Miller: Profit must go from health insurance

| 15/07/2019 | 50 Comments
Cayman News Service

(CNS): North Side MLA Ezzard Miller, who has been calling for a single-payer system to address the increasingly problematic provision of health insurance in the Cayman Islands, believes that the profit motive must be removed from the insurance side. Last month government opened a tender process to find consultants to examine the publicly-owned health insurance company, CINICO, including the possibility of making it the single provider of insurance.

Miller said he supports that option and is concerned that the tender process that government is embarking on will be extremely complex and costly because it is asking the consultants to analyse five possible and very different scenarios, instead of narrowing down the options to meet government policy.

“I have a number of concerns about this process, not least how vast the request for proposals is and the amount of work that will be required to analyse all five possible options,” he said.

Miller warned that this will cost millions of dollars to produce when several options should not even be considered, such as the whole or partial privatisation of the government company, since that would obviously lead to abuse.

He pointed out that the original strategic outline business case already found that several of the options would not meet the government’s stated goals.

“Cabinet really needs to make a policy decision about what it prefers,” Miller stated, urging government not to get bogged down with fears about the future liability, as that does not have a direct impact on the costs of annual provision.

He said it is the “immoral acts” of private sector insurance companies, which are making a profit while Caymanians cannot afford insurance, that does have a direct impact on the costs. He said that because “government has failed to legislate to prevent the runaway profits of the insurance sector, we must now take the profit motive away completely”.

Miller warned that successive administrations have been manipulated by the health insurance companies but it is time now to accept that healthcare is a right.

The one-time health minister told CNS that he supports the concept of CINICO becoming the national insurer while allowing everyone to have a choice about where they seek medical attention. If they choose a more costly provider, then they can supplement that with additional health insurance or with their own money.

Miller made it clear that he does not support a single healthcare provider, only a single health insurance provider.

He said Cayman is ideally suited for a single pay system, given the significant young and transient workforce that can pay in to support the sick and the elderly without burdening the system themselves.

He said it was absurd that government is not only paying premiums for those who cannot afford to buy insurance on the private market but allowing the insurance companies to cherry pick and reject those with pre-existing conditions, paving the way for the sector to make annual profits in excess of $50 million, which is essentially being subsidised by the public purse.

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Category: Health, Health Insurance

Comments (50)

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  1. Victor Look Loy says:

    Preventative health care is underfunded in favor of Hi Tech expensive curative procedures. Medications are way too expensive..most of the profits are made by Hospitals.Since Doctors are not able to bill any large amount as is clear if one reads the heath insurance
    Plans. Only the hospitals make money.

  2. Anonymous says:

    Thank you Mr Ezzard Miller. Cayman has needed this for a long time. It’s time to nationalise health insurance.

    • I Holler says:

      A surreal wild statement from the Sherif of North Side. Are we leaning towards Communism sir. While it is agreed that health insurance costs indeed high, there is a basic reason for that and that is politicians. Politicians never understood the industry when the first laws were enacted, there is no politician who has been involved in this psrticular segment of the business, and it appears that no one up to now has had the wherewithal to seek help from independent experts.

      So holler Hillary and blah blah on no profits is just a parrot sound bite with no real effect, just bleating to be noticed on this subject. By the way want he involved in the crafting of the health insurance law back when, I’m not totally certain but seem to recall some rumblings from him during that period, perhaps CNS knows maybe you weren’t around them days.

      • Anonymous says:

        What ignorance I Holler. Communism? Give me a friggin break. Canada and Australia have single payer systems and they are not communist.

  3. Anonymous says:

    Private sector profits are most likely cheaper than CIG management inefficiencies. CIG doesn’t run anything as efficiently as the private sector. At least there is competition in the private sector insurance biz.

    • Anonymous says:

      You clearly have no idea how private insurrance companies operate.
      I know because i worked there.
      Everything is about deny deny deny.
      When a claim can not be denied it is about stalling stalling stalling.
      You are misinformed…..

      • Anonymous says:

        I don’t disagree. Insurance companies make a living off not paying claims. What makes you think a CIG run agency will operate any differently? The first thing they will do is hire an insurance industry “consultant” to set it all up. If they do pay without question, we will all be paying the shortfall price in the way of premiums plus CIG taxation to subsidise the “Authority” in charge. There is no free lunch.

