Guyana needs a medical welfare fund for the poor

Dear Editor,

Earlier this year there were reports about the abuse of public funds allocated as medical aid for cosmetic purposes rather than bona fide medical emergencies, etc. In one case, a former minister had used up $2.1M to fix her teeth. This would have occurred even while many persons, particularly children, continued to suffer from life-threatening conditions. Some died awaiting the helping hand that never came.

For those who are parents, one of the most distressing occurrences in life can be to watch your children become gravely ill, while you are helpless to do what is required simply because you do not have the resources or the connections to get the medical attention needed. Probably equally agonizing is when as a sickly breadwinner, you have to choose between your medical care and providing for your family’s needs.

I have listened to many broadcast messages in which parents and relatives plead for public assistance, or have seen where they beg door-to-door to raise the money needed for treating their loved ones, most often the money being a fraction of what was spent on that one woman’s teeth.

In a country like ours, with so much wastefulness and disparity in wealth, there must be something that can be done to make such heartrending situations something of the past. Surely we can find the money to put aside for helping those who are the most needy amongst us.

There are three things that we, as private consumers, spend a fair amount of money on: alcohol, cigarettes and legalized gambling/lottery, which we cannot say for sure bring any benefit to society. The fact that many can complain so bitterly about a 2 am curfew on the sale of alcohol, suggests that we have a lot money to splurge.

Each of these ‘vices’ in our society represents a significant opportunity cost at the individual, household and national level. The money spent on these items means that many other things of value had to be forgone. In many poor households, the opportunity cost of these expenditures is very glaring, with what is actually forgone often being the sustenance and healthcare of family members.

There has been a lotto fund since the lottery company was established here in 1997. There are taxes applied to the sale of tobacco and alcohol, which I am sure amount to a sizeable share of public revenue. Whether or not the tax rates applied to these items are justified is debatable, but as a bystander they do not seem to have forced demand downward, which is one of the purposes of such taxes.

These three streams of revenue all now go into the big barrel we call the Consolidated Fund (CF), a victory for public accounting that was well-fought for. However, we know what happens with how the CF operates. Tax administration is meant to redistribute inflows to where they are (most?) needed and not necessarily in support of development related to their sources/sector. Like how the environmental tax is used!

Using the argument of a collective opportunity cost to society, I am suggesting that we take these three revenue streams – alcohol and tobacco taxes, and the lotto fund – and commit these monies to starting a special Medical Welfare Fund for helping the most needy with their healthcare.

With our current capacity for providing effective medical care still being below the desired level, there will be some net outflows from the economy, particularly where medical treatment must be sought overseas. However, with ongoing improvements in technology and capacity in the existing hospitals, and with the Turkeyen Specialty Hospital coming on stream some time in the near future, many healthcare issues that could only be dealt with abroad will soon be taken care of right here in Guyana. Even when that happens, the cost of effective healthcare will still be prohibitive for our most needy, and as such public support funding will still have to be sought. Welfare expenditure in this area will mean that a larger share of the money will actually re-circulate within Guyana’s economy.

Removing the three revenue streams from the CF may suggest undoing what was fought for, in the case of the lotto fund. However, there can be special provisions for channelling these revenues to the Medical Welfare Fund on an as-needed basis, or to keep the fund at a certain replenishment level that matches our needs in the described healthcare areas. Whatever needs to be done, can be done; the technicalities of fund management can be worked out later.

With an increasing number of children requiring corrective surgery, and with chronic non-communicable diseases such as hypertension, diabetes and cardiovascular disease being on the rise, there will be increased demand for healthcare-related welfare support. Part of the welfare fund can also be used to push education about the harm associated with alcohol and tobacco abuse.

There are many possibilities of what can be done, when what is seen as wasteful spending can be taxed and brought back to benefit society. And certainly, spending taxpayers’ money on fixing cleft palates in 2 or 3 poor children, or helping a breadwinner stay alive to see his children grow up is going to be more ‘palatable’ than brightening the smile of one mature woman who can well afford to do so, on her own.

Let us make 2016 a year when no one has to beg to save their own life, or that of a child in Guyana.

Yours faithfully,

Khemraj Tulsie

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