Dear Sir,
KPMG’s claim that the implementation of the primary care phase of NHI will make the Bahamian economy “almost $500 million bigger in 2040” can only be met with scorn and disbelief by right-thinking Bahamians. Their recently-presented report is full of unsubstantiated figures and misleading conclusions, and attempts to present health care in a vacuum, completely ignoring the issues plaguing us as a country today.
If KPMG’s report is to be believed, NHI is the long-awaited panacea for much of what ails us as a nation. According to the report, among other things we can expect a “larger economy”, “improved productivity”, and “a more skilled workforce”. Very grand claims, but taking into account our economic, social and educational systems, it is difficult to understand how NHI will accomplish these.
The size of a nation’s economy is usually measured as Gross Domestic Product or GDP, defined as the monetary value of all finished goods and services produced within a country’s borders in a specific time period. We are told that the promised economic growth will result in “an additional 5.1 per cent in total household consumption by 2040”. Let us be clear: "household consumption" will not increase our output of goods and services, it will only sink us deeper into debt. This fallacy that ‘consuming one's seed corn’ equates with an increase in GDP was shredded centuries ago by Adam Smith (The Wealth of Nations), Ludwig von Mises (The Austrian School of Economics) and others.
It is difficult to understand how a figure of $500 million dollars in total growth is arrived at when there has been no real discussion of the costs of the scheme, which will be implemented in multiple phases, with as-yet unidentified funding. We are told that the study predicts a return on the Government’s investment, yet how can the returns be calculated on unknown expenditure? The introduction of NHI is more likely to reduce our GDP, due to a reduction in the private health insurance business, as many people will either drop the primary care portion of their health insurance under the assumption that it will be provided by NHI, or will be unable to afford private insurance period due to the increased tax.
In addition, the language of the report seems to be deliberately misleading on the concept of “primary care”. The KPMG report attempts to sell NHI by using emotive statements such as, “Today, most Bahamians do not enjoy the security that comes with a meaningful right to healthcare. They must live with the fear of what might happen to them if a loved one becomes ill, including how they will pay for care”. Very true: but what comes to most peoples’ minds here is catastrophic care, not primary care. And as yet, there has been little to no discussion about how and when, or even if catastrophic care will become a part of NHI. Primary care doesn’t pay for surgery, or chemotherapy, or hospitalization. So if our streets are still violent, our youth at risk, our lifestyles still unhealthy, will we still be experiencing that $500 million growth in GDP?
The KPMG report must be addressing a Bahamas that exists in an alternate universe and not the one that we live in to make such broad, sweeping statements. Let me enlighten them on a few facts: the Bahamas has had at best a “D” average high school grade (functionally illiterate and innumerate) for more than a decade; has a murder rate that is ten times (1000%) higher than that in New York City; is suffering brain drain (especially in the medical field) at an enormous rate; imposes business taxes that are choking the life blood out of ordinary citizens, professionals and businesses; collects Value Added Taxes for which the Government has been unable to give (to many) a satisfactory account; has an increasing debt rate, four successive annual downgrade ratings by Standard and Poor’s and utility/communication/water bills that are amongst the highest in the world with some of the worst service in the world. KPMG and its consultant partners are making the mistake of looking at healthcare in a vacuum. I will say this again: the only way to provide universal healthcare is to have universal employment consisting of well-paying, meaningful jobs, a proper educational system and the rule of law.
Surely, if the immediate implementation of NHI will so positively affect our health, skills, productivity and GDP growth – to the tune of $500 million – then there should be no need for any type of NHI tax. However, if KPMG’s assessment is incorrect will they pledge to pick up the tab for any NHI taxation?
All that Bahamians are asking for is frankness and honesty on the part of KPMG and its partners, seeing that we are paying millions of our hard-earned dollars for their expert opinion.
Regards,
Sy Coolidge Pierre,M.D.
President, Medical Association of the Bahamas
The views expressed are those of the author, and not necessarily those of the WeblogBahamas (which has no corporate view).