  4. Anonymous says:

    No business should be profitable, Ezzard for Emperor!

  5. Bertie : B says:

    All insurance companies are scams , if one uses health insurance the price goes up , they get it back , same with car insurance , Anyone remember how much hurricane insurance used to be ? by the way this does is not just in Cayman , its anywhere the sheep are forced to buy insurance ! Full frigging stop .

  6. Jotnar says:

    Cheese Face at 7:15 – that’s funny, but real comedy gold is when

    a) you pass a law requiring everyone to have insurance, but allow the private sector the capacity to pick and choose who they will insure (and certainly no one over 65 despite however many years they have been paying premiums),

    b) say ONLY Cayman based firms can provide the insurance freeing them from any pricing competition from overseas insurers allowing the pricing to drive higher risk case to CINICO or be uninsured

    c) give CINICO a blank cheque to pay for the high risk cases, the uninsured, the indigent, the discretionary medical treatment

    and then be surprised when it all blows up in your face and the tax payer bill becomes massive whilst the Cayman insurance oligarchy are making eye watering profits..

    • Anonymous says:

      Come on, Jotnar, the dude implied teachers devise a plan to come here to get pregnant after they realise they have to get some sort of costly surgery. Meaning ONLY women are marrying for convince and even more specific, women teachers. Or maybe they were implying only women sit down and google “how to get free knee surgery”…. It was pretty funny.

      Yours was just sad funny.

  7. Anonymous says:

    Here’s a thought. Free healthcare for Caymanians paid for by the government, no insurance involved. Expat healthcare paid for by their employers by however they want, insurance or whatever. Everyone else must have proof of insurance to get a visa.

    • Anonymous says:

      So just like it is now then. HSA can’t refuse care, no need to pay a cent.

    • Anonymous says:

      Define “Free”……

      Free as in any doctors and nurses that provides services to Caymanians will work for Free?

      Free as in any facility that provides services to Caymanians will offer the space rent-Free?

      Free as in any facility that provides services to Caymanians CUC will provide the electricity for Free?

      Free as in any facility that provides services to Caymanians Water Authority will provide the water for Free?

      Free as in any facility that provides services to Caymanians materials and supplies will provided from vendors for Free?

      Free as in any pharmacies that provides medecines to Caymanians CUC will provide all medecines for Free?

      Free as in any hospital that provides organs transplants to Caymanians organ providers will provide those for Free?

      OR “FREE” as in: Caymanians don’t have to pay for anything this because you want to force SOMEONE ____ELSE____ to pay for all that?

      Is that what you mean by “Free”?

    • Anonymous says:

      Of course. Why have any integrity when you can be a freeloader?

  8. Anonymous says:

    Listen to last Friday’s Talk Today Show. The truth will be forthcoming from CIMA at the end of this month.

    • Anonymous says:

      I doubt it…Last time the MLA grilled CIMA it became blatantly obvious that the MLA’s did not have a clue how insurance worked and therefore will be unlikely to be able to solve it.

  9. Anonymous says:

    Many companies have contributed towards the success of the Cayman Islands. That being said, corporate greed has become a cancer that, if left unchecked, will eventually destroy the Cayman Islands.

    Many lives have already been sacrificed because of the lobbying work done by and for our local health insurance companies. They have fought for a system that puts profits over the lives of the people that are in need. It is time for our political representatives to step forward and make the bold decisions that are needed to ensure that we are a caring and compassionate society that recognizes access to essential healthcare as a right instead of a privilege.

    • Anonymous says:

      so cap the profit. Basically make a law that says no more than 5% or something reasonable. Because no business runs for free.

      • Anonymous says:

        Too simplistic-it will end up with even more inflated charges for everything just so the 5% is more in actual hard cash terms. You need a permanent and qualified board that checks prices charged for everything from beds through to medicines to carer charges…Real answer is an NHS type system with the ability to go private if you so wish.

      • Anonymous says:

        We should want our public agencies to keep transparent accounts, while retaining such capacity to reward star employees so that the work culture supports excellence. CIG should be run the same way, with carrots and sticks, and employees that want to exceed baseline performance criteria. You don’t get that by giving away their bonus money.

