Miller: Healthcare in crisis

| 21/08/2017 | 87 Comments

(CNS): The opposition leader is calling on government to form a special select committee made up of members of the Legislative Assembly from both sides of the aisle to take look at the country’s healthcare system as he believes it is now in crisis. From the numerous issues relating to health insurance and the massive amount of public money used to plug the enormous gaps in cover to the the cost of medication, Ezzard Miller said too many people are being refused the care they need. “The healthcare system is falling apart,” Miller told CNS.

The independent member for North Side and one-time health minister said that he is no longer prepared to sit back and watch another administration fail in its efforts to tackle the growing problems relating to the entire healthcare system. The opposition leader has filed a private member’s motion, seconded by first-time MLA Chris Saunders representing Bodden Town West, asking government to join forces with the opposition to review policies and laws relating to healthcare and insurance, with the aim of improving both the quality of, and access to, care.

Miller said far too many people were being refused care when they need it, or are unable to access the medications they require, because of high costs and inadequate insurance. He said Caymanians are being turned away or procedures cancelled because they don’t have money or cover. Healthcare professionals are also frustrated by the insurance companies who are focused on the money and not care, he said, adding that they are clamouring for an increase in prices because they claim not to be making any money. But he said the Cayman Islands Monetary Authority’s figures paint a picture of an industry making millions and millions of dollars a year while people are being denied necessary care. That situation leads to more pressure on the emergency room and the need for urgent treatment, and in the long run the public purse picks up the tab.

The opposition leader said he believes it is time for Cayman to consider a single-payer basic national system as the population has reached the point where it can sustain the cover for all, and the public money now being pumped in could be much more efficiently utilised in a single insurance pool.

But he said he wants government to form a six-member committee, with four MLAs  from the government benches and two from the opposition, to see whether that is viable option or if there is some other way to fix Cayman’s ailing healthcare system. He also said the review should be done in open hearings with the committee calling key witnesses, including  doctors and health insurers, so the country gets a full picture of the challenges and the potential solutions.

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Category: Health, health and safety, Health Insurance

Comments (87)

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  1. Anonymous says:

    The negative comments about doctors is astonishing. Over the last 10-years healthcare premiums have increased 400%. In the same period, doctors reimbursement has risen 0%. That’s right, doctors haven’t had a pay rise for 10-years — not even a little cost of living increase. Have you? So before you slate the doctors, consider this basic fact and ask your health insurance company if the doctors are getting no more, why the increases and where’s all the money going to?




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  2. Jotnar says:

    Compass Aug 6th: “In 2012, the government Ministry of Health predicted that by 2020, heart disease, cancer and diabetes would account for 60 percent of the illnesses in the Cayman Islands. At the time, the ministry noted that 37 percent of teenagers in the islands were classified as “overweight or obese” and were likely to face future health risks.

    “Our national health systems will be severely stressed and there be will significant negative economic and social consequence,” the report noted.

    In addition, a comprehensive review of the Cayman Islands health system completed last year by the auditor general’s office noted that chronic illness rates in the islands may be “masked” by a large influx of relatively young and relatively healthy work permit holders in the islands. These non-Caymanian workers, who cannot come to work here unless they are in relatively good health, could make reported percentages of chronic illness in the local population look smaller, auditors found.”

    So, rather than focus on preventative measures to improve general health and lifestyle habits that contribute to the burden created by diabetes, heart disease and cancers associated with lifestyle choices like smoking, lets spread the cost across everyone by having a single payer insurance scheme where individuals don’t take economic responsibility for the consequences of their unhealthy lifestyles. Perhaps we should be talking about sugar taxes, increasing alcohol and tobacco tax, educating the youth and public on healthy eating, and subsidising healthy foods instead, and focus government assistance on the truly indigent.




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  3. Anonymous says:

    A few years ago we had to call the ambulance for one of my neighbors who was on Island on a work permit, working for a restaurant or bar. She got the urgent care but later on they would not release her until someone came to settle her bill because either she didn’t have valid insurance or the insurance coverage wasn’t sufficient. We called her employer who reluctantly came to settle the bill. My understanding was that employers are responsible for the person they hold the permit for and so this is exactly what should happen. If you don’t see to it that your employees have decent health insurance then employers need to be held responsible for the cost occurred. Those health insurances who only provide coverage for hospital stay and give only CI100/year for outpatient services are ridiculous and need to be banned.




