But don't begin until you count the cost. For who would begin construction of a building without first calculating the cost to see if there is enough money to finish it? - Luke 14:28

As the implementation date for the government's National Health Insurance (NHI) scheme approaches, the debate among several stakeholders has heated up. In recent months, we have heard from the Chambers of Commerce, the Pharmaceutical Association of The Bahamas, the Medical Association of The Bahamas, the Bahamas Hotel and Tourism Association, the Bahamas Insurance Association (BIA) and trade union leaders just to mention a few.

This is expected as leaders of the various groups are supposed to speak on behalf of their members and represent their interests. It cannot be emphasized enough that as we mature as a nation, we must learn to engage in constructive debates and separate messages from the messengers.

In a democratic society, individuals and companies alike should have the right to voice their concerns without fear of intimidation or ridicule. Whether we agree or disagree with the views of others, we must be tolerant of one another and be willing to entertain opinions that differ from ours. It is only in an environment in which we celebrate our diversity and welcome unique perspectives that our nation can grow to become all that it ought to be. This article is the first of a series of articles that consider various angles to the NHI debate.

The starting point
The discussion about universal healthcare (UHC) in The Bahamas dates back to the 1970s and 1980s. A quick review of the archives and some online searches will reveal that we have been talking about achieving universal health coverage for decades albeit the actual description may have been different initially. However, the point is that we have seen the need to ensure that our people have access to quality healthcare without suffering financial hardship in doing so.

That being said, when we consider these reports and the recommendations contained therein, it becomes obvious almost immediately that we have not addressed this important goal in a focused, comprehensive and determined manner during this period. In the meantime, our people have had to endure substandard conditions at public healthcare facilities and relied on cookouts in some instances to finance private healthcare.

Hence, we need to call a spade a spade in admitting that we have not done as much as we could have to this point. In the same vein, it is important that we acknowledge that we have some form of universal health system in The Bahamas even though it is not broad enough and is hardly efficient.

Support for universal healthcare
It is apparent that there is broad support for universal healthcare in The Bahamas. In fact, no individual, business or group has come out to oppose an initiative that is being touted as one of the most significant developments since political independence. The question then is if the stakeholders in the private sector that have been occasionally portrayed as opponents of this noble objective have all voiced their support for the program, what is the problem?

There have been various papers published by international and multilateral organizations on UHC. These documents are consistent in emphasizing that UHC is a journey and each country's path will be different based on its unique circumstances. This is why we must leverage the expertise and existing infrastructure within our country in the design and implementation of UHC in The Bahamas.

The broad-based support for UHC across the country must not be squandered by the government and policymakers on a false perception that the requisite knowledge is concentrated in the public sector. Rather, we must invite stakeholders in the private sector to "put their money where their mouths are" and help to design the best possible UHC model for our nation. It is simply not prudent to fight or isolate individuals or groupings that can help us achieve our objectives in this regard.

Cost implications
One of the main disagreements between the stakeholders that all support UHC in The Bahamas is how much the proposed NHI scheme will cost taxpayers. It has been reported that the consultant engaged by the Ministry of Health estimated that the scheme will cost between $360 million and just over $600 million. The BIA on its part has floated a cost estimate of between $895 million and $1 billion based on local data from its members while noting that its estimates may be conservative.

The prime minister and minister of health have recently indicated that the actual or potential cost of the program is unknown at this time. The PM acknowledged the need to investigate the significant difference in estimates and has engaged an accounting firm to review these figures in order to provide an independent assessment of what NHI will cost us as a nation.

This is the right thing to do and it is this point that provides the impetus to refer to the popular Bible scripture - Luke 14:28 - which was highlighted at the beginning of this piece.

Our country is challenged with stunted economic growth, high unemployment, high Debt-to-GDP ratio and pressure on our credit rating. Many will recall that Moody's had warned in an earlier release that the government's NHI plans may create "upward pressures" on recurrent spending and complicate the fiscal consolidation exercise. It is therefore important that we first ascertain the true cost of what we will be embarking upon and determine how we will be funding the scheme.

Subsequently, a proper cost-benefit analysis must be conducted in order to decide on the phases, the impact on our economy and consequences from an employment perspective. We must also never forget that UHC is a journey and we can begin to take steps immediately to address the deficiencies within our healthcare system. The words of the prime minister that he will not risk the economy to fund NHI provide some comfort in this regard.

Collaboration with stakeholders
The first part of this series concludes with an appeal to all stakeholders to make genuine efforts at working together to deliver universal healthcare to the Bahamian people. Regardless of our individual interests and differences, we all share a common loftier goal of advancing the national interest for the benefit of present and future generations. The government has a duty to work in the best interest of the country and in doing so must be inclusive in its design of the best possible model of UHC for The Bahamas.

The distrust between the government and private sector that sometimes manifests in the form of reluctance to share information must be addressed. It is important that there is transparency in this whole process and we should not allow egos or pride to get in the way of doing the right thing for our nation. The extension of an olive branch by the government must be met by an equivalent commitment by partners in the private sector to act in good faith in discussions on the way forward. Time is of the essence and the Bahamian people need all parties to acknowledge their differences and for the sake country, work through them as we commence this important voyage.

The NHI series will continue next week to address true healthcare reform in The Bahamas. Until then, we should encourage an elevation of the quality of the discussion on universal healthcare and focus on the issues that have been raised by all stakeholders to date. There is nothing we cannot achieve as a nation when we utilize our God-given gifts and genuinely work together for a bigger purpose.

o Arinthia S. Komolafe is an attorney-at-law. Comments on this article can be directed to a.s.komolafe510@gmail.com.

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