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Intervention by The Hon. Fred Mitchell M.P.
Minister of Foreign Affairs and The Public Service
On The National Health Insurance Bill
Wednesday 6th December 2006
The House
of Assembly
Nassau
Mr. Speaker,
I rise to
support the Bill to enact National Health Insurance legislation. It
is long overdue. There has been enough talk. Now is the time for
action. As a minister I have witnessed first hand what a small and
deceitful minority can do to derail government policy. Just this
morning I saw a ridiculous and misleading ad in the press comparing
power blackouts with a collapse in health care in National Health
Insurance. This is patently dishonest, since we have a health care
system now and there is nothing that suggests that the level of
competence in our public facilities approximates or compares to the
scare tactics that are being employed. Those who are fighting this
should do well to remember that it does not follow that because a
public policy is a good idea that it will succeed. The Government
must to ensure the success of a policy be committed to it, fight it
on a broad front, continue to consult but also be resolute and
further engage professionals to help the campaign.
Let me repeat
what other colleagues have said with regard to this matter. The
government is committed to this and each person in both Houses of
Parliament should and I daresay must give an account of where they
stand on this. The poor and the middle class that it is designed to
help want to know where you stand. Are you like the libertarians,
one of example we saw write a letter to the press yesterday, who say
the Government is so bad it must stay out of everything? The result
of that is that the poor will suffer if no third hand comes to their
defence. Or are you part of the moderates, the people in the centre
that say there are some things that only governments can do, and one
such thing is national health insurance. I expect that the
Government will call for a division when the votes are taken at the
end of this debate, and each member will be called to say do you
vote yea or nay. We will count the nays and the yeas, and history
will record where we all stood when the role was taken down here.
It should be
clear now that in 2006 we cannot fight a campaign like we did in the
year 1974. This is a different age, with a broader range of media
and with a public that has less time for, patience for details. We
have a public that is no longer in the thrall of independence and
the patriotism of the new Bahamas which is not to say we are not
patriotic but we view these things today in a different light. The
public is much more cynical and much more distrustful of
politicians.
This is no
longer the age of the messianic politician who succeeds because he
says so and it is so. If we mean to succeed, we have to win hearts
and minds.
I have no
doubt that the majority of my constituents in Fox Hill support this
legislation and so do the majority of people in the country. A
nurse, a staff nurse at the Princess Margaret Hospital, who lives in
my constituency, recently lost her son to cancer. In speaking with
her, she was soliciting funds to pay for radiation treatment at a
facility here in Nassau. She was soliciting donations directly. I
tried as a representative through the Ministry of Health and the
Social Services Ministry to get her a cash donation under the scheme
for the indigent to pay for a treatment. She knew that he son could
not be cured but she also knew that with some interventions, his
life could be prolonged and that is the chance she was seeking.
With our absolute value on life, that is all she sought to do. She
told me how she had managed to scrape up a payment for one treatment
and that the tumour reduced dramatically because of it and he sons
comfort level improved. Sadly he has now died. Who knows what
could have happened if he had insurance that could have paid for
it?
The other side
to this debate has accused us of fighting on the basis of emotion,
as if something is wrong with that, that something is unfair about
that. Nothing is unfair about it. Many public policies that are
beneficial to this country have been moved by emotion. Human beings
are rational creatures but they are also creatures of emotion.
Surely the other side is not arguing that we must so strip ourselves
from our emotions that we lose our feeling for people.
But the fight
is not just on emotions. This makes logical sense. You can save the
lives of citizens, to stay in the work force or become productive
citizens if you are able to provide them with quality health care.
You do so by spreading the risk of the cost and you do so to allow
those who are in their senior years or too young to join the work
force to be able to be cared for without bankrupting their parents
or their care givers or themselves.
Let me share
some facts. NHI will allow choice. Although all working people
will contribute that does not stop you from going to your private
doctor. The system will pay the fee and if the private sector
charges more then, the overage will be for your account and this is
where supplemental insurance will come in. Smart insurance
companies will now be designing new products to bring and sell to
the market.
Further, NHI
will cover pre existing conditions, not like private health
insurance that denies you a claim or insurability because you have
some pre existing disease. No matter what develops NHI will not be
dropped and this includes when you reach the age of 65 or 70. It is
lifetime coverage. It is also portable in the sense that today if
you have a private health plan, once you lose your job you lose the
coverage. NHI will not be like that. It carries from job to job and
without a job.