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  4. Anonymous says:

    As usual, the focus is on bureaucratic issues, completely missing THE “HEALTH” in it.

    It is YOU and only YOU who is responsible for the state of our health. Emergency medical intervention is what must be provided and then again it is not a human right. Majority of acute conditions resolve on its own, given time and home remedies that worked for centuries and suddenly were call barbaric by medical community and public at large. A castor oil compress for aches and pain does more than all the pills you take to block the pain. Try it. Mother nature can’t go wrong.

    Modern medicine has no idea what to do with chronic conditions and where it is coming from.
    Fortunately more people realize that and are seeking healing and cure outside of mainstream SICKCARE system, because it can offer nothing.
    Thankfully you can buy CBD oils now in the USA, not cheap, but not expensive compared to monthly medical insurance premiums. And it works, not a panacea, but it works for very many health issues . Marijuana oil is available by prescription. People learn about low-dosage naltrexone. People learn about EMF and Smart meters gravely danger. They learn about GMO . They learn that Sun is not your enemy but #1 health ensuring factor. Life on earth started with light. People take their health in their own hands.




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  5. Anonymous says:

    Why are doctors and dentists allowed to make patients with valid insurance cards pay upfront and deal with the reclaim themselves? I thought by laws doctors and dentist must accept the insurance card? I get that dealing with insurance is a pain, but that’s the cost of running a hospital or doctors practice world wide. No wonder so many people don’t seek medical help until it becomes an emergency. Too many simply can’t afford to shell out hundreds of dollars for a doctor visit and we know that some doctors charge you CI$ 350 and up after making you wait for over an hour and then seeing you for about 10 minutes max!




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    • Anonymous says:

      Because otherwise they dont get paid.




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    • Anonymous says:

      You need to let them know with your dollars. Do not use a provider that does not accept your insurance. If they are not making money, they will adjust their policies. I never use a provider that won’t directly bill my insurance.

      It only takes a phone call to find out if you are covered for an elective procedure. If it is an emergency go to GT Hospital it is covered for before CTMH or Health City. But it is subject to your policy limits. And if you can, even in an emergency, try Health City, because they offer, IMO, far superior care.




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      • Anonymous says:

        All well and good, but when your insurance company doesn’t pay for all or part of your care do the honorable thing and go back to the doctor and your pay the outstanding sum. Everyone is notified by their insurance company if part of the care has not been reimbursed, but how many go back to pay the doctor for the work they did? Very few.




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  6. Anonymous says:

    NHS in UK is over burdened too many foreigners took advantage of the system and now the locals here are paying the price for it . Same thing happened in Cayman, blame mass grant of status as far as I when population increases the healthcare suffers.




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    • Anonymous says:

      The problem with writing at 1.53 in the morning is that you rarely make sense. The issue here is to do with an over complicated American style system plus Cinico which fail to function completely…




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      • Anonymous says:

        Actually 1.53 here in Cayman is 7.53 in the UK: that is when the correspondent probably made the post. He or she was hopefully wide awake.




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  7. Anonymous says:

    If you went to CTMH before they were Doctors Hospital you could see post it notes advising their billing staff to code all procedures at level four. If you were in the States you would loose your ability to process Medicare claims, and most likely face fraud charges. I have no doubt similar coding existed at George Town Hospital.

    You want to know why health care cost have skyrocketed? It is because we have zero oversight. I have emailed several MLA’s with evidence of BLATANT over coding. Response…zero.




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    • Anonymous says:

      Okay you four thumbs down folks. Tell me why it is okay to over code, and explain to me why it is okay for you to steal. Because that is what every over coder is doing.




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  8. Anonymous says:

    The question is: Is healthcare a human right or is it a product you buy ?

    In most countries it is a right. In the US and here it is a product you can buy. As a result, many people who can not afford the care they need and many of them will die.
    Yes they will die.




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    • Anonymous says:

      And if we stopped letting so many foreign under and uninsured persons live here, there would be more money available to treat local persons in need. It really is that simple.




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      • Anonymous says:

        So simple? Would you like to elaborate on this. Makes ZERO sense…




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        • Anonymous says:

          Many hundreds of persons have settled here from other countries in recent years who cannot maintain themselves. They receive care, and benefits from the government, for free. It costs us millions, and leaves less money for local persons. They are supposed to have insurance, but do not.




