"Investing the necessary public resources to achieve universal health [care] is a social, political and economic necessity that should no longer be delayed..." said participants in a forum organized by the Pan American Health Organization/World Health Organization in the lead-up to Universal Health Coverage Day, Dec 12, 2015. We do not believe any right-thinking Bahamian would disagree with that statement and thought. To our knowledge, no one in The Bahamas disagrees with it.
What most people find frightening and offensive is the fact that government believes that the only way to achieve universal health care it has is to nationalize the private healthcare system in The Bahamas. That is not the case. Universal health care in The Bahamas can be achieved without nationalization of the private health care system in The Bahamas. It is an accepted fact that the government is not capable of running anything effectively.
There is not one example that can be shown where government has been successful in operating any of its entities to world standards. Bahamasair, the Bahamas Telecommunications Company (BTC), the Bahamas Electricity Corporation (BEC), the Water and Sewerage Corporation (WSC), Bank of The Bahamas (BOB), the Bahamas Agriculture and Marine Science Institute (BAMSI), the Bahamas Development Bank (BDB) and the Public Hospitals Authority (PHA).
Let us look at some facts. We know governments do not like facts, but these are their facts. Both the prime minister and minister of finance, in the person of Perry Christie, and Dr. Perry Gomez, as minister of health, have admitted that both the public sector and the private sector spends approximately $400 million per annum for healthcare costs. That is a total of $800 million, which will only increase.
Dr. Glen Beneby recently admitted that although the PHA has a government subsidy of over $400 million, it manages to waste at least some $100 million per annum. Furthermore, he has admitted that the PHA is not capable of delivering the standard of medical care it ought to. Is this the fault of the private sector? Absolutely not.
The PHA squanders its money and in return asks government to nationalize health care in The Bahamas. Increasing the PHA's budget under a new name will not result in a miraculous improvement in delivery of the world-class service the PHA should have been delivering all along. Bahamians ought to be outraged that their precious tax dollars have been handled with such blatant disregard for a vital social service with life and death consequences. But rather than rein in public wastage, the government sees fit to vilify the insurance sector through its foreign mouth-piece and "consultant', Sanigest.
Indeed, Sanigest has had the effrontery and gone so far as to state that the insurance sector consists of nothing more than "money-grubbing asses". No apology has been issued by government for these remarks. Apparently, government believes that it does not qualify as a "money-grubbing ass" for wasting $100 million per annum of taxpayer money. We do not know how much public money has been wasted on the foreign consultant (but hear it is the region of some $1.6 million) to bastardize a fully fledged and properly functioning Bahamian industry.
What happens when government takes charge
Insurance premiums may be considered high but that cost is primarily driven up because of the high cost of medical, hospitalization and pharmaceutical costs. While the public may complain that insurance premiums are high and unaffordable, there are few cries from the private sector that their medical needs are not being adequately met by their private insurers. Rather, it is those persons who have to frequent the public hospitals, the public clinics, etc., who are not being properly serviced by the government, even though there is the same amount of spend by the public sector and the private sector that is some $800 million.
Nationalizing the private insurance companies will not lower medical costs. Medical and hospitalization costs and pharmaceutical costs will remain what they are, only now government will have to pay - that is, through your taxes - the doctors, hospitals and pharmacists directly in place of the private insurance companies. Admittedly, the government recently revealed that the present national drug plan has more than doubled in cost than what had been anticipated since inception. We can surely expect the same under any government nationalized healthcare initiative.
To cut costs, eventually, government will have to put a cap on -- or "capitate" -- these doctors, hospitals and pharmacist costs. Government has already indicated through its Deputy Chief Medical Officer Dr. Delon Brennen that primary care providers under the nationalized healthcare initiative will be capitated at $212 per person per annum. Whether the doctors will agree to this is an open question. Nevertheless this can be done now without nationalizing the private health insurance market.
Note recent events in Canada as reported by the CBC: "Toronto - Cuts to doctors' fees that took effect Thursday triggered dire warnings from Ontario physicians... about longer wait times for patients.
"The Ontario government has cut funding for physician services by a total of 6.9 percent since February, which includes across-the-board cuts and a number of targeted cuts that affect specific specialties," said OMA President Dr. Michael Toth.
"These short-sighted cuts to physician services will result in longer wait-times and reduce the access to care for Ontario's patients," he said.
Progressive Conservative Leader Patrick Brown told the legislature: "That means longer wait times and less access to care in Ontario."
The New Democrats said the government needs to recognize that doctors should be properly compensated for the care they provide.
"This government is bound and determined to paint every single physician in this province as money hungry and opportunistic, and this is wrong," said NDP health critic France Gelinas.
All sounds very familiar does it not? Doctors in The Bahamas beware. At least some 30 percent of the population is not privately insured, but that does not mean that those people do not have access to health care. The Bahamas government has been in the healthcare business for a very long time; there is no reason not to be able to access health care in The Bahamas for very little cost. Unfortunately, it is the total ineptness (and corruption) of the government in its delivery of health care that has made and continues to make the provision of adequate health care to this segment of the population unsatisfactory.
We can do better
Universal health care in The Bahamas can be achieved by the government strengthening the provisions of the healthcare system and services that it now operates at a level that is compatible with private healthcare expectations, while leaving in place the existing system of private healthcare services (private insurance).
Moving forward with the present universal healthcare initiative will result in increased taxation. There is and will be a need to increase general taxation, which may also include taxes on harmful products like tobacco and alcohol. Additional reforms will have to be made to improve tax collection and increase overall efficiency in public spending, in general, as well as more specifically, for health, to ultimately stem the corruption and sclerosis of the healthcare system. But it has to be good, efficient and fair taxation.
Universal health care cannot be accomplished without raising taxes. Do not let government fool you on this. Health care will not be free. This was emphatically stated by Deputy Chief Medical Officer Dr. Delon Brennen on the ZNS Thursday evening news recently.
Alarmingly, today the government still cannot tell us what the costs will be. History has shown that the government cannot operate efficiently. The national drug plan has already more than double in cost expectations.
How can we afford to support government on such an important undertaking when it, as proposed, may ultimately destabilize the entire healthcare system for the private and public sector? The government ought to halt NHI and go back to the drawing board. The government should not be in the business of running a healthcare enterprise. There is a need to focus on improving quality healthcare service to Bahamians, especially the 30 percent of the population who must endure the inefficiencies and poor quality of care for which only government has been responsible.
We must have transparency on the use of funds and preventative care discussion; there are significant cost savings here. Over spending, wastage and other inefficiencies must be addressed to adequately serve the most vulnerable among us. Engage the insurance industry, do not dismiss it, to allow for a less onerous tax burden than an entire nationalization of health care. Take a responsible approach, not a nationalized option that uses a sledge hammer to kill a mosquito.
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