State Control of Health Care

First Published: 2006-04-27

A presentation by The Nassau Institute to Civil Society Bahamas Ltd (CSB) 7:30pm, Wednesday, April 19, 2006, at The College of The Bahamas.

“A long time ago, there was a master archer who began looking for an archer of even greater talent so that he might improve his craft.

After months of searching he came upon a tree with an arrow in the exact middle of a painted target drawn on the tree. As he walked on he saw other trees, each with a perfectly centred bull’s-eye. Perfect bull’s-eyes peppered the forest.

Suddenly, he entered a clearing and saw a barn with row after row after row of perfect bull’s-eyes. He knew he had found his mentor, and began asking everyone he saw: “Whose barn is it that displays so many perfectly-centred arrows?”

When he found the man who owned the barn he saw that he was a simple man, slow of speech, and seemingly awkward in his movements. Unperturbed, he asked the man to share his secrets: “How do you do it?” To which the man explained: “Anyone can. After I shoot the arrow, I take some paint and draw a target around it.”

We hope we are not simply painting targets with our national health insurance exercise like in the archer in that ancient Jewish proverb.

Dr. Dennis Furlong, former minister if health of New Brunswick, Canada, wrote in the introduction to his 2004 book – Medicare Myths: 50 Myths We’ve Endured About the Canadian Health Care System – that “The Canadian health care system remains the most valued, the most costly, the most criticized, the most abused, the most misused, and the most overused public program, with funding shared between the federal government and its provincial and territorial partners”.

We don’t wish to convey that his book opposes the Canadian health care system, because that would not be so, at least as we understand it. He does confirm though that “Sustainability, which means affordability, can only be had through this sort of process of utilization control and therefore cost control.”

In a nutshell, Dr Furlong, and many others, believe that the Canadian health care system is failing the consumer in its present form.

The Nassau Institute has been offering constructive comment about the pitfalls of a nationalized health plan for several years, but the political rhetoric has never been louder as in recent months. Could it be an election is approaching and we have to be sold another bill of goods about how much our government is going to “help” us?

The good folks involved with the Blue Ribbon Commission worked very hard to compile the data they have in support of nationalizing the health care system of The Bahamas, but they do not appear to have spent enough time analyzing the alternatives and what is causing the litany of reported problems within the current public health system.

We do not doubt their sincerity, but can’t put it any better than Dr. John Goodman at the National Center for Policy Analysis (NCPA) in the United States, when he says that the “Do No Harm” principle of doctors should be applied to public policy. His point being, “it would mean that before we ask the government to enact a new reform, we ought to make sure that the government is not the cause of the very problem we are trying to solve.”

If we think the queues at our public health facilities will be shorter, we should think again. The Canadian system (and the Blue Ribbon Commission uses the Canadian system as a guide) is not fulfilling its mandate and the queues are not getting shorter.

In Canada they have been closing hospitals for the past few years, because they cannot afford to maintain them. The archipelagic nature of The Bahamas is no easier for the delivery of health care than the vast expanses of Canadian land and remote areas.

You might have received one of our handouts incorporating 19 questions that we think the Blue Ribbon Commission should answer before considering recommending a government takeover of the health care system.

Let’s take the time to highlight eight of them:

1. The 148 page Report of The Blue Ribbon Commission offers approximately three pages of information on other alternatives. Surely the study of other alternatives is equally as important as introducing National Health Insurance? In other words, this is a political objective with the government’s firm intention of forcing it on the country.

2. Why not simply pay private insurance companies to cover the costs of health insurance for those indigent individuals unable to pay? Or offer the indigent a voucher that can be used to purchase health insurance for their family? This way, the insurance companies do the administration of the program that will be more cost effective and efficient than typical government bureaucracies.

3. Why not buy catastrophic insurance coverage for patients in the public system rather than implement a nationalized health scheme? Maybe insurance companies can be asked if they can provide catastrophic coverage for private payers as well. This might encourage more participation and encourage individuals to save to pay the premiums that could very well be less than full coverage.


4. Have the costs of a government run system been set against the increased taxation that will result? Thanks to the economic cost of taxes, the cost of paying taxes, and the cost of enforcing taxes, the direct cost of NHI is less than the total cost of NHI. Also, has it been determined what costs government regulations and taxes presently add to the cost of private health care?

5. There is an acute shortage of doctors in Canada. This is primarily the result of restrictions in the training of new physicians in Canada – the government targeted the current number of physicians in their plan. Canadian physicians are leaving Canada for the US where they are more able to practice medicine because rationing is less prevalent. How will the nationalized plan address this inevitable development?

6. What outsourcing options have been considered?

7. How will costs be controlled? How will the added costs affect taxation? Less money in the consumer’s pocket means slower economic growth.

