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Take 2 —Views on the News: LBJ

I could spill a lot of ink covering the endless testimony of LBJ officials as they appear before countless Fono tribunals, retelling their story over and over.

But I pretty much know what I need to know: running a hospital system in American Samoa is freaking expensive and we don’t have much money.

Let’s put a few bullet items on the table:

Emergency Rooms are very expensive things to maintain, but for some reason, LBJ sends everyone to the ER to be seen.

LBJ charges $10 to be seen at the ER (or at a clinic), which is a service that probably costs them about $200. Maybe it is only $100. In any case, the cost to LBJ is a whole lot more than $100.

Ditto for pharmaceuticals: LBJ only charges a small fraction of the cost of drugs.

Ditto for most other LBJ services (e.g., delivering a baby): LBJ only charges a small fraction of the cost of the service.

And it’s not like we are a very healthy population. American Samoa is well documented to be at the extreme end of all sorts of bad things: prevalence of obesity, high blood pressure, cancer, diabetes, dialysis, heart problems, gout, etc. Most of these “bad things” are what are called “lifestyle diseases.” That is, they are caused by lifestyle patterns (primarily diet and exercise and weight). To make it worse, most of these “bad things” are “chronic diseases.” In other words, they are diseases that you don’t treat and recover from (like a broken bone or infection or fever). They are diseases that last and last and last.

The high incidence of lifestyle diseases should not surprise anyone familiar with the unhealthy lifestyles that most residents follow. I’m not blamin’; I’m just sayin’.

Did I mention we are thousands of miles away from support services (e.g., medical labs, warehouses, experts, technicians)? Did I mention that hospitals use a lot of electricity (very expensive here)? Did I mention that hospitals use a lot of advanced technology, which is even more expensive to maintain and train people to use properly than it is to purchase it?

We have trouble maintaining ditches in American Samoa ― can you imagine how hard it is to maintain a hospital, and to maintain it to the federal standards imposed by HCFA (Health Care Financing Administration)?

So nobody should be shocked that we have trouble providing a high standard of health care here under any budget, and nobody should be shocked that LBJ is having financial problems today, yesterday, and tomorrow.

What should we do about it? I dunno. But we know a few things:

LBJ is going to need a lot of money today and tomorrow.

The off-island medical referral program could be so costly that LBJ has no chance of ever being adequately financed if monies are instead diverted to that worthy program. That’s a vexing problem.

Money for LBJ is going to have to come from somewhere. If the federal government won’t come up with it (something I don’t know much about), we will have to come up with it through taking money from other government programs, raising taxes or fees, or some other form of financial alchemy.

We have been putting off the problem by borrowing money from the Retirement Fund. That is a scheme that cannot last long. Let’s say LBJ borrows $10 million and spends it all in a year. The loan from the Retirement Fund has to be repaid for the next ten years. So what happens in years 2-9? This is basically the problem that the Fono is grappling with right now, and that they would be grappling with it in 2012 was entirely predictable.

We’ve got a bunch of people running for Governor. I’m looking forward to hearing what they have to say about this challenge.

A version of these commentaries first appeared on the website ‘’ and is used with permission