The Tribune

By DR KENNETH D KEMP

IN Japanese culture, having a garden pond filled with Koi fish is believed to bring good fortune to home owners and their visitors. Koi fish are considered resilient because they can survive harsh environments, have notable courage and perseverance as they repeatedly swim upstream against the current and are beloved because of their beautiful vibrant colours and their surprising ability to form attachments to their human owners. What makes the legend and culture around Koi even more interesting is that while they are resilient and seen as symbolic of success, universally they are symbols of love and peace.

Beyond that, a garden pond, in and of itself, devoid of fish transforms a backyard into a relaxing oasis. I personally prefer high rise apartments and all the amenities that go along with them but, for those with gardens large enough to accommodate a pond, I appreciate the appeal.

Recently, I was speaking with a friend who complained about the rising cost of water lilies which she needed for her pond. These freshwater flowering plants help inhibit algae growth and provide much needed shade and protection. As she explained to me, apart from their cosmetic appeal they provide a successful breeding ground for her beloved Koi fish.

Later that evening, I couldn’t help but associate her vigorous condemnation over the steadily rising price of what most would consider a luxury purchase with a lot of elasticity, with the ongoing complaints throughout our nation regarding the cost of health insurance. In this analogy, the Koi fish are humans requiring protection and the water lilies represent necessary health insurance required to provide shelter, comfort and an opportunity for the Koi fish to survive longer. Without it, they will still live, but against the harsh sunlight and unspoken elements, life is much more challenging.

On a near daily basis, patients lament the high price they pay to maintain their health insurance, the little they get in return and the challenges they face when they file a claim. In many instances, their protestations have merit. Near tears, I can recall a patient telling me how it costs him over a thousand dollars per month to pay for him and his wife to have health insurance, which was more than they received in their monthly pension. So, this proud man who’d worked hard his entire life now depended on his children to provide him with the basic necessities. Every time he gets sick and has to see a doctor, his eyes say everything without him ever speaking a word. Fortunately, he and his wife live modestly and have no debt. Others are not so fortunate.

Another patient lost his insurance coverage along with his job when his company downsized. He simply couldn’t afford to keep up with the premiums without any other source of residual income. He and his family struggle to pay their mortgage, their children’s school fees, utilities and provide food. Each month, they grow deeper and deeper in debt and the constant fear and worry has strained their marriage. In the US, nearly 40 percent of all divorces occur (annually) because of financial problems or disagreements and it is rare to find even a happy marriage where finances do not count as a cause for worry or dissension. Local statistics in this regard are unknown, but from the ‘where your paycheck gone?’ to ‘why did you gamble on that high-risk investment?’ the subject of finances, equivalent to survival, is always present.

The difficulty with losing insurance, or attempting to switch to a less expensive provider, is that if you have a pre-existing medical condition, more often than not, you won’t be covered for that illness and if you are covered, payments will likely be too exorbitant for the rank and file. In this scenario, Patient X suffers with a heart condition. Then, Patient X, for whatever reason switches to an alternative insurance provider. In many instances, this new insurance will not cover any future health challenges that Patient X suffers related to his heart condition. So, the patient is forced to stay with the original insurance company and continue paying the ill-afforded increasing costs or switch and pray to never be hospitalized for anything related to their pre-existing condition. It’s not an easy choice.

Another reason for distress that causes frustration is that they can’t use their insurance for approximately one year after activation and then once they start, they can only start submitting a claim after their deductible is met. Meaning, if your insurance policy states that you have a yearly deductible of $500, for example, then you can’t use your insurance until after that $500 has been paid for the year during one of your doctor’s visits. Then, even when you are able to use it, you have a co-payment which varies between 0-20 percent or more of the total cost of the visit, if visiting a specialist physician in a private setting.

Some people have insurance their entire adult life and rarely ever use it. Years later at an age when it’s most necessary, they can’t afford to keep it. It’s an unfortunate paradox common throughout small Caribbean nations like The Bahamas. For a while, there were repeated calls by disgruntled activists for health care to be made more affordable and for people who invested so much money in insurance over the years, to be able to get something back out of it. Those requests have largely been ignored and I suspect will likely never be addressed.

On the opposite end of the spectrum, insurance providers, who for the most part have very good intentions, have an onerous and herculean task ahead of them. They have to provide coverage to an admittedly obese population with some of the worst health statistics in the western hemisphere while reining in costs. If that weren’t enough, they have to do this all the while battling a dramatic increase in their own reinsurance costs following the Covid-19 pandemic coupled with increasing administration, taxes and commission costs locally, wherein administration costs alone can total nearly 20% of premium volumes.

In Japan, all 126 million residents have health insurance coverage provided either through their employer or via a national health insurance programme. Medical fees are furthermore regulated by the government in an effort to maintain affordability for the general public. A National Health Insurance (NHI) was initiated in The Bahamas over five years ago but private insurers remain the prevailing source of coverage for Bahamians and there are concerns about the long-term feasibility of NHI given the state of the population’s health and the demands on the healthcare system. Despite this, there are plans underway to expand the reach of NHI locally ushering forward a promise of hope for the uninsured with no alternative recourse.

Until then, Bahamians will have to bear the costs until they can’t. One way as a nation to help mitigate those costs for citizens and insurance providers is to limit consumption of alcohol, fried, salty and sugary foods, focusing instead on healthy options like fruits and vegetables on a daily basis, exercise regularly and get regular health check-ups which often don’t require any co-payment when insurance is utilized.

Koi fish ponds adorned with the most stunningly beautiful water lilies are common in gardens throughout Japan. And there, the price of water lilies, like insurance, is affordable to all of their citizens. Interested parties take heed; with a burgeoning elder population and crushing inflationary concerns, proactive counter-measures must soon be adopted to curtail the rising cost of health insurance throughout our nation. Fifty years of independence have shown us that despite all our progress over the years, we certainly have much more work to do and a lot more miles against the current to swim.

This is The KDK Report.

• Nicknamed ‘The Prince of Podiatry’, Dr Kenneth D Kemp is the founder and medical director of Bahamas Foot and Ankle located in Caves Village, Western New Providence. He served as the deputy chairman for the Health Council for five years and he currently sits on the board of directors for the Princess Margaret Hospital Foundation in his role as co-vice-chairman.