Wilberne Persaud, Financial Gleaner Columnist
Persaud
Michael Moore's new film Sicko is cleverly referred to by the Associated Press as "his dissection of the nation's health-care infirmities."
The film compares the private health care system in the United States to the public system of Canada, the United Kingdom and France, with an excursion to Cuba for actual treatment of a sick 9/11 worker.
Reviews claim it Moore's best film yet. He is not ever present and controversial as he was in his Academy Award winning Bowling for Columbine - the gun control documentary - or Fahrenheit 9/11, his 'in-your-face' attempt at debunking the rose-filtered exposure of the media picture of George W. Bush.
But his choice of comparisons suggests his point of departure: sickness is not for profit.
In the private health care provider insurance system of the United States, sickness can mean bankruptcy. Insurers routinely deny treatments and allegedly, providers defraud insurers, claiming for services never rendered.
The system is absolutely broken. Yet it provides good living for some - they won't change it. And they have the ears of Congress.
Doctors complain that the system is inefficient, delivering more administration, form-filling, decision querying and battles with insurers over payments than health care.
The profit motive brings out the worst. Instead of health care the system spews out endless paper, leading to costlier care which fewer people can afford which in turn leads to more ill health.
Today in Jamaica controversy surrounds the Government Employees Administrative Services Only (GEASO) health scheme over the proposed shifting of public sector providers from Blue Cross to Life of Jamaica.
The Gleaner published on June 27, claims: "Some experts have opined that the Finance and Planning Ministry was lured by the more than $100 million it would save by awarding the contract to Life of Jamaica."
The National Contracts Commission's latest list of endorsements revealed that LOJ would receive $148.93 million to administer the scheme while unconfirmed reports are that Blue Cross was receiving close to $250 million per annum.
Actuaries
Honestly, you might lure rainbow trout and salmon with artificial flies but there is nothing unreal in saving $100 million. What is this about actuaries? Are they saying that LOJ cannot deliver the proposed payments for health services based on their assessment of future sickness of the insured government worker categories and projected costs of the services to be accessed?
Is LOJ brandishing a loss-making lure to gain the business? Or was inefficiency or price gouging the order of the day? What is at stake here?
Beyond these questions look at the philosophy behind health care financing and the 30-year trend to the notion that 'for-profit health care' delivers best.
We have always had private, for-profit health care. The difference today is its scale. Some of this has been the result of unintended consequences of unwise decisions, short sighted budgeting, copying systems from the United States where most of our doctors have had, if not post-graduate training, at least exposure to systems and procedures — in other words, transplanting systems just as Tastee now mimics, for its own survival, KFC.
In the 1960s, the days of Sir Harry Annamunthodo and other medical legends of the University of the West Indies and its associated teaching hospital the University Hospital of the West Indies, the 'public' hospitals provided health care for 'free' to the people. Government footed the bill.
The system was a kind of all inclusive - doctor's visit, testing, imaging, nursing care, hospital stay - everything was provided in one shop.
At least two things stemmed from this. Our doctors tended to have the best equipment and facilities available to them. As a result, attrition rates from the system were negligible.
With new developments in medicine, medical techniques and technologies, the availability of complex and costly equipment began to create push/pull factors.
Funds were not made available to purchase the latest and the best in sufficient quantities for the public institutions.
The one-stop operation ceased. You might see a doctor but your testing and imaging would be done elsewhere. The health care provision system became more profit-centred and driven.
'For-profit' medical services
So with the demise of the public institutions, the growth of 'for-profit' medical services required private financing of health care.
This is what we have today. It is clearly a work in progress and who knows what it will look like at the end of the day.
For me, Sicko makes me fear a completely for-profit driven health care system. We can do a much better job than we are currently doing.
That we can reduce 'for-profit' care delivery to the affluent in the society is a matter of choice, reflecting a philosophy that generally, healing the sick should not depend on the coins in their pockets.
wilbe65@yahoo.com
Nurses raise their hands in a vote against plans to award the public sector health scheme, GEASO, to a new insurance provider after 10 years with Blue Cross of Jamaica. President of the Nurses Association of Jamaica Edith Allwood-Anderson is at left. - File