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          • Anonymous says:

            Any evidence that can be used? Present it please.




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            • Anonymous says:

              Check the immigration status of the debtors and if they are Caymanian, when and how they became Caymanian.




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          • Anonymous says:

            Sounds like you have an Americanized Healthcare issue. People from other countries, settling in, not wanting to work and sucking every freebie possible from an Americans taxed dollar, only to damage the locals opportunity for reasonable healthcare costs. Yes, I can sympathize with you…




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        • Anonymous says:

          The real elephant in the room is that the “Standard Health Insurance Contract” prescribed by the Health Insurance Law is woefully inadequate. The minimum cover should be at least 1million but no one will pay the necessary premiums. If they did the HSA would not be in trouble and we would not be in the awful situation that we send the underinsured off in aircraft at risk of death just so they don’t die here. It’s insane and immoral and probably in breach on several provisions of our constitution. The Auditor General has done at least one report highlighting this. The SHIC is the singlemost issue that needs to be fixed because it is totally bogus. Does not give anyone any proper level of provision and is a sham which leaves many many residents at massive risk which most of them don’t appreciate and they are the ones doing potentially dangerous jobs for which their employers are not even required to have liability insurance. Cayman needs to get its house in order




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      • Anonymous says:

        Kicking the expat as usual.




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      • Anonymous says:

        No, not really. Most of them are young and healthy. They lower the risk pool.




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      • Veritas says:

        7.27pm and if you stopped 10,000 civil servants and dependents from not paying for any medical treatment, there would be a lot MORE money to treat local persons in need. It’s that simple.




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    • Anonymous says:

      No they just get free treatment through the emergency room paid by the taxpayers.




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    • Anonymous says:

      This is complete utter bullshit and you obviously never lived in the States. Let me give you once simple example of many thousands
      https://www.browardhealth.org/pages/financial-assistance.

      I personally knew someone on this program that got cancer and paid absolutely 0.00 dollars and got all of the treatment he needed.

      The States DO NOT let people die on the streets. Ever saw the bum that got his face eaten off by the guy on flakka in Miami? Well he his whole face got reconstructed and he wasn’t left to die on the streets and he had no cash.

      There are ton of programs for people who can’t afford health care. There always were programs.

      Why do people that don’t know jack, always feel the need to spew bullshit?




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    • Anonymous says:

      True, true. But you must also contain costs. I know too many people who go to the doctor for every little hiccup and boo boo. They would drive up the costs significantly. I think some degree of co-pay is necessary.




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  9. anon says:

    Ezzard, you should have been the Health Minister. The HSA and wider health industry made a sigh of relief when you didn’t get it because they knew you would have shaken things up. Dwayne is being educated as he goes along, but this particular matter is too serious for a newbie to tackle.




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  10. Anonymous says:

    When it comes to insurance costs to the Government., are all the Insurance companies paying into Government the $10.00 stamp tax charged on every insurance policy written. This stamp tax was to have been used to help fund the indigent health needs. Government may need to check into this.




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  11. Anonymous says:

    Maybe one of the first places to start is a complete review and amendment to the flawed Insurance Law 2010 spearheaded by some who apparently confused the basic domestic issues while focusing on offshore interest with the notion to expand the Captive and Re-insurance industry.




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  12. Anonymous says:

    This is a review that needs to be done by a team of specialists who have expertise in this area – not by members of the LA! Cayman needs to look at other countries and see where they can base their health insurance model on.

    I was disgusted last year when I had to have an operation and the insurance company refused it! I had paid into the plan for 10+ years, never made a claim, nor needed surgery and when I finally needed it my claim was refused! Then I heard about some people (including the doctors) who had been scamming the system. It is no wonder when you hear stories like that, that when someone who legitimately needs to make a claim and the resources are no longer there!

    I have since left the island. When I tell people how much I used to pay monthly on health insurance they are shocked! And to be honest, it is shocking when you think about the cost of health care.

    Why doesn’t the Government hospital chase their outstanding debtors? If they did this the health system would not be as strained as it currently is. The Emergency Room at the hospital is actually for “emergencies” – not for Caymanians sitting there to be seen who have a cold!

