Common Ground On NHI:

By Candia Dames -
Nassau, Bahamas:

A well-respected physician who is a member of the National Coalition for Health Care Reform said Tuesday that National Health Insurance should be implemented now, but Dr. Duane Sands raised serious concerns about the present proposal for NHI.

Dr. Sands, who was one of five guests on Love 97’s "Issues of the Day" with Wendall Jones, suggested that the drafters of the National Health Insurance Plan were not being completely honest with the Bahamian people, but it’s a suggestion Dr. Perry Gomez, who is a chief engineer of the NHI proposal, scoffed at.

Dr. Sands insisted that the specifics of the proposed plan have yet to be revealed, and he added that there was not proper consultation.

"I have absolutely no problem with a National Health Insurance Plan," Dr. Sands said.

"I think it should happen now. I think we need to make dramatic changes in the way healthcare is delivered. We need to improve access for our Bahamian people, but I’ve gone on record, and I go on record today, as saying this plan as currently touted will not do what it’s intended to do, and more importantly, I believe that we’re not terribly far off from the proponents of the current [proposed] National Health Insurance Plan.

"I believe that there’s enough talent in this country that if we sit down together and hash out the differences we can all develop a National Health Insurance Plan which we can be proud of, which would be sustainable and which would achieve the noble goals set out by the Blue Ribbon Commission [on National Health Insurance]. We’re not terribly far off."

Dr. Gomez insisted – as Minister of Health Dr. Bernard Nottage has done consistently – that there was widespread consultation before Prime Minister Perry Christie took the National Health Insurance Bill to the House of Assembly two weeks ago.

"There were consultations all along," said Dr. Gomez, who chaired the Blue Ribbon Commission. "The Blue Ribbon Commission, we had town meetings. We met with all of the stakeholders. Most of them were a part of the Commission to start with. We had them come in and speak with us as a Commission…and so you understand why I say it surprises me when people say there was no consultation because it was born in consultation."

But Dr. Sands said, "Consultation is not information giving; consultation is not outlining a plan; consultation is a back and forth exchange of information, ideas [and] views with ultimate compromise to the greater good of the nation."

He said government officials and others responsible for putting together NHI have put a spin on the whole issue, which he said was "disingenuous and almost dishonest."

"For instance, we’ve come with this wonderful sounding concept of cradle to grave. It’s all inclusive. It’s to provide benefits that are available in any private health care plan, at less cost than you can get it in a private health care plan, and quite frankly that is not possible. It is not possible," Dr. Sands said.

"There will be limits. There are specific questions that have to be answered like: Will the National Health Insurance Plan provide generic or brand name medications? If I want brand name medications how much would I have to pay for them and where would I get them from? If I’m to see a specialist do I have to go through a gatekeeper? And what if I don’t like that gatekeeper’s view?

"Are we going to set limits? Let’s say that I’m 75 years old and I need a kidney transplant, are we going to allow a kidney transplant for a 75 year old? We have to set some limits."

Dr. Sands said these kinds of issues impact on whether NHI will be sustainable.

"They impact tremendously the decision making process that reasonable human beings in this country must go through," he said.

Dr. Gomez then explained, "Whether you give a kidney transplant to a 90 year old or a 40 year old is a different issue. In principle we will pay for kidney transplants, but that goes to the practice of medicine, not every 90 year old should receive a transplant."

He also explained that the costing for the plan makes provision for an expected 20 percent increase in demand for health care under the advice of consultants who helped the formation of the plan.

But Dr. Sands insisted that the utilization of health care will be far greater than 20 percent.

"[The estimate of a 20 percent increase] will be shown to be pure, unmitigated rubbish," he said.

"It is definitely going to be far more and understand that you cannot have both sides of the fence. If you’re saying that the reason why we need this plan is that this unmet need [for healthcare] is of such dramatic social significance that we have to come up with this huge national policy, then on the flip side of it, it is going to impact utilization tremendously. And so it’s not going to be 20 percent. It’s going to 50 to 100 percent."

Dr. Gomez questioned on what basis Dr. Sands could come up with such an estimation.

Dr. Sands said similar utilization estimations in Canada, Great Britain and the United States all proved to be "totally off".

"The Blue Ribbon Commission, the working committee (on NHI) and the Ministry of Health estimate that this plan is going to cost $235 million. I would suggest to you, Mr. Jones, that it’s going to cost 300, 400, 500, up to 600 million dollars annually," he said.

Dr. Sands added, "There’s a lot of economic data that shows that the same way that I am waving my hands in the air to try and come up with a figure, the Blue Ribbon Commission did exactly the same thing. They waved their hands in the air and they came up with a number that has no basis in fact."

Dr. Gomez shot back, "Now that’s rubbish. That’s rubbish. You really shouldn’t come here talking foolishness."

