HEALTH Minister Dr Duane Sands. Photo: Shawn Hanna/Tribune staff
Reader poll
Would you be happy with a 2% salary deduction every month to go towards National Health Insurance?
- Yes
- No
543 total votes.
By KHRISNA RUSSELL
Deputy Chief Reporter
krussell@tribunemedia.net
A CONTRIBUTORY scheme in which the salaries of every employed Bahamian will be subject to a deduction of about two per cent each month was proposed yesterday by the National Health Insurance Authority as a means to pay for universal healthcare coverage for all, including children, elderly, and the unemployed.
While NHIA Chairman Dr Robin Roberts was careful not to classify the proposition as an income tax, the details of how the deductions are to be made mimic that of such a tax.
The proposal is likely to also spark some push back as it mandates that those already subscribing to private insurers will not make any extra contributions but it would mean two per cent of payments to these insurers would go into the universal healthcare pool, Dr Roberts explained.
If a person earns $5,000 each year, a salary deduction of $8 per month will go into the National Health Insurance pool. Those with an income of $10,000 will pay $17 every month and a person that takes home $15,000 every year, their deduction will be $25 per month.
Those legally in the Bahamas earning $20,000 each year are expected to pay $33 each month; $25,000 a year will be $42 per month and those making $30,000 or more will contribute $42.
Officials say this is either 50 percent of the premium’s cost or a maximum of two percent, whichever is lower, of their annual salary. It is therefore proposed that the employer will be responsible for at least 50 percent of the premium or the remainder of the premium cost.
And no one will be excluded or charged more because of pre-existing conditions, Dr Roberts said.
Asked by The Tribune how the deductions were expected to coincide with the state of public healthcare, Dr Roberts said it is the intention of NHIA to minimise the level of “bad” care that patients receive as the scheme essentially makes everyone “private” patients.
He expects it to be at least another year before these deductions begin, if approved by Cabinet.
Timelines
The newly released NHI policy paper outlined several timelines: including April to July 2019 for the launch of the standard health benefit and NHI expanded coverage; July 2019 for a sugary drink tax and national wellness programme; a January 2020 launch of the employer mandate/two per cent deductions for businesses with 100 or more employees; and January 2021 employer mandate expansion for all employers and deadline for all grandfathered private insurance plans.
A 45-day public consultation with stakeholders, beginning yesterday, will also have to be completed at which time it is expected many suggestions will be made as to how NHIA should proceed.
“Everyone will be contributing,” Dr Roberts said yesterday at NHIA’s offices on East Street and Purpose Way. “Some will pay directly. The other half the government will pay so what we are looking at is called an employer manual.
“Everyone who is employed will be expected to have salary deductions.
“First of all, we don’t expect this plan to be implemented until for at least another year. Secondly, we are looking for those employers that have at least 100 employees that we think might have the capacity to carry the load.
“Those that have less, we would expect for them to make a small contribution for each of their employees and for those individuals not employed, then we would expect that when they go to the government healthcare services that they would enrol in the same way they are enrolled now in our primary healthcare services that in order for them to get these benefits senior citizens, retirees, children, unemployed they would be carried by the system as a part of the shared responsibility.
“So, it is in our best interest then to get the economy going quite well such that everyone, as many people as possible are employed but more importantly as you spread the risk across the population that everyone who is working, I would expect that it would drop the premium significantly and so therefore we could have more affordable premiums as there are those who would prefer to have private care and such that again it would take more off the burden of the public.”
To those who say the fees are not affordable, Dr Roberts compared the cost to four Kalik beers.
“One of the major problems in our healthcare system is we lack equity. Those who need care can’t get it and those who need more can’t. We just don’t have the money. One of the things we have is you will find very few places will pay insurance for individuals who make minimum wage, so what we are looking at is even those who make minimum wage will make a contribution but in those instances, we expect the employer to pay a little bit more for them.
“They are paying $10,000 per year. We expect them to pay $17 per month towards their health insurance, that’s the cost of less than four Kaliks depending on where you go to buy it. So instrumentally we have attempted to make this as affordable (as possible) and if you are above $25,000 the maximum you will pay is $42.”
