The Tribune

EDITOR, The Tribune.

Thank you for allowing me the space to write my perspective on something I feel is very important as a Bahamian finishing school overseas and considering my return home. From what I have been reading in the Bahamian papers online for the last few months, 70% of Bahamians have no health insurance and over one third lack any affordable access to quality healthcare.

Many have suffered in recent years through a loved ones problems of ill health and the increasingly high cost of helping them receive care in our country. Every day hundreds take time off work waiting in lines at public clinics or hospitals in uncomfortable conditions with a lack of focus on our people’s needs or satisfaction.

Two major challenges seem to coexist – strengthening the existing public health services while swiftly implementing some form of assistance to address the current inequities and reduce the burden of catastrophic health spending that so many families face. Together, it seems these are having a huge toll on our lives, our economy and our society.

The lack of a solution to the challenge of affordable health care means that across The Bahamas our most disadvantaged are forced to go without their medications for deadly chronic diseases such as diabetes and hypertension, while many others can’t access critical services such as ultrasound during pregnancy or the surgery to repair a hip or knee because they cannot afford the expense. Still, hundreds more are forced to turn to family, friends, churches, employers or high-interest loans (if they can get one) to raise funds for medical expenses that can easily reach tens of thousands of dollars and have forced hundreds of Bahamians into bankruptcy.

Starting nearly 30 years ago, Sir Lynden Pindling set out a vision for universal healthcare in the country and despite the approval of the National Health Insurance Law in 2007, and other initiatives under both parties, it appears that universal health coverage remains elusive. I just can’t understand how so many countries, less developed and lower income than us, have been able to provide this basic protection to their people, but we have not.

It doesn’t have to be this way. A number of developing countries from Brazil and Thailand to regions in India have shown, through their pioneering public policies, that basic healthcare for all can be provided at a remarkably good level at very low cost if the society, including the political and intellectual leadership, can come together. Are we saying that Bahamians cannot do this? I certainly hope that is not the case.

Nearly all the top developed countries in the world have universal health coverage today through a combination of public funding, contributions and innovative financing mechanisms.

Detractors to the vision of National Health Insurance, protecting their interests, have repeatedly taken to the pages of this paper and others to decry the demise of the economy, their livelihoods and society as we know it. These declarations, made to protect the interests of what appears to be a few hundred people and the economic interests of small select group, clearly overlook the pain, suffering and financial hardship of more than one hundred thousand Bahamians. Let’s put the people first. According to the government’s consultancy report, last year more than 700 people perished because the health system could not meet their needs or they couldn’t afford the care they needed.

We can’t afford to standby while waste weakens our system, millions of dollars flow overseas and administrative expenses take nearly ¼ of our healthcare dollars.

There is no surprise that the goal of affordable healthcare for all Bahamians has been centrally placed in the government’s policy agenda but the question remains regarding how we afford it. The newspapers often cite figures of between $362m to over $950m depending on the source and the objective of each estimate.

The private health insurers would clearly like to protect their high profits and ample administrative expenses, while the government would like to minimise the impact on the budget and contain costs. How can these two competing interest be reconciled within an affordable framework? To answer these questions, let’s examine a few key facts:

1) Bahamians are currently spending nearly $900m a year in healthcare costs. There is a lot of “wiggle room” in there. Just like when my family and I were deciding on which school I should attend, at first it seemed we wouldn’t have enough for my choice school. Then we realised if we saved money on gas, cut money on dinners out, and lowered our cable TV subscription services we could save over $5,000 a year! In my mind, that’s what has to happen here. We need to find a way to move our money around, be more efficient, and get the results we need.

2) Each year, more than $60m is spent overseas for a lot of care that can be done in the country. At the absurdly high prices in the US, a lot more healthcare could be purchased with those resources if they stay in the country.

3) There are many other opportunities for the government to raise revenue to contribute to financing affordable care for all. Other countries have recently had success establishing levies on alcohol, tobacco, high fat and high sugar foods, gambling and others. Even small improvements in revenues from property taxes could boost revenues to allow government to fund the initiative.

4) Government is still spending less on health, at 4.5 per cent of GDP, than most OECD countries – which spend around six per cent. Making health investment a priority should be reflected in the overall spending and will yield huge economic and productivity gains in the future.

So let’s stop being led by business and ideologues who want “the government to be out of our lives” and let’s get started with the implementation of affordable access for all Bahamians. Tomorrow is not another day for those who can’t afford or get access to the care they need today. I don’t want to come home to a country where we consider the health needs of the sick and vulnerable less important than those of the few who are financially powerful.

PHILLIP ROLLE

Graduate Student,

Nassau,

May 28, 2015.