“...And now, ladies and gentlemen, the moment you’ve all been waiting for. The winner of this year’s ‘Most Incredibly Cheeky Headline in a Local Newspaper’ award. And boy, I can tell you the competition this year was tough. Here in this envelope is the name of the lucky winner... hang on while I open it... OK, here we go... and the winner is... Oh, my God, I can’t believe it...! It’s... It’s... It’s Health Minister Louis Deguara, for the unbelievable headline of his article in last Friday’s The Times: ‘Time for decisive decisions!’...” (Standing ovation, lights, music, camera, action, etc.)
***
Honestly, though. What the hell is a “decisive decision”? Oh, all right. Let’s leave aside the immediate tautology, and instead concentrate only on the “Incredible Cheek” for which the headline won the prestigious award in the first place. After all, this is our Health Minister talking here. This is the man who promised us that the “St Luke’s incinerator would be replaced by the end of 2001”. Yes, the same incinerator which, four years after its supposed “replacement”, is still there, unreplaced, and happily rivalling Mount Etna with its daily discharges of thick, black and highly toxic smoke, all over the homes and gardens of one of Malta’s more densely populated residential areas.
Yes, folks. The man who publicly committed himself to solving that particular problem – arguably our second most pressing health hazard after Maghtab, though I may be exaggerating – has just told us that “the time has come for decisive decisions”. Am I the only one to spot the irony here?
***
Hang on a minute. Of course! I forgot... The minister has a perfectly valid reason for failing to fulfil his promise in the distant summer of 2001. After all, as his ubiquitous communications secretary keeps pointing out tirelessly in the press, Decisive Deguara is “powerless to intervene” in this case because “the tender process has already been adjudicated.” Never mind that the contract-winner is currently languishing in prison for insolvency, with the obvious result that the contract cannot possibly be honoured. The official argument seems to be that once the tender process has started, no minister can simply step in and bend the rules in order to get the job done. No, not even in a case where public health is being gravely threatened on a daily basis; and no, not even if the Minister concerned prides himself so publicly (and so groundlessly) of being some kind of decision-taker extraordinaire.
***
Well, hate to sound suspicious or anything, but I just don’t buy this “tender process” argument. After all... wasn’t it just a couple of months ago that Lawrence Gonzi personally intervened in another health-related contractual impasse? I seem to remember how our Prime Minister – also keen to prove himself a “decisive decision” maker in his own right – arm-wrestled Skanska into agreeing upon a fixed date for the completion of the Mater Dei hospital project. I also recall how the Nationalist media trumpeted this agreement as some kind of “moral victory” for our much-maligned PM... although the same deal was elsewhere described in terms of “caving in” to Skanska’s demands.
Either way, nobody seems to have objected to any illegality or impropriety on the PM’s part. Quite the contrary: it seems by all accounts to be perfectly acceptable for the government to intervene directly in the case of a hospital contract which failed to adhere to either time or budget constraints, as was the case with Mater Dei (which, much as I hate to remind everyone at this stage, was yet another fine project entrusted to Minister Deguara). In this case, too, the tender process had been adjudicated, and the contract awarded. So why is it suddenly such a big No-No for a Minister to do precisely the same thing, in an almost identical case, which also happens to involve a dodgy hospital contract, this time for an incinerator?
I don’t know. Maybe, seeing as the time has come for decisiveness, Dr Deguara may one day decide to explain.
***
For my part, I can supply a simple explanation... though I doubt that the minister will agree. If you ask me, this administration is simply not very good at living up to promises made years ago... especially when these promises concern public health.
Anyone remember, for instance, the following little electoral pledge? “A DOCTOR OF YOUR CHOICE WILL VISIT YOU AT HOME FOR FREE: social services with a personal touch.” (PN electoral manifesto, 1987) Or, while I’m on the subject, how about this one? “... This is the main purpose (of our health system), which will be achieved through the scheme of a free family doctor, which scheme has been completed after a lot of work over the past five years, and which will be fully implemented over the five years to come...” (PN electoral manifesto, 1992.)
***
Well, so much for electoral promises. Thirteen years later, the noises coming from the direction of the Health Ministry are... um... let’s just say slightly different.
Today, we are repeatedly being bombarded with warnings that the healthcare situation is “alarming” and “unsustainable”, and that “decisive decisions” have become necessary if we don’t want the entire system to implode before our eyes. So far, there are no clear indications regarding what form these decisions may take. None, that is, except for a rather worrying front-page story on It-Torca a few Sundays ago.