  10. Anonymous says:

    I agree with Ezzard on this issue. If you look at this logically and compassionately you would agree that people that are in need of potentially life saving care should not be denied that care because of money. Additional, there is no way that the government should be effectively subsidizing the private sector companies that provide health insurance.

  11. Anonymous says:

    Fix the damn dump Ezzard!

  12. Anonymous says:

    Sort of agree with Ezzard but there is no reason not to outsource the ADMINISTRATION of a single payer scheme to the private sector. Having the government administrate it would be as much of a sh*tshow as everything else they attempt to administer.

    They should select at least three companies to license to administer the programme and let everyone choose their administrator.

    Otherwise, if you had a single privatised administrator you can’t change them and they become just as crap, bloated and corrupt as a government dept would. If you have several smaller ones you can more easily change them.

    The other advantage of this is that the government would never be in the position of turning someone’s claim down and being subject to political pressure to approve it. You don’t want a government department approving health insurance claims. It needs to be independent and subject to audit.

    Otherwise, bring it on. Young healthy people will complain about subsidising older sicker people but that’s how insurance works. I’m tired of being told by our insurance company that premiums are going up because they lost money on us as a company. They don’t put premiums down for the companies they win on. This amounts to a “heads we win, tails you lose” business model.

  13. Ezzard short term memory says:

    So after briefly reading the comments and seeing that your readers agree with Ezzard, who should we blame for the high cost of insurance
    I stand to be corrected but I recall when Ezzard was health minister in the early 90’s (the dates that is, not the info) , Ezzard was the health minister and is the one that put the health insurance law into effect, I Fact at the time certain health insurance companies gave advice and Ezzard insisted that our current laws are it and that was final, in fact a couple of members on the committee at the time walked out in complete disagreement stating that in the future health insurance cost would not be affordable to Caymanians and companies on island, we’ll guess what he is now trying to rescind what he put into place all those years ago.
    To those of you that say he is a specialist in insurance he has only been a minion in all the companies he has worked in.
    Ezzard is a joke when it comes to health coverage on the island ..

    • Anonymous says:

      You obviously just live to hate.No one is saying he’s a specialist from what I’ve read only sounds like the most sensible person in the room to me.Yes we do remember well when he was the Health Minister and you must agree we have not had one any where near his quality since.Hater.

    • Anonymous says:

      You should be thanking Ezzard for the fact that you even have health insurance in the first place.
      By your own admission, Ezzard was the only politician back then who saw the need and did something about it.

      Ezzard also appears to have much more of a grasp of Health Insurance that you have and in this case, I wholeheartedly endorse what the article says he is trying to accomplish.

      Perhaps you are one of the big wigs in the insurance industry that is profiting handsomely from the way insurance is presently structured.
      At any rate it would be great if you could put forward some type of alternative to his proposal instead of just criticizing the man while glossing over the idea.

      Thank you Ezzard for at lest having the balls to bring the idea forward. It is long overdue.

  14. Anonymous says:

    Agree with Mr. Ezzard, and have for a long time. Single provider may stumble in other places, but we are sized just right for it. The insurance companies have been having a very profitable time yanking us all around on a government-mandated health insurance scheme.

    It’s time to nationalise it and reduce the costs for all of us. Many elderly and others pay $300 per month for CINICO insurance that covers $400 of doctor visits per year, low-level catastrophic care and not much else. Imagine year after year paying $3600 per year so you can get a couple doctor visits per year. Insanity. We can and must do better.

  15. Anonymous says:

    Health insurance companies make a profit of 50 million each year.
    Your premium can therefore drop with 200 to 400$ per month.
    Interested ?
    If the top incomes pay a health tax, the poorest in the country would have free care.

    • Anonymous says:

      Health insurance companies have consistently made great returns every year for their shareholders. This is the basis of the overall problem of high health insurance costs in the Cayman Islands, but also in America.

  16. Anonymous says:

    It is a fact, the health insurance system is sick.

    For the first time it is hoped the health insurance review will be a truly open and transparent process.

    A few suggestions towards ensuring transparency:

    1. ALL MLAs commit to published on a website and make available at all libraries for free access by anyone, including but not limited to, ALL conversations / communications between themselves, individuals, groups, organizations and / or companies.

