From the perspective of professional experience, a patient may walk into a doctor’s office carrying a neat file of laboratory results: blood sugar within range, liver function normal, cholesterol under control. You flip through the papers and smile: “Your tests look excellent.”
The patient looks up at you with eyes exhausted by sleepless nights and says, “But I’m tired, Doctor. I’m in pain.”
That is the moment when a doctor is truly tested.
The worst doctors are those who cling to the paperwork and tell the patient that his pain is imaginary, that his complaints are nothing but fussing. Worse still are those who tear up the paperwork and declare that the laboratory is lying. The wise doctor understands that the laboratory measures what it measures, while the patient experiences what he experiences—and that the truth lies in the space between the two. The bridge that closes that gap is called trust: respecting the symptom, believing the patient, and searching for the truth.
I thought of this scene while reading the Citizen’s Budget issued by the Ministry of Finance, which came to me in a file from the respected, honest, and professional Minister Ahmed Kouchouk.
Let me be fair: it is clearer than those that preceded it and more candid in several respects. It contains genuine steps forward, from a white list for compliant taxpayers, to tax facilitation measures concerning real estate, to improvements in transparency indicators. It also contains, without doubt, some encouraging test results: a targeted primary surplus of nearly 5% of GDP, a declining debt burden, and growth approaching 5%.
And yet, the citizen reads these results and then opens his own bill and finds it heavier.
So, is the laboratory lying?
I do not think so.
But the laboratory examines the body as a whole, while the patient feels only one particular organ—the pocketbook, the cost of private tutoring for his children, and the medical expenses of any member of a family that he may simply be unable to afford.
A careful doctor, when handed a medical report, does not begin with the number. He begins with three questions.
First: What unit was used to measure it?
A blood sugar reading of 5.5 millimoles is not the same as a reading of 5.5 milligrams. The number is the same; the meaning is not.
The Constitution requires specific percentages of GDP to be allocated to health, education, and scientific research. The document says that these requirements have been met, putting health expenditure at 4.2%.
But when I divided the allocations by the GDP figure stated in the document itself—EGP 24.5 trillion—the health allocation remained above the constitutional threshold by roughly 3.5%, while education and scientific research fell below theirs.
The stated percentages only work if one uses a GDP figure of approximately EGP 20.5 trillion, which appears to be the previous year’s GDP.
That may be an accepted accounting methodology. But a number written without its unit cannot be properly read.
Second: What exactly has been placed in the box?
The document acknowledges—and this is a credit to its candor—that the share of the two sectors in debt-servicing costs is counted as part of their allocations because they benefited from the borrowing.
It is as though the installment on the loan used to build a hospital ward were counted as part of the cost of treating the patients inside it.
I have no objection to the accounting entry itself. My concern is the missing scale of the matter: of every pound allocated to treatment, how much actually paid for the patient’s bed, and how much went to those who financed the construction of the ward?
The document does not say. I do not know. And I do not believe anyone can know until the detailed accounts are published.
Behind this question lies a figure that weighs heavily on the chest:
Interest payments alone amount to EGP 2.42 trillion in this budget—more than health and education combined, at EGP 2.09 trillion.
Third: Does the report say the same thing on every page?
If you read on one page that the health budget increased by 30%, and on the next that it increased by 39.6%, you send the report back to the laboratory—not because you doubt the integrity of those who prepared it, but because a laboratory that prints two different figures for the same test inevitably loses some of its claim to credibility.
There is another lesson medicine can teach economics: what doctors call treatment adherence.
The best medicine in the world will not help a patient who does not trust his doctor.
When the state bets today on voluntary compliance and on broadening the tax base, it is betting on trust even more than it is betting on the law.
A taxpayer who submits a report prepared by an auditor accredited by the state itself, only to see a discretionary assessment override that report, is like a patient who arrives carrying test results from an accredited laboratory and is told: “We will simply estimate your condition by looking at you.”
How do we expect that patient to come back to the clinic tomorrow?
And when he hears that the state intends to make room for the private sector, then sees a senior surgeon announce that he will step aside to make room for younger doctors, only to remain in every operating room with his scalpel firmly in hand—would he not question the sincerity of the plan before asking about its details?
I am not writing this out of any doubt about the minister. In my view, he is a competent professional, and he has done the right thing by placing in our hands a document that allows us to ask questions in the first place.
I am writing this because the danger is not that we may get one number wrong. Errors can be corrected.
The real danger is that people become accustomed to distrusting all numbers—both the accurate and the flawed. Then, in their eyes, the most honest doctor and the most dishonest doctor become indistinguishable, and everyone eventually stops reading the test results.
The remedy is simpler than we imagine:
Let the laboratory write, beside every number, where it came from and where it went.
Only then can the patient believe that he is healthy if he is healthy, or accept that he is ill if he is ill.
And in either case, treatment can begin.
So when will we see, beside every number in our budget, a small line that tells us:
Where did it come from—and where did it go?
