Martin Henry, Contributor
On Tuesday, April 1 (All Fools' Day), all user fees will be abolished in government health facilities, except the University Hospital of the West Indies, which is a regional institution not directly controlled by the Government of Jamaica.
Fees were introduced for a range of public services, including health care, during the last administration. If sheer wickedness is ruled out, there must be a reason why a government having the pedigree of the People's National Party (PNP) with its socialist and state-welfare roots had to introduce user fees. If they wrecked the economy and had to resort to user fees for a bail-out, then this Jamaica Labour Party (JLP) government has had no time to build back a 'broken' economy since being sworn into office six months ago on September 11 last year.
Indeed, the Government does not miss an opportunity to complain how external conditions beyond its control are battering the economy. And it says it has had to "find the money" to meet off-the-book expenses inherited from the last administration.
But, "we are irrevocably committed to the view that it is the duty of the Government", the full-page newspaper advertisements announce, "to provide unrestricted access to basic health services ..." And "one of the pledges of the Government is to abolish user charges at all public (Government) health facilities, including hospitals". Secondary-school fees introduced by the last JLP government have already been abolished in one of the first campaign promises fulfilled by the JLP government in office.
Grief
Clearly, contrary to the protestations of the Government, it has to have a magic wand, or more, somewhere. Actually, governments have three magic wands to which no one else has legal access, raising taxes, state borrowing, and printing money. The problem is these magic wands quite quickly deliver grief to the very people who were to benefit from the waving of them.
The Ministry of Health has had $1.5 billion tacked on to its budget for absorbing the removal of user fees - in year one. A sustainable public policy will have to run successfully in perpetuity. National security, education, housing and local government are getting more. Somewhere is getting less. Even with magic wands, the 2008-2009 Budget could not have been made substantially more than last year's. And already, some two thirds of each revenue dollar goes to paying back what we have borrowed, much of it to finance unaffordable freeness.
Former Finance Minister Dr Omar 'Run wid it' Davies pointed out when the second Supplementary Estimates were presented to Parliament on March 18, the Government's cutting back on capital expenditure on a number of projects financed by international agencies adding up to some $2.3 billion.
Health Minister Rudyard Spencer, who has spent most of his professional life in an environment where many people believe money does in fact grow on trees, seems to believe in magic as well. Listen to him jawboning policy into reality: "Failure is not an option. It is not a matter of if it can be done. It simply must be done."
Health-care workers
To make it happen, "we have to beef up the system", says Chief Medical Officer of Health, Dr Sheila Campbell-Forrester. So "with two weeks to go before the abolition of user fees". The Gleaner reports on March 19: "The Ministry of Health and Environ-ment (is advertising) for health-care workers to fill posts in public facilities across the island." They need just about everybody in health care. Where are these people to come from in two weeks, or two months, or two years? And what are they to be paid?
Nurses, whose association's leaders apparently also believe that money grows on trees, are still agitating for a 100 per cent increase in salary, which Minister-of-Finance- in-waiting Audley Shaw had told them they deserve and he would provide in Government. Big people, unlike young children, should be able to make the difference between 'joke and serious thing' and learn to take a little joke.
I am afraid that the promise of free health care is also a little joke that has become deadly serious, and deadly in more than a metaphorical sense.
Access is one thing. Quality is another.
In the early days of this column, in the tail-end years of the last JLP government. I wrote about 'A long night at the hospital' which drew a phone call from then Minister of Health Dr Kenneth Baugh. The piece was about the 'sufferation' encountered in trying to get 'free' medical care for an acutely ill person in a public facility. User fees were introduced to pull some additional dollars into the system poorly financed from public revenue in order to improve the quality of service.
Unless this Golding government pulls off a major miracle, it will not be able to provide high-quality health care for free across the range of its policy prescription. In 1974, Michael Manley announced free education to university level. Legend has it that his Finance Minister David Coore, heard of the policy like everybody else in that impulsive public announcement. At least Audley Shaw and Ruddy Spencer have some lead time to 'find the money' pulled out of the hat.
Quality did not follow access and a generation later the free school system was still generously delivering illiterate graduates for JAMAL, the Manley temporary literacy initiative which became everlasting. University education has subsequently expanded explosively on fee. And school administrators and parents alike agree that the secondary school cess introduced by the Seaga JLP Govern-ment had made a difference in improving school quality.
Golding and the JLP are banking on possessing more powerful magic than Manley and the PNP of the 1970s. Politics will again attempt in futility to defeat economics - a game to which politicians are addicted. The very people, the poor, who are supposed to benefit most from freeness will end up suffering most.
Martin Henry is a communications consultant.
