STATEMENT
BY
THE CABINET OF ANTIGUA AND BARBUDA
On
MONDAY 19th AUGUST 2002

The Cabinet of Antigua and Barbuda has considered the original Report of the Commission of Inquiry into the Medical Benefits Scheme that was submitted to the Government in accordance with the law on 31st July 2002.

The Cabinet received a revised version of the Report last Wednesday (August 14th), two weeks after the original version was submitted.

The Cabinet is dismayed that the Commission has not identified the revisions made to the Report. Consequently, we are not able, at this time, to comment on these revisions.

The two documents are being studied, on a line-by-line basis, to try to identify the changes. If we find that the changes are material in any way, we will comment on them in due course.

Since the first Report was received, the Prime Minister with the full support of Cabinet, has taken steps to implement fully all but two of the recommendations of the Commission as they apply to the Government.

But, even these two recommendations have received such serious attention as the Government can give them at this time, given constraints of funding and the law.

In two broadcasts and several press releases between the 7th and 13th August, the Prime Minister has provided details of the implementation measures to the Nation.

We have noted that the Director of Public Prosecutions has moved swiftly to implement the recommendations as they relate to his office in terms of investigating individuals named by the Commission to establish whether or not they should be charged with fraud or other infringements of criminal law.

We are shocked that the Leader of the Opposition in several public statements has pronounced all the named individuals as guilty without investigation or trial, even though the Commission of Inquiry has itself pointed out that it is not a court of law and that it is up to the DPP to decide, after investigation, who should be charged.

Mr Spencer’s irresponsible statements have the effect of being prejudicial to the work of the DPP and any subsequent trial that may result from it.

On other matters, it is worth recalling the two recommendations identified by the Prime Minister that presented difficulties to the Government.

The first was that the Government should pay in cash 50% of the sum owed to the Medical Benefits Scheme by the Government.

The second was the conversion of the Medical Benefits Scheme into a National Health Insurance Service.

With regard to the first recommendation, the Prime Minister has requested that a reconciliation be done of the sums owed to the Government by the Medical Benefits Scheme and vice versa up to 30th June 2002. A decision has been made that while the Government cannot pay in cash 50% of what is owed after the reconciliation is complete, it will enter an arrangement with the Scheme to repay the full sum that is owed through securities redeemable over a reasonable period. In the meantime, the Financial Secretary and Accountant-General are devising a plan by which Government can pay future monthly contributions on a current basis.

With regard to the second recommendation that the Medical Benefits Scheme should be converted into a National Health Insurance Service and should not fund the health requirements of the nation, there has been no inconsistency in what the Prime Minister has said on this subject.

On Wednesday 7th August he said, “Agreement with this recommendation, even if it were desirable, would place an enormous burden on any Government. No government could afford it without either increasing taxation significantly to pay for health services or dismissing thousands of public servants”. He also made it clear that “neither the United States nor Canada, our two largest developed neighbouring countries, have such a system in which Government pays for the health costs of the nation. Neither for that matters does it exist in any of our sister-states in CARICOM”. He concluded by saying. “A departure from the Medical Benefits Scheme system requires a national debate with a full understanding of all the implications including the fact that any government that changes the system will also have to increase taxes to pay the for the costs”.

When he returned to the subject on 13th August, the Prime Minister recalled his statement six days earlier in which he said that a departure from the MBS system would require a full understanding of the costs involved, and he said that “Government is prepared to carefully investigate a National Health Insurance Service that meets the nation’s medical needs particularly the funding of the hospital”. In this regard, he said that the government “will now actively solicit proposals for such a service and we will place the best of them before Parliament for debate and endorsement”.

We note with astonishment that the Leader of the Opposition said in his published statement on 14th August that “the UPP knows that the current MBS revenue stream of 7% of the national wage bill is more than adequate to cover a National Health Insurance System”. How Mr Spencer could make such a statement without a feasibility study of a National Health Insurance Service including its size, delivery mechanisms and costs, is truly amazing. We would despair of Antigua and Barbuda’s economic prospects, if a government headed by Mr Spencer made decisions without proper studies and analysis.

In any event, Cabinet will shortly put arrangements in place to solicit feasibility studies to convert the Medical Benefits Scheme into a National Health Insurance Service which exclusively funds health services including the hospital.

We draw the public’s attention to the fact that certain of the recommendations made by the Commission were not directed at the Government. Some were addressed to the Director of Public Prosecutions, one to the private sector and one to the Governor-General.

The DPP is already taking action on the recommendations made to him, and the Government has acted to give his office such support as he deems necessary to carry out his duties.

In relation to the private sector, the Report said at page 103: “We recommend also that arrears in private sector contributions (to the Medical Benefits Scheme) should be settled immediately. Failure of firms to do so should result in court action against them”.