The opponents
of this have not been frank or entirely honest with the country on
this matter. They have said that they were not consulted. The
facts show otherwise. It is pure sophistry on their part to seek
now in answer to the fact of consultation with them to say that
there is a difference being called to a meeting and being given
information and in being consulted. Happily they now appear to be
resiling from the position of public confrontation and are seeking
to discuss matters with the Minister out of the eye of the public
and the press.
Their
objections have been put in a slick advertising campaign that is
disingenuous at best and quite frankly dishonest.
One thing we
know with the experience all around the world is that the two groups
who have nothing to worry about in terms of income are the insurance
companies and the doctors. Insurance companies will clearly get a
windfall from supplemental insurance. Doctors will get a windfall
from the increase in demand for their service, services that will
under NHI be paid within 72 hours. They all know that the present
systems of insurance in the private sector often requires months of
waiting before the doctor receives a payment. The Minister under
this system proposes that every insured person will get a swipe card
and that card will be an identity card for the insured but also once
swiped in the doctors office will guarantee a transfer payment into
the doctor’s account within 72 hours.
Right now Mr.
Speaker the average GP in the United Kingdom under their National
Health scheme makes one hundred and six thousand pounds a year which
is about two hundred thousands US dollars. Surely they jest if they
believe that doctors will end up any poorer as result of this.
And here Mr.
Speaker, I think a distinction has to be made between the British
Health Scheme which is paid for out of their consolidated fund from
the taxes of British taxpayers. Not so this national health
insurance in The Bahamas. The fee to be paid will be like any other
insurance, dedicated to the insurance and that is all.
Now some of
the detractors have gone on to say that after the experience of the
National Insurance Board and its failure to collect from those who
should collect, and also the high cost of administering the fund
that this means we should not go ahead. With respect, that seems to
me to have the whole argument “bass ackwards.” The fundamental
question is whether or not there should be national health
insurance. Apart from a few far out libertarians, there is the
broad agreement that this is something we ought to do and that it is
the moral thing to do. The National Insurance programme while not
perfect works generally well, as well and as efficient I would guess
than any other institution in both the public and the private
sector. In fact the experts tell us that it is perhaps the best
performing system in the region.
The Bahamas
and Bahamians including those who are the detractors of this policy
should learn to be frank and honest about our country. We do not
like to pay for services. We do not like to enforce the payment of
tax laws, and as soon as some one comes along in any Bahamian
institution whether public or private to rigidly enforce rules,
there is a hue and cry and intervention which causes the rules to be
stayed or permissively enforced. That’s just us. But we must not
use that cultural fact about us to delay this policy. We must
reform the culture and be serious about doing so.
What is
suggested for example is that the payment rate by self employed
persons in the National Insurance programme is likely to go up
significantly because the National Health will be infinitely more
attractive and personal, but the plan is that in order to enroll in
the national health insurance scheme, the individual must show that
he pays national insurance. And further, if you show up to a public
hospital facility without a national health insurance card and you
do not fall within one of the social service exceptions, you will
have to find the money or be denied elective services.
With regard to
the future of National Insurance, it stares us right in the face
with the aging of our population, the actuarial reports on the fund
and that of the Commission on Socials Security that hard choices
have to be made to save the fund and improve collections and
investment procedures. But in our present world, who pray tell will
make those hard decisions in this country?
We are wrapped
up in a great irony in this present policy. The same cast of
character who oppose national health insurance are the very ones who
argued not two months ago that the PLP and its leader was
politically damaged because he could not make a decision, that he
consulted too much. No the very same crew are arguing that there
has not been enough consultation and that eh is rushing the
policy.
The question
we have to ask is how much more consulting do we need after starting
this process in 1984 under the now Leader of the Opposition Hubert
Ingraham. At some point we must make a decision, let’s get started
and while we develop the model, we can improve as we go along. What
we know is that the present model is not working adequately, it is
unsatisfactory and this present model will in fact break the bank
since the funds come directly from the consolidated fund, all of us
the taxpayers. We cannot without a dramatic rise in general taxes
continue to fund health care in the way we are doing. We cannot
continue to provide the present levels of inadequate health care,
with waiting lines and poor service, and no equipment available, no
choices available and the perpetuation of a great untruth that we
provide equal levels of quality health care for all. You just have
to remember my example of the nurse at the start of my intervention
who said to me “Mr. Mitchell I now know that if you do not have
money in this country for health care, you will die.” Die indeed
and some want us to continue with that. Dying is a choice that is
easy to make, when you are not the one doing the dying.
