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Dear Editor,

I’m responding to G.M. Malala’s LTE of 02/17/2012 (“…By the Law of Insane Economics”), which referred to the “Policy Implications” of part 3 of the 3-part-series editorial I wrote in the Samoa News on the 6th, 7th, and 8th of this month. On the fourth policy implication (the focus of Malala’s LTE) I briefly discussed the impact of LBJ Hospital’s economics on the increase in “reasonable” fees as allowed under the “free” medical attention law. 

Given LBJ Hospital’s dire financial predicament (which Malala doubts) as explained by the management and board of LBJ Hospital, the law of economics, as it is universally understood (not “Keniseli’s adopted law of economics” as Malala puts it), will always prevail over our territorial “free” medical attention law, and fees will increase to the point where some might consider unreasonable and some (me for one) might consider not necessarily unreasonable. 

Charles “Mick” McCuddin in his recent LTE correctly stated that the health care cost rises faster than the general cost of living as measured by the consumer price index. The costs of medical technology, drugs, etc. has a lot to do with this significant gap. One of my medication costs $76 at Longs Drug Store in Hawaii; LBJ’s increased prices ($40) compares reasonably in my case. (There’s nothing “gymnastic” about the “semantics” used to express my opinion, just facts).  

     According to the LBJ management and board, LBJ lost over $5 million dollars in funding last year due to ASG’s non-payment or under-payment of the ASG hospital subsidy.  This necessitated the increase in fees in the range of 400%-500% implemented two weeks ago (now reversed). I have no evidence to dispute LBJ’s financial reports, but I understand the functional relationship between fees and revenues in a health care equation. Simply put (as stated in the editorial), when ASG subsidy decreases, Medicaid grant decreases; given other sources of revenue, patient fees gravitate north to make up the shortage caused by the non-payment or under-payment of the ASG subsidy (over $5 million in 2011).

Malala may call it “insane economics” or “draconian measures to screw the poor”, but I call it basic economics. The functional relationship as expressed in a health care equation is a mathematical tool, void of human emotions, but used by management and policymakers in efforts to address human needs. (Yes, this stuff is taught in college but not promoted and understood or appreciated enough in the territory; otherwise we would have had a health care system that makes sense by now).    

 Malala might ask how humanity is manifested in the face of the 400% to 500% increase in fees as dictated by this “insane” law of economics (as Malala puts it). 

For starters, LBJ has had a sliding scale fee program in place (for some time now) to account for the wide range of financial abilities of its patients to pay (which includes “free” care for the absolute indigent).  That means people like the governor, lt. governor, Fono leaders, judges, and perhaps Malala get to pay the full 400% to 500% of the increase if they don’t have Medicare or other forms of private insurance (and that’s not necessarily unreasonable). 

Secondly, there’s the EMTALA (Emergency Medical Treatment and Labor Act), a federal law mandating LBJ to stabilize and treat anyone coming to the emergency clinic regardless of insurance status or ability to pay. 

Thirdly, the average American Samoan spends 50-60% of income on food/church/fa’alavelaves and 1% on health care. There’s definitely room here for people to heed Kigaiga’s timeless advice — “use your wise consideration” — to make the much needed adjustments in their spending behavior to help pay for their health care.   

     If Malala doubts the accuracy of LBJ’s financials, I suggest that he visits LBJ and confirms such information with the management.  I am sure the management would be obliged to accommodate his curiosity. The LBJ CEO told the hospital employees as reported by the media last week that the LBJ tank was empty — no cash in the bank. The governor, whose administration caused the shortfall (now praised and worshiped as a hero for reversing the fee increase), believed the CEO, for not only did the governor sign the immediate cash infusion bill as proposed by the Fono into law, but is now working or struggling with the Fono on measures to tide LBJ over the rest of the year. 

(That said I have issues with the funding measures being proposed, including the one just signed into law, to address long term financing needs of LBJ Hospital. I wish to discuss my concerns in the near future in this forum if I may).  

     Finally, if Malala read my editorial piece to the end, he would find that there’s no disconnect between our research and policy recommendations and the everyday economic struggle of our people.

The recommendations proposed in our CAAS Project report (summarized in the editorial) account for all in the territory including the most vulnerable amongst us. First and foremost of the recommendations is amending the free medical attention law to reflect the territory’s reality. If our policymakers maintain the status quo (which appears to be the case in view of the funding measures being swiftly pushed through the process without much thoughtful analysis and meaningful engagement of the community), it is invariably the poor who pay the price.  

Keniseli Lafaele