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Op-Ed: Current LBJ crisis calls for ‘history not repeating itself’

Our policymakers (Administration and Fono), in a haste to address the immediate cash flow needs of LBJ, decided to kill two birds with one stone — thus attempted to address the long term financing needs of LBJ as well.

In so doing, they are providing long term funding to a fragmented health care system that needs to be defined by a well thought out health care policy and health plan to include among other things amending the existing free medical attention law. Moreover, our policymakers opted for the convenience of a wage tax, which sacrificed a more equitable distribution of the tax burden among income earners and LBJ users in the community, and I find that problematic.

For example, the $3 million loan bill signed into law two weeks ago will convert into a long term funding measure for LBJ operations and off-island care when the loan is retired within a year. However, without a health care policy in place, the ad-hoc health care development continues, resulting in inefficient allocation of limited resources, while the burden befalls disproportionately on wage earners vis-à-vis other income earners and users of LBJ and beneficiaries of the off-island referral program (when reinstated).

The various financing bills now on the table, the recently signed loan measure, the lack of dialogue on the payment of the hospital subsidy, and the lack of a long term health care policy for the territory all point to one conclusion: We will meet here again four years from now, if not sooner, to try and solve the same problem. It’s the political cycle and ad-hoc development at their best — history repeating itself. 

Delineated below are my concerns with t he current efforts by our policymakers to resolve the health care problem. I am hopeful the policymakers will find this discussion useful in their lawmaking efforts.  

First, the Fono should be commended for initiating and passing the aforementioned loan bill to avoid compromising of health care services at LBJ, albeit temporarily. The wage tax however was probably not the best solution available to repay the loan for equity reasons at least.

A better alternative would have been a tax on unhealthy discretionary purchases such as cigarettes, alcohol, soda, and perhaps fast food (as a local businesswoman of note had publicly suggested).

Business people who are not paid wages or salaries but are living off their business income, workers who are paid “under the table”, members of the clergy who file or not file income tax returns, rental property owners, and independent contractors (taxi drivers, bus drivers, fishermen, farmers, tradesmen, etc…) are all spared the wage tax to fund the loan repayment, let alone paying the minimum tax (out of which the hospital subsidy is paid) if they are not filing income tax returns.

Second, there is no clear dialogue, let alone a dialogue, as to the hospital subsidy in the midst of the various financing bills being proposed. Are these bills intended to make up past shortages (as there are LBJ bills to be paid from 2011 or are there?), and are the 2012 subsidies paid current? Or are the financing bills not intended to address 2011 shortages, but in lieu of 2012 subsidies?  We need to get a clear picture from the policymakers and LBJ regarding these questions. 

Third, the administration bill for $10 million to fund the off-island program is scary in that the availability of these funds creates its own demand; before we know it the $10 million has evaporated, then there will be call for another $10 million. Without a health care policy to define the funding and parameters of the off-island program, this will prove to be a money guzzler. 

This amount represents about one third of the LBJ budget thus the question should be asked if this is a better utilization of limited health care funds. 

Reportedly, the $10 million loan is to be repaid by a 4% wage tax; hence adding to the burden already carried by the wage earners who help fund the hospital subsidy and will be funding the recently approved loan starting next month. Is this the intention of the administration? 

Moreover, there appears to be an ongoing effort by the administration to look for private major medical insurance coverage plan for government employees. Is the $10 million loan purported to defray the cost or part of the cost of this insurance coverage plan? These questions and concerns need to be addressed by the policymakers.

Finally, I cannot emphasize enough the need to amend our health care law to address both the LBJ care and the off-island care being premised on the fact that health care is not free. 

In conjunction with the needed legislative effort, a health care policy group, in the spirit of the former American Samoa Health Planning and Development Agency (ASHPDA) of the early 1980s, should be established to construct a meaningful health care policy and health plan for the territory.

The policy group should be tasked with the answering these basic questions some of which were posed by Mick McCuddin in his recent Samoa News LTE: What is the breadth and depth of health care services at LBJ given patient needs and limited resources? What is the breadth and depth of health care services under the off-island care program given patient needs and limited resources? Who should pay? How much should they pay? What is the best mechanism(s) for them to pay? 

This undertaking shouldn’t cost much money as those appointed to serve (representing health care providers, health care management, health department, business community, patients, government) could serve without compensation. I don’t think there’s a shortage of people willing to give their time to this important endeavor. And enough studies have been done for the policy group to draw upon for this purpose.

     I plea with the policymakers that after they address the immediate and short term needs of LBJ, they then focus on establishing an American Samoa Health Care and Health Planning Policy Group to address, in a coherent manner, the long term health care and health needs of the territory. 

I further plea with the policymakers that upon receipt of the policy recommendations from the policy group that they act on them, not shelving them to collect the proverbial dust.

Only then can we break out of the political cycle/ad-hoc development syndrome that has been dictating the health care and health of our people over the past thirty years.