The Tribune

AS PRIME Minister Christie scratches his head to find money to rebuild the southern islands, badly damaged by Hurricane Joaquin, he anticipates having to face what he has called a “confusing debate, between the government, the Medical Association of The Bahamas and the insurance industry”.

By taking the National Health Insurance (NHI) out of the hands of the Ministry of Health and moving it into his own portfolio, the Prime Minister had hoped to avoid all the pitfalls that could present obstacles to the introduction of NHI in January. But, has he really made it clear to Chief Medical Officer Dr Glen Beneby that future decisions have been transferred from his to the PM’s office? Apparently not, as there still seems to be confusion with the left hand not knowing what the right hand is doing. Instead of having a smooth sail around the obstacles, as the Prime Minister had hoped, one office appears to be on a collision course with the agenda in the PM’s office.

What will make the future difficult for the Prime Minister is that he doesn’t seem to be sufficiently clear as to what path he wants to take to achieve his goal. With him keeping the essential information of costs close to his chest, he makes it impossible for the doctors and insurers to make their own analysis of what they are facing. Because of the lack of information — or deliberate secrecy — a panic has started in the medical profession.

We have heard cases of recently qualified Bahamian doctors questioning whether The Bahamas is the place that they want to practice their profession —none of them want to exist in a welfare state — they only have to look at the problems in the UK and Canada to help them decide that The Bahamas under this health scheme is not for them.

As for doctors already established they also want to know exactly what they are facing, so that they too can decide their futures — is it to be The Bahamas or should they start putting their house in order and seek to set up their practice elsewhere? They want to know this before they get to the age that moving would be difficult. This is the talk that we are hearing. The fears of a profession, whose members have not been given sufficient information to make a personal decision, are going to be the background against which the Prime Minister will argue his plan for NIB.

Both doctors and insurers are upset that they have been denied a copy of the non-disclosure agreement between the Association, its health insurer members and PricewaterhouseCoopers (PWC) so that they can do their own review of what NHI could cost the industry — and whether it is feasible for the country.

This review would allow them to discover PWC’s assessment of the cost figures supplied to government by their consultants, Costa Rican-based Sanigest Internacional. From what we have heard, the doctors and the insurers will not budge from their position until they have the figures to understand what trap they might be walking into. And until the Prime Minister is prepared to release this precious nugget of information, we predict that he will be faced with an immovable object.

Prime Minister Christie has estimated it will cost about $60m to restore these ravaged islands. From what we have seen and heard, we think this is a conservative estimate. But from where is this extra money to come? Already VAT has been introduced, ostensibly to pay down the $6.248 billion debt. Has any part of VAT gone as yet to this debt repayment? In December 2014, the Central Bank reported that the Bahamas’ national debt was now above the 70 per cent bench mark “which the International Monetary Fund (IMF) has previously described as the threshold where countries are in increasing danger of losing control of their financial affairs and sovereignty.”

Instead of bringing down the debt, Mr Christie is looking for more funding – should we borrow from the Caribbean Development Bank, go cap in hand to the People’s Republic of China or to ”other traditional sourcing”?

Instead of cutting back, we are plunging even deeper into debt — soon we shall hear the death knell for our economy from Standard & Poor and/or Moody’s.

Incidentally, we think it is time that government gives Bahamians an accounting of how deeply in debt we are to the Republic of China and how much and what does that government own in this country. Also when it comes to a vital vote in the UN whose side will the Bahamas be on – the US or China? Or will we have to abstain to remain neutral? We hope this government is thinking of the future — which, they must remember, exists beyond the ballot box.

Outlined in government’s “Stronger Bahamas” plan there is a commitment to “phasing in National Health Insurance over the course of several years starting with strengthening existing health services, then focusing on Bahamians with no access to health insurance.”

A prudent government facing the destruction left by Hurricane Joaquin would immediately know that NHI has to immediately go on the back burner.

And certainly from the primitive standard of medical service that government can barely supply in the wake of this hurricane, we believe that a sensible government would understand that the plan now should be to get the standard of care up to an acceptable level before they even think of moving into anything more complicated. From our observations over the past several days in the path of Joaquin the standard of medical services is so inferior that any money that can be spared should go to raising those standards.

Imagine sending nurses into an area where there is no electricity, no generators, no diesel and no refrigeration with medication that has to be kept at a certain temperature. They are provided with no small change and no “topped up” cell phones to keep in communication with each other or their headquarters in Nassau. These are the first responders, who didn’t even arrive with the basics. Such private organisations as SOS-Save our South, Save our Bays and many others provided the funds and planes to fly in generators, fuel, and medication. In Crooked Island SOS “topped up” the cell phones for the nurses, police and Defence Force so that they could at least communicate with each other and their Nassau headquarters.

Without power, the refrigerator in which the insulin for diabetics was stored shut down. Of course, the insulin was destroyed. Nassau apparently sent a new supply without a second thought that that too would spoil unless it was accompanied by a generator to keep the refrigerator running. In fact, the second supply did spoil.

A private donor quickly stepped up to the plate and not only was a new supply of insulin flown in, but a solar powered generator to keep the refrigerator running accompanied the medication.

The decision that the Prime Minister has to make at this stage of our backward development is to concentrate on getting what we have up to standard so that better medical services can be provided for more Bahamians before NHI is even considered. If he makes this sensible decision he can avoid the “confusing debate” that he now fears.