The Report also proposed that “a Governor-General’s Conference be called with representatives of the Government, the Opposition and non-governmental organisations to discuss the organizational changes proposed with the aim of reaching understandings on these matters”.

We are aware that this proposal, as well as a suggestion that the Governor-General be asked to appoint the Board of the proposed National Health Insurance Service, has been the cause of some agitation by the Leader of the Opposition and some members of the so-called NGO’s – the majority of whom are also executive members of the UPP. For instance, at the press conference of the NGO’s last week were Dr Edward Mansoor, Executive Member of the UPP and President of the Medical Association; Baldwin Spencer, Leader of the UPP; Bruce Goodwin, UPP member of the Electoral Commission and President of the Small Business Association; and Valerie Harris-Coleman-Pole, Executive Member of the UPP.

This calls into serious question the credibility of the NGO’s of which Mr Bruce Goodwin claims to be President. The Antigua Labour Party faced a general election at which the electorate decided that it should be the Government. However, it is not known when last the NGO’s had a meeting at which they elected their executive. It is also not known what rules and regulations govern their organisation, nor is it known if these rules are being applied. In other words, apart from the very strong political affiliation to the UPP of the spokespersons for the so-called NGO’s, it is not known whom they represent.

Be that as it may, they have focussed on these two proposals of the Commission concerning the Governor-General’s Conference and the appointment of the Board of the National Health Insurance Service, and they claim that the Government has not addressed them. These allegations are nonsensical.

With regard to the proposal for a Governor-General’s Conference, the government has no power to instruct the Governor-General to convene such a Conference. The powers of the Executive and the powers of the Head of State are quite separate and are defined by the Constitution. It is therefore quite wrong for the Leader of the Opposition and his supporters to allege that the Government has wilfully ignored this proposal.

In any event, it is equally doubtful whether the Governor-General could convene such a conference. It should be recalled that the Governor-General is the representative of Her Majesty The Queen as Head of State. Should he seek to convene such a Conference, he would be exercising more power than Her Majesty The Queen has in the United Kingdom and, indeed, under the Constitution of Antigua and Barbuda. We have no doubt that the Governor-General would want to seek the advice of the legal officials at Buckingham Palace before proceeding to act, in any way, on this proposal.

Both the Leader of the Opposition and the UPP spokespersons for the so-called NGO’s claim that the Commission recommended that the Governor-General should appoint a new Board to the Medical Benefits Scheme.

The Commission did no such thing.

What they actually said was that the autonomy of the National Health Insurance Service that they proposed “should be underlined by provisions for the Chairman and members of the Board to be appointed by the Governor-General after consultation with the Prime Minister, the Leader of the Opposition and Non Governmental organisations having competence and interest in health services”.

This means that the proposal that the Governor-General should appoint the Board, after consultation, applies to the proposed National Health Insurance Service and not to the present Medical Benefits Board. Therefore, to say that the Government has not acted on this proposal is simply wrong. We cannot act on what does not exist.

And, as we have said earlier, the Government will now solicit studies to determine the feasibility of converting the MBS into a National Health Insurance Service that pays for health services including the hospital.

Once these studies are received, they will be taken to Parliament for debate and a full ventilation of the costs involved. If Parliament endorses the conversion, including the costs and remedial measures that will have to be taken, Government would be happy to implement it with the understanding that the Nation as a whole understands fully all the implications.

At that point, Cabinet would also ask that each member of parliament - government and opposition - be allowed to vote according to his own conscience and with the guidance of the constituency he represents for the constitutional amendment that would be required to give effect to this recommendation.

Finally, we draw attention to the fact that the Board of the MBS has been asked to develop a schedule by which it will accomplish the recommendations for the restructuring and reorganisation of the Scheme. This schedule has to be submitted to the Cabinet Secretary, the Speaker of the House and the Leader of the Opposition as Chairman of the Public Accounts Committee so that implementation can be closely monitored.

In this way, all the representatives of the people on both sides of the political divide will be in a position to ensure effective implementation of the Commission’s Report as it directly affects the Scheme.

The Prime Minister stated on 13th August that Cabinet will no longer be involved in any way with applications for medical benefits. We propose to enshrine this in legislation.

Cabinet will no longer seek advances from the Medical Benefits Scheme without the approval of Parliament. This has already been implemented administratively and will also be legislated.

We, the members of Cabinet, consider that all of the recommendations within our competence have been addressed fully and effectively. We are determined that public should have full confidence in the Medical Benefits Scheme, and we are now consulting widely to identify persons representing the private sector and other sectors of society who we could add to the Board to give it broader representation.

When these consultations are completed within the next few days, we will duly advise the Minister to widen the representation of the Board.

Cabinet Secretariat
St John’s

19th August 2002