Apart from the salary deductions, the authority is also proposing that funding come from government contributions from the national budget; earmarked allocation of value added tax collected on private health insurance premiums; distributions from the risk equalisation fund; and the sugary drink tax earmarked for an NHI wellness programme.
‘Christian values’
Primary care services also will be expanded in this under this new proposal to now include cancer screenings for the most common cancers in the Bahamas, new diagnostic imaging services – various x-rays and ultrasounds, including prenatal ultrasounds.
Dr Roberts said: “We took the Bahamian approach, never hang your basket higher than you could reach. The question would be what can we afford?
“We proposed to implement an essential package of benefits – a high cost care programme to include comprehensive coverage for select conditions or treatments, all of which have a high prevalence in the Bahamas namely breast cancer and cervical cancer in women, prostate cancer in men, colon cancer and rectal cancer that occurs in both with attention to high prevalence in diseases of the heart and blood vessels. We focus on heart attacks and its related health problems.
“We also included pacemakers for when the heart beats irregularly and death is impending.
“Finally, we included the caring for those with end stage kidney disease not only to better their dialysis care but to include the scope and the hope for a kidney transplant.
“These proposed changes and funding of National Health Insurance are grounded in our Christian values. We are our brother’s keepers. It is what we do for the least among us. It is one of shared responsibility fairness commitment to the community and working forward upward and onward as a people to achieve the triple aim of healthcare to better the patient experience to improve the health of the population and to give us the best value for the money we have,” he told reporters.
Officials say under this new model, NHI will act as a catalyst for change in the way Bahamians experience healthcare by implementing a value based payment system that incentivises providers to improve the quality of care by tying a portion of provider compensation to service quality.
Providers will be incentivised to follow best practises, be proactive and preventative in their approach to care and collaborate with each other for the good of the patient.
Comments
Sickened 6 years ago
I certainly wouldn't mind paying if PMH was a decent hospital. But the way it functions now, and how NASTY it is, I certainly don't think I would be getting value for money.
Pouring money into such a unorganized, pathetically run/monitored health system will only create more problems and graft.
OriginalBey 6 years ago
MinnisCare
ThisIsOurs 6 years ago
About his Oban finders fee
John 6 years ago
So they start off with 2% and increase it every three years? And the minister has admitted that NIB administration has become too expensive. Admistrative and operating costs are gobbling up all NiB funds and if you’re under 40, the NIB scheme will go belly nip (bankrupt) if no serious adjtments are made. Fact is there is too much wastage, fraud, corruption and lack of accountability in government for these systems to work effectively and run efficiently. So government should build in a ceiling cap on how much they can deduct from any employee.
Naughtydread 6 years ago
More taxes that will be poorly managed and wasted as always. Its rather strange that the government keeps on taxing the people but we get nothing in return. When will these idiots get their shit together?
Porcupine 6 years ago
No Naughty, When will WE get our shit together and kick these jackass politicians to the curb?
TalRussell 6 years ago
Finally, there are positive signs we are are marching forward in right direction towards offering Universal BahamaCARE ((UBC) accessible to each and all. Of course the biggest obstacle and loudest cries in opposition anything resembling implementation Universal BahamaCARE (UBC) by 2019 or at anytime will come from comrade business owners who generally have a major influence input into whatever this Imperial red shirts regime ends up doing.... in short will the red red regime heed to calls of business owners in opposition or do what is right for and by the people...... Is it really the People's time to no financial obstacles accessible Universal BahamaCARE (UBC )?
rawbahamian 6 years ago
So with the legally employed persons paying into this scheme, the Haitians will now just start flocking here for free everything at our cost. Oh goody, I can't wait to go broke paying for the drug abusers, drunkards, illegal immigrants, and the baby makers, what a joy this is gonna be !!!
Well_mudda_take_sic 6 years ago
LMAO. Proposed NHI plan for catastrophic and other healthcare is totally ill-conceived with no basis at all in economic reality. This is nothing but yet another tax by another name. And, like our VAT dollars, the vast majority of Bahamians will get very little if anything in return for their NHI tax payments.
It should now be abundantly clear to all honest and hardworking Bahamians that the very dimwitted Minnis and his equally mentally challenged side-kick, Turnquest, only understand governing to mean one thing - tax, tax, tax and spend, spend, spend!
