The estimated $90 million in bad debts for public healthcare says much — but not much good — about the state of these islands.

Last year, the revelation that Cayman Islands public hospitals had “doubtful debts” (i.e., bills that have been outstanding for more than 12 months) of more than $70 million sparked cries of outrage and consternation among many of our readers, particularly since the cause of the accumulation of bad debts had been identified as the deliberate decision by the government, as far back as 2010, not to pursue collection of debts through the courts.

And yet, despite the harsh spotlight, the Health Services Authority’s unpaid receivables have accumulated at an accelerating rate — with $20 million in further bad debts racked up in the past year, twice as much as officials had estimated.

Now, official expectations are that HSA will have more than $108 million in bad debts by Dec. 31, 2017.

Whatever kind of calculator you’re using, it is clear that, in spite of very public warnings from auditors, top HSA brass and others in the community, our elected officials are allowing bad debts not only to go in the wrong direction, but to go in the wrong direction faster than ever.

We can’t help but be reminded of former Complaints Commissioner Nicola Williams’s bombshell report showing that, in 2010, some 670 local businesses were delinquent in paying their employee pensions. Three years later, that number had grown to 1,144 delinquent businesses.

Where is the accountability?

Contrast the government’s hands-off approach to the collection of the $90 million in public healthcare debts with police officers’ “handcuffs-on” approach to ensuring the payment of private debts, exemplified by the recent arrest and overnight detention of an American “soccer mom” over a disputed hotel bill of $233. We fail to see the proportionality.

From the perspective of an individual, it only makes sense that the government’s pronouncement that it will not pursue healthcare debts would directly lead to an increase in those debts. Why should someone make financial sacrifices to pay (oftentimes astronomical) bills that the government essentially has announced it will waive?

From the perspective of politicians, it is fairly unthinkable that anything will be done to collect on, reduce or even slow the accumulation of bad healthcare debts — given that the next election is less than one year away, and, in all likelihood, much if not most of that debt is owed by voters.

The problem, however, with “free” healthcare is that it isn’t free. Those debts that people aren’t paying (not to mention the $50 million or more in taxpayer money that flows annually to CINICO) represent subsidies being paid by “everyone else” in society.

Some may argue that the public hospital can’t be expected to turn away sick or injured people without treatment, and point out that many hospitals (including Health City Cayman Islands) offer services at no cost, or according to patients’ ability to pay. That’s true, but there is a difference between those practices, and HSA’s bad debts — particularly because officials are not even attempting to make a distinction between those who can’t pay, and those who won’t.

If our government’s position is that, as a matter of policy, everyone in Cayman has a right to “free” public healthcare — then at the very least it is a position that must be articulated, codified, calculated and budgeted for.

A word of caution: That course, if our elected lawmakers indeed choose to follow it, is a potentially disastrous one. Universal healthcare, public pension entitlements and runaway civil service spending — as exemplified by places such as Greece and Venezuela — are, as we have written before, potential “country killers.”