8. Are there any intentions to institute price controls on private practitioners?

Other issues worth extensive investigation and discussion are:

1. What is the evidence supporting the introduction of National Health Insurance? Is this the best use of valuable and scarce public resources?

2. How will new technologies (including diagnostic machines, surgical techniques/equipment, and pharmaceuticals) be handled under the program? Will the government ration their adoption and implementation? How will that rationing occur?

3. Our ageing population.

4. Economic downturns. In other words, is it sustainable? Is it affordable today, considering the economic costs of raising revenue for National Health Insurance (including the costs of economic distortions from taxation, the cost of tax compliance, and the cost of administering the tax)?

5. The fact that the NHI is in effect another tax, and

6. The future fiscal issues (bankruptcy) faced by the National Insurance scheme which is simply another unfunded liability for the Bahamian taxpayer.

7. Does the National Health Insurance programme account for immigration patterns (both legal and not) in The Bahamas?

8. Do the finer details of the programme (who provides the care, how they are paid etc) reflect international best practice? And finally,

9. If we accept that National Health Insurance is to be implemented, is the Blue Ribbon Commission’s proposal the best path forward?

At the moment, many Bahamians, are fortunate enough and free to choose to pay for private health insurance, but fail to do so. Then when something happens, the rest of the Bahamian taxpayers are expected to pay for it. This is equally as unfair as not providing care for the indigent among us.

Let’s not forget that government can give us nothing without first taking tax dollars from us. So as sensible people, those of us that are employed should ensure we provide for ourselves by purchasing private health insurance while we still have the luxury of choosing who our health insurance provider will be.

As Milton and Rose Friedman said in their great book Free To Choose: A Personal Statement: “Fortunately, also, we are as a people still free to choose which way we should go – whether to continue along the road we have been following to ever bigger government, or to call a halt and change direction.”

In closing we would like to share another story that is instructive when we consider government intruding more and more into our lives. According to Ms. Annette Simmons, in her book The Story Factor, this story is adapted from Doug Lipman’s retelling of a Chinese folktale:

“Once upon a time, there was a poor stonecutter who lived alone. He was a pious, compassionate man and God listened to his prayers. He prayed to be rich and powerful. One morning he awakened to find he had riches beyond his dreams. He announced to the world, “I am the most powerful.” The sun mocked him and said, “Are you powerful enough to make plants grow?” He was not. The pleasure his riches brought him began to fade. So he prayed, “Make me as powerful as the sun.” The next morning he arose with the sun, because he was the sun. His pleasure knew no bounds. He warmed the earth, made the plants grow, and scorched the fields of those who did not love God. He announced to the world, “I am the most powerful.” The wind mocked him and said, “Are you powerful enough to move ships through the ocean, to move the rain and the clouds so they block out the sun?” His pleasure again began to fade. So he prayed, “Make me as powerful as the wind.” The next morning he awakened to find that he was the wind. He swirled and blew and took great pleasure in moving the clouds and ships in the ocean. He announced to the world, “I am the most powerful.” The mountain heard his boast and mocked him, “Are you powerful enough to move me?” He blew and he blew yet he could not move the mountain. His delight faded and soon he began to pray to God to make him as powerful as the mountain. One morning he awakened to find that he was a mountain. He delighted in the majesty of his form. The wind blew and could not move him. The sun shone but could not reach behind the giant shadow that he cast. He was indeed powerful. Yet one day his attention was drawn to a chip, chip, chipping sound. Below, a stonecutter was knocking away big chunks of stone and carrying them away to make a house. He growled, “I am the most powerful. Go away!” The stonecutter smiled, “If you are so powerful, you go away. I am busy. I am building a house to keep my family dry and warm.” The mountain sighed. He had wanted to be the most powerful. It was a long time before he prayed again to God. “Make me as powerful as a stonecutter.” God spoke, “Are you sure?” He replied, “It is all that I want in the world.” And the next morning the stonecutter awoke in his bed and his joy knew no bounds.”

Our advise is for you go to your employer tomorrow and ask to sign on to their existing health care plan in order to help prevent this government take over.

If your employer doesn’t have a plan, lobby to get one, or find one you can sign onto by yourself.

Also call your M.P. and tell him or her to consider an alternative to the National Health Insurance Plan because they are not all powerful, and like the stonecutter, we can and should take care of families and ourselves.

In the final analysis we need to ask ourselves if National Health Insurance is really necessary? Are there less invasive policies that could be implemented to achieve the goal of ensuring access to health insurance for those without sufficient means, which also leaves those with sufficient means the opportunity to choose for themselves without the force of government coercion?

The Nassau Institute

Date: April 14, 2006

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