The_Oracle 6 years ago
No problem, add $100,000 to payroll per year, need more? Go ahead take more ya dumb *ss. Healthcare will not improve, as that which appears free will be forever in short supply. Between this and Disney this crew will be history. Why don't you just resign and save us all the additional financial hit? The Conflict of interests aspect is blatant, Here we have a Dr. who will no doubt be over billing the system and riding his guaranteed income into the sunset. Always taking more and cannot even perform the basic services like mail, garbage pickup, water quality and quantity, power, Healthcare, defense of borders and resources, public safety, justice system, and all the above will get worse no matter how much $$ they decide they need from "The People"
242concerned 6 years ago
Here we go. The heart surgeon and the urologist propose to direct tax money to their pockets by covering catastrophic procedures that they and their comrades will carry out. Can't believe the people gonna stand for this when now the NHI is spending most of the money on administration and doctors are tiefing millions from the system per year.
bahamian242 6 years ago
I dont see anything about Taxing KFC or the Chinese take outs that serve a very unhealthy diet to the people! Its just not sugary drinks that are unhealthy, its all that breaded fried chicken with potatoes, and the Rice the Chinese serve as well. Lets call in everyone on this not just the Juice Bowl that Lil General have on sale for $20.00 per Case!
Economist 6 years ago
I agree.
Why are we not taxing them?
BahamaPundit 6 years ago
The 2% will just be placed by Minnis and his robber barons in the consolidated fund and treated like VAT. It will be spent on crony projects and given away like candy by black men in white leotards. Just another theft to add a notch to Minnis' belt. WE DON'T TRUST YOU ANYMORE FNM SO YOUR WORDS ARE POISON TO OUR EARS.
OriginalBey 6 years ago
Hurricane Tax coming soon to an archipelago near you!
BahamaPundit 6 years ago
From 2% it will go to 5% from 5% to 12% from 12% to 20% from 20% to 30%. There you go Income tax!!!!! This is how these slime balls do things. Secretly incrementally boiling the frog. They believe you put a frog in boiling water, it will jump out, but if you gradually raise the temperature, the frog will be cooked.
ohdrap4 6 years ago
it will nt be incme tax, the income tax will be additional
TalRussell 6 years ago
Ma Comrade The-Oracle, best provide doctor for mother's sick child or question - where's PeoplePublic outrage over many $100,000 s have done since 10 May, 2017 been added payrolls to fund dozens large scale delegations dispatched abroad... is it true that as we post to this hereto Tribune blog page - Minnis and KP, has a 20 plus persons Bahamaland delegation for elimination of discrimination against women's - over in Geneva, Switzerland,, also in attendance, be's none other than the always on plane heading somewhere foreign is Imperial red shirts minister Frankie.
{ Can't make this up }.
DDK 6 years ago
Buncha crooks!
OMG 6 years ago
The real problem is in implementation when you consider the number of Hatiens who contribute nothing to the economy but sure make use of the Government clinics. Then what about the workers Bahamian and foreign who do daily work on say construction sites or gardening?
TheMadHatter 6 years ago
"Those legally in the Bahamas earning $20,000 each year are expected to pay..."
Of course, and as usual illegal Haitians get off Scott free.
Can i turn in my passport to the Passport Office and just claim to be an illegal Haitian? The benefits just seem to be never-ending under this administration (and the former one).
Im going to tell my children when they turn 16 - the school leaving age - they should drop out and also claim to be illegal Haitians. Im not even going to apply for Bahamian passports for them. A waste of money.
DDK 6 years ago
LOL Oh Mad One!
yeahyasee 6 years ago
LOL
Chucky 6 years ago
The Oracle is correct in saying that " anything that appears free will be in short supply"
But also, we must note that the amounts suggested are no where near adequette to fund full healthcare. Canada has this system, they claim it costs over 6000 CAD per year (about 4500 usd) per person. Their system long since hijacked by corporate greed and crony capitalism; but none the less it doesn't suffice at those costs. With Canadians waiting 6 months to see a specialist and years to get non life threatening treatments. To their credit, if you ate busted up in an accident you will get immediate top quality initial treatment. Though sadly this won't be followed up with expedient therapy etc.
