The Tribune

By TANEKA THOMPSON

Tribune News Editor

tmthompson@tribunemedia.net

THE way the Christie administration is mishandling the proposed roll out of National Health Insurance is an appalling insult to Bahamians, but not surprising.

With just over three weeks until the registration process for the universal healthcare scheme is expected to begin, health industry stakeholders and the general public are still in the dark about the details of the plan.

We do not know how much it will cost or exactly how the first few phases of NHI will work. Those who will be queuing up to register in January have little idea of what they will be signing up for.

Most right-thinking people are in favour of universal healthcare. Members of our society are all too aware of how many of our friends or loved ones have had to stage cookouts or plead for financial aid to fund costly surgeries or treatment.

We also know how expensive personal health insurance plans are and those of us who are lucky to have comprehensive employee medical coverage are thankful.

However, these reasons are not enough to rush a plan to meet the Progressive Liberal Party’s long unfulfilled campaign promise.

NHI must be well planned and executed in a pragmatic way to ensure its success.

Perhaps most perplexing about the current NHI debate is the defensive, emotional and condescending way government officials respond to critique or concerns about the proposal.

Those who raise legitimate questions about how our tax dollars will be spent have been painted with the broad brush of elitism and not caring for the poor.

However, with a recent admission by Dr Glen Beneby, the Ministry of Health’s chief medial officer, that around $100 million or 25-30 per cent of the government’s annual healthcare spending is wasted, the public has good reason to demand transparency over NHI.

“We know that we are spending $400 million on average in the government sector,” Dr Beneby said in November at an NHI forum. “We have yet to determine what we are spending in total. That’s where the discussion needs to go.

“We know of the $400 million we are spending, we have about 25-30 per cent wastage, so we are getting the value of $300 million. If we . . . improve our system by improving the way we function, the way our protocols are, improve the efficiency of our system, we have $100 million today estimated that we can access. This is in the public sector.”

Prominent cardiothoracic surgeon Dr Duane Sands believes this admission highlights one of the many reasons why the government needs to evaluate its approach to NHI implementation.

Dr Sands, a former Free National Movement senator, believes the push to get NHI through the door is a way for the Christie administration to secure votes in the next general election regardless of the implications.

“Unfortunately there is a huge political imperative to get this done,” Dr Sands said yesterday. “Had this government accomplished any significant social (or) financial programme then there wouldn’t be this huge impetus to get (NHI) done. If you look at every single commitment of the Progressive Liberal Party administration, they have failed. That’s not an opinion; that is a statement of fact.

“If you ask: Did mortgage relief work? No. Did crime reduction work, no. Did Baha Mar come off, no. Did carnival work, no.

“You pick something and you ask objectively have there been any significant tangible successes of this administration, the answer is no. Did BAMSI work? The answer is no it didn’t. So now, going into an election they have no choice but to knock a home run. Now the definition of that home run is to get as many people to believe that this is a wonderful thing, and that typically means that you have to appeal to those persons who feel disenfranchised, who find the inequities and challenges of healthcare financing to be a major problem and you gratuitously go after that segment of the population and you say, ‘We are going to give this to you.’ You combine that with almost a level of class warfare where you say that this is about the rich versus the poor – a strategy that is incredibly divisive but what else do you have?”

According to Dr Sands, chief among the concerns of the medical community is the fact that NHI as proposed would not address the critical, catastrophic illnesses that are plaguing many Bahamians. In the second quarter of NHI’s roll out, from April to June, patients would have access to free primary care (or an office visit) but this would not cover costly surgeries or treatment.

“NHI as currently outlined does not address the issues facing the same people that they intend to pander to,” he said. “The biggest challenge right now is that people have a problem accessing certain expensive services like cancer care, cardiac care, pacemakers, open heart surgery, joint replacement . . .so when you say to somebody who is being promised now access to primary care that you are now going to have these problems discovered, ‘Well okay we can’t do anything for you more than we can do for you right now.’

“So how does that help? Most people do not have a problem finding $50 or $75 to go to the doctor, what they have a problem with is when the doctor says ‘I need you to get a $1,500 test or a $40,000 procedure.’

Not good enough

“That’s what the cook-outs are for, that’s what is bankrupting families,” Dr Sands added. “So we are distressed as a profession that while this is being billed as healthcare reform that it is not going far enough. And in some instances it’s going too far, in other words you are spending a huge amount of the public’s money to fix a problem that really isn’t that broken.

“Secondly, it does not adequately address the challenges of infrastructure, human resources and service.”

According to Dr Sands, infrastructure in the public system such as access to cat scans, ultrasounds, quality of staff, lack of electronic medical records, and emergency room capacity remains a challenge.

“We’re concerned because if you have a heart attack and you come to the public hospital, it cannot manage your problems. It doesn’t have the tools and that is the number one killer of Bahamians. Now how does that make any sense?”

In spite of lingering concerns in the medical community and health insurance sector, Dr Sands said stakeholders are “being asked to sign on the dotted line and agree without any specifics, without any details.”

He added: “Now, who does that? How do I agree that this is a good thing when you can’t even tell me what you want to do, how you want to do it, what’s going to be included and you also want me to simultaneously take the financial and professional security of my career, my practice and put it in your hands?”

“Every single government corporation is in red ink and we want to expand the government’s role in the one part of the healthcare industry that has made it possible to take care of patients?”

Registration for NHI is expected to begin on January 1 and last for three months. The process will likely be cumbersome and fraught with problems, given the execution of current government services.

As the date draws near, there has been little public information sharing about what that process would entail.

Even more concerning is the way the government is dancing around the question of how NHI will be funded in the long-term. It has been nearly one year since the implementation of value added tax (VAT) and many people are still grappling with the effects of higher priced consumer goods and services as a result. Last month, Health Minister Dr Perry Gomez, in defending NHI, said such schemes are being proposed around the world.

However, one of the world’s longest running publicly funded healthcare systems has its own set of challenges.

On December 4, the United Kingdom’s Institute of Economic Affairs released a report highlighting the flaws in Britain’s National Health Service (NHS).

According to the report, the NHS is a tax funded system “which leads to a lack of transparency. It is virtually impossible for taxpayers to work out how much they pay for healthcare.”

On the political aspect of the NHS, the report noted: “Political desires to ‘leave a mark’ have led to the NHS being in a constant state of reorganisation. The idea that the British people run the NHS collectively is a myth. Accountability is vague, and there is almost no overlap between the health policies proposed in general election campaigns and those enacted afterwards.

“The incredibly political climate of debate means the UK fails to learn from other countries with better outcomes. International evidence on outcomes is ignored entirely, with the only comparisons used to highlight the deficiencies of the American system, and to show we spend less on healthcare as a proportion of GDP.”

The report also noted that the NHS has “poor health outcomes.”

“The NHS tends to be judged by its intentions and ideals rather than its outcomes. Our system lags behind the health systems of most comparable countries in terms of health outcomes, quality measures, waiting times and efficiency.”

If these are the concerns about the NHS, a government programme introduced in the UK in 1948, it is not hard to imagine the possible negative outcomes of NHI, given our government’s track record with failing public institutions.

Because of this, officials must take heed of the recommendations and concerns of industry stakeholders and not implement an ill-planned scheme that could be to the detriment of us all.

• What do you think? Email tmthompson@tribunemedia.net