    And one last thing, I had to pay for my visit prior to being seen at the Chrissie Tomlinson Hospital. I found it very interesting that the cashier (someone that I previously worked with years prior) taking my money was previously fired from an employer for stealing money/cheques out of the post. Good to see that they pay close attention to checking references!!!!




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  13. Anonymous says:

    politicians are giving the citizens a bad name!




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  14. Anonymous says:

    Anonymous 9:27pm you dont have clue about the NHS in EngLand it’s failing please dont compare or suggest Cayman’s Healthcare with the NHS in UK. Cayman you are 100% better off healthcare wise. You are restricted to 10mins with a doctor and only complaint to be discussed.




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  15. Anonymous says:

    Good point but UK’s NHS is also in crisis now.




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  16. Anonymous says:

    What did Webb Watson and others do with the money?




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  17. Anonymous says:

    Hundreds of millions of dollars given for free and now he is mad because there is no more. The bill for all that is still yet to be paid and I wonder if he has a plan for that other than make the expats pay for it.




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  18. Anonymous says:

    Failing it is. The emergency room needs to be at least doubled in size. The older persons who reside on the medical ward need to be cared for by their families or government but certainly not be housed,for years on the ward. It’s a hospital not an extended care facility. Their needs to be an increase of staff and number of ambulances needs to increase. The demand exceeds the supply. Just ask around, people are constantly waiting for the ambulance to respond but have to wait because they are consumed taking people to doctor appointments. Separate the 911 system and create a transport division. Trying to do both is failing. Enlist that blue ambulance you see running around everywhere. They must be encountering several emergencies, always blasting around with their siren blaring.
    And can we please let Health City have an emergency room. They already take in countless “emergency” patients. That would relieve some of the pressure on the government hospital and keep people closer to their district/homes. Cayman is growing and with it there must be change.




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    • Anonymous says:

      Health City don’t want an Emergency Room. They’re not profitable, which is their business plan, remember. (Unless you go the US billing method in which case you bill people ‘out of coverage’ rates when the ambulance rolls them in to the ‘wrong’ ER.)




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      • Anonymous says:

        If they do not want an emergency room then they should not except emergency patients. I know for a fact that they do on a daily basis. If it’s good for some then it’s good for all. You either except emergencies or you don’t.




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        • Anonymous says:

          Problem with an emergency room is that 95% of you idiots hanging out there have no need to be there in the first place. The clue as to its intended use is contained within it’s name.




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  19. Sharkey says:

    Mr Miller you can’t clean the dirty pot with dirty water . You have to clean a dirty pot with clean washing water and soap .




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  20. Anonymous says:

    Stop importing poverty! That alone would solve half of this problem and pretty much every other problem we are facing! I am amazed that we keep repeating a failing experiment. What was wrong with be able to sustain yourself and your dependents (including their healthcare) or you cannot come and live here from overseas? It worked. Now we ignore it and act surprised that our systems are collapsing.




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    • Anonymous says:

      Big business wants cheap labour and big business runs the government.




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      • Anonymous says:

        Labour does not have to be given permission to live here uninsured forever, with multiple dependents, and with social services and every other arm of government turning a blind eye.




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      • Anonymous says:

        The money class love to exploit people so they can line there pockets even more, crummy pay and crappy benefits; but they want the best for themselves. This goes for certain high ranking government positions also. It will be the ruination of this country just as it has done to other civilizations all throughout history. But the chosen class do not care and will continue until they have destroyed everything then just pack up and move on.




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    • Anonymous says:

      That is a really dumb racist remark.
      Poverty is not imported, but created by politicians, churches and business.
      You pay a worker 3 $ and you have created poverty. Where the person comes from is irrelevant.
      Got it ???




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      • Anonymous says:

        Except our laws make it clear that persons from foreign countries that cannot maintain themselves or their families are not allowed to come or stay, and it has nothing to do with race!




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    • Anonymous says:

      I agree! Ugly old Caymanian men stop marrying Honduran hotties! The BJ’s evaporate faster than your dollars.




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  21. Anonymous says:

    politicians running a hospital? oh please……snork…phew…snork phew…😧 lord help us




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    • Anonymous says:

      Check Ezzard’s credentials. On this stuff he is in fact eminently qualified.