Health care in the Bahamas will be minimal at these prices and even the minimal care will be rationed.
concernedcitizen 6 years ago
Stop watching Fox news ,Half of my family are Canadian and 86% of Canadians like their healthcare . They have better longevity then the U S ,at lower cost .See how long it takes to see a specialist in The U S .And no Canadians are not flocking across the border to see U S Doctors etc ,its like .05 % of Canadians get treatment in the U S and those are mostly Canadians that get hurt or sick while in the U S . Canada is single payer to cover the cost and the hospitals and Docs are private
Tarzan 6 years ago
Seriously? I guess my experience in the waiting rooms at the Mayo Clinic and at Special Surgery in NYC are highly unusual. All .05% of the miscreant Canadians must utilize those two institutions. Also I have experienced zero difficulty seeing a specialist in the U.S. Stop watching CNN.
TalRussell 6 years ago
Ma Comrade Chucky, regardless whether it be Canada's or any other country's Healthcare, its complexities can be positive and negative. What works well within Canada's healthcare system works pretty damn well - - far exceeding what doesn't. The first 5 years beyond 2019 is be expected as our country's Universal BahamaCARE's (UBC) learning curve sets in. Will you deny cost workers healthcare premiums will cover decreasing range medical needs along with larger worker deductible contributions have and will have skyrocketed by 2019, and every year beyond? When you compare Canada's healthcare to the Americans, it functions pretty damn good at providing superior healing and treatment patient care.... no Canadian is tossed out hospital onto the public sidewalks to suffer or die in pain.
BahamaPundit 6 years ago
A public health service can only work properly in The Bahamas if it is bifurcated. There should be separate health services for legal Bahamians and those that are here illegally (Haitians). A single health service that must constantly deal with illegals popping out babies and the sheer number of illegals will be unable to aptly serve the Bahamians public. The Government must chose who it serves. It can no longer afford to serve two masters: does it serve legal citizens or illegal Haitians? The choice must be made.
TheMadHatter 6 years ago
If the maternity wards and neonatal clinics were constructed separate and apart ftom the main PMH building then at least you might be able to walk in the hallways. Haitians breeding like rabbits and Bahamians breeding like donkey.
TalRussell 6 years ago
So, the intent comrade opponents Universal BahamaCARE is get those with private workplace healthcare plans to hears dog whistle when others don't. Fact is in coming years the private workplace healthcare premiums for ever decreasing range medical coverage - along with high out pocket deductibles - will become extinct over next 5 to 10 years. Why stop providing healthcare Haitian nationals Shouldn't government then also turn away workers who suddenly find themselves no longer having access affordable private workers healthcare?
Chucky 6 years ago
TalRussel. Unfortunately you are sadly mistaken in your praise for the Canadian system. I have fist hand experience as have many family and friends and their system simply does not work for regular healthcare. I.e. weeks to get doctors appointments, years to get to a conclusion/treatment for non life threatening issues. But yes for trauma victims there is imediate care.
What you miss in your analysis is that American care is much better. As an example in Canada if you're waiting forever, as you do, one cannot obtain private care. As it is illegal for money to be an inhibitor to access to care, so therefore even if you have money, one cannot simply pay for a surgery for example , since that would be an inhibitor to care for someone without the money. So Canadians with health issues, and money, go across the line to USA for expedient care.
In USA, if you can pay, all the beat treatments are available. The best in the world.
USA is the better system.
No disputing that everyone does not have unlimited funds , and therefore even in the USA many go without proper healthcare. But that's an issue about funds, not available care.
In fact the key issues is funding, and of course ensuring the funding is spent well, i.e. not sucked up by corporate greed or crony capitalists via scams.
There is no sense in getting excited about a national healthcare system that will not have sufficient funding to function. You simply cannot care for the populous for 500 dollars per capita.
Obviously this is a moral issue that every nation faces, but the results as shown even the most developed nations speak volumes. There is no example of a nation, not even USA, as rich of a nation as it is, that truly wants it's people to have proper healthcare.
The ones with money, yes they want full care, and they will pay for it. But unless you can convince those with money, to cough up enough to care for those who don't. You will never achieve proper health care.
