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Healthcare reform is still not a good idea

May I respond to Jan-Ann Martin who critiqued, in The Royal Gazette of January 13, my overlong comments on the proposed government health reforms?

First, it is worth noting and recording that Bermuda does come out reasonably well by comparison with other countries and the data may be found on the Lancet website.

In the healthcare league (page 2243) Bermuda is ranked 37 out of 197. By comparison, Britain is No 23 and the United States No 29. Top of the heap is Iceland, while for further contrast, Bahamas is No 90 and the Central African Republic No 195.

According to the Bermuda Medical Doctors Association, as reported in The Royal Gazette of December 23, 2019, the following are the top five reasons to be proud of our present system, based on statistics sourced from the Pan American Health Organisation and the Bermuda Government:

1, Bermuda consistently ranks in the top three countries worldwide for achieving the lowest infant mortality rates

2, Bermuda also ranks in the top three countries worldwide for maternal health

3, Bermuda has not experienced any critical health problems related to emerging and re-emerging diseases, neglected diseases and other poverty-related infections or tuberculosis

4, Emergency room visits for asthma have decreased versus increases in similar jurisdictions

5, Bermuda is one of the only developed countries worldwide to have flattened the curve of rising obesity rates

While this is not perfect, it is commendably high.

Second, the main point made by Ms Martin is the assertion that healthcare is a human right and that Bermuda, somehow, is in breach of human rights by not having a comprehensive and government-subsidised healthcare system.

But is that assertion correct? I think not.

It must be emphasised that healthcare is not found for free in nature. It must be produced by the work of many highly skilled human beings. As a consequence, such people must be paid by their patients, aka customers, adequately and properly for their time and skills, just like other professionals such as lawyers, accountants and civil servants.

We should always be aware that over the past 100 years or more, medical advances were achieved that our ancestors would have regarded as truly miraculous. Most were made by highly intelligent people escaping the dead hand of government regulation and supervision.

After all, what is healthcare?

It is nothing more than the output of healthcare providers, whether they are doctors, dentists, nurses, technicians, office staff, drugstores, and so on. It is one of our most important industries, and I can see no reason why they should be converted into public servants because of a misguided belief by uninformed politicians that healthcare in Bermuda should be made more affordable.

The idea of government is to cap the payment to healthcare providers, but that would have the unintended consequence of diminishing the number of providers, which, by definition, reduces the number of doctors in total and decreases patients' access to care. Not a good idea.

Not only that, but because upfront costs are reduced, there will be a tendency to increase the use of healthcare services.

This is an elementary principle of economics that when the price of any product is reduced, the quantity demanded increases, thus adding to system stress. Increased demand coupled with reduced supply is a recipe for queuing and less opportunity for individual choice. Additionally, the incentive to enter, or remain, in the medical professions is diminished. Not a good idea.

With increased demand and a reduction in the supply of medical skills, the power of administrators, the gatekeepers to medical care, is increased and bureaucracy triumphs. Again, not a good idea.

The question then arises, why should government bureaucrats be entrusted with determining who should be next in the queue to see the doctor or dentist? Or more bluntly, why on earth would anyone in his right mind want the people in charge of creating a bus timetable to be in charge of running our medical clinics? Yet again, not a good idea.

If these scenarios sound far-fetched and alarmist, take a peek at Venezuela, where one third of patients admitted to public hospitals die from otherwise preventable conditions, while the wealthy and powerful enjoy private care or seek healthcare in other countries — including in the United States.

In that benighted country, which was once the most advanced nation in South America, patients are required to provide the medical equipment that will be used on them, which largely comes from the black market.

Like many other government programmes, the proposed healthcare would leave Bermudians with devastating unanticipated repercussions.

The solution is not simple, but surely the determination of healthcare rates is nothing to do with government, and we should acknowledge that top-class healthcare depends on a healthy personal relationship between a patient and a doctor — not on government bureaucrats.

The assertion that healthcare is a human right is not supported by law — check the Bermuda Constitution. Bermudians have a human right to freedom of such things as speech and movement, but not a constitutional right to healthcare.

If Bermudians have such a right, then it must be the duty of healthcare professionals to provide it free of charge. But that cannot be a human right because there is no right to the fruits of the labours of someone else.

Granting someone the right to the products of someone else's labour without full payment is the quintessential definition of slavery.

No one in his right mind would demand the right to the products of farmers or supermarkets, but somehow it is OK to demand a right to the labours of health professionals.

May I finally make the point that the Government does not have a stellar historical record of sound management.

Indeed, when one examines the sorry record of such things as education, the reports on government finances by the Auditor-General, and the failure to draw up a bus timetable within a reasonable time, one would have to be a supreme or starry-eyed optimist to believe that the Government will make healthcare more efficient and more affordable. It is simply a delusion.

Surely, we have learnt by now that big government is divisive, intrusive, non-responsive, usually incompetent, rarely works and is endlessly expensive.

Seven thousand Bermudians have signed a petition seeking to restrain the Government from interfering in our healthcare system and adding to our financial woes. Does that sound like widespread dissatisfaction with the existing arrangements?

Ms Martin applauds our politicians for seeking reforms, but I suspect she has fallen for the myths of government efficiency and effectiveness.

The Government always promises to do better next time, but you do not have to be a sceptic like me to believe that our existing crop of politicians is performing its usual stunt of dangling a carrot in front of the donkey's nose.

Robert Stewart is the author of two books on the Bermuda economy

Healthcare is not found for free in nature: people chat at a free heallth screening recently (Photograph by Blaire Simmons).

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Published January 22, 2020 at 8:00 am (Updated January 22, 2020 at 7:15 am)

Healthcare reform is still not a good idea

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