Bid proposes CINICO as sole national provider

| 10/07/2019 | 82 Comments
Cayman News Service
CINICO office in George Town

(CNS): Government has opened a request for consultants to review its health insurance company, CINICO, and present an outline business case for the future of the public company which could see it become the sole national health insurance provider in a single-pay system. One of several options, including doing nothing, scrapping the company altogether, privatising it in part or whole, or allowing it to become a more commercial enterprise, the sole provider proposal was added by Cabinet after approving a strategic outline case that had not included such a solution.

The Cayman Islands National Insurance Company (CINICO) has been without a director for around nine months after the former CEO, Lonny Tibbetts, was fired for undisclosed reasons last September. Other issues plaguing the beleaguered company range from concerns about fraud perpetrated over home care payments to allegations of internal corruption.

The government-owned company currently provides health cover for around 15,000 civil servants, some SAGC workers, seaman and veterans and their dependents, as well as indigents and those unable to get insurance on the open market because they are too old, sick or have pre-existing conditions.

CINICO is part of Cayman’s wider mandatory health insurance system, where employers must provide health insurance to workers and are required to pay half the premium. But with the private companies accused of seeking profit above genuine provision, the system is failing.

Health insurance companies have been allowed to cherry pick the people they cover and politicians on both sides of the aisle have raised the prospect of a single-payer system in which all 65,000 plus residents in the Cayman Islands — young, old, Caymanian or expatriate — pay their premium into one pot.

Such a move would put an end to the private health insurance providers’ estimated annual profit of some CI$50 million, which means moving to single-payer will face significant backlash.

Nevertheless, the proposal is firmly on the table. With healthcare costs increasing year on year, core government budgeted for this financial year a whopping CI$114.2 million, or 17% of its CI$657.8 million operating budget, on healthcare, including premiums to CINICO for those it covers, HSA medical bills for the uninsured and medical costs to overseas facilities and local providers for the under- or uninsured.

In recent times government has returned to Finance Committee every year for supplementary appropriations to cover medical bills, which seem to always outstrip the budget by many millions of dollars. Given the ongoing challenges and costs, government is now seeking consultants to examine CINICO to see whether it could become a viable entity and consider five possible options for its future.

Under a Strategic Outline Case (SOC), which was was prepared and approved by Cabinet in September 2016, the first option was no change, but that was considered the worst. Another two options seen as more favourable were either partially or wholly privatising CINICO, which would involve farming out large parts of the work it does to the private sector or closing down the whole thing and having private companies compete for the business.

The concept of commercialising CINICO, which would open its services to everyone, allowing it to sell all types of insurance and to do away with government’s premiums discount, was also seen as a potential solution, according to the findings of the SOC.

But the fifth option, which was added after the SOC was completed and not given a rating, would effectively usher in a national single-payer system where everyone is covered regardless and paying into the same pool.

The goal now is to find consultants who can conduct a rationalisation review and detailed analysis to determine which one can achieve the Cayman government’s objectives.

In the bid documents government said it wanted the consultants to conduct “market research” as well as an analysis of all the Cabinet-approved short-listed options against agreed evaluation criteria, “including high-level financial benefits, implementation challenges, organisational readiness, potential market interest, risks and issues, implications, implementation considerations and the time, effort and cost required to fully execute” the change to CINICO.

Health Minister Dwayne Seymour recently stated that he wants all children in Cayman to receive free healthcare and is currently working on a specialist insurance cover option designed just for people over 65.

Both of these proposals have been roundly criticised by the opposition and the wider public. The 65-Plus health plan would obviously be challenging, given that it undermines the principle of pooling insurance cover, where the healthy ensure there is money in the pot for the sick. And providing free cover for all children, even those of the wealthiest in society, would mean that public cash, paid disproportionately by the poorest people under Cayman’s consumer-based tax system, would be used to subsidise the wealthiest families.

But the concept of a single-pay system is growing in popularity, especially if the cover would offer all premium holders the freedom to select their healthcare provider. If everyone was paying into the same pot, Cayman’s younger and transient workforce would help ensure that cash constantly flows into the insurance pool but be less likely to still be here to make demands on it in their old age. And even though government would still be paying premiums for those it covers, CINICO itself would be collecting even more premiums, allowing it to subsidise the costs.

Full details of the bid which closes at the end of August are available on the government’s procurement website here.

