Dear Editor,
Your Editorial comment of November 30 (What if Bahamians Don't want the PLP's NHI?) is more thought out and cogent than much of the naked scaremongering that we see coming from the opponents of progressive health care. But it is wrong on many fronts and it is a continuation of the politicization of the whole subject of NHI.
I begin with your premise that the idea of a single payer, tax-funded system is something about which Bahamians are reluctant or uncomfortable. This is untrue. Whether or not you accept the scientific accuracy of the study reported in your business section on November 27 (that 78 percent of Bahamians support NHI and support paying a tax for it), what is clear is that the vast majority of Bahamians are not satisfied with the system we have now. While there is no doubt that skepticism exists as to what will replace it, much of the doubt is generated by the politicization of the issue and the media's constant association of the whole notion of NHI with the PLP.
A recent, honest and very intelligent letter by Noelle Nicolls, a young journalist, sums up the confused informational vacuum produced by this politicization of the issue. Nicholls begins, naturally, by declaring her own interest, as a recently rebuffed seeker of private insurance (because of a job change and an existing precondition). But while strongly registering her dissatisfaction with the Bahamian private insurance industry, she is uncomfortable buying something being sold by a politician (in this case, Bradley Roberts). The result: a total dilemma.
But Nicholls' dilemma did not need to arise, and it likely would not have if the media were not so obsessed with politics and the debate itself was not constantly being steered into a beauty contest between the BIA and the PLP. Many Bahamians trust neither. But attempts to conflate the larger picture with small politics are a dangerous distraction.
The simple answer to Nicolls is that YES, publicly funded, single payer systems work. And YES they are a viable alternative to the private system which Nicolls, like most Bahamians, can see does not work for her. Single payer systems work in Canada, the UK and throughout the developed world to such an extent that, once introduced, no serious political party would dare to threaten their removal. They are not only the norm in advanced countries, they are the way the whole world is now moving.
Unfortunately, the media has so cluttered the issue with politics and theatre that serious commentary is largely absent in the Bahamas. Pastors, union men, insurance executives, chamber of commerce representatives and politicians galore are quoted making assertions on the viability and effects of a single-payer system, but not one serious, disinterested economist ever seems to be sought out by the media. That is the nature of the coverage this matter gets.
As to your assertion that references to cookouts and other indignities are part of an emotional campaign to push NHI, I fail to see what is wrong with that. I and every Bahamian that I know has had family members resort to such extremes as a result of our lack of a sane and fair public healthcare system. It is worthy not only of emotion, but of disgust. Your assertion that a single-payer system (funded by an earmarked tax) would not change that is curious, and I would be interested in the logic that supports it. Certainly, cookouts for healthcare are unheard of in any country I know of with a universal healthcare system.
Lastly, your suggestion that we should voluntarily impose on ourselves a system like Obamacare, which was forced on Obama by the realities of the Tea Party, the Koch Brothers and a corrupt congress under the control of special interests, is frankly chilling. In an ideal world, the U.S. President would have shunned his namesake in favor of a system more like those supported by his ideological counterparts in Canada, the UK and everywhere else in the developed world. He has as much as said so. In fact, even the right wing Tories in the UK support the 'socialist' NHS and would consider Obamacare insufficiently universal coverage to even contemplate as a serious proposition. So let's keep this in context when we cross national borders for reference.
Obamacare is a uniquely American product of a uniquely American environment. It is the culmination of the long American tradition of progressive governments compromising with the well-financed forces of regression. This, in turn, is an unintended consequence (most of the Founding Fathers lived to regret it) of a feature of the U.S. governmental system which intentionally engenders standoff, confrontation and quagmire between the different branches of government. The resultant tradition of 'compromise' has been at the heart of all of the country's most serious historic failures.
From the 'Compromise of 1850' (which delayed yet made inevitable the Civil War a decade later), to the hideous Kansas-Nebraska Act of 1854 (which temporarily placated slave-holders), to the compromises with a Democratic congress that ended the era of reconstruction (reversing much of the progress for which Abraham Lincoln died and signaling the start of 100 years of Jim Crow) to the infamous "Southern Strategy" by which the likes of Nixon and Reagan captured the south for the Republicans for two generations by playing to the racist fears engendered by Lyndon Johnson's self-sacrificing commitment to integration, to Bill Clinton's pathetic nod to inclusivity when he told gays they can serve in the army, but had to keep it hush so as not to offend Neanderthals, progress has been watered down by 'compromise' at every turn in U.S. history.
Indeed, the fact that basic access to healthcare is being debated in the USA today (50 years after being resolved throughout the developed world) is a result of the compromises that boxed in FDR's first attempt to leverage the U.S.' wealth into a 'New Deal' for its citizens. So when students of history hear 'compromise' in the U.S. context, they know that it seldom means anything good.
Obamacare is likewise a 'compromised' product of good intentions. It reflects the deeply corrupt power that special interests (like the private insurance industry) hold over the U.S. Congress today. In recent years, this corruption has been deepened by a politically appointed Supreme Court, which has practically removed limits on the extent to which special interests can buy policy (the so-called "Citizens United" decision).
The resultant 'Obamacare' that has emerged from this process is not the brainchild of Barrack Obama or even of the Democrats. Rather, it is the vestige of an old Republican attempt to head off genuine reform. You will recall that it was Mitt Romney (of "corporations are people, too" fame) who essentially pioneered it in Massachusetts.
Consequently, and predictably, what it boils down to is a system that is, whatever else you want to call it, NOT universal healthcare. It does not ensure access to the neediest. Basically, it requires all Americans to purchase private health insurance and prevents insurance companies from doing what was done to Nicolls - denying consumers coverage because of risk-related factors. It does not, has not and will not bring down healthcare costs generally.
After Obamacare, as much as before Obamacare, medical expenses remain the single largest cause of personal bankruptcy in the United States. Meanwhile, insurance companies have continued to make obscene profits. Nobody is denying them or any other capitalists the right to make as much profits as possible. But what populations of democratic states are entitled to expect is that their governments will at least remove the vulnerabilities that make them the potential victims of somebody else's profit. Healthcare is not a discretionary expense. It should not be left to the vagaries of an unfair market where the forces of concentrated power make the rules.
Americans want truly universal healthcare as do Bahamians. Americans won't get it as long as their fate is in the hands of a big business machine that long ago bought their congress and has now apparently filed the deeds with the Supreme Court. Obama is therefore excused and credited for bringing something better but still not good enough for his people, given what he is up against. Perry Christie has no such excuses. He should listen to the people, not the special interests, and introduce the truly universal healthcare that is the hallmark of every almost successful capitalist country on earth.
- Andrew Allen
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