We refer to the $70 million in unpaid bills the Cayman Islands Health Services Authority expects to be owed by the end of June 2015.
It’s the latest in a long series of staggering figures — $35 million for Cayman Islands Development bank loans, US$312 million in soon-to-mature government bonds, $178 million for public pensions, $1 billion or more for public health liabilities — that represent money Cayman’s government has already spent or committed to spend, with little obvious benefit to the average taxpayer, and with few government solutions aside from proposals to keep our creditors at bay.
Take the unpaid bills, unfunded liabilities and looming debts, and combine them with the public funds tied up in personnel costs ($242 million for central government employees), payments to service existing debt (about $74 million) and ritualistic subsidies for loss-making entities such as Cayman Airways ($23 million) and Cayman Turtle Farm ($9.5 million) — and central government’s $658 million budget begins to seem tighter than it may have at first glance.
Factoring in all the hundreds of millions of dollars that are out of lawmakers’ control (for practical, personal and political reasons) helps to dispel the mystery of how Cayman — which is not only one of the wealthiest jurisdictions in the history of mankind, but is also one with the least amount of international obligations — cannot afford necessary infrastructure projects such as highways, landfills and ports, and indeed is hard-pressed to fulfill basic governmental functions, such as maintaining roads, collecting garbage and delivering the mail.
It may not be fair to declare categorically that Cayman’s government, over recent decades, has flat-out wasted the tax revenue (tens of billions of dollars) it has received from financial services and tourism (not to mention the windfall in duty that resulted from post-Ivan repair and reconstruction), but enormous sums certainly have been cavalierly squandered.
Setting aside some of the largest numbers for now, we’ll focus on one that’s a bit smaller but as inexplicable as any: The $29.3 million in unpaid bills owed to the Health Services Authority just for the two-year period from June 2013 to June 2015.
A pair of comments from lawmakers outlines our thoughts on the subject:
First, Finance Minister Marco Archer: “While there is a legitimate case of some people being unable to pay, there are some people who believe they do not have to pay.”
Second, North Side MLA Ezzard Miller: “We’re talking about $30 million. How can we have $14 million in bad debts for the year?”
While the amount of unpaid bills due to any organization, especially a healthcare provider, will never be zero — how could it possibly be $29.3 million over two years … in a country of only 55,000 people … where more than 90 percent have health insurance coverage?
We can imagine a handful of scenarios resulting in unpaid healthcare bills, including:
Visitors who receive treatment while in Cayman, then board an airplane or cruise ship, never to be seen again.
Uninsured residents who are not, or cannot, be enrolled in CINICO, and who truly cannot afford to pay.
Insured residents who cannot, or will not, pay the portion of health expenses not covered by their insurance policy.
Such cases exist, but surely they must be anomalies, those who slip through the proverbial cracks in the system.
But when we’re talking about a cost of $14 million per year or more, we’re no longer talking about a crack. We’re talking about a crevasse, and one that Cayman cannot annually afford to fill.