Cruel scalpel as the sick man’s money fuels health crisis

From left Director of Medical Services Dr. Jackson Kioko, PS. Nicholas Muraguri, Council of Governors Health Committee Chairman Jack Ranguma, Health CS Dr. Cleopa Mailu and Council of Governors Human Resource Committee Chairman James Ongwae address the media at Afya House, Nairobi on Monday 05/12/16 Over doctors strike. [PHOTO.BONIFACE OKENDO/Standard]

For four years, I have been blogging about the politics of healthcare and nationhood. I have been arguing that Kenya needs universal healthcare, but more than that, that politicians need to be obligated by law to seek treatment in public hospitals for themselves and their immediate families.

As I share these ideas on social media, my greatest surprise has been the hostility from some ordinary Kenyans, many of whom, I’m sure, would not afford life-saving treatment without a harambee. So I was beginning to accept that I was an odd Kenyan who actually believes that our lives matter enough for us to have a government that provides quality healthcare for all, not just for politicians whose bills in hospitals abroad are paid by the taxpayer.

When the doctors’ strike started, I didn’t agree with the union’s strategy, but I supported the doctors on the principle that public healthcare depends on good working terms for medics. I was often frustrated by the doctors not making a philosophical argument for universal healthcare, even though I understood that the sacrifices they are making for this struggle are personal. So I gave up and wrote on Facebook that I was checking out of the #LipaKamaTender conversation.

Sweet spot

But one day later, I read a tweet from Ahmed Tawakal with links to two websites. One was to his blog post about the government’s end game for the strike being the end of public healthcare, so that wananchi can seek private healthcare in expensive private hospitals, meaning profits for investors in insurance, medical equipment and hospitals.

The other link was to an article in the New York Times, which cites an employee of Abraaj Group, a Dubai-based investment firm, savoring the prospects of buying private Kenyan hospitals because Nairobi was a “sweet spot” with an emerging middle class that would pay for private healthcare. The cynicism in the article is very shocking.

But Tawakal hadn’t shown me everything. He pointed to an article that appeared in November 2013 about a groundbreaking ceremony for a Sh2 billion facility of the Nairobi Hospital in Machakos County. The President was guest of honour. The then CEO of Nairobi Hospital was current Health Cabinet Secretary Cleopa Mailu.

For me, the Machakos event was more than a coincidence, especially because I had tweeted my opposition to Mailu’s nomination for the Health docket in 2015. I said that the billions in profits reaped from Nairobi Hospital disqualified Dr Mailu from taking care of health for the poor.

Again, several Kenyans who swallowed the lie that profits and efficiency are synonymous said that Mailu was perfect for the job because he would make Kenyan hospitals more efficient. But other Kenyans shared their stories on Twitter, for example, of the cost of treatment at Nairobi Hospital multiplying the cost by as much as 200, when covered by insurance, and premature discharges to make room for the next customer.

For me, the fact that the government’s silence on the doctors’ strike was taking place under Mailu’s watch was so similar to the groundbreaking in Machakos.

It so happened that just before my short-lived resignation from #LipaKamaTender, it had occurred to me that in all their statements, the government had not said what was wrong with the CBA. With the teachers’ strike, the government’s argument was that the country could not afford a pay hike. But it has not said the same thing in the doctors’ case.

So I asked a doctor whether the government had explained why it would not implement the CBA agreement. To my surprise, the doctor told me that even the union had not anticipated the government stalling on the agreement, and the government had offered no explanation for stalling.

But with the Uhuru-Mailu partnership, it could only mean one thing: the public healthcare services are being crippled to pave way from members of the Kenya Hospital Association, the Abraaj Group and other investors to make insane profits from the middle class escaping public hospitals.

Also interesting is the similarity between the way insurance companies and private hospitals make profit on one hand, and the tenders in Sh5 billion Health Ministry scandal denied by the government.

In both, profit is made by inflating costs of care and instruments. The tenders won by Sundales – which was registered around the same time as the President visited Machakos – were to supply units such as syringes, scissors and gloves at inflated prices.

After one has drawn all these connections, the New York Times article becomes even more depressing.

The article makes two assumptions. First, that employed Kenyans and small-scale entrepreneurs will run to private hospitals because public healthcare is necessarily bad.

The assumption means that if public hospitals are not seen as bad, investors’ first investment will be to make sure that they are. And that’s what is happening with the refusal to implement the CBA. The Jubilee administration is essentially destroying public health services to boost private hospital business.

Skyrocketing premiums

The second assumption is that the middle class in Kenya will not ask questions about why public healthcare is bad. The investors trust the Kenyan middle class not to raise an eyebrow, because for the last 35 years, we have been responding to public problems with private solutions. When security fails, we live in gated communities and hire security companies. We buy water from trucks harvesting underground water when our local governments fail to provide water.

We invest in private medical insurance when public hospitals crumble. We take our children to private schools.

Investors are so confident that we will say nothing.

What we don’t realise is that we may have gotten away with private solutions, but with healthcare, the bargain is most likely going to backfire. It is already backfiring, but we all need to watch Sicko, the documentary by Michael Moore about America’s healthcare system, to know that it can get much worse.

Once there is no public healthcare, the middle class will have nothing to protect them from the greed of the healthcare industry.

And then, premiums will skyrocket. Employers will probably stop paying the whole price for medical cover, and we shall have to foot some of the cost of the premiums from our pockets. And the insurance firms and private hospitals will continue what they’re already doing, except with less subtlety. They will impose higher profit margins on products and services.

But the cynicism will not stop there. The insurance companies will come up with more and more reasons to deny paying our medical bills, so that in the end, it will seem as if your insurance will pay your bill only if you bumped your toe against the table.

And worse, private investors will enslave doctors in doctors’ groups. Doctors’ decisions will be influenced less by the patients’ best interests and more by profits of the companies. Insurance companies will dictate which treatments can be offered by whom, often forcing unnecessary tests so as to raise the bill. Soon enough, more doctors will be managing companies rather than treating patients.

And remember that all this mess will be happening at your expense because you had the inevitable misfortune of getting sick. In other words, when you get sick, someone sees an opportunity to make money.

And just in case you still do not believe how little this government cares for human life, you need to check a harmless article that was posted on the president.go.ke website in August 2015. The article is about the first comprehensive cancer care centre that was launched by the First Lady.

Unless you’re paying attention, it is easy to miss the import of the second sentence of the article: “the 10,000 Kenyans who seek cancer treatment in either India or South Africa at a cost of Sh10 billion annually will be treated right here in Kenya”.

‘Deserving patients’

According to our political vernacular, that sentence is supposed to mean: “Great! We can save ourselves money since we don’t need to go to India or South Africa. We have a hospital of our own. Na hiyo, ni maendeleo (as former President Moi used to say).”

On the contrary, you will not save money. The hospital has not promised a change in price; just a change in who is charging it. Second, the centre is not a public hospital. That is why, to ease their conscience, the article talks of a foundation being established for “deserving and underprivileged cancer patients.”

In other words, for the public there will be philanthropy, which is how the political class has been solving public healthcare problems.

The line about “deserving patients” should disturb every Kenyan. Is it up to the rich to decide which life is worth saving and which isn’t? Are there lives that matter more in Kenya than others?

The writer is a lecturer in Literature and French and blogger at wandianjoya.com