The Tribune

WHILE Health Minister Dr Duane Sands is to be commended on his announcement regarding Universal Health Care, we, as Bahamians, need to answer some fundamental questions as to the future of our public healthcare before we go any further down this slippery slope of a single payer, income-tax funded socialised medical system, such as they have in Canada and the UK.

Firstly, do we consider healthcare to be a right of all the people, or a commodity made available based on income or a civil servant making gut-wrenching life or death treatment decisions? Or are we as a nation prepared to accept the elephant in the room and refuse to acknowledge the appalling hospital mortality rates and heartbreaking survival rates for Bahamian children as opposed to those diagnosed with similar cancer and other auto-immune diseases in Canada and the USA?

There are a number of reasons for the unfortunate reality that those who live in the first world – USA, UK, Australia, Japan, Canada and Europe – live, on average, 20 years longer than those residing in the world’s poorest counties. The reason is obvious.

If you have private health insurance, then you go to the doctor on a regular basis, resulting in life-threatening illnesses being detected at an early stage when they can be effectively treated. If you are of the working-class, or among those less fortunate – without health insurance that keeps you out of a doctor’s office when you are ill or cannot afford annual physicals – your chances of survival from a serious illness are significantly reduced. These are the facts even though you might be treated in our nation by the very same physicians who work at both Doctors and Princess Margaret Hospitals.

Secondly, our problems are magnified ten-fold when talented physicians, nurses and support staff are asked to deliver patient care in the “crumbling dilapidated infrastructure of our nation’s public healthcare system….,” the details of which former Managing Director of the Public Hospitals Authority, Mr Herbert Brown, shockingly revealed in his pre-retirement letter to the then newly appointed Health Minister Dr Duane Sands.

Shedding light on his repeated requests to the former government for funds to repair the extensive damage suffered by the PMH roof and wards during Hurricane Matthew [2016], which were “impacting patient outcomes,” Mr Brown reported that the structural deficits; unfunded obligations; lack of a capital budget; increases in personal emoluments, allowances, overtime and sessional pay and ongoing revenue woes, such as the PMH’s financial systems, which had been unable to send out patients’ bills; insurance reimbursements or charge tourists for services since 2012 — a period of almost seven years. All of this led to inexcusable short falls in funds needed to purchase medicines, vaccines, medical/surgical supplies or undertake repairs and maintenance.

According to Chairman of the National Health Insurance Authority (NHIA), a scheme has been devised so that no one will be excluded on the basis of their current illness, nor will they be charged.

“One of the major problems in our health care system is we lack equity,” said Dr Robin Roberts, explaining that “those who need care can’t get it and those who need more care can’t get anything. They just don’t have the money…”

This is a rather simplistic explanation from Dr Roberts in view of Mr Brown’s final report as he departed the system. Dr Roberts should know that our current public healthcare system is not designed to provide quality, cost-effective care for anyone. Adding a Health Income tax on top of an outdated, bureaucratic system which has been destroyed by politics, conflict of interest and alleged systemic corruption makes a solution almost impossible. Having refreshed our memory by having a quick look through The Tribune’s files one could make the argument that our current public healthcare system enables a select few to benefit from chaos with a glaring lack of accountability thus ignoring the appalling patient outcomes.

How else could anyone explain a hospital without a roof or patient beds? Or an institution whose billing systems are so outdated that they cannot issue patient bills, submit reimbursements to private health insurance providers for patients or even charge tourists resulting in receivables which the Minister of Health has publicly said are close to $800 million? Or how about the financial secretary agreeing to generous raises for the Consultants Staff Association. Obviously they have not taken the time to read the PHA Act - resulting in many getting raises, but no one raising the issue of patient care. How can interns and medical residents receive a reported 80-plus days paid leave a year? What about patients in public wards of the PMH receiving private bills from entities claiming fees for services for physicians contracted by our nation to work as part-time civil servants?

Even the blind can see how surprising it was to read that some had withdrawn their services from treating public patients, yet, continued to admit and treat private patients in the operating theatres and wards of the very same public heath institution from which they had withdrawn their services hours earlier. Refusing to treat patients unless they are rich enough to pay by cash, credit card or are in possession of health insurance is unconscionable.