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      • The Ghost of Dr. Hortor says:

        He’s a failed pharmacist who has already screwed up the Health Ministry once. Qualified? Not in the real world BoBo.




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        • Anonymous says:

          Dr. Hortor was the right solution, and would have cost a fraction of that which replaced it.




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          • Anonymous says:

            Bullshit 5:38, and by the way the country didn’t want it or Ezzard, they voted him and his entire government out because of his handling of it. Just ask Linford what he felt about losing all that political power because of Ezzard and that damned Hortor hospital.




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        • Anonymous says:

          To The Ghost of Dr. Hortor: Ezzard is not a failed pharmacist . That is an outright lie. Ezzard operated a successful pharmacy ( or two) which he sold when he was chosen as the Exco Member for Health (Now called the Ministry of Health). He sold this to avoid a conflict of interest This is a far cry from being a failed pharmacist, but rather shows a man choosing to do the ethical thing instead of concentrating on personal gain. FYI Mr Miller is a qualified Pharmacist and also holds a degree in Hospital Administration from the University of Minnesota.In order to better understand Ezzard I recommend reading the article linked here;http://www.journal.ky/2012/01/04/a-dinner-conversation-with-ezzard-miller/




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  22. Anonymous says:

    Good idea. Listen now for the onslaught from the private rip off insurance. Companies, who have been raking in the dough for years. Yes, the same ones who were so against Cinico. Thank God the proponents of Cinico did not back down. The plan was that Cinico a.k.a the Cayman Islands National Insurance Company woild be just that. It is about time.




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  23. Anonymous says:

    We need to do away with the strictly for profit insurance companies and move towards a national healthcare system. It’s not going to be easy or perfect but it will definitely be better than what we have today.




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  24. Veritas says:

    The obvious first step which does not seem to be highlighted is to save tens of millions of dolars a year by requiring all public sector employees to pay for their medical care on identical conditions to the private sector, and this includes of course Mr Miller and all his fellow MLA’s. This does not require consultants or committees, it just needs ACTION!.




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    • Anonymous says:

      Hey, I’m ready to renegotiate my Govt. contract any time you are. First lets talk about my pay compared to the private sector. Can you say bonuses? Maybe not in your job, but in my field my colleagues get a bonus equivalent to my monthly check. I stick with Govt. out of love of country, and because the benefits equal out – my health care vs my friend’s bonus. But take away my health care and you will need to step up the pay to remain competitive.




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    • Anonymous says:

      Once again let’s attack the civil service without understanding the issue. Civil Servants don’t get free healthcare. civil service salaries are depressed to provide the difference for health insurance premiums. The government forces civil servants to access health insurance through CINICO only as the official insurer of the civil service, which then forces civil servants to use the HSA as their primary health care provider. Which means that CINICO pays the HSA for that care, so plainly speaking, there are three main points to take note of. First, through this methodology the government is subsidizing the HSA through civil servant premiums. Second, if you expect civil servants to further subsidize these costs by reducing take home salary further to prop up the premiums then you have to give civil servants choice of provider. Surely you can’t expect to deduct even more money from their premiums and then force them to still have no choice in primary care provider?! However, if you were to do this then government would have to further subsidize the HSA so basically it would be giving HSA the same money but from a different pot, which makes no difference for you or me. Thirdly, people keep speaking about this item as if the civil service is the problem. What you dont k ow is that many employers have very generous health plans. What you should be trying to do is improve the coverage provided generally for all people by the insurers instead of trying to reduce the covereage for civil servants to the mediocre levels that many of us in private sector experience.




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      • Veritas says:

        2.00pm Time to drop this fantasy of lower salaries in return for free medical care.There are plenty of fat cats in the Civil Service enjoying salaries well in excess of $100,000 pa, The truth is most of you are paid salaries that reflect your productivity and would not survive in a competitive private sector job.
        Just look at the numbers if you can add up, and you will see that you are bankrupting the country and that before long there will be no money left to pay your inflation proof non contributory final salary pensions.




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      • Anonymous says:

        Yes by all means let’s provide as many thumbs down as possible to this person, who obviously knows what they are talking about, instead of actually paying attention to what is being written. Government forces civil servants to use HSA because if they didn’t then HSA would have to close down and as much as people rag on HSA we are all happy it’s doors are open when it really counts. This issue has been discussed time and time again for years and there is no change, not because of the civil service union, but because once they get into power the politicians see how much it would cost to give civil servants choice and therefore how much they would have to susidize the HSA and they quickly realize that the status quo is cheaper.