The unspoken intent of any goverent is exemplified in the outcome. That in healthcare is not ANY different than the education. The systems are designed to facilitate only enough education and healthcare to keep you producing. Not a smidgen more will be available to the masses, and the government will take as much from the populous as is possible for providing this.
Our education system sucks, our healthcare too. And this is only because that is the intent. We have had succsessive governments that can come up with some very creative and sophisticated scams, to enrich themselves and their friends, without consequence. If they really wanted a smart and healthy populous, they would have one.
concernedcitizen 6 years ago
Read my previous comment ,,you are not truthful or don,t have the knowledge about Canadian healthcare .There is no large influx of Canadians coming across the border and 86% of Canadians like their healthcare
DDK 6 years ago
Buncha jerks! If these greedy, inefficient idiots had listened to the outcry against VAT in the first place, and to the draconian VAT increase in the second, folks would be much more amenable to a Bahamian citizen health care tax.
TalRussell 6 years ago
Ma Comrade Chunky, your family sources living up Canada must be aware that not a single one of the hundreds in numbers hospitals operating across Canada, are neither government owned nor government operated...... And, yes, yes indeed, there are thousands "private for profit medical clinics" operating across Canada. Trust me, what is good about Canada's healthcare system is far better for patients than the bad.... unlike the Americans healthcare, none it is considered as being equally american healthcare ugly, Not only will no hospital patient live fear being tossed out onto public sidewalk for lack ability pay for medical care.... but your family's Canadian government will pay see to it they return to their place residence - safely.... and, the Queen is also the Queen of Canada.....in fact, your family had swear allegiance Her Majesty to get live up in Canada.
proudloudandfnm 6 years ago
You got PMH out there killing people in that old nasty building, you got disgruntled nurses and doctors pissed off and ready to strike and ya'll want us to pay more? Even though we are where we are now because of government incompetence, waste and theft? More money to lose, waste and tief????
Yinna gots to be out ya damned minds...
Sickened 6 years ago
Addicts, gang bangers, the terminally ill and mothers with more than 3 children should go to the back of the line. We must prioritize services to those who need and DESERVE it most. Certainly some will die, but that is part of life. After all, GOD created us so that one day we too will die.
Clamshell 6 years ago
This is great! Good working people now get the chance to pay for first rate health care for bums, drunks, addicts and all those gang related shooting victims! Hooray!
voiceofthepeople 6 years ago
I thought the F.N.M. said if they got in power it will be no new taxes or tax increases ....a$s#oles never again will I ink my finger blue in this country!
TalRussell 6 years ago
All the comrades ugly disparaging posts to this hereto Tribune blog page - must not be aware past part we own history - when long before today's Haitian nationals ever thought set sail for jobs we colony of islands, we then British subjects by the hundreds - had done set sail to seek paycheques from abundance available higher paying jobs in Haiti, Oh yes, the same Haiti.....How else you thinks the Haitian bloodlines - got serve Imperial red shirts cabinet?
Tarzan 6 years ago
So no where in this article does it state what the total premium is. If someone is salaried at B$150,000 a year does that person's payroll get a 2% deduction or $3,000.? Does his employer have to pay some portion of his payroll as well? What about employers who provide private health insurance to their employees? Do they have to pay payroll tax for this plan as well? Do their employees have to pay, when they are covered by private insurance? Please the facts!
ohdrap4 6 years ago
the thing is capped at 42.00. the guy whomakes 150,000 pays the same as the one who makes 25,0000
any tac in the bahamas is regressive.
Chucky 6 years ago
TalRussel. Once again and as usual you know nothing about what you speak.
Private clinics exist in Canada, not hospital, but under federal law no private medical facility can offer services that are covered under health Canada.
You are a great example of what is wrong with the mindset of our people.
You spew the ignorance that you believe to be true, when it's clearly wrong, false, and you have such a closed mind that you fail to reason honestly. With people like you amongst us there is sadly not much hope for change. If you could only open your eyes to learn about the world we all live in, you might just put that pen of yours to good use.
Sadly, like most , ours is a country fully of people fraught with a willing ignorance guiding their every thought and action.
TheMadHatter 6 years ago
No marches No boycotts Just talk
DDK 6 years ago
Thing is Hatter, time, money and ability are needed to organize such things. I also feel people have become exceedingly disheartened as their protests fall on deaf ears, unless the protesters are affluential. I often ask what We March Bahamas and its leader was actually all about!