I had hoped
that the official Opposition and the Non Governmental Organizations
would all be one on this. Unfortunately, that is too much to ask
for. There’s a clever answer by them instead. We are for it but
then they give a thousand different reasons why it can’t work. The
FNM is the best. They now say they are for it but we need to run
it so elect us and not the Member for Farm Road because he can’t run
it. I suppose that’s what you call damning the Member for Farm Road
with faint praise. They in fact are admitting that he has a good
idea. They didn’t have the courage to put it in their platform but
now they want to run it.
So much of the
criticism means to me, and I admit I have a tendency not to see any
gray here, that you are against it. So why not come out and say
that. You are against National Health Insurance.
I am glad that
some of my friends who have been on the other side of every issue
that this Government has proposed are supporting this initiative and
praise God for that. I am concerned at some of the dissident voices
on this; dissidence has become a knee jerk reaction to everything
put forward by the PLP.
The most
fatuous comparison that I have heard is the comparison between this
policy of the PLP and the FNM under Hubert Ingraham and the FNM in
2002 to amend the constitution. There is no comparison at all. But
the PLP should not sleep and think that a powerful group of well
monied allied forces against the idea of national health insurance
can’t turn it into one, if we don’t counter at this disinformation
and quickly.
First,
consultation continues. Secondly, this is only the framework
legislation. The details must come later. The details will require
in depth discussions with all the stake holders on a number of
issues that will be delineated in the regulations. Anyone who knows
any Bahamian legislation will know that the design of this is no
different from any other legislation. You have a board, you have
power to collect funds, you have purpose for the fund, and you give
the minister the power to make rules. There is nothing asking why
the Government wants to rush national health insurance before
Christmas. You can forgive ordinary members of the public for this
but not the opposition, not the doctors, not the insurance
companies. They all have the aptitude, the access, the resources to
read and understand; they also have the ability to consult with high
paid professionals who can assist them where they do not
understand. In the present climate, all have to be careful less
their public expostulations don’t end up being misinterpreted as
knee jerk anti PLPism as opposed to a genuine philosophical
disagreement in national health care and how it can be paid for.
Now the
question has been raised as to whether or not the Government, its
advisors and actuaries from around the globe and the hemisphere have
adequately predicted the increase in demand for the services of the
hospital and the public health facilities and whether or not the
public facilities will be able to meet the demands. That is a good
question but that surely cannot be a reason to stop going forward
with national health insurance.
First if there
is an increase in demand for services at public facilities, it may
mean almost surely will mean that some people who were putting off
going to the doctor to get care were not going and their health was
suffering as a result. So that makes it a good thing if it benefits
one person to make them healthier. Secondly, while there will be a
demand effect, in the sense that there will be greater demand, there
will also be a new equilibrium overtime in that after a while those
who simply go for the sake of going to a newly available service
will fall off as the novelty wears off. Thirdly, the investment in
public facilities will continue both directly from the consolidated
fund, from National Insurance and from the new resources from the
National Health Insurance. One aspect will be better utilization
hospital beds in the Princess Margaret Hospital. All of that will
not be quick or easy but that in my view Mr. Speaker is not a reason
to stop national health insurance as we presently envisage it.
Let’s deal
with some facts. The fact is that the 20 per cent increase in
demand that is expected is a 20 per cent increase over the entire
health care system and it is over 3 years not just NHI starts today
and the demand increases tomorrow. People simply concentrate in
their criticisms on the hospital but the increase will be over the
whole system including private health care and the public clinics
where incidentally most people receive their health care. The
hospital PMH deals with 30,000 annual visits. The public clinics
in New Providence receive 300,000 annual visits. So PMH should not
be the focus. The fact is also that the NHI will open up new
opportunities for doctors who want to go into private practice since
it will increase the market and they will have a better payment
system to support their businesses.