Stanley Lalta, the NHI project manager, who was also a guest on the weekday programme, said the team of persons who worked on the numbers categorically denies Dr. Sands’ view that they waved their hands in the air and came up with numbers.

He explained that there was careful, scientific analysis of data which led to the various estimations.

"When you look at the data for example, we found that on average Bahamians were making 3.2 visits to their general practitioners on an outpatient basis," Mr. Lalta said.

"We did not think that when we compared the data with Barbados and other similar countries that that is what the level should be or will be as a result of NHI so we’ve bumped that up by adding this 20 percent increase or about 4.2 visits and this will not happen in one year. This is something that will happen over three or four or five years."

Mr. Lalta said as far as he is concerned, the capacity issue is not a big hurdle.

"What you have is a plan that makes provision for a strong public sector and a strong private sector, and I would think that the combined capacity of both of these sectors should be adequate to deal with the expected demand on an NHI plan," he said.

"We have made provision for growth over time and capacity does not stay stagnant. Capacity will also be moving over time, both in the public as well as in the private sectors, so the issue of capacity is not the biggest hurdle."

Dr. Gomez, meanwhile, said that while there has been consultation there had not been an aggressive public relations push on NHI in the past because the officials and consultants were working out the details of the plan.

He pointed out that the bill took "time and work" and didn’t happen over night.

Dr. Gomez denied the suggestion made by Mr. Jones that the government was putting the cart before the horse in taking the bill to parliament. Dr. Gomez insisted that this was not so, repeating that there had been widespread consultation.

Also appearing on the show was Winston Rolle, another member of the National Coalition for Health Care Reform, who said one of the reasons why so many questions are arising about NHI is because the devil is in the details.

"The details are what have not been made available to us to look at as yet," Mr. Rolle said. "That’s what the issue is at this point."

Another guest, John Pinder, who is the acting president of the National Congress of Trade Unions, said that some union leaders are concerned about exactly how the plan is going to work, and whether they will receive access to private hospital care under NHI, rather than having to go on the public wards.

29 November 2006

health

Government Warned To Forge Ahead With NHI:

By Rogan M. Smith -
Nassau, Bahamas:

Leaders of a group comprised of Bahamians in support of the proposed National Health Insurance (NHI) warned the PLP government on Tuesday to fulfill its campaign promise to implement the health scheme or face being ejected from office in the upcoming general election.

Attorneys Paul Moss, Fayne Thompson and several members of the Bahamians for National Health Insurance group, said if the government allows itself to become sidetracked in its quest to deliver national health insurance for Bahamians it risks its dismissal in 2007.

They criticized insurance companies and doctors that have voiced their opposition to NHI, saying they are only opposed to the scheme because they have a selfish, vested interest in safeguarding their bottom line.

"We are demanding that the PLP government do what they promised in ‘Our Plan’ and pass National Health Insurance legislation at warped speed. This is what we require. This is one of the reasons we fought hard against CSME. That was not included in the PLP plan. Now, here we have something that was included in its plan, and we want them to carry through and do what is right. It’s a contract between you and us and we look forward to you not breaching that contract," Mr. Moss said.

"This is all about money for the opponents and they do not really care about the people of the country. I find it perplexing that those who took a vow to fight for patients are now fighting for profits."

Mr. Thompson said some people are starting to lose focus and are allowing themselves to be manipulated by those who don’t want the health insurance plan to be implemented. He said the NHI plan has become too political.

"One thing that I must criticize the government for is they have a lousy public relations exercise going on insofar as NHI is concerned. Dr. Bernard Nottage, bless his soul, is doing his best. But the individual man cannot achieve this initiative all by himself. The opposition has deep pockets and the campaign which they have launched, to some extent, has been successful," he said.

"Their campaign is ‘let’s slow it down.’ This is a political season. Perhaps if this had been done before [it would have been better]. Notwithstanding the timing and political season it’s still an initiative that the Bahamian people, if given the chance. . .will look at and embrace. It’s not perfect, but it rescues Bahamians from bankruptcy."

Mr. Moss said the government is not rushing this plan, but merely delivering on its campaign promise.

"How much more time is needed? How much more time must we allow people to simply walk around dying? It’s not being rushed. I submit that those saying that it is being rushed are simply those who do not want the plan," he said.

"You cannot say that a commission [Blue Ribbon] that has reported, has done its work and taken the time since 2002 to do its work and report two years later that it’s being rushed now in 2006. It’s not being rushed. In fact, they ought to do it faster than they’re doing it. It has been talked about since 1984. They have been derelict in their duties and they should do it faster."

Mr. Moss said there is a powerful minority that has voiced its objections to the National Health Insurance initiative.

"This is demoralizing when one recognizes that the objections are from groups and individuals who have access to quality healthcare, those who can pay for quality healthcare and benefit from the status quo remaining," he said.