TalRussell 6 years ago
Ma Comrade Chunky, before you launch any more attacks - do make sure arm ya self by not drawing Canadian healthcare facts from your chief source idiot manufactured false facts from one Donald J Trump,,,, and your Fox News watchers republican tarnished family up in Canada.
.
birdiestrachan 6 years ago
Doctor Roberts the rich and famous should be ashamed of himself with his comments of beer. does he believe the vast majority of Bahamians are drinking beer..
He is in bed with the other rich over weight doc Minnis, and Sands. their bellies are over and they do not care about poor people. Suddenly there are problems with the dialysis Patients that was not there before
A shameful crew in deed, But it is the peoples time good for all of them.
The_Oracle 6 years ago
Point is the constitution provides for various services, all of which are neglected and falling apart, failed. Every new administration has failed at the core responsibilities. So lets jump on new services and taxes! All of which will fail. A Bifurcated system as stated above is what Cayman has. Citizen or legally here? N.I.B is being paid so therefore Minimal cost. Not here legally? Paid full pop. The way we Mix "Christian Values" and the Government believing they should also be in charge of our health displays our complete and utter Delusion. Get your sorry #&&es back to your core Constitutionally mandated Jobs! Fix all of that and then we can talk about what you would "like to do"
yeahyasee 6 years ago
Couldn't say it any better. Spot on
sheeprunner12 6 years ago
This is nothing to do with Christian values ......... this has to do with 40 years of robbing the NIB cookie jar for Government projects and "investments" .............. and NIB overpaid management bigwigs and stupid payouts.
sheeprunner12 6 years ago
60% of Bahamians do not collect any form of accurate/traceable "monthly" salaries ............ so how is this fair to the other 40% (Govt workers, private sector/corporations etc.)?????
birdiestrachan 6 years ago
Christian values?? it is supersizing how the Devil and his agents know all about Christian values. Do they know that liars and lies are of the devil.??
This FNM crew are the only Christians and you had better agree with them or you are not a Christian. who can believe these masterful liars and deceivers
DEDDIE 6 years ago
Cuba has a pretty good health care system. Pay them the money to takeover ours.
John 6 years ago
Some of the largest retailers in the country have been having financial challenges that escalated since the VAT increases in July. Just look at them struggling to survive. They are putting out Christmas decorations since early October and one has reduced its staff by almost 50 percent. Government in its financial ignorance continues to pile taxes on these businesses not realizing that they are knocking the bottom out of the financial bucket. Yes NHI may be important but can local businesses take on this additional tax burden at this time and survive? Seriously?
TheMadHatter 6 years ago
I propose a 50% payroll tax, to be sent to Haiti to help Haitians. That's what Bahamians really want. Dr. Minnis knows this is the will of the people also or else he wouldn't have started down that road.
The Christian Council who was making all kinda noise last week about aid to Haiti and formed various delegations to go down there (and give away money from the 10% plate) - they would surely support a 50% tax.
Bring it on !!!
Down with Bahamians !!! Up with Haitians !!!! Yaaaaaahhhhh!!!!!!!!
BONEFISH 6 years ago
Will this NHI scheme be properly managed and provided the desired benefits? Or will be like the environmental levy?
ohdrap4 6 years ago
it will be like the environmental levy.
the sugar tax will also be like the environmental levy.
Required 6 years ago
Your author should do some more research before using terms such as "income tax." This plan is nowhere near as progressive as an income tax for the Bahamas would be.
In fact, this tax is, once more, not just regressive, but uber-regressive, thanks to the cap and thanks to the fact that it only applies to wages and salaries but not to the incomes of those who own businesses or other investments.
The_Oracle 6 years ago
"But also, we must note that the amounts suggested are no where near adequate to fund full healthcare. Canada has this system, they claim it costs over 6000 CAD per year (about 4500 usd) per person." If that is correct, (not doubting) that equates to $1.575bn US required for 350K Bahamian pop @$4500/person Cuba has great and cheap healthcare for Foreigners Deddie, It is a foreign currency earner. Me thinks the locals don't access the same depth of care.
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