The changes
that NHI will bring, promise to be significant to the delivery of
health care. For example, should the public system re examine how
it deals with consultants. Consultants now work for twenty hours
to contribute their specialty to the public system. Some patients
complain that when they go to the doctor as a public patient, they
are told that you must come back in a month or three weeks but if
you come to my private clinic, I can do it tomorrow. There is also
the question of accountability of consultants to the system. How
does one monitor that the public system is getting it money’s worth;
what system can be put in place to ensure that the public system
gets the full benefit? Do you for example have to start a career
path which will lead to specialists simply working full time for the
system as opposed to the present system.
We know for
example that junior doctors coming into the system today have
expressed a strong desire for such a career path, and we also know
that they have complaints about various injustices in their
treatment and training under the present system, that today’s
consultants out to take note of and review.
The whole
system then must be examined and it is important that when opponents
of this in the medical profession raise the issues in the
confrontational way that they have, that the public puts all the
practices under scrutiny, not just the Government’s practices.
Mr. Speaker,
what has sold me on this programme is the Minister’s commitment to
primary and preventative health care. In other words, the promotion
of healthy lifestyles, the promotion of the fact that so much of
what happens to us and our health and health care comes as a result
of choices that we make: how many children we have, what kinds of
food we eat, what kind of life we live, whether we engage in healthy
eating and activities that keep are minds healthy. By doing so, the
evidence is that we can prolong our lives. The BBC website lists
today life expectancy at birth for a Bahamian born today to be 66
for men and 72 for women.
I am advised
that 11 million dollars will be allocated from the fund for the so
called wellness component, dedicated to healthy living. The
Minister has also heard the requests from practitioners and
supporters of natural medicine as well and while do decisions have
been made, he has agreed to look into their requests.
In the case of
all of us, obesity is a serious issue and its affect on the rate of
morbidity, that is the diseases we get and on death are serious.
For men, the epidemic of murder, accidents, and other self inflicted
problems like drugs and alcoholism affect that rate. Any of the
youngsters can tell you in Fox Hill that one of my main concerns is
the young men riding up and down on the Fox Hill road and through
the village without a helmet. The evidence is there for them to see
of mainly young men being killed on the cycles almost every month
but it does not seem to stop it and the police appear to have given
up on enforcing the law on the use of helmets on motorcycles. Just
that one enforcement alone can save lives and all of the public
education and slight changes in behavior together with better
medicine and health care will lengthen the days of our lives and
improve the quality of our lives. The question is: do we have the
national will and discipline to do it?
I am certain
Mr. Speaker that this bill is the right bill at the right time.
There are plenty of questions but this is right general framework.
I have decided that this is the best thing for my constituents and I
am prepared to rise or fall on it. It is clear what my position
will be with regard to those who oppose it. They will have to
explain to each household in Fox Hill why the FNM opposes national
health insurance and the assistance this will give to the poor and
the middle class to defray the expenses of their health care. This
is no joking matter for me. Health challenges face us all.
For example,
as a Cabinet Minister having left my private practice, my private
health insurance has lapsed. Health insurance comes with this job
but when I no longer have this job, the immediate question will be
if there is some issue with my health who will I pay for it. For me
and many others in this place and for former members in this place,
this is no joke. We and our constituents face the same issues and I
think that this is the best way to resolve it and the quicker the
better.
In terms of
the control of the fund, this is o slush fund and there is no
opportunity for corruption as some of the nay sayers point out. The
fund will be carefully governed and controlled and there will be a
ten million dollar reserve for extraordinary medical expenses.
Mr. Speaker in
my research on this matter and in discussions with the Member for
Farm Road, I had the opportunity to discover that the National
Insurance Act was passed in 1972, yet the actual National Insurance
scheme did not come into place until 1974, some two years later.
The industrial benefits under national insurance did not come into
effect until 1984. No one today can argue that National Insurance
is not beneficial to the Bahamian people. I was particularly
happy that my friend and mentor Sir Clifford Darling in an otherwise
sanitized ceremony had the courage to remind us that the arguments
on National Health Insurance are the same ones he heard a generation
ago on National Insurance. What he could not say was that it was
also from the same people and their inheritors? We all remember, we
are for independence but not at this time.
But I urge the
PLP not to sleep on this one. This is not 1974. We are dealing with
a different generation, a different era. Our resolve must not
slacken but our methods must change.
I support
national health insurance. I commend it to my constituents. I
remain at the disposal of the Prime Minister and his Minister of
Health for whatever little bit I can do to further promote this
policy.
I thank you
Mr. Speaker.
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