The Tribune

When doctors at Princess Margaret Hospital threatened to withhold services because of poor pay and, in some instances, deplorable working conditions, the public was aghast. How, they asked, could a doctor turn his or her back on a patient in need of urgent care or ongoing attention?

We believe doctors and the medical community shared that concern and the thought of leaving even a single patient unattended in what could be a life-threatening situation must have deeply troubled those dedicated to saving lives.

The commitment of a doctor is beyond the pale and far above their counterparts in other professions. In addition to the years of study and preparation and the costs involved to become a doctor, the act of being a doctor is unlike being anything else. Long hours, unpredictable schedules. Tedious work, heavy responsibility, incalculable stress. Tough on marriages and relationships, yet critical to society.

Thus for a group of doctors already accustomed to great sacrifice to say ‘enough is enough, you need to pay attention to our cries’ could not have been easy for them and must serve as a wake-up call for all of us.

The doctors’ complaint, however, cannot be looked at in isolation. The Public Hospitals Authority simply doesn’t have the money the doctors are demanding and cannot be stitched up with a temporary bandage.

The problem is the entire governmental budgetary process. Taxes in The Bahamas are too low for the high expectations we have as a nation. We want well-paved roads but do not want to pay the price. We want better education but balk at having to pay Real Property Tax. We want greater security measures but mention higher VAT rate and be prepared to be a one-term administration. We need a new prison, more parks and sports facilities. We need a far better equipped Royal Bahamas Defence Force and we need members of the Royal Bahamas Police Force to make enough money that they don’t have to take second jobs as night security officers.

We want. We want. We want. But we don’t want to pay.

The truth is a bitter pill made evident by the medical community’s strike threat.

The patient, The Bahamas, has a disease called anti-taxitis. It has been passed down from generation to generation and in the last four decades plus since Independence from government to government. Until a government has the courage to do two things, it will continue to plague the nation and we will continue to borrow until our lenders, including China, own our ports and airports and other critical infrastructure as they already do in many countries.

This is not fear-mongering. This is reality. Sri Lanka just handed over its harbour and port to China because it could not repay a debt. China loaned Maldives money which they could not repay. Now China owns more than 38 percent of the state-owned resorts. In Kenya, 70 percent of the mineral resource mines belong to China because Kenya kept borrowing and could not repay its debt.

What the threat of a strike by doctors translates into is an alarm waking us from a national slumber. As long as we believe we have a right to low-cost or indeed free medical care with high standards, as long as we believe we have a right to free public education, as long as we believe we have a right to better roads without paying a highway tax or tolls to use those roads, we have to find a way to fund hospitals, schools and public works. And we must do it without borrowing.

At the same time, we do have a right to demand better service from many in the civil service, a bloated machine that for too long has harboured those who were all too happy to provide half-hearted assistance to those who sought help whether for a passport, work permit or business license and were even happier when the clock struck five and the day was over.

Yes, there are those who go above and beyond and they should be thanked by everyone who comes into contact with them. They are stars in a system with little reward for being exceptional. The lack of dedication of far too many in the civil service is the antithesis of the absolute dedication of almost all who make medicine their lives and it is because of that dedication that we are so shaken by a threat of strike and we know the cure lies outside the system we currently call our Bahamian way of doing government business.

It is no accident that Scandinavian countries have excellent education or that Canada and the UK have good if not brilliant national health care. Their citizens pay for it. Talk to someone from Sweden or Denmark and ask if they object. Chances are they will explain exactly what they are getting for their money.

In Britain VAT is charged at 20 percent: National Insurance contributions at 12 percent and anyone earning over $60,700 a year pays income tax at 40 percent. We won’t even mention the taxes on business.

This is the rub. Bahamians feel they are paying already with high Customs rates, 12 percent VAT and hefty fees and they get little for it. It is a business plan doomed to fail. You do not go into a store and pay a high price for a low quality item. Likewise, you cannot command higher taxes to raise the revenue you need when the services you provide do not meet minimal standards.

When there are no repercussions for poor service and no reward for excellence in the public sector, there is little incentive beyond personal morals and self-imposed standards to work harder. But if you change the culture of public service and raise the level of services provided, you can raise revenue.

It will take higher taxes, like it or not, to meet the high expectations of Bahamians - doctors included. The request for approval of additional revenue must be accompanied by a demonstration that it will be spent wisely, services will improve and no one in the public service will get a free ride anymore. Let the threat of a strike by doctors serve a valuable purpose, a wake-up call to shake up how The Bahamas manages its finances, its input and its output.