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Editorial | Sunday, 31 May 2009
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Free health? What free health?

It had to happen. With less than a week to go for an election, the Opposition leader – like his immediate forebear last March – has produced a document which he claims will spell the end to “free health for all” as we know it today.
Cabinet, Joseph Muscat argues, is currently examining ways and means of introducing payment for various medical services. And for their part, both Prime Minister Lawrence Gonzi and parliamentary secretary for health Joseph Cassar insist that health services will remain “free” for as long as the Nationalist Party remains in government. On the contrary, it was Labour’s MEP candidate Edward Scicluna who, on the TV discussion programme Reporter, claimed that charges of one kind or another would one day have to be introduced. And on it goes: allegation, rebuttal, counter-allegation, counter-rebuttal, etc.
But the real question we ought to be asking ourselves is: are the Maltese national healthcare services really free at all? At a glance, the answer appears to be... No. Not, at least, for the hundreds of patients currently on three-year waiting lists for cataract operations, or for other interventions of an even more serious nature: cancer patients, for instance, who are told to expect their test results of their tests in three, four, six or even 12 months down the line...
Let us be honest for once about healthcare in our country: a service cannot realistically be described as “free” when it remains obtainable in practice only at a cost. In many cases, the sheer length of the waiting lists involved at Mater Dei – as well as the consequences of postponement, which can include blindness, debilitation or even death – will sooner or later force the hapless patient to turn elsewhere.
How can we keep calling our national health service “free” when so many of its potential users are compelled to resort to private hospitals, locally and abroad, sometimes even for basic operations? Lawrence Gonzi and Joseph Muscat may boast of their unbending political ‘direction’ to keep healthcare free, but the underlying reality is considerably different from the image projected by their rhetoric.
Ironically, Prof. Scicluna was right before he was made to retract his arguments for purely political reasons. The truth is that our national health service, in its present form, can only be sustained by a further increase in taxation. Our national insurance contributions are currently supporting national pensions, but the State has not yet provided a health fund to support the NHS.
And why should taxpayers sustain a slew of free services and medicinal products, from rudimentary medical disposables to basic medicine and pills, for people who can clearly afford a subsidised price on their cost?
With our politicians’ ideological inflexibility on means testing for certain services that are presently gratis, we are risking turning the health-financing conundrum into something infinitely worse.
Perhaps we should remind ourselves of the beginnings of free healthcare. When the British NHS was created in 1947, Labour minister Aneuryn Bevin said the system had to be a basic, “lean” safety net of services guaranteed by the State, in conjunction (not in competition) with the private sector.
Arguably, this is the system in place in Malta today. But the local development of the NHS model has given birth to a monster, with the mushrooming of ‘pink card’ beneficiaries, an annual €120 million running cost for Mater Dei, and more worryingly, a lack of political ownership on the cost of running the system.
Hackneyed as it may be, there really is no such thing as a free lunch. The cost of Malta’s healthcare is real, and users must understand the value of the NHS healthcare before availing of the service.
First, the introduction of a means testing system for certain basic services will help cut down in unnecessary usage and encourage more responsibility in people who do not want to see their money wasted.
Secondly, people must be encouraged to use the primary healthcare network and GPs, to secure the frontline of medical care at initial contact without any unnecessary use of the Mater Dei emergency department.
These are precisely the sort of proposals that Cabinet should be discussing, if we are to continue providing a decent service to future generations. Unfortunately, however, political expedience has once again got in the way, and instead of discussing how to salvage a sinking ship, our politicians now compete with promises they know they can’t possibly ever deliver.


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