A Critical Analysis: Why The National Health Insurance Law is Not Sustainable

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On many frontiers, the Anglo-American counsel has not made us prosperous in many areas but has left us with a black eye. Instead of lifting a stylus and playing the old tune repeatedly because the disc is defective, we resign to letting it condemn us into the abyss!

It looks like remedies pursued in the Western world have been adopted wholesale without much consideration of relevance, cost and sustainability in our situation, which impresses more like, despite sixty years after gaining independence, we are still haggling our way out of “primitive accumulation!”

Today, we shall review new health laws that have been passed by the Parliament and assented to by the President and attempt to evaluate whether this legislative initiative has considered our local health niggling issues and accommodated them. And of more significance, if the health insurance laws would give us a chance to improve our collective health,

Soon after independence, Tanzania was blessed to commence health policies that understood our economic limitations. As a result, health was free, and our government did not feel overburdened to chip in a large chunk of its budget to ensure all access to health services without much fuss.

In my specific example, I was born with allergic asthma, and regular attacks pushed me into public hospitals where freebies helped me to be fit and attend the rigours of primary education. I cannot imagine, given the financial constraints my parents were facing, that I would have been able to manage the asthmatic attacks without free medical services.

In my early secondary education in the early seventies, I developed an eye disease which dragged on for weeks, threatening my right eye with blindness. Still, a two-week hospitalization at Mvumi Eye Hospital led to a full recovery of my right eye. I did not part with a single penny! And, I keep wondering how many Tanzanians in similar economic circumstances could secure medical attention under the umbrella of “Bima ya Afya”: a National Health Insurance. I see it as just a one-way ticket to blindness for such poor individuals.

The new “Bima ya Afya” law makes all Tanzanian registration mandatory, and there is zero leeway to opt out. Whether you like it or not, you must be registered, and there are penalties, which may include jail terms for one’s refusal to register. There are prohibitive monthly fees an individual or family has to cough up to stay actively registered. Still, little thought was given to considering the disposable income of an average Tanzanian.

We see the monthly contributions are well above the ability of most Tanzanians to pay. We read that it is not an unwillingness to pay the monthly fees but the inability to pay, which may end up being persecuted by this law. Senior citizens aged 65 years and above are excluded from paying the subscriptions.

There are efforts to spread the revenue nets as wide as possible to include double taxation in certain areas which are already visited again and again by the taxman. Our concern has always been where the taxes collected in the same regions are marching to, and we cannot accommodate the new costs under the Bima ya afya.

There is also the government budget that was usually set aside since independence to cater for our health needs, and the way this Bima ya Afya law has been crafted looks like the government contributions have been pulled out, now it is everybody by himself, and the retaliatory threats against disobedience to this law are sufficient to sustain it. But, suppose, and it appears very likely, that compliance to the payments is less than twenty per cent, then this law’s whole objective will come down tumbling.

We have appraised the underlying assumptions behind this law and concluded that most of those assumptions are killer assumptions. We should now expound on that as a matter of urgency.

The first killer assumption was that the cost to sustain the “Bima ya afya” was manageable and sustainable! Our assessment leads us to say that since the workforce establishment of the Institution to run “Bima ya Afya” is inconveniently lacuna in the law, it means staffing issues are left at the peril of those entrusted to run it.

Our experience has shown that over-employment is the day’s currency in public service. Without attaching benchmarks against over-employment and recurrent budgets, we should have every reason to worry the latter will gobble between seventy and eighty per cent of the revenue generated.

When that comes to pass, the “Bima ya Afya” law shall serve the administrators of the Institution, but the intended health of the contributors shall be left to pick the rotten end of the stick. Superficially, on paper, the law targets to apprehend sickness. Still, in practice, it is another generous dints to get the well-connected unemployed and the underemployed to earn a living at the expense of the indigent of the society who may be incarcerated to keep the administrators in a payroll packed to the rim with perks.

The second killer assumption is that Tanzanian culture is Westernized, where individualization trumps kinship. We argue that the Tanzanian social welfare system is still based upon kinship and is yet to be shambolic to such an extent that sick people will be left to their own devices, save for isolated cases.

This killer assumption is behind the extortionate terms members of the “Bima ya Afya” contribute to retain their membership. Had this variable been well considered, the rates would have been very affordable, penalties would have been reduced to fines, and nobody should reckon with a jailbird scenario.

The third killer assumption is that the Western welfare system is working, subsequently, a model we should all adopt. Well, the reality is harsh. The Western welfare system is complicated in the ICU. In the US, the much-vaunted Obama care is bleeding to death, and it is the medical health insurance practitioners who are making the killing by portraying their patients as sicker than they are.

The waiting list to secure medical services in Canada is meandering to a “cul-de-sac”. In the UK, the NHS is notorious for delisting medical conditions that it can foot the bill because health costs are skyrocketing daily. It is wrong to glorify the Western welfare system that has already collapsed. We need to fork out our remedies to many health problems befuddling us today.

Perhaps we must take a second look at this ” Bima ya Afya” law and inject a dose of pragmatism, reality and creativity. Acknowledging our limitations should go a long way to lowering the subscriptions, which seems to be our major killer assumption. We need a legal provision prohibiting public servants from dipping their grubby fingers into the national health budget to attend to their medical bills overseas.

One senior politician took two floors in an alien hospital, razing more than Tshs 2 Bill in less than two months. Such an appetite to look down on our medical services could be a catalyst behind undercooked health laws such as the one under the spotlight today.

When we were gunning for our independence, one of the gist of our arguments was the wearer of the shoe knows where it pinches. But that argument no longer holds any water when those responsible for charting our future snub the services they spearhead.

They are divorced from reality, so they rushed to impose this bad law on us. What this law says to us sounds like “pay to play our game”, which themselves are not in any way affected because once sick, they board a plane to get the medical services they deem sufficient, but the only snag is they do this at our expense.

In our well-thought-out calculus, we declare that health insurance subscriptions will be in the basement if the government outlaws absorbing senior public officers’ overseas medical treatment. Do we have the political will to do that? We seriously doubt knowing the level of selfishness in the national political leadership.

If there is any model of health care we may take in our stride, it is of Cuba, where we never pay attention for reasons that are not clear. Cuban politicians, unlike in Tanzania, are never treated abroad. We should ask ourselves more significant questions: why? Cuban leaders esteem the medical services of their country in Tanzania, and their deeds betray our leaders’ talk. They never walk the talk.

The author is a Development Administration specialist in Tanzania with over 30 years of practical experience, and has been penning down a number of articles in local printing and digital newspapers for some time now.

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