EDITORIAL - Gov't can't afford free health care, education

Not surprisingly, the partisans have interpreted the People's National Party's (PNP) Dr Dayton Campbell's remark in Saturday night's political debate as a retreat from that party's criticism of the current policy of free public health care. Or, the PNP, should it form the government after the December 29 general election, will linger indefinitely over ending the scheme.

Our understanding of the remark, however, is that a PNP government would not, on day one, strike out the existing system, but would require some time to implement a replacement. The basis of his position was that access to health care should not be based solely on the individual's right to pay, so as to exclude the poor.

Should the misreading of Dr Campbell's comment be ours, that his party is not in retreat on the issue, it is important that the PNP clarify the matter now. For health-care delivery, and how it is financed, is among the issues, along with tuition-free secondary education, that the PNP and the governing Jamaica Labour Party (JLP) must address with fulsomeness in their manifestos.

Beyond affordability

The stark truth is that these are programmes that the Jamaican Government can ill-afford, and from which it should now, transparently and honestly, extricate itself very early into the new administration.

Of course, this newspaper believes that the State must look out for welfare and, therefore, provide social safety nets for the poorest of its citizens. But those who formulate policy must be absolutely realistic about the economic capacity of the Government to finance services and, therefore, the breadth of the entitlements that are offered.

In Jamaica's case, even a cursory analysis shows that much of the Government's spending cannot be sustained. The national debt is now a shade under $1.6 trillion, or around 130 per cent of gross domestic product. After servicing that debt, including amortisation, what is left can pay only two-thirds of public-sector salaries. So, our Government finds itself on a treadmill of borrowing to maintain services.

Indeed, the implementation of state free health care and the elimination of the euphemistically labelled cost-sharing in secondary schools - which won the JLP votes in 2007 - contributed to a jump in the national debt by $175 billion, or $480 million a day, over the past four years.

In the 2007-2008 fiscal year, the governments health system was projected to earn $1.74 billion in fees from patients, to supplement the budgetary allocation of $17.8 billion. The removal of these fees may have, as the administration boasts, greatly improved access.

Lingering poor quality

But there is little doubt, as the numerous complaints show, that despite the rise in the health-care budget by 60 per cent, to $28.5 billion, over the past four years, this has not translated into commensurate quality. Moreover, the anecdotal information suggests that many of those who now use the hospitals and other facilities have health insurance, can themselves afford to pay, or need not use these services. Similarly, many parents who can afford to contribute to their children's education have the same subsidy as the poor.

These arrangements are not economically sustainable, and the parties must have the courage to say so. It cannot be beyond the capacity of the Government and technocrats to devise appropriate means tests, to be applied with dignity, to determine those who genuinely cannot afford to pay.