Your Thursday editorial (“A radical Rx needed for Cayman healthcare”) about healthcare in the Cayman Islands raises an important issue. It appears that private health insurers provide cover for the generally healthy and the unhealthy or high risk are denied cover and are thrown back onto the government system. Some of the people concerned cannot pay and to then blame the government or the individuals in that situation is not right.
A private healthcare system will only work if the healthy and unhealthy receive cover and can participate through paying premiums. The system here seems to allow the insurers to cherry-pick the good risks while the government is left holding the bad risks. Obama tried to sort this in the U.S. by forcing the healthy to take out health insurance so premiums would decrease generally and the high risks would be covered overall. Obamacare is like a publicly funded system but is delivered in a hybrid way. Obamacare is breaking down because the young and healthy do not want to participate and would prefer to spend their income in other ways.
Unfortunately, the young and healthy in Cayman are compelled to participate and the older and unhealthy who need the service are often excluded. This suggests to me someone, somewhere, is making a profit from the status quo while the government is left picking up the tab.
I would suggest that the Cayman Islands move toward a publicly funded system for all residents and that this be funded by a levy on earnings or some form of consumption tax. This will ensure that all residents are provided with cover and approved providers here can supply services at negotiated rates. I see no reason for the government to operate a hospital. All it needs to do is fund the procedures and regulate the costs and services. Hospitals ideally should be run by those who know how to run hospitals as private businesses. This would immediately solve the problems of nonpayment and take the government out of the firing line. It only needs to fund from the funds it raises through taxation.
Those who wish to seek private cover above and beyond the public services can do so and they can pay for the perceived benefits. Those who do not wish to do so have a choice knowing they will in any event have cover if they get ill. Those with the public cover and those with enhanced cover can chose their doctor or hospital and this should create a competitive market for services. Government can set a maximum fee for a particular procedure but doctors, hospitals and surgeons can compete. Whether the George Town hospital or Shetty or another provider provides the service should be irrelevant to government.
It appears, like many things in the past, Cayman has been sold a proverbial pup which is not fit for purpose. The best healthcare systems in the world are publicly funded. The worst in the world are publicly funded. The outcome depends on the level of funding, which is a political choice. Private funding and insurance works for the wealthy but average outcomes for the general population are mediocre or disastrous for some in the U.S.
Let’s start again with a proper discussion about what Cayman society wants in terms of the level of healthcare and find a way to fund it which works for maximum benefit. It will never be free. You either pay the government as an intermediary or a private health insurer, but only the government can offer cover for all at a reasonable price. Or you compel private insurers to insure all risks. The current system is the worst of all worlds. Properly funded social healthcare systems are the best in the world in terms of maximum benefit for the most people.