"I do not see any person who does not have health insurance coming forth against this plan. This group – and I’m talking about those who control the economic wealth in this country seemingly control tremendous funds and could very easily drown out the majority of those who can benefit from National Health Insurance. We must resist this."

Mr. Moss accused the National Coalition for Health Care Reform, which includes private businesses, medical and allied health organizations and trade unions, of creating a smoke screen to distract Bahamians from the real issue at hand – providing quality health care for Bahamians who are unable to afford it.

The Coalition has strenuously denied that.

Mr. Moss said the NHI plan is not being rushed, but is timely.

He also addressed calls by some Bahamians to put the NHI to referendum. He said the Bahamian people decided they wanted NHI implemented almost five years ago, when they voted for the PLP in the 2002 general election.

29 November 2006

health

NHI: Keeping The Promise:

Bahama Journal Editorial -
Nassau, Bahamas:

The time is now in the Bahamas to set partisan politics and self-interest aside to introduce universal and mandatory health insurance for all Bahamians.

We agree with our own experts and leaders and we do so with the International Labor Organization experts who gave the Bahamas’ proposal the "thumbs up" sign.

Today, there is no gainsaying the fact that the process has been steady, deliberate and responsible. The attentive public now wants to know whether the government they elected in 2002 has the guts and gumption to do what it has promised in its book of promises, Our Plan.

That same public that voted them in is that same public that can and will vote them out if they fail to make good on the solemn promise of National Health Insurance.

That same public is quite aware of the fact that you get nothing for nothing and very little for your penny. In other words, they know that they will have to pay for any improved services they get.

Since so-called ordinary people are not as foolish as some other privileged ones might wish to believe to the contrary, these same people know that others will be obliged to carry their fair share of the burden.

This is what is needed in any situation where there is a public commitment to ensure the achievement of the common good. After all is said and done, this is precisely why the people vote for this or that party. They do so because they have faith enough in one party that they will do what they have promised.

In this regard, we agree with those people who have concluded that there is a direct correlation between economic development, national development and the health of a people. Indeed, Caribbean Heads of Government were so convinced of this truth that they adopted the Nassau Declaration, that "The Health of the Nation is the Wealth of the Nation".

Closer to home, a commission of distinguished citizens was appointed to review the health challenges of the region and to make recommendations as to how they might improve the health of their citizens.

We recall that one of the recommendations that they made was the need for universal access to affordable quality health care (NHI).

That Blue Ribbon Commission was summoned to examine the capacity of the health system to meet the health needs of the population and to recommend the most feasible financing arrangements for meeting those health needs.

Members included representatives from the public and private sectors, the Medical and Nursing Associations, private insurers, the Christian Council, Business Community and civil society.

We were entirely satisfied with this roster. We respect its judgment. So should the government. We also know that the Bahamian people cannot and will not eat clichés about how it is that the heath of the nation is the wealth of the nation.

And for sure, we want all and sundry to know that like other Bahamians who are leery of politicians who always talk a good talk, we want to see some action.

That is why we want the debate concerning National Health Insurance to be taken to parliament for discussion and requisite action. That is where these issues are to be fully discussed, fully debated and voted on.

The Minister of Health and National Insurance is absolutely correct when he says that "the time for this action is long over due."

Today, therefore, we go on record as being in full agreement with the current administration as it moves forward with the National Health Insurance project.

This project is timely and is in the interest of the Bahamian people.

Not only do we support this project, but we are quite truthfully tired of all the talk that has been going on concerning this long over due initiative.

From where we sit, there is an impression that is coming in clearer and clearer by the day that the government is giving far too much credence to those people and interests that would sacrifice little or nothing for the common good.

In this regard, our advice is simple, blunt and to the point. It is that the matter involving National Health Insurance should be taken to that place where parliamentarians discuss issues, vote on them and then and thereafter produce laws.

That is why we have a parliament.

That is why today we say enough of this chatter about National Insurance!

28 November 2006

health

Chief Justice Troubled:

By Candia Dames -
Nassau, Bahamas:

In his first public comments since two stunning rulings from Supreme Court Justice John Lyons sparked widespread debate about the independence of the judiciary, Chief Justice Sir Burton Hall admitted that he is troubled by the controversy.

But Sir Burton refused to be pinned down on any matter related directly to Mr. Lyons’ rulings and pronouncements from the bench, saying he was determined not to be "set up" by his interviewers when he appeared as a guest on the Love 97 flagship programme "Jones and Company", which aired on Sunday.

Sir Burton explained that it would not be appropriate for any judge to comment on the judgment of another judge, and he said a judge is never wrong in his own court and can only be proven wrong by an appeals court.

He added, however, "The fact that a judge is overturned on appeal wouldn’t necessarily be a sign of incompetence. Bear in mind that…each judgment is a matter of opinion…each judge is in conscience bound by his judicial oath to do right as he sees it."