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      • Anonymous says:

        Omg, are you kidding me? The civil service coverage is like the old Colin Luke, unsustainable.




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    • In every other developed country in the world, public sector employees pay for their medical care similar to the private sector. Why are the Cayman Islands an exception.




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  25. Anonymous says:

    Sounds like a great plan make the ripoff. Insurance companies stick to property, they screw us there too but at least you won’t be totally screwed.




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  26. Grady Foster says:

    It would be nice if something could be done about the outrageous prices charged for damn near everything in healthcare. Not long ago I was charged $65 for a tube of skin medication which should have cost about $3. The doctor and hospital fees are unreal! If there were fair and honest charges we wouldn’t need fat cat healthcare insurance companies.




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    • Anonymous says:

      Yep, and I had one Doctor write me a prescription for 9 medicines for swimmers ear…a joke…clearly hoping I would buy at their pharmacy. And they always talk sh*t just to rack up the hours so they can charge more…as bad as lawyers, if not worse.




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      • Anonymous says:

        in my experience, they don’t like to talk but rather push you out the door as quickly as possible with a prescription.

        Next!!!




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        • Anonymous says:

          must depend on where you go…not my experience at all…many a time when we could have been done in 10 minutes, they have kep on showing me things on the internet about minor ailments just to rack up an hours bill




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    • Anonymous says:

      Blame the USA patent for that cream. If a ‘Latin America’ version was available in a generic it would be $3.00.




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  27. Anonymous says:

    Why didn’t he took on the ministerial position when the cabinet was about to form. I always maintained that he was ideal person for this ministry instead of putting someone who hasn’t a clue.




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  28. AlanP says:

    It is health crisis, not healthcare.




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  29. Anonymous says:

    Yes it is time for a single health insurance and also dame on the pensions. Just fear that the money people will do there best to derail as they are good under the present systems since they have the money to do anything they want.




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    • Anonymous says:

      OMG are you crazy? These idiots do not know the first thing about health insurance. They are beyond ill equipped, most of them cannot even conjugate a verb. Really? You want to give them a single payor system? God help us.




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      • Anonymous says:

        Help you? You need to help the this country instead of raping it. We need a direct taxation system and get these fat cats to start paying their way; or they can donate to legitimate community projects (not just there special elite clubs). All they want to do is stay in their big cars and gated communities having all the cheap labor doing all their dirty work. But they have the money to buy off the powers that be while the common person suffers under the outdated tax system that is now in place. If they want to leave then hit the airport, the sooner the better!




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        • Anonymous says:

          You don’t get it, do you? It’s the low paid foreign workers who do all the horrible jobs who suffer when they don’t have adequate health insurance because the Law makes it possible to pay zip and provide nothing of any use which is never revised by the law makers so gets worse every year. No one else. The privileged lifestyle in Cayman – way better than the region and probably most of the developed world (yes it really is) is all made possible off the back of low paid long suffering workers from abroad – “helpers”, “carers”, gardeners, labourers etc. Let the scales fall from your eyes and just see how your lifestyle is made possible by the low paid workers. It’s not to do with the relatively small financial sector. That just creates jobs and wealth.




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      • Anonymous says:

        Not crazy but trying to look at what the every day worker here in Cayman experiences. You people of class and money could give a shit because it is all about what you can stick into your pockets.




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  30. Anonymous says:

    Cayman needs a state system similar to the UK’s NHS. If people want faster care, they can pay for it with insurance or on their own, but the basics have to be there.




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    • Anonymous says:

      Difference is, UK’s system is paid for by taxes. Cayman doesn’t have that so where is the money going to come from?




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      • Jotnar says:

        Come on – you know the answer. Its in the article – single payer. Basically everyone pays a fixed fee irrespective of their personal lifestyle or health risk indicators that a private sector insurer would build in. Oh, and of course those that already choose not to pay are probably not going to pay the new fee either.
        Next up – a modest deduction from everyones pay to pay for the costs of bailing out the unemployed. Of course, no reduction in all the other indirect taxes we already pay that contribute to the eye wateringly high cost of living, but you cant seriously expect government to rein back on their other spending to accommodate this, can you.




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