by Rick Lowe

In this December 22, 2006 story by Ms. Candia Dames in The Bahama Journal under the headline Report Outlines ILO’s Approval of NHI Proposal is curious indeed.

The National Coalition for Health Care Reform (NCHCR) has posted this politically correct statement about the ILO report on their web site:

After the House and Senate have passed the National Health Insurance Bill with some minor amendments (the revised document will be posted when available), the ILO Report touted by Government as giving a "thumbs up" to NHI has come into the Public Domain. Upon review of the report we find its scope to be very limited as it is actually an analytical and technical review of studies carried out in The Bahamas.

It would appear the Bahama Journal was provided with the governments press release in advance of other news organizations in an attempt to "sell" the NHI working committee’s perspective on the ILO report if you will before an honest perspective of the ILO report could be rendered.

To be fair, the Journal did print some of the derogatory points made by the ILO, but their headlkne is misleading to say the least.

We have previously discussed the demonization of the the NCHCR and anyone else that would dare to offer constructive criticism of this great plan by the PLP for that matter in this previous post, but the government approach now seems to have added deceit to its approach with the NHI at this point.

As an aside, one can’t help but wonder if this is desperation by a political party as an election approaches.

However, it seems more like the "curse of power" that comes with being the government as outlined by Matthew d’Ancona in this piece at The Spectator in the UK.

He writes:

Power does terrible things to people, disfiguring their sense of normality. Progressive politicians are particularly prone to believe that actions which would ordinarily be considered wrong are justified by a sense of higher purpose.

The Nassau Institute (NI) has a catalogue of articles on this important subject and the difficulties faced in other counties with socialized medicine. Click here for the NI list of information.

If time permits you might also wish to check out this list of articles over at Cafe Hayek, one of this bloggers favourite blogs.

One can only hope that the government jumps in at the shallow end of the NHI pool and stays clear of the deep water that has caused as much, and in some cases more pain than if the government stayed out of health care.

As stated ad nauseam, working Bahamian’s should buy their own health care through private insurers leaving the government to deal with the genuine hardship cases and those persons that have been locked out of private health insurance for legitimate reasons.

When all is said and done, read the link to the ILO report and see for yourself what the "curse of power" has done to our country’s leaders.

The complete Bahama Journal Story follows:

Report Outlines ILO’s Approval Of NHI Proposal

By Candia Dames

A report prepared by the International Labour Organization (ILO) on the government’s proposed National Health Insurance Plan confirms overall support for and approval of the proposal.

That report was actually completed five months ago, but has never been made public before now.

The ILO says that with regard to sustainability, it is the opinion of the consultant (the ILO) that it will be possible to operate the scheme for the foreseeable future on a basis which is financially sound and which should not require large changes to the major parameters, including in particular the basic contribution rate.

The report says, "This opinion is, however, subject to the qualification that, beyond the next two to three years, it is simply not possible to make a very accurate assessment of the actual year by year surplus or deficit to be expected, mainly because the fluctuations of financial conditions are, essentially random, or quasi-random, and incapable of exact forecasting."

The ILO’s Social Security Department says in the report that the continued viability of the proposed NHI scheme after being inaugurated will depend on management, which must be uncompromising as regards matters such as compliance with membership obligations and insistence on payment for medical services in NHI facilities by those who fail to join and contribute.

"Given the nature of the needs in the field of health care, management must nevertheless deal sympathetically with members of the scheme and promptly with all reasonable claims," the report says.

Both Prime Minister Perry Christie and Minister of Health Senator Dr. Bernard Nottage have pointed to the ILO’s favourable assessment of the government’s proposed NHI plan.

In its report, the ILO says one aspect of future variability which can be foreseen with ‘relative’ clarity is the ageing of the country’s population, which will inevitably have an impact on the pattern of demand for health care, and its cost in the longer term.

"An important aspect of the NHI design is the affordability of contributions paid by and on behalf of the members, and does not require that such contributions should cover in full the cost of the package of benefits provided to them," the report says.

It adds that comparison with schemes in the countries in which the ageing process is more fully advanced indicates that the cost of a comprehensive benefit package will eventually rise to a level which equates to a contribution rate significantly higher than the proposed initial rate of 5.3 percent.

The report also says that care needs to be taken whenever officials share in public their perceptions as to the development of NHI.

It appears that comments have been offered to reassure the public as to the "comprehensive" nature of the health care to be offered under the scheme, the report says

"Comprehensive care is not intended to mean, as might be assumed by the public, that every conceivable medical procedure will be supported by NHI," the report says.

"The potential for misunderstanding – and unfortunate inflation of public expectations – is clear, and it may be helpful to prepare a briefing note on this and other items of technical terminology for the use of officials likely to be engaged in presenting or explaining the scheme in public. However, it is envisaged that a specific consultancy will be undertaken to crystallize the concept of ‘comprehensiveness’ for NHI purposes."

In the report, the ILO also points to key assumptions that had been made during costing and financing calculations.

One such assumption was that every working person will be required to contribute to NHI.

The ILO says this will require strong management and effective sanctions.

"Consideration should be given to the means by which each of these may be put in place," the report says.

In addition to the assumption that every working person be required to pay into the scheme, there is also the assumption that NHI will not pay for the cost of care for those who are not paid-up members.

Again, the ILO says the level of rigor required of management in this regard will be important.

The report says, "It will be important that proper annual auditing of NHI is commissioned and the results publicized; in particular it is critical that ‘bad debts’ are not allowed to accumulate, and that appropriate sanctions are available to ensure a high level of repayment of such debts."

Another assumption at the time was that pensioners will contribute at the rate of $1 per day.

The ILO says, "This proposal has already been returned to the technical team for reconsideration. It is considered that in equity, pensioners should pay some level of contributions to the scheme, probably at a rate set as a percentage of (pension) income.

"The annual quantum of contributions estimated from pensioners at the outset under the original assumption is, however, around $8 million, in an expected non-government contribution total payable by workers, employers and pensioners of $124 million."

The ILO also found to be appropriate a number of other assumptions including assumptions which say: employers and employees will share contributions equally; government will pay contributions for indigent members; government will continue to fund costs of public hospitals related to administration and essential public functions; the government will continue to finance and provide direct medical care associated with public health; the government will allocate $18 million for capital expenditures; and total government financing of healthcare should remain at current levels.