Saga of a medical scheme that went terribly wrong Analysis by Rickey Singh
Guyana Chronicle
September 13, 2002

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IN ANTIGUA and Barbuda, often caricatured by critics of the successive governments of the Bird family as "Birdsland", there is an escalating political controversy over a Medical Benefits Scheme (MBS) that went terribly wrong.

So wrong that its very character had fundamentally changed from its original design when it was created some 24 years ago, followed by strong and persistent allegations of financial corruption and unauthorised diversion of monies from the scheme to help fund government expenditures for the health sector.

Amid a crescendo of allegations from political opponents and sustained criticisms from sources like the militant "Outlet" newspaper of the journalist and politician Tim Hector, Prime Minister Lester Bird established a "Royal Commission of Inquiry into the Medical Benefits Scheme of Antigua and Barbuda".

Even before this development in July 2001, however, with the distinguished Caribbean man, Sir Alister McIntyre, as Chairman of the Commission, two cabinet ministers had fallen political casualties, followed by a third while the Commission was still labouring to complete its report of findings and recommendations.

First ministerial casualty was Attorney General Errol Cort, followed by then Health Minister Bernard Percival -- both of whom were dismissed amid their protestations of innocence. Then came earlier this year the dismissal of Trade Minister Hilroy Humphreys, but for wrongdoings as a former Health Minister, and roughly dismissed by the Commission.

By the time the McIntyre Commission had submitted its findings and recommendations in July this year, it became evident that Prime Minister Bird had to take the bull by the horns and move with haste.

In fact, to the surprise of even some of his staunch critics, Bird has moved with such haste, that he may have ignored, deliberately or otherwise, that the Commission's report ought to have first been tabled as a public document in Parliament. Given the 12-5 parliamentary majority his Antigua Labour Party enjoys, he can win any vote in the House.

Claims have been made in the Commission's voluminous report of some EC$120M (EC$2.71=US$1) being owed to the MBS by the government for using monies from the scheme over the years to help fund the country's health services.

This was contrary to the original intention, as outlined in a 1978 Act under which the MBS was created with supporting 1980 regulations for it to be a contributory health insurance, with specified beneficiaries. Workers were required to contribute two-and-a-half per cent of their wages and their employers match their contributions.

But within its first three years of operation in 1978, that followed, significantly the abolition of personal income tax by the then government of the late Vere Cornwall Bird, patriarch of the twin-island state, the MBS was contributing as "donations" some seven per cent of its total expenditure to the Ministry of Health.

These "donations" (sic) had grown to almost 50 per cent of the scheme's total expenditure to help cover the operating costs of the Health Ministry, compared to 33 per cent in payments for medical benefits.

The government's response, not entirely without merit, was that it had to provide funds for the inauguration of the scheme and that, ultimately, it was the population at large that benefitted from the monies allocated from the MBS for the health sector.

That contention, like the official argument that diversion of monies or '"donations" from the MBS by the government for the Ministry of Health should not be confused with the corrupt practices that had bedfellows ranging from cabinet ministers to government officials, staffers and suppliers to the MBS, may have escaped those more focused on the web of deceit and misuse of the scheme that finally led to the establishment of the McIntyre-led Commission.

One former Health Minister was honest enough to admit to the Commission that the MBS may very well have been created primarily, if not solely, to supplement the financing of projects in the health sector.

Now, with the work of the Commission over, it has come forward with wide-ranging recommendations, including suggested legal actions to be pursued by the Director of Public Prosecutions against those accused of fraud.

Moreover, that the MBS has become so abused and corrupted, that urgent consideration should be given to the creation of an entirely new scheme, solely for the benefits of its contributors and their dependents, managed independent of any executive control by a cabinet minister, and with annual audited reports submitted to the parliament and, by extension for relevant action by the Public Accounts Committee.

This is one of two recommendations that Prime Minister Bird has already explained would require more careful consideration, including feasibility studies and changes in laws to determine how best to respond to a replacement of the MBS, a suggestion with which he empathises.

If there is surprise in the Commission's call for a new National Health Insurance Service to replace the MBS -- knowing that this cannot happen in the near future -- then greater is the surprise of another recommendation with which the government would have difficulty in implementing.

It is the recommendation that the country's Governor General, Sir James Carlisle, should convene a special conference of representatives of the government and opposition as well as non-government organisations, to discuss the organisational changes to the MBS discussed in the Commission's report.

But such an initiative by Sir Carlisle would clearly involve him, as the Queen's representative in Antigua and Barbuda, in direct political activity, and he is already reported to have signalled his disinterest following indications from legal opinion that he would have no constitutional authority to do so.

Outside of those two sensitive recommendations, Prime Minister Bird has moved swiftly to implement the recommendations of the Commission, including replacing the Board of the MBS with one broadly-based and embracing nominated representatives from the private sector, doctors and nurses associations, trade unions, media workers and other special interest groups.

It has received, since the submission of the Commission's report, information from a team of forensic experts from India, that the actual debt now owing to the MBS by the government is EC$28M, not EC$120M, based on analyses of contributions made to the health services and the government's repayments and expenditures.

The government has also created an administrative structure, pending new legislation, to prevent any further borrowing from the MBS by the government without parliamentary approval.

For the main opposition United Progressive Party (UPP) of Balwdin Spencer, this is, however, simply not enough. So last week, he led his supporters into demonstrations in St. John's, and called for the resignation of Prime Minister Bird, who he holds personally responsible for the scandals associated with the MBS.

But not even Bird's resignation would be enough. Spencer and his UPP are demanding that Bird not only step aside as Prime Minister, his government must arrange for new general election as soon as possible.

A new election is not constitutionally required before March 2004 and in this respect, the UPP's call seems as unrealistic as the Commission's proposal for a Governor General Conference to address suggested organisational changes proposed for the MBS pending new legislation.

What is evident, even at this stage of limited implementation of recommendations resulting from some of the more damaging findings that may yet lead to police arrests and court trials, is that a definite process is under way to clean up the mess of the MBS that had started in the 1980s.

More than the tough political actions he was forced to take, including ministerial dismissals, Prime Minister Bird's government also had to find US$3M, or some EC$8M, for the year's work by the McIntyre Commission that had five sessions of public hearings, received testimonies from 69 witnesses and conducted 50 interviews. What a saga for the MBS from 1978 t0 2002!

Right now, whether or not it has to do with internal government/party pressures, or demands coming from the main opposition UPP, Prime Minister Bird has carried out a cabinet reshuffle, naming