To the former administration’s credit they allocated the Public Hospitals Authority $1.1 billion between 2012 -2017. Sadly, as Dr. Duane Sands pointed out in his 2017-2018 Parliamentary Budget contribution money cannot fix a toxic culture of “politics, entrenched corruption, chronic incompetence, unaccountability and lackadaisical leadership.

“What is needed,” he said, “is a healthcare revolution.” Without a radical transformation and revamp along the lines of the airport authority, BTC, and BPL, a select few will reap the benefits, as they always have, while tens of thousands of Bahamians will still be unable to get the healthcare they need and deserve.

For decades, every man, woman and child in Canada and the UK has been guaranteed healthcare through a single-payer health care programme. In fact, while Universal Healthcare in a variety of forms exists in every wealthy industrialized country, they are not single payer, socialised medicine schemes like Canada or the UK.

We need to have an open, brutally honest understanding of the state of our public health infrastructure, the benefits and financial implications before we rush to join the rest of the world given that no-one – including the Minister of Health or Private Health Providers – supports nor can even explain how NHI arrived at its costings. For example, NHI promised in April, 2017 that Primary Care would be free. Previous to that the PLP had said that NHI would cost 5.8%. Now Dr. Robin Roberts wants to start with a 2% Health Income Tax?

While we don’t share the concerns expressed by the Chamber of Commerce regarding the quality of healthcare given the unconscionable neglect that we have seen at the Princess Margaret Hospital, NHI Primary Care is a useless drop in the bucket of what is really needed to “guarantee” universal healthcare for all citizens if the hospital remains in its present condition. To implement universal health care, the World Bank estimates we need to increase per capita spending from approximately $1,750 and bring it in line with those of Canadians $4,533, the Germans $5,353, the French $4,530, the British $4,125 or Americans $8,793.

According to an editorial in Investor’s Business Daily (IBD) “no industrialized country in the world has a government-run health care system dollar coverage without limits. Even Canada’s single payer system doesn’t cover prescription drugs, home care or long term care, vision or dental.” Every countries relies on out-of-pocket spending to cover a significant portion of their health costs, ranging from 27.7% in Switzerland, 15% in the United Kingdom and Canada, 13.7% in Denmark to 12.2% in the Netherlands. Surely the FNM is not proposing an income tax on top of 12% V.A.T., duties, business licence fees; some of the highest electricity rates in the world and an ease of doing business only marginally better than the war-torn Gaza strip.

Fourth, while Universal Healthcare should be a citizen’s constitutional right, just as anyone over the age of 18 needs a drivers licence every gainfully employed citizen needs some form of health insurance. NHI should be catastrophic healthcare, not “socialised medicine” which is a dangerous illusion. “The biggest problem,” says IBD, is “socialised medicine and the underlying assumption that government central planners can manage trillions of dollars’ worth of resources better than hundreds of millions of people making trillions of decisions every day in the free market.” Look no further than the Soviet Union, North Korea, Cuba, the East Block, the chaos in Venezuela and delays facing patients in both Canada and the UK to see what a failure it has been whenever and wherever it has been tried.

Given the billions in staggering losses, inefficiency and mismanagement at Bahamasair, Princess Margaret Hospital, old Nassau International Airport, BaTeLCo, Inflight Services, BEC, Water & Sewerage, the Hotel Corporation and various other state entities over the last 40 plus years surely in a moment of optimism someone of Dr. Roberts’ medical expertise is not suggesting, as the recent “Citizens for Universal HealthCare” wrap in The Tribune recently quoted Ron Paul as saying “we accept that the state can make medical decisions for us because we accept it owns our bodies?”

Unless Prime Minister Minnis has changed his mind from when he slammed the PLP’s greed in Parliament, castigating the former administration for the “chaotic manner” in which it sought to implement NHI without an accurate estimate of what it will cost, surely he’s not proposing giving Dr Robin Roberts authority for NHI to charge citizens with income tax rates that will inevitably reach 30-40%. So far the NHI Primary Care proposal is a non-starter!