The Government, NHI and the ILO; or a Half Truth is a Whole Lie

Members of the PLP Government have invoked the name of the International Labour Organization (ILO) in support of their proposed National Health Insurance (NHI) Scheme with comments like, "the ILO experts gave the Bahamas' proposal the 'thumbs up' sign", the ILO has given the proposed NHI "its firm support", and "the ILO submitted a Report to the Government in July of this year giving a technical and analytical review of the entire NHI program".

All of these comments were made prior to the ILO Report coming into the public domain. Upon perusal it becomes clear that the ILO Report was limited in scope as can be seen from the final sentence in the first paragraph of the Introduction that reads, "In order to confirm that the technical studies undertaken under the auspices of the Steering Committee properly reflect the vision of the Blue Ribbon Commission, and that the Government and Cabinet may therefore have confidence in the contribution rates determined by the calculations of the technical study team, the Government, through the Ministry of Health and National Insurance, requested that the ILO undertake, within a fairly limited scope, an Analytical and Technical Review."

It can also be seen from the final paragraph of the Report that the ILO felt additional work was needed, "It is envisaged that a number of contextual issues facing the NHI in its implementation phase will be addressed by way of specific consultancies, some of which are mentioned in previous sections of this report. The full benefit of the social insurance vehicle for health care financing depends needs to be realized through the integration of the financial and care aspects of health provision. The ILO would welcome further opportunity to participate with the Ministry and NIB to work towards the optimal outcome of the NHI proposal."

The truth of the matter is that a Consultant from the ILO Social Security Department conducted a limited analysis focusing on the contribution rates determined by Government's NHI Technical Team. The ILO Consultant, utilizing information provided by Government that has not been released to Bahamian Civil Society, determined 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." However, the Consultant qualified his opinion by stating, "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 quasirandom, and incapable of exact forecasting."

The ILO Consultant went on further to state, "One aspect of variability which can be foreseen with relative clarity is the ageing of the population, which in the longer term will result in a pattern of costs of health care such that the cost of the benefit "package" must eventually be expected to equate to a significantly higher contribution rate than the initial rate selected of 5.3 per cent of earnings." This statement confirms the conclusion of Nadeem Esmail of The Fraser Institute on page 11 of his report commissioned by The Nassau Institute, which is available on BECon's website, where he states that, "The Bahamas' current health care program is more costly than those found in any other developed nation except for the United States once the relatively small proportion of Bahamians over age 65 is accounted for."

     How the ILO Report Came into the Public Domain
The ILO was founded in 1919 and became the first specialized agency of the United Nations in 1946. The ILO has a unique tripartite structure with Workers and Employers participating as equal partners with Governments. This composition puts the three Social Partners on equal footing within the organization. In The Bahamas the ILO recognizes the Bahamas Employers Confederation (BECon) as the official voice of the Employer and the National Congress of Trade Unions (NCTU) as the official voice of the Worker.

The first time this writer became aware of the ILO pertaining to the proposed NHI was on the 28th of June, 2006 at the Annual General Meeting of the Bahamas Chamber of Commerce where the Minister of Health, Senator Dr. Bernard Nottage, spoke on the proposed programme. Minister Nottage stated that the ILO reviewed the proposed 5.3% contribution rate and determined that this rate was sufficient to fund NHI to the level determined by Government. At that time the Minister did indicate that the ILO review was limited in scope. Although the ILO is a tripartite organization, it does have a Government desk, Worker desk and Employer desk so unilateral works can occur.

The second time was the 22nd of August, 2006 when a newspaper article stated that the ILO would visit The Bahamas in mid or late September to conduct a microeconomic study on NHI to develop a plan to bridge gaps in the existing healthcare network. It was further reported that the Minister of Health, Dr. Nottage said the first areas will be those shortages in critical areas such as pharmacy. Since this reported study would go beyond the scope of Government only, BECon sent an email the next day to the ILO Subregional Office for the Caribbean asking if the planned study would be tripartite in nature.

A response was received on the 25th August, 2006 from Dr. Ana Teresa Romero, Director of the ILO Subregional Office. Dr. Romero informed BECon that currently no mission to The Bahamas was planned by the ILO. She did state that she was aware that the ILO Social Security Department provided the services of an actuary to do a technical review of the NHI scheme in The Bahamas. According to the Social Security Department the review entailed an analysis of existing technical records. Dr. Romero also stated that officials of the ILO's Social Security Department had noted the importance of carrying out an economic and social policy analysis to put NHI issues into broader context and she assured BECon that should the Bahamian Government decide to undertake this analysis in a second phase of the work that the Subregional Office would become involved, and that there would be consultations with tripartite constituents.

The second phase of an economic and social policy analysis recommended by the ILO never happened, however with the introduction into the House of Assembly of the National Health Insurance Bill on the 15th of November, 2006 the frequency of comments from Government linking ILO approval of the proposed NHI plan escalated and the truth of the limited actuarial review was stretched past the breaking point to the ILO giving NHI the "thumbs up" and the ILO having reviewed "the entire NHI program".

On the 14th of December, 2006 the Directors of BECon were visited by Cleopatra Doumbia-Henry, Director, International Labour Standards Department, ILO, Geneva. When asked about the ILO giving "thumbs up" to the proposed NHI plan, Dr. Henry responded that only the ILO's Committee of Experts could give approval of that type and to her knowledge that approval was not given.

Based on this information BECon emailed the ILO Subregional Office on the 16th of December, 2006 and requested a copy of the ILO Report prepared by the Social Security Department on the proposed NHI programme. BECon is a member of the National Coalition for Health Care Reform (NCHCR) that has requested from Government all reports and facts pertaining to NHI, however Government has not been forthcoming with information. The ILO report was one of the many reports that have been requested.

On Thursday, the 21st of December, 2006 at 3:23PM the ILO Subregional Office emailed BECon a copy of the ILO Report on NHI. The ILO also emailed the Report to Government asking them to forward it to the Workers organization, NCTU. Less than two hours later, at 5:14PM the Report was emailed to BECon as a representative of the NCHCR by a member of Government's NHI Technical Team with the statement, "Permission has now been given to release the ILO's 'Commonwealth of The Bahamas: Report to the Government, Ministry of Health & National Insurance: Technical and Analytical Review of the Proposal for a National Health Insurance Programme'". One can't help but be cynical when only one of the many requested reports "released" by Government is the very same one that was obtained through another source with the full knowledge of Government less than two hours previously. The ILO Report is available on the websites of BECon, www.bahamasemployers.org and the NCHCR, bahamashealthcarereform.org.

The level of secrecy in Government is alarming. It is unconscionable that Government has yet to release all of the relevant reports and facts on the proposed National Health Insurance Scheme to the Bahamian public. Although these reports have not been released, Government is using them for propaganda purposes as we can see from the example of the ILO Report. The misinformation being dished out are half-truths, erroneous statements and outright falsehoods which bring to mind the quote from Austin O'Malley, "Those who think it is permissible to tell white lies soon grow color-blind." It is frightening, isn't it?

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