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November 10, 2009


Rick Lowe

Well written as usual Larry:
Here are some numbers that were compiled for the Nassau Institute recently.

GDP: $7,564,000,000 (and dropping)
Health Expenditures: $271,533,000
Social Benefits & Services: $99,434,000
Other Community & Social Services: $28,857,000
Total expenses 2008/9 $399,824,000 for 5.29% of GDP

The country is running serious deficits now, so how can we afford we afford to double health care expenditures which is what it will take for a universal plan?

I still maintain this can save the Bahamian taxpayers a lot of money by issuing vouchers to the needy and those that cannot get their own insurance.

Countries inevitably get into rationing health care. There's no choice.

There is no panacea.


where do you get those figures? this is from the budget: in the 2009/10 Fiscal period, $226,023,376 or 15% of the recurrent budget has
been allocated for health services.

We are running serious deficits because of the drop in tourism and because we are a low-tax country. I am willing to pay for a properly done national health programme that would give me security.

Rick Lowe

The numbers come form the Central Bank and the Government's budget.
See this article and review the spreadsheet: http://www.nassauinstitute.org/articles/article839.php
But you have insurance no?
By the way, we were running serious deficits before he economic crisis.

larry smith

Those GDP figures appear to be for public spending on healthcare-related services. They do not include private spending. The figure I have for 2006/7 is 7% of GDP.

Rick Lowe

That's correct.
Imagine what total spending is?
If we cannot sustain the public sector costs, which is what the current changes are about, how can government handle the whole thing?

larry smith

There needs to be a national mandatory insurance plan that operates as a public private partnership - taking the best approaches from other countries and trying to avoid the pitfalls - all phased in gradually.

This excellent PBS documentary offers some interesting perspectives from other countries.


Rick Lowe

1. What makes us want to believe the government can avoid the pitfalls?
2. What makes us believe that we can decide the price for the fruits of other peoples labour?
I watched the PBS documentary you refer to. While it was professionally done, I felt it was skewed in favour of socialised medicine.
There seems to be a number of things in play, so we need to define what we wish to achieve.
Is the objective to take care of the poor and those that cannot get insurance for some reason?

larry smith

What makes us believe that the private sector can address the pitfalls that currently exist?

The risks falling on the public sector are increasingly those who are sicker, poorer patients with chronic illnesses, those who have been excluded from private cover, retirees who fall outside the private insurance schemes, and those who require long-term care and post-traumatic rehabilitation.

Therefore the public sector is in the position of having to provide increasingly costly services without a sufficient revenue base.

The cost of physician services in the Bahamas - despite the growing numbers of doctors - is very high and i understand that insurers have difficulty negotiating discounts.

On the other hand, the biggest chunk of money in the public sector apparently goes towards salaries and admin costs, and transparent management does not exist. Likewise, there is no accountability in the private sector either - as the insurers and doctors can do largely as they wish.

I think that those conditions make some form of public private partnership essential going forward.

larry smith

The PBS programme reviewed healthcare systems in comparative countries in an attempt to draw lessons for the US debate.

If it was skewed it is because those are the systems that apply in all other rich countries.

Rick Lowe

Like those before us that came up with the idea of Socialised medicine we will be dead and gone and the generations after us will face not being able to continue to fund the perfect health care system that we created like so many of those countries you refer to.

larry smith

well I guess in the long run we are all dead.

However, it is worthwhile noting that more money per person is spent on healthcare in the United States than in any other nation, and the US also spends a greater share of total national income on healthcare than any other nation except East Timor. Medical debt is the principal cause of personal bankruptcy in the US - about 700,000 bankruptcies a year.

Rick Lowe

It boils down to who you trust with your health care. A doctor you can choose or a state bureaucrat.
I choose the former. How about you?
If the day comes I am locked out, I'll have to deal with the consequences I guess, as unpleasant as that might be.
For example, my bother in law cancelled his insurance because he could not afford it. Now he goes to PMH and the government clinic to get the free health care and medication they provide now.
What gives any of us the right to decide that he should be treated privately because we decided health care is a right?
Now if we are all agreeing to help those that cannot get insurance or are locked out of the market, that is a different matter.
One last time, my point is the government can fund those people with vouchers. They do not need to takeover the health care business as they are doing with the drugs for current chronic non-communicable diseases.
When they price control items etc innovation in service and availability are impacted.
Thanks for the discussion.

larry smith

Does that mean you have the last word?

What's the difference between a government bureaucrat or an insurance company clerk?

Why should your brother-in-law get free 'socialised' medical care?

Rick Lowe

Of course not. This is your blog so you can have the last word.
Medical savings accounts can deal with the "insurance clerk" issue.
That's a whole other issue and is part of the problem that the economists I follow have highlighted.
Insurance has taken our personal decision making out of the process, highlighting the issue of why we need to accept personal responsibility for these things.
But I asked about your doctor.
I can't answer why my brother in law should receive treatment free.
I don't advocate that.

drew Roberts

Does anyone know if we have an mutual insurance companies here?

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