When my family and I were on an extended stay in Mauritius I was stung on the hand by a hornet after I accidentally disturbed a nest hanging from a tree in the garden of the house where we were living.
By evening the problem seemed to be getting worse rather than better and I was advised by some of my in-laws – my wife is Mauritian – not to wait another night but to go to the local hospital for help.
After a brief wait I saw a doctor, was treated and quickly recovered from the sting.
Now, all of this was free. I didn’t have to pay anything for the treatment or the medicine because the type of healthcare provided in Mauritius is a universal state provision which, to some extent, took its lead from the British National Health Service.
Fourteen years on from the hornet’s assault, I fear for the future of the Mauritian system which is under siege from ex-World Bank economist Percy Mistry – he’s advising that country’s government to take a radically new approach to healthcare and welfare provision.
Some of Mistry’s points about the general economic context are undoubtedly well made: the end of subsidies on sugar and the phasing out of textile quotas in key markets like Europe means that Mauritius faces some serious challenges in generating income in the new global economy.
He quite rightly notes that no country is owed a living just because it has nice beaches and the sun shines a lot.
But Mistry is convinced that the real problem for Mauritius is that it continues to follow a European “socialist” style system.
He uses the word “sclerotic” to describe the economies of the countries that make up the EU – something of a surprise to those of us who live here in the UK where there are only 2.5% classified as unemployed, the lowest since 1975.
He contrasts the European model unfavourably with the American free-market system which he thinks is far more dynamic and competitive (he also likes the Chinese and Indian economies for similar reasons) although it is noteworthy that he fails to say anything about the US budget or balance of payments deficits and the problems with healthcare.
He recently told the Mauritian paper L’Express: “Europe really believes in trying to equalise everything and rips you off in taxation to provide universalism in the name of equity.”
Mistry advises the Mauritian government to dismantle many aspects of the health and welfare system in the country – or “wasteful public expenditure, ” as he puts it
“You [must] get rid of this notion that everything should be universalised for everybody — that everybody should have free education, free health, free transport,” he argues.
Gung ho free marketeers like Mistry often miss the point about economic and social change partly because they tend to be well insulated from the effects of policies they advocate.
Mainly, though, their error falls in a commitment to a particular theoretical framework which means they are often so obsessed with wealth creation they fail to understand the issue of social solidarity and, ultimately, therefore what makes a functioning society tick.
At the time of my experience with the hornet, I was reminded of a book I was obliged to read as part of my university course, The Gift Relationship: from Human Blood to Social Policy by the late Richard Titmuss, then Professor of Social Administration at the London School of Economics. (He also advised the first Mauritian government led by Dr Seewoosagur Ramgoolam on population policy and family planning amongst other things.)
The book was first published in 1971 and has had a huge influence on government policy and the academic community in the UK (and, to some extent, in the US). Titmuss’ thesis on blood donation contrasted the American system, where blood donors were often paid for their services, with the British system where people donated their blood for nothing (although they were and still are given tea and biscuits afterwards).
Titmuss concluded that the latter system was more efficient because not only was more blood wasted in American hospitals compared to British ones but that, more importantly, blood purchased from poorer American donors was more likely to be contaminated with Hepatitis B because many donors were drug users and were only interested in the money they would receive rather than their contribution to their nation’s health.
The book was written, of course, before the era of HIV infection.
As well as producing a specific analysis of blood donations, Titmuss was also trying to make a bigger point. For him, the contrasting practices around blood donations in the UK and US were indicative of two very different types of systems of healthcare.
The first based on private and commercial forms of care, the second based on altruism and public service. He considered that the British system was ethically superior because it generated a sense of mutual responsibility and social solidarity amongst all citizens, rich or poor.
Although Titmuss is not much talked about now, his influence has been long-lasting because he helped shape the British (and Mauritian) welfare system. In the UK recent governments of all persuasion – left and right – accept that some services are best provided on a collective basis and some best left to the private sector (although there is healthy disagreement about the precise details especially when public-private partnerships are involved).
But I was interested recently to read two related stories about this subject published over a couple of days. The first was announcement by David Cameron’s Conservatives for the roll-out of a dedicated maternity nurse service to help every new mother in her home for up to six hours a day during the baby’s first week of life.
The idea, based on a policy initiated in the Netherlands, is to give every child the best possible start as well as supporting families as they begin a new phase in life.
The second story was that Republican governor of California, Arnold Schwarzenegger, now backs proposals for a universal care plan for all of his state’s citizens. In the present US system not having health insurance can be a matter of life and death.
It seems that even centre-right parties in both the UK and US can believe that the state shouldn’t remain neutral in matters of child and family welfare and healthcare.
And I can only hope that Mauritius’s government realises a free-market ideology shouldn’t be the one that they adopt.
After all, institutions like education and healthcare in Mauritius have contributed to the success and solidarity of the country and should be preserved for the sake of future generations.
A version of this article can been found on the Mauritian newspaper L’Express website.
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