Sir Burton also said the fact that a judge may be a contrarian does not necessarily mean that he is wrong.

In his rulings of November 6, Justice Lyons accused the government of breaking the law on two occasions by failing to appoint a commission in accordance with the Judicial Remuneration and Pensions Act to review the salaries of judges.

He said this has compromised the independence of the judiciary and he accused the government of plunging the country into a constitutional crisis.

Again, Sir Burton declined to say specifically whether the judiciary is independent in The Bahamas, but he said as it regarded the three areas of judicial independence – adjudicative independence, institutional independence and administrative independence – there were some "serious challenges" with administrative independence.

Sir Burton pointed out, for instance, that the judiciary is dependent upon government and the public purse for salaries, and administrative improvements in the judiciary, and has to compete for public funds as the government has other obligations it has to meet.

The chief justice also said that friction between institutions – if it does exist – is not answerable in a courtroom, but is a debate the public at large must be engaged in.

The attorney general has appealed the rulings of Justice Lyons, but this is not something Sir Burton commented on when he appeared on Love 97’s "Jones and Company". He was clear to stay away from getting bogged down in the controversy.

Asked whether it was right for a justice to make himself controversial by drawing attention to his race and place of origin, the chief justice said, "Some judicial officers may be at pains to use language to avoid anything which may possibly become controversial, and even then they do not necessarily succeed. And others may not see the need to be as cautious, but again, this is a personal idiosyncrasy."

Speaking in a Freeport court last Monday, Justice Lyons suggested that his personal security may be threatened because of the colour of his skin, and because – in his words – Attorney General Allyson Maynard-Gibson called his integrity into question by saying that he had been misleading in his November 6 rulings.

But Sir Burton said he had no comment on this suggestion from the judge.

The show’s host, Wendall Jones, pressed him, saying, "If you have a judge who believes that his personal security is at risk wouldn’t you as chief justice be concerned about that?"

Sir Burton responded, "The matter of security would be – if any judge or indeed any member of the support staff has a concern in that regard, I would think that they would bring it to my attention and I would then refer it to those responsible for security."

He said the matter of Justice Lyons’ reported concerns for his safety had not been brought to his attention.

Sir Burton pointed out that all judges except Justice Lyons are hearing cases, and Mr. Jones asked whether this was an indication that those judges do not agree with the conclusions of Justice Lyons.

The chief justice simply responded, "As a reasonable observer, Mr. Jones, you are perfectly entitled to arrive at that conclusion."

Mr. Jones shot back, "But it is true isn’t it?"

Sir Burton said, "It is true that the judges have continued to sit. Each judge has continued to work his (or her) list."

While admitting that he was troubled by the ongoing controversy surrounding the judiciary, Sir Burton said he was relieved because the debate was providing an opportunity for more members of the public to become knowledgeable about the judiciary.

27 November 2006

bahamian law

GB Human Rights Assoc. Calls For AG’s Resignation:

Bahama Journal:
Nassau, Bahamas:

The Grand Bahama Human Rights Association released a statement on Wednesday calling for the resignation of Attorney General Allyson Maynard-Gibson, accusing her of "disrespectful behaviour" regarding the independence of the judiciary and comments in parliament regarding Supreme Court Justice John Lyons.

"The attorney general cannot defame a judge under the protection of parliamentary privilege," said Fred Smith, president of the Grand Bahama Human Rights Association.

"In addition, the Association calls upon the chief justice to bring Mrs. Maynard-Gibson, an officer of the court, before him to show cause why she should not be committed for contempt of court in making scurrilous and disrespectful comments about the Bahamian judiciary."

In a ruling on Monday, Justice Lyons accused Mrs. Maynard-Gibson of calling his integrity and reputation into question by saying in parliament that he had been misleading in a judgment he delivered on November 6.

In that judgment, and another delivered that same day, Justice Lyons accused the government of breaking the law by failing to appoint a commission under law to review the salaries of judges.

"In failing to comply with the Judges Remuneration and Pensions Act, the PLP government has shamed our democracy," Mr. Smith said.

"This is but one of the many examples of the PLP’s disrespect for the judiciary, the third branch of government. The Westminster model of constitutional democracy which governs The Bahamas depends on equal power and respect being shared by the executive, legislature and judiciary."

In addition, the Association called on the government to end the "pernicious practice" of appointing acting judges "who are beholden for their continuation in office or future permanent appointment to the arbitrary dictates of the executive."

Mr. Smith said, "It is time that the Cabinet and Parliament respect the judiciary as an equal branch of government. Our Association supports the position expressed by Justice Lyons and the position adopted by the Bar Association in defending the integrity and independence of the judiciary in The Bahamas.

"If we do not have an independent judiciary, there is no sense in having a chapter on fundamental rights and freedoms in the constitution."

23 November 2006

bahamian law