    2. Publish ALL submissions received by any government, including those directly to Cabinet.

    3. Publish ALL Cabinet papers / Minutes on the subject, regardless of source.

    4. Publish all internal Government records on the subject.

    5 Publish ALL CINICO Board Minutes, including all records of matters received by Board members.

    6. Open CINICO Board Meetings to the public.

    The above suggestions will begin to give public confidence in the process.

  17. Anonymous says:

    I wonder how those other three young fellas up in North Side deh feel when they listen and read what Ezzard Miller says?Big shoes to fill if you plan to take his seat in the next election.Hate him if you must but he knows his stuff.

  18. Anonymous says:

    It’s a nonsense that every resident in Cayman MUST by law have a policy from one of the ‘approved local providers’ such as the SHIC minimum policy, including that from CINICO. It covers almost nothing, leaves residents with massive medical bills to pay from their own pockets, or facing the option of not having the needed treatments.
    Much cheaper and better insurance policies are available from foreign insurers that cover us here in Cayman, and yet even with an exceptional policy we’re forced to buy the SHIC in addition, which is both useless and hopelessly overpriced.
    This is already a forced tax on all residents, so isn’t it about time the health system was funded by government, and all working residents and employers paid a percentage of their salaries to cover those costs for everyone – children and elderly and disabled etc.
    I know that’s not going to be a popular option, but how else can the elderly afford skyrocketing premiums for a policy that leaves them hopelessly still underinsured?

  19. Rick says:

    At first blush I was skeptical of Mr. Miller’s concerns. I do not like single payer systems as a rule. However, a single health care insurance provider as opposed to a single health care provider is the difference which gets my support. I agree with Mr. Miller.

  20. Anonymous says:

    Ezzard knows! He’s a qualified health-care professional, a wise politician and he has Cayman people at heart! Hope the Government “experts” will listen to him!!

  21. M.D. says:

    A lot of whart Ezzard comes out with is rubbish, but in this instance he is absolutely correct!

    • Anonymous says:

      This is nothing new. When Cinico was set up it was envisaged that it would become what the acronym emplies. Cayman Islands National Insurance Company. I don’t understand why it took so long, Ezzard is just repeating the obvious. The credit goes to Gilbert McLean, who was the Health Minister back then.

      • Anonymous says:

        Anon 5:53. This is your revisionist history of the Cayman Islands. Ezzard was the Minister of Health before Gilbert McLean and is who put the health insurance law into effect.
        Mr. McLean is the person who set up CINICO during his time as Health Minister, when the law was later brought into effect.

  22. Anonymous says:

    All well and good Ezzard, but if healthcare is a right, can we please do a better job of ensuring we do not spend our children’s future providing for the healthcare of impecunious thousands of persons from outside the Islands. There is an economic, as well as a public health reason, that immigration are supposed to vet the health and health insurance of people coming to live here.

    • Anonymous says:

      Agree big time on this one. I have seen so many teachers come here over the years who get pregnant immediately, send kids to expensive rehab, get operations for previous conditions…the list goes on and on.

      • Anonymous says:

        Everyone knows its the Caymanians that do this. One of the many reasons Caymanians don’t hire Caymanians. The list goes on and on.

      • Cheese Face says:

        Comedy gold! Impregnated as soon as they step of the plane.

        • Anonymous says:

          Wouldn’t have happened if only they put in jetways!

          • Anonymous says:

            The jetways are not a part of Caymanian culture. Tourists need to get the full Caymanian experience which includes getting wet.

            We will never get jetways here. Sad but true.

        • Anonymous says:

          Despite all their pre-existing conditions and addicted kids. Those teachers man – wild bunch.

        • Anonymous says:

          Seriously! I wish to have a beer with that weirdo just to laugh at all the delusional thoughts in his mind.

  23. Anonymous says:

    produce when several options should not even be considered, such as the whole or partial privatisation of the government company, since that would obviously lead to abuse……

    Ahhh, because Cinico is ertainly NOT subject to abuse as a government programme now is it?
    In fact the MO is just about every government ran program IS about abuse…

    So let’s FORCE everyone into this shitshow why don’t we?

    You clowns!!

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