The Tribune

EDITOR The Tribune.

The discussion around the proposed NHI scheme brings to mind the now-iconic Wendy’s television commercial in which three elderly ladies were served a hamburger. Admiring the “big, fluffy bun” on the outside, they opened the bun to find a burger so small that one of them exclaimed, “Where’s the beef?”

The Government’s planned National Health Insurance (NHI) scheme seems to beg a similar question, that is: “Where’s the value?”

When in Opposition, the present Government bombarded the media constantly, pointing out the inadequacies of the proposed NHI programme: poorly planned, inadequately funded, ill-suited for our health care needs, etc.

Bahamians may be forgiven for believing that once elected, the new Government would take steps to retrench and rethink its approach to health care.

It seems inexplicable that now that they are no longer in the Opposition, members of this Government not only want to continue with an NHI funded primary care programme but also expand the programme to include specialty care. This at a time when by its own admission, “the cupboard is bare”!

Let me be clear: the physicians of The Bahamas are committed to the provision of quality health care for all Bahamians.

We welcome any fiscally sustainable plan that will achieve this, but the current plan does not meet that criteria.

However, since the Government seems determined to move forward with an NHI scheme in some form – along with the inevitable increases in taxation that this will bring to bear – the important question to address is: How can NHI best provide value for the Bahamian people?

To arrive at an answer we must first acknowledge two truths.

First, the NHI scheme in its present form provides absolutely nothing not presently available in the public health sector.

Yes, it is true that our public health care system is beset by management issues, excessive red tape and misuse of resources. However, upwards of 90% of the health care needs of Bahamians are accessible – right now - through the public healthcare system.

The proposed NHI scheme will not add a single service, test, screening or care opportunity that is not presently available to the Bahamian public.

So why add millions of dollars of additional debt, new layers of bureaucracy and opportunities for mismanagement for a service that presently exists?

Second, even the most ardent collectivists have abandoned the idea that National Health Insurance can provide the amenities made available by private health insurance.

There are ample examples around the world to debunk this theory. So the discussion of an NHI scheme attempting to equal the amenities of private insurance is a moot point.

With the above in mind, what is the best way forward for National Health Insurance?

If we are going to have a National Health Insurance with its accompanying increase in taxes (which almost always happens) why not use this money to provide needed medical supplies and services that have to be paid for out-of-pocket in the public service.

That is, NHI would fund such things as vascular grafts for patients on dialysis, comprehensive cancer care, pacemakers, paediatric heart surgery, extended care including rehabilitation for stroke victims, etc.

NHI for services not presently available in the public sector will enhance our healthcare service, fully utilise our present infrastructure, add minimal debt, remove the need for cookouts to fund medical care and would receive buy-in from all stakeholders, especially physicians.

So to answer the question, “NHI, where’s the value?”… The value is in providing medical services that are urgently needed but not presently available.

If we must move forward with this concept, let it be in a way that truly benefits Bahamians and adds value to our standard of living.

Hopefully, this government will listen to and execute the plans of our exceptional professionals and not go searching the globe for foreign consultants.

Or worse, attempt to implement some ill-conceived, harebrained scheme meant to gain political traction but instead causes incalculable suffering for the Bahamian people.

SY COOLIDGE PIERRE, MD

President, Medical Association of the Bahamas

Nassau,

July 8, 2017.