almost two million claims per year or fund every feathery stroker bonkers health regime. Drive down Jervois Rd and take a look at how many places will give your leg a rub all on the public purse. Personally, I have never found physiotherapy does any good whatsoever. Not to mention fringe industries like osteopathy which ACC sanctions. Not sure about acupuncture and aromatherapy, but I wouldn't be surprised.

Then there is the point that some of the things ACC pays for do not appear to be accidents. Apparently claims relating to suicide have gone up $12 million in the last year. And although we seem like a jolly caring society since we pay for endless therapy for sexual abuse victims, does this really qualify as an accident? The aim of trying to put right every wrong in the world might be noble, but it is also deluded and ultimately doomed. Why is it parents who lose their child in a car crash get compensation but parents who lose their child to meningitis or another disease don't? ACC's fluffy kitten sentimentality has created some bizarre and disturbing inequities.

Putting aside how the scheme has grown like topsy under the Labour Government, there are some other problems with the fundamentals of the scheme. I am still waiting for someone to explain to me why it is that large corporates, such as Fonterra and Air New Zealand, can opt out of ACC and self-insure - but I can't. Oh, I get the practical reason - that I don't have a lazy mill to cover a claim - but where is the policy rationale? The opt-out clause (cosy name: the "partnership programme") takes 15 per cent of the country's workers out of ACC. So if these corporates can manage their health and safety liabilities more efficiently than ACC, what does that say about ACC? Can it really be true that ACC pays a fixed charge to the state which is allocated to district health boards without a single price or volume negotiation taking place at any stage of the process? Everyone wants benefits but no one wants to pay for them. This is mad, actually. Sorry I can't come up with a cosier name for it. Just mad.

deborah@coneandco.com