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December 12, 2018

MUGWE: To help the poor, privatise health

Patients at Kenyatta National Hospital waiting to be treated./ EZEKIEL AMINGÁ
Patients at Kenyatta National Hospital waiting to be treated./ EZEKIEL AMINGÁ

 "When you are helping the Hebrew women in childbirth, if it is a son, then you shall put him to death; but if it is a daughter, then she shall live".

These were the instructions given to the Hebrew midwives by King Herod of Egypt when he ordered the execution of all male children two years old and under in Bethlehem to avoid the loss of his throne to a newborn King of the Jews.

From this account, we gather that the massacre of the innocents is as old as creation. And as if to confirm that there is nothing new under the sun, as the Good Book says, this week we had our own rendition of infanticide, if the accounts by the Nairobi governor Mike Sonko pass the smell test.

It was alleged that during an unannounced visit by the governor, 11 corpses wrapped in polythene bags, stuffed in boxes and hidden inside a store were uncovered.

The governor alleged the cause of death was due to negligence by the hospital’s management, but the latter laid the blame on systemic failures such as lack of a mortuary, insufficient personnel, equipment and budget to efficiently manage the hospital.

The jury on this infanticide is still out, as the investigations by the Directorate of Criminal Investigations are ongoing. Nevertheless, one human death is one too many regardless of the findings.

But the more salient question we ought to interrogate is, why is healthcare a government business?

To answer this question, we should first ponder where we shop for groceries, clothing, or electronics. And more importantly, if we are content with the services we receive, our purchases and the prices we pay for them. This is the marvel of the free market.

By leaving these sectors to private market forces, it creates an iterative competition amongst service providers, which in turn incentivises creativity and innovation, improves service delivery, reduces prices, and ultimately leads to mass consumption. And with every iteration, consumers enjoy unprecedented advancements at affordable prices. 

So, can healthcare be left to private market forces? Most people get horrified at this suggestion because they surmise that healthcare is a human right, and therefore expect the State to fulfill this right. But is healthcare a human right? The simple answer is NO. Allow me to explain.

Firstly, let us define a right. Rights describe a relationship between a rights-holder and a duty-bearer. If someone has a right, it implies that others have a corollary duty.

This nature of corollary duty is what distinguishes a positive from a negative right. For the latter, the corollary duty is to refrain from doing something to someone else, for example, do not kill or do not interfere with one’s freedom of speech.

For the former, the corollary duty is one of action, where the duty-bearers are required to act affirmatively, for example, to provide protection or ensure food security.

Human rights are said to be absolute. So are negative rights. For instance, it can be deduced that in 2012, all the Liechtenstein citizens enjoyed absolute negative rights on their right to life, because there was not a single murder that year.

Conversely, positive rights are not absolute because they conflict given that scarcity is a fact of life. For instance, the Kenya Renal Association states that there are 29 kidney specialists against four million chronic kidney patients.

If all these patients require surgery at the same time, they would be denied their positive rights because of the ratio of specialists to patients. Hence, their right would not be absolute and consequently not qualify as a human right, if the latter is deemed to be absolute.

Secondly, everyone wants good healthcare services but as in the case of the dialysis patients, there is only so much to go around. Scarcity leads to high prices.

And when prices are high, the demand for the commodity or service is low. Therefore, in a bid to make profits, entrepreneurs find more affordable ways to provide the same goods and services. 

The more people become involved in providing these services, the less scarce they become and the lower the prices drop. Eventually more and more consumers are able to afford these services or commodities. The smartphone is one such example.

Thirdly, when we buy goods and services with our own money, we are very careful about how much we spend and how we spend it. We shop around to maximise quality while minimising costs.

This causes the businesses that are competing for our limited money to constantly seek more efficient ways of producing superior products and services at lower prices, to secure our market loyalty.

Conversely, people don’t behave as prudently when they don’t bear the full cost of their purchases. And this applies to governments. They use other people’s money to pay for health and hence they do not worry about efficiency or cost. Third party payers distort the market because the bill payer and the patient are different entities.

Anything that is free or priced below market level will be over consumed. And this is the case of our healthcare services. Subsidised healthcare has encouraged consumption beyond that which can be reasonably provided at the artificially induced low price because the manpower available is not commensurate with the increase in the number of consumers seeking the free services. Consequently, consumers end up indirectly paying the true, higher cost which is lack of, poor and/or delayed services.

Fourthly, critics of applying the free market philosophy to healthcare claim that this only benefits the rich while denying access by the poor.

But the question they neglect is that when healthcare is provided by the State, the poor pay a double price for them because they are taxed to pay doctors, nurses, equipment, drugs and a whole government bureaucracy to administer healthcare.

If the poor can afford this, yet receive inferior services in return, then why not get government out of the way as the middle man, and have everyone pay directly to hospitals run by the free market where they will have the leverage to demand better services?

Finally my unsolicited advice to us all is, what you receive without working for, another person works without receiving it. The State cannot give you anything they did not first take away from someone else, or from yourself.

Health care and education are too important NOT to be left to the free market.” - Kevin D. Williamson, 


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