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OP-ED: Moving Forward, Part 8

(Continuation of Part 7, published in Samoa News, June 21, 2012, Thursday’s edition)

Sales Tax for Health Care

The aforementioned village farmer, Lokeni Nuusolia, eloquently suggested a sales tax for health care where everyone — from a king to a pauper — pays into a health fund to help pay for their health care at LBJ, but criticized the wage tax as an unfair penalty on formal workers (those who receive W-2 forms).

An interesting point to ponder is how Samoa finances its health care system — approximately 70% of Samoa’s NHE ($433 ST per capita) is paid for by government through taxes (value added tax on goods and services) and duties, 20% by donor counties, and 10% by private sources including households. American Samoa on the other hand, per CEO, 80% of NHE is funded by the federal government, with the remaining 20% by ASG, and private sources including households.

The policy implications for AS are clear — increase public funding through ASG (a fair form of tax), or increase private funding including households (via public insurance plan), or a combination of the two.

LBJ Budget

Most of the speakers in the audience had a thing or two to say about the budget with respect to payroll. While Sandra King Young, a lt. governor candidate, opined the medical and nursing staff are overworked and underpaid and that LBJ needed and deserved more funding, there was notable concern about the increase in the payroll in late 2011 when it appeared an inevitable budget shortfall was looming. The pay raise for non-medical staff appeared to be the crux of the concerns expressed. 

The House representative Allen from Aua (whose sister died of breast cancer recently) was particularly disturbed to learn the mammogram machine was down, while an attorney (no longer working at LBJ) was hired for $90 thousand. In an unmistaken firm military tone, he strongly advised the CEO that in tough times, management should not hesitate to make tough but sound decisions.

The lt. governor candidate Le’i Sonny Thompson (another military retiree) in the same vein wondered about the feasibility of adjusting the LBJ compensation schedule (downward) given the current budgetary constraints.

When the CEO revealed there was no staff radiologist and the cost of obtaining one from the US being $300-$400 thousand, the village farmer inquired about the local physician who completed a post graduate program in radiology in Australia. The CEO was silent on that question, but stated LBJ was landing a radiologist from the Philippines at $90,000 (better use of money than on the aforementioned attorney). 

But I wonder about the displacement of the local Australia-trained radiologist and the waste of public funds on his college education, medical school, and post graduate training. Could this investment have been saved or cost of schooling recouped from this individual?

Quality of Service

Corroborating the general favorable LBJ performance presented by the CEO was a couple of testimonies. Sandra King Young shared her personal experience where her life was saved and her child was treated, despite a mishap (which provided an educational opportunity for the medical and nursing staff to improve their performance). 

A local attorney was appreciative of a successful medical treatment she had at LBJ which would have cost a bundle of money in Hawaii. Last week we read about the heroic effort by what I would call the “Dream Team LBJ” of which Dr. Kumar was a part of in saving a young child’s life; and putting a happy smile of relief and gratefulness on the young mother’s tired face, as shown in a Samoa News photo.

I am certain for every feel-good story there are two or three sad untold stories. But there’s no doubt in our minds about the potential LBJ has if the financial resources allocated for the hospital are paid in full and on time.

The successful effort by the “Dream Team” shed light on opportunities AS is foregoing — ASG scholarships have been given out for the next school year and not a single medical school scholarship was awarded. In fact, none have been given for several years now. 

American Samoa needs to think Pacific and Pacific Rim when considering human capital investment in the medical area, as US medical school training is beyond our financial means. Dr. Kumar and Dr. Sunia (two of the players in the “Dream Team”) are graduates of Fiji School of Medicine (FSM) and received their post graduate credentials from Australia and Fiji respectively. 

Oceania University of Medicine (OUM) in Samoa, which renders Samoa’s Tupua Tamasese Hospital a teaching hospital, is a viable option to consider in addition to FSM. The government of China is building a multi-million dollar modern medical complex for Samoa to include both OUM and the Tupua Tamasese Hospital; and the Samoa government aims to attract medical experts from around the world to practice, teach, and do research. We can benefit immensely from Samoa’s development if we develop our human resource pipeline now to include OUM.

It is important that the next administration and Fono establishes a program to start sending our students to these medical schools. Otherwise, we’ll continue to import doctors and nurses from other countries, foregoing these fine employment opportunities for our children. 

And we can pretty much say good bye to our scholarship students (they are not bonded to return) who graduated from US schools and are now practicing their medicine in the US, as it is not likely they would voluntarily give up the much higher financial compensation the US offers.


Le’i Thompson shared part of the LBJ problem is the unchecked immigration problem in the territory. In view of the significant unpaid fees incurred by nonresidents, I agree. Sandra King Young proposed to do away with the current sponsorship system, and proposed an alternative system that would address the abuse allowed under the current system. As mentioned in a previous opinion piece, we proposed a health immigration bond to help defray health care costs incur by immigrants.

Nonresident Fees

The brunt of the current proposed LBJ fees befalls the nonresidents, yet not a single nonresident was present to plead their case. King Young stood in their stead from a moral/ethical perspective, and vouched for equal treatment of residents and nonresidents. Health care is a matter of life or death, she said.

In their well attended kick off several weeks ago, Lolo Moliga in his speech was critical of the high fees slated to be imposed on nonresidents as they are an important part of the territory’s development and for humanitarian reasons.

The governor in his radio program two Saturdays ago, reflecting on our kinship to Samoa, fondly remembered Samoa’s Head of State Tupua Tamasese’s reference (during Samoa’s recently celebrated golden jubilee) to his country as “not a nation, but a family and a brotherhood”. In response a caller asked if Samoans are brothers, why LBJ is charging nonresidents from Samoa $695 US per day if hospitalized.

_The caller may have a point considering Samoa’s Tupua Tamasese Hospital charges $5 ST (Samoan Tala) per consultation and $5 ST per inpatient day for Samoa citizens; and $20 ST per consultation and $60 ST per inpatient day for non-citizens, including brothers from American Samoa. Their private rooms cost $50 ST daily for Samoa citizens and $80 ST daily for non-citizens including American Samoans. Moreover, Samoa’s off-island care program is available to all Samoa citizens including those residing in American Samoa.

Moving Forward

On the whole, the board and management of LBJ are doing as good a job as can be done considering the resources they’ve been given to work with, with a couple of exceptions.

The non-essential hiring and pay increase implemented last year didn’t make sense; and the inpatient fee for nonresidents, whose average income is well below $7 thousand if working, is not affordable thus needs to be reconsidered.

In moving forward, the next administration and Fono need to address the health care mandate as discussed above; replace the current piecemeal and ad-hoc financing with a well thought out permanent plan to include concrete funding measures — a fair health care tax measure or a public health insurance plan, or a combination of the two.

Equally important is the establishment of a health care human capital investment program to start next year to ascertain that LBJ Hospital is continually and appropriately staffed for years to come.

After all, health care is a matter of life…or death.