***
Yes, the jolly General Worker’s Union newspaper – with all its customary glee in announcing death, doom, disaster, and other such cheerful stuff – anticipated a “major health reform” which, in its view, may well bring a sudden and very emphatic end to the concept of “free health for all” as we know it today.
Quoting from an unpublished MCESD report, It-Torca stipulates any or all of the following reforms, effective as of mid-April 2005: a five per cent charge of the total cost of hospital treatment; a five per cent charge on all medicines given out at hospital; a two per cent contribution from pensions towards healthcare; and a 100 per cent charge on all hospital meals.
According to the same story, MCESD is also recommending a more rigorous means testing system, as well the setting up of a “National Health Contribution” scheme, whereby all those over 16 years of age will contribute according to their income.
***
Never mind, then, all that nonsense about “free doctors” popping up as if by magic all over your home. If this report is reliable (so far, to the best of my knowledge, it has not been challenged), it seems that even Mater Dei hospital will soon become a standing testimonial to yet another failed electoral promise. After all, a hospital in which the patient must pay for his meals – not to mention five per cent of the total treatment cost, including surgery and medicines – can hardly be described as “free”.
And there you have it: one thing is promised, and the very opposite scenario materialises in its place. Rather than receiving for free something for which we previously used to pay, we will soon start having to pay for the service we previously received for free.
***
How, you might be asking, did this come to pass? How is it possible that our finances, so recently described as “on safe footing”, are suddenly insufficient to guarantee the one service which has for years been our saving grace as an otherwise poor nation?
Well, the official answers are many and various... and, needless to add, all of them can be ascribed to factors beyond the government’s control. Rising costs of medicines worldwide. Technological advances which allow for previously undreamed-of surgical interventions. Greater longevity among patients (who keep insisting, very unfairly, on staying alive for as long as possible, with all the added costs their failure to kick the bucket invariably implies...)... these are the factors currently being invoked to justify the impending health reform.
Naturally, the Lm200 million+ that the government will have spent on a hospital which is much larger and more complex than necessary – not to mention that same hospital’s estimated running costs, rumoured to be exorbitant – have nothing to do with it whatsoever. Neither, of course, does mismanagement of public finances across a wide spectrum of government related activities... including the health system itself, which has slowly been whittled away over the years (yes, by Labour administrations, too) until it is scarcely even functional in its present state: primary healthcare centres neglected; district medical officers never reinstated; the public hospital treated almost as an extension to existing private clinics ...
No, not a single of one of these factors are ever mentioned as
reasons for the government’s
failure to preserve the concept of “free health for all”. And again, I hate to sound suspicious... but I can’t help discerning a pattern in all this.
As in the “international oil price” saga last month – when the price of crude oil was used to justify the 17 per cent utility surcharge – the reasons cited for the unsustainability of our healthcare system never involve the government’s actual performance over the years, but always something to do with the bad, wicked world of which we are unfortunate enough to be part. Globalisation. 11 September. War in Iraq. Sars. Possibly even the tsunami in the months to come... anything to hit the international news and capture the popular imagination, especially if it instantly conjures up images of something beyond all human control... whatever it is, if it can be used as a scapegoat to cover up for gross mismanagement or wholesale incompetence, then you can almost rest assured it will.
***
On this issue, however, I fear the old tactic might no longer do the trick. Judging by the great collective yelp of pain that accompanied the latest budget announcements, it would seem that people are already feeling the pinch of indiscriminate price-hikes, lost leave etc. If, in the near future, these same people also find themselves forced to take out private health insurance (to add to the private pensions schemes that they would have already purchased), and to pay, on top of their annual premiums, for most aspects of hospitalisation, including meals, medicines, X-rays, and all but the most essential surgical interventions... if in future, we are asked to accept all of these changes and more, then I think that yes, the time would indeed have come to take some “decisive decisions”.
One decision that some people may well take – especially those who earn the minimum wage or marginally more, and who cannot realistically afford to lose the one social advantage Malta still has to offer – will be whether it is worth their while to continue facing financial destitution in an increasingly right-wing country... or whether to pack up and emigrate to another country... a country where the health system might not be free either, but where the wages, at least, would be higher.
***
Meanwhile, for all the “decisive decision” makers responsible for our present state of affairs... well, here is a little decision you might wish to take yourselves. I won’t spell it out for you... but I will give you a little hint: One word. Six letters. The first is “R”, the last “N”... and if you remove the “S” in the middle, you will be left with a word synonymous with precisely the kind of unchallenged power that many of you have enjoyed now for far too long.
Sahha...