It can also be downloaded from the CNS Library

Tags: , , ,

Category: Health, Health Insurance

Comments (82)

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  1. Dr.S.K.mohanty says:

    I applaud the Govt on this initiative.
    A single Insurance provider which runs efficiently would work wonderfully well.
    All the other insurance providers at present are profitable even though they have a fraction of the 65 thousand who would be clients of the new entity.
    Of course the new entity should be able to provide a variety of plans/premiums to suit individuals like basic/premium plans or even better.
    All individuals could then avail of Secondary insurance from other companies if they so deem it to be feasible and necessary.
    I would strongly suggest insurance experienced personnel as senior officers in the New entity and certainly not political appointees !
    Good Luck !

  2. Anonymous says:

    Maybe they should fix the damn dump first before worrying about this crap!

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  3. Anonymous says:

    A well run national health service is a thing of beauty. Unfortunately here, the poorest and least informed, are the ones who don’t want it. Ah well.

    Also, see above, I refer to a well run one, before people start complaining.

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  4. Anonymous says:

    Would not hurt to offer the CEO position to the man that created the CINICO in the first place.
    Mr. Gilbert Mclean should be able to make it work or wrap it up.

    Just a thought.

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  5. Anonymous says:

    @5:02, Great! Go ahead, be brave!

    In a country the size of Cayman, the economic disaster will not take decades as it does it most socialized countries, it will take only a few years. QUALITY Healthcare is a very important issue for many people. Like job-choosing and residence-choosing important in many cases. And if you think this system will not implode in a manner of a few years unless you infuse LOT of and have a majority of expat (labor and corporate) dollars in this government mandated Ponzi Scheme, you are delusional.

    Here is what will *actually* happen.

    * Upper middle income and High earning expats will no longer choose Cayman as a workplace if forced into a shit national healthcare system. (And it will be shit, just much more more expensive shit than IT ALREADY IS)
    * Local expats (especially those with families) will no longer renew their employment here as there will be better options in the States (This is already true with banking, the banks here have stopped growing and are dying. No investment funds open Cayman bank accounts, that market is DEAD and going to get worse with the public ownership registrars. Thank you CIG.)
    * Many young upper middle income Caymanians that can afford/are able to leave Cayman will leave for better opportunity and healthcare
    * Health insurance companies will stop offering coverage
    * Health service providers will no longer find Cayman attractive to invest and operate here
    * Health service providers will start leaving as this economic abortion fully flourishes
    * The quality of all healthcare will start to resemble the quality of CINICO recipients which SUCKS and the best days! Except it will get worse because as those imbeciles start to realize the money they thought they would have dwindle away fast.
    * As things get worse, politics will set in further, and the political climate will become an US against them in terms of getting proper healthcare
    * Class warfare policies will be proposed to tax expats/rich/upper middle class to help “the poor people”

    * Corruption will set in

    * Cayman will begin to look like Nassau. How do you think Nassau became the shit hole it is today? Dumb ass self-serving politicians looking out for “the poor people”, that’s how!

    So yes, go ahead, let these CINICO clowns take over MORE the economy, they certainly have a stellar track record!!

    More government is always the answer right? Let’s not look at the failed socialized single payer systems throughout the world, government has got YOUR interest at heart!

    In EVERY SINGLE Canadian election, Healthcare is always a central issue because it’s always getting worse, quality wise and politics wise.

    Obamacare was a complete economic disaster! Caused historic level record unemployment. Millions lost the healthcare they were told they would be able to keep. Educate yourself! Do you think Cayman has the capital to sustain that sort of employment disaster and recover like the US did??

    Morons!

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    • Anonymous says:

      No one is saying you could not continue to get premium cover on a private basis.

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    • Anonymous says:

      BoBo or Teedee.
      If you in Cayman for the health insurance benefits, then you in the wrong country.

      Half the expats that I know never seem to ever had insurance or anything as such until they start to work in Cayman.
      So it might sound harsh, but take your kids and pack your bags to wherever you can get a better health insurance if that’s what you here for. no hard feelings.

      Do not forget to support our National Airline when you booking your flight out.

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    • Anonymous says:

      Have you considered switching to decaf?

    • Anonymous says:

      I am in the upper middle class and an expat and still have chosen to use CINICO for my insurance provider (via marriage) when private options are available to me. I have had excellent care generally and this is inclusive of multiple surgical operations. Fear mongering about the healthcare system is a load of crap. Go crawl back under your bridge.

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    • Anonymous says:

      So many lies in one comment I cant even bother calling them all out
      Run on back to fox news
      CNS I know you guys are pretty casual with what you let people post

      But at some point you have to step in to stop people from spreading actual fake news and lies

      Propagandists and the brainwashed need help, not a larger platform to spread their lunacy

      CNS: This is something that I do actually grapple with, and I agree that the comment is in the Alex Jones category of bizarre and uninformed opinion. However, if such views are expressed on CNS they can be countered with fact – which I try to do when I have time. If people with such views are only allowed to comment in a social media bubble, that’s where they will fester. Most conspiracy theorists believe what they say.

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    • Anonymous says:

      In 2018 60% of all personal bankruptcies in America were directly related to the inability to pay for health care costs. In Canada, 0% of personal bankruptcies in 2018 were related to the inability to pay for health care costs.

      Huge health insurance costs in America are basically one big tax. The difference is that rather than paying the tax to the state one pays to private health insurance companies.

      Year after year in America health insurance companies provide their investors one of the best returns for their investors. Wonderful if you own shares in health insurance companies.

      One final point, you are incorrect. In the last federal election in Canada health care was not a central issue. However, in some provinces, not all, it has been an issue, mainly in Ontario.

  6. Anonymous says:

    I’d like to know why Lonny Tibbetts was fired, please.

    There must be transparency first and foremost in everything that is done by CINICO.

    There was a major situation in October 2018 and we heard not a peep. Was money stolen? We all need to know.

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    • Anonymous says:

      While we wait for that, can we also please know what (if anything) Linda Evans, Waide DaCosta, and Kim Davies are supposed to have done to warrant their treatment?

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  7. Say it like it is says:

    Only in this country can the CEO of a major government related organization be fired without the public being told why. Yet again we suffer from this absolutely unacceptable practice of secrecy which only encourages this type of behavior. This man by his actions has given up all rights to privacy and the public should be given full details of his transgressions.

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    • Anonymous says:

      7:46pm

      Foolishness, happens all over the world, all of the time, and will continue well beyond your life span.

      The man lost his job, had no charges brought against him, and has offered no public comment.

      You just too freakin’ fast!

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      • Say it like it is says:

        7.46pm It does occur all over the world, but protecting the transgressor with secrecy certainly does NOT.

    • Anon2 says:

      Well it starts questions like with who runs the damn place which is the board. Get rid of the current chairman and board and start over, there is already a level of secrecy mongering and alleged corruption in the place as already have witnessed by local media open foi, like Trump man say, drain the swamp!!

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  8. Anonymous says:

    If it was a single payer system, would civil servants finally pay in also or are the rest of us supposed to cover them? PS, even Canada us moving towards private health cover because they cant balance their books.

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    • Anonymous says:

      Having recently had dealings with my parents with breast cancer with mother and hip replacement with my father must say that the Canadian Health care system in British Columbia is magnificent. Certainly a model for the Cayman Islands.

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      • Anonymous says:

        Agreed, but as someone that grew up in Canada, nothing is free, try 50% tax rates. I would rather keep my money and pay for private insurance, at least then I can decide where my money goes, not some government bureaucrat.

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        • Anonymous says:

          The only people in Canada that pay 50% tax rates are people making over $400,000 a year. Only a tiny portion of Canadians make that much money. So I have no doubt that you could afford private insurance.

          I assume that as a Canadian, you probably went to public schools and universities. You received an education at a fraction of the cost of most top American universities because your education was subsidized by the Canadian taxpayers. Did you define your professors as government bureaucrats?

          My family experience is that the Canadian health care system is excellent value for money, especially compared to the American and Cayman health insurance costs. Furthermore, God help you if you have a pre existing condition with the American and Caymanian health insurance systems.

      • Anonymous says:

        Try going to a hospital for a broken arm. you will wait 12+hours to be seen in a major city. When you can go to the emergency for a headache or “not feeling well” the wait times get very, very long….

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  9. BeaumontZodecloun says:

    I have been pushing for this for years — to nationalise CINICO; broader base of participating groups, more savings for the individual, and apart from the preexisting “scheme”, could provide actual benefit for the customer, instead of paying for something that only provides catastrophic care.

    That said, I wonder if we are a mature enough country to be able to suss this all out. Will those in power skew it in a way that a few make beaucoup bucks, and screw the rest of us? Or will people in power actually step up and do a good thing for the whole of the people here — Caymanians and expats alike — and create a health provider that actually functions?

    History would suggest the former, however I’m hopeful. Properly administrated and funded, it could save us all a LOT of money and provide much better care. The government mandated health care, and many of us end up paying for all of our actual service.

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    • Anonymous says:

      The only rate of success socialized single payer system have throughout the world, is by their rate of failure.

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      • BeaumontZodecloun says:

        Remove the political rhetoric and think about all of us — the people — and our needs. That’s all I ask.

      • Anonymous says:

        Please site your source other than from a private health insurance company that the socialized single payer system is a failure throughout the world?

        Suspect you have a large number of shares in a private health insurance company and the last thing you want to see is your big profits wiped out.

      • Anonymous says:

        NHS worked excellent for me and my family when I lived in London 10 years ago. Not sure I agree with your statement NHS fails to work every day. Bet you have shares in a health insurance company reaping in the big bucks every year. Health insurance companies certainly provide big returns for their shareholders.

  10. Anonymous says:

    First pensions now this what next?

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    • Anonymous says:

      Exactly. They sure didn’t learn that lesson!

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    • Anonymous says:

      Yeah my employer still hasn’t paid me my pensions he’s owed me for years. I’ve complained to the pension board and nothing’s come of it. Now they want to nationalize health insurance. Well I bet when I get to the hospital that hasn’t been paid up either!

  11. Anonymous says:

    So they can corrupt that like they did with CINICO? No thanks!!!

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  12. Anonymous says:

    Whoever is proposing this, are very dangerous blistering imbeciles.

    This will result in an exodus of talent off of this island, and the economy will follow. And the end result will be, SHIT HEALTHCARE FOR EVERYONE!

    What is WRONG with you MORONS!!?? Are you really THAT stupid??

    If you think capable and competent people will be FORCED into using your overpriced pathetic menu of unadulterated incompetence, you have a very rude surprise waiting for you!

    Can someone with a brain please tackle these foaming at the mouth economic arsonists!

    These people should be NOWHERE NEAR POWER! They are economic cretins wooed by the repeat-failed-socialist systems who could not recognize failure if it slapped them in the face with a shovel! Why do you think CINICO is a continual disaster?? Well here is a clue…, it’s NOT because you don’t have enough people in it to propagate your sheer incompetence further!!! It’s because you’re imbeciles, and now you want to smear your shit on everyone else! No thank you!

    If you think for ONE second I will let this buffoons dictate to me and my family’s health coverage, you can keep and simmer in your own f*ing sewage!

    And unfortunately if this is EVER put into law, this will become an economic abortion that can’t ever be undone. Once the exodus happens, it won’t ever reverse.

    Imagine trying to solicit talent for your organization! Yes come to the Cayman Islands, but you will be forced to use our overpriced incompetent government single payer system, OR double pay for your own insurance in your own country and fly there if you are every seriously ill. Yeah great pitch! you know who you will appeal to?? Economic LEECHES!!

    You FOOLS!

    What a JOKE! Freaking clowns!

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    • Anonymous says:

      Uhhh private health insurance will not be affected and still be available alongside whatever cinco’s alternative will be…. you also realize that private health insurance is nothing but for profit right ?

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      • Anonymous says:

        ? The last option that was added is a single payer system. A large portion of the article is about setting up CINICO as the ONLY provider for health insurance in Cayman. Are you sure you read the whole text? You realize that a single payer system means private health insurance options will not exist anymore.

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        • Anonymous says:

          No, they could exist in addition to the public sector system. Same as the UK and Canada – everyone pays into the state system but you have the option for taking out private cover if you want better coverage, faster access to healthcare, less exceptions etc. You end up with a two tier system where the rich get far better care, but we are frankly there already.

          If they wanted to be revolutionary could open the private system to international competition. Now that would make the BritCays if the island squeal and drive down costs.

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    • M.D. says:

      This contribution to the thread exemplifies the need for censorship. I have never read such unadulterated ill-expressed rubbish in my long life.

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    • Anonymous says:

      Dude, sell your shares in the health insurance company. Apple has better long term prospects, and sells products we can all use.

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    • Anonymous says:

      You have a lot of anger, and I would guess you channel it into whatever strikes you at the moment. Passionate discourse is always welcome. These are important issues that need to be discussed, and wrangled, and kneejerk rage doesn’t help anyone, ever. Be part of the process, instead of a fuming person standing outside of the circle and ranting.

      Peace

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      • Anonymous says:

        That’s comes from being though numerous single payer systems, watching family members literally die waiting in line for proper specialists. You’re a clueless moron.

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        • Anonymous says:

          Nice talk. You don’t have an single clue of what I’ve seen, done or had to go through for health care.

          That isn’t the point. My point was that few heard much of what you had to say due to your acerbic, accusing, insulting attitude. Remove the exclamation marks, superfluous capitalisation and calm down a bit, and *wonder of wonders!* you actually start to make sense.

          You’re welcome.

    • Anonymous says:

      Yes they are morons. One can look at the mess they did to traffic from the East. Big pretty, expensive nice roads and you can get nowhere on time in the mornings or evenings. Big cost overruns at the new airport and passengers still can’t fit at peak times.

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    • Anonymous says:

      @3:01 – Angry much? You should probably get that temper looked at, preferably with the doctor of your choice.

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  13. Anonymous says:

    The stupid part of health insurance is that when you need it most in your old age you are not covered. Insurance companies collect from you all your life and even if you made zero claims once you reach a certain age they don’t want to know you. Yes we are small enough territory to have our own NHS that could actually work and run these rip off insurance companies out!

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    • Anonymous says:

      They don’t cut you off, thats not allowed. But they can increase your premiums at such a rate that you have no option other reduce the coverage.

      Sign me:

      A former holder of premium health insurance.

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    • Anonymous says:

      You’re clueless and obvious have never traveled nor receive healthcare from socialist country in your life. There is a reason they fail, everywhere in the world.

      Also: The fact that Cayman has limited population to contribute in a single payer system is a _detriment_ not a benefit (This ought to be obvious). And once put into effect, you will not lose 1 or 2 expats that refuse to be forced into using this rubbish national system, you will have _thousands_ coming out of it. Once this happens, Health care professionals will also leave…

      Then you will be left with a national system with no one paying in, and no one servicing it.

      Enjoy your old age!

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      • Anonymous says:

        If it is ‘obvious’ why are you wrong? I have travelled extensively in my 65 years on this earth. When i needed medical attention, most of the time my US based insurance company (a major one) was not accepted. Probably because they do the same foolishness there in setting their own rates of payment as they do here. In the meantime I am out of pocket.

        Am I to presume you are some sort of economics wizard to dismiss a single pay scheme. Strangely enough you offered no evidence except comparison. While I have my own doubts about an NHS, I do believe competition to the insurance companies cartel could only result in better premiums for all.

        Finally have you ever given thought that starting a counter argument with insults does not reflect well on intelligence?

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        • Anonymous says:

          No one is proposing NO government healthcare. It’s opposition to forced government healthcare ONLY.

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        • Anonymous says:

          How are you not smart enough to get coverage when you are traveling extensively overseas? The standard ones do not cover treatment overseas, as most people know., which is probably why your insurance was not accepted. That’s the main reason people buy travel insurance.

      • Anonymous says:

        You misunderstand. The story is not talking about socialising medicine. It is talking about nationalising CINICO such that those that are forced into paying for health care actually get a benefit.

        Agree with you that socialism doesn’t work for the people anywhere.

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      • Anonymous says:

        I’ve travelled extensively. The very best medical care I’ve received has also been the cheapest and most easily obtained, and has been in countries with national health services.
        Your logic is simply flawed, and your bias is clear.

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      • Anonymous says:

        just keep watch fox news to get all your “information”

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      • Anonymous says:

        Not sure you understand socialism. I have received excellent health care in both Canada and Australia and both those countries are certainly not socialist countries though both are single payer systems.

  14. Anonymous says:

    Did anyone in our government ever consider asking the UK for advice on setting it up, considering that they operate the largest single-pay healthcare system in the world?

    Private insurance can co-exist, offering service beyond what the single-pay system does, or offering to do things faster for those willing to pay extra.

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  15. Anonymous says:

    Communism is cool.

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  16. Anonymous says:

    Just look for the masons. Summa wun gunna maka da munny.

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  17. Anonymous says:

    Seriously, they can’t pick-up the garbage, so let them control the future health of all of Cayman’s resident’s.

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  18. Anonymous says:

    Do it!

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    • Anonymous says:

      Did you actually read it? Do which one of the many options? Pray enlighten us with your blind wisdom.

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      • Anonymous says:

        Do single payer and enforce it on anyone who has means (and the employers of all work permit holders). The present system in unaffordable and unsustainable. Brave and determined action is needed. The private companies have pushed it too far and cannot be trusted to provide a solution that actually works for society.

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        • Anonymous says:

          so you mean only charge expats

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        • Anonymous says:

          In the rest of developed world all / all people who work, contribute to their health insurance programs including civil servants. The system in the Cayman Islands will never be sustainable until CIG employees contribute their fair share like everyone else who works.

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