As the National Health Insurance Commission explores the feasibility of a public health insurance scheme, political leaders and an insurance expert have concluded that it cannot be done – not without raising taxes. And that is something Prime Minister Perry Christie said he would not do.
Last year, the previous government explored the possibility of implementing a catastrophic health insurance, but that proved to be "very" difficult, said Tommy Turnquest, leader of the Free National Movement.
An International Labor Organization report showed the government how costly it would be to implement such a scheme.
Those who can afford to pay are going to have to pay for those who cannot, Mr. Turnquest said.
"Someone has to pay for it," he said. "The government operates either through taxes or borrowing and so something like this – which is considered to be a necessary initiative by the present government – has to be funded in some way.
"The only way to fund it would be through National Insurance contributions and that would be an additional tax."
Leader of the Coalition for Democratic Reform Dr. Bernard Nottage agrees.
"It is impossible for the government of The Bahamas to have, or to introduce a national health insurance scheme of any kind without the insured persons and, or their employers contributing towards the cost of that scheme.
"Bahamians have to understand and accept that you can not get a service of that importance and magnitude and not pay for it.
"In my opinion, the funds do not exist for it to be paid for out of existing taxes. Nor can the present contributions made through the national insurance scheme meet the cost of a comprehensive, national health insurance plan," Dr. Nottage said.
In the late 1980's, a working party on a National Health Insurance scheme was appointed. Its final report estimated the cost of such a plan to be around $119 million for the country's population, which was at about 240,000 at that time.
During the recent election campaign the Free National Movement had said that the Progressive Liberal Party's insurance scheme would cost $100 million annually, but pointing to the old 80's report, Dr. Nottage said it would cost much more due to a population swell and expensive, medical technology.
"It's going to be more than $100 million," said the French Canadian born, Executive Vice President of Imperial Life Financial, Guy Richards. "If your plan covers only headache it wouldn't cost a lot but if it covers catastrophic illnesses it's going to be very costly to implement," Mr. Richards said.
"The big problem is how do you finance that? Who is going to pay for it, individuals, corporations? At some point there would have to be some tax or fee base. Since there is no personal or income tax it might have to come from corporations."
The cost, he said, would depend on the type of plan the government implements – if it's universal, if it covers everybody and the definition of "catastrophic."
The National Health Insurance Commission appointed several weeks ago, has less than six month to deliver its report to the government.
Although board members are very tight-lipped about their work, Commission Chairman, Dr. Perry Gomez says they are examining public health care models like Britain's National Health Service and those in Canada, Bermuda and "perhaps" Chile.
The Commission, he said, are looking at health care systems in first world countries.
Systems in Britain, Canada, the United States and parts of Europe are all tax based.
But, at the opening of Parliament on Wednesday, May 22, the government reaffirmed that under its fiscal policy there will be no income, corporate, capital gains or inheritance tax."
Britain's 54-year-old system is based on need and not the ability to pay.
The NHS is funded by the taxpayers, managed by the Department of Health and accountable to Parliament.
Drawbacks of this $50 billion a year scheme include the fact that beneficiaries frequently do not get timely care, are subject to queuing for a year or more and some die while on the waiting list.
Canada's national health care system, Medicare is predominantly, publicly financed and privately delivered. Health care in Canada is financed primarily through provincial, federal personal and corporate income taxes.
The United States health care plans – Medicare, Medicaid and Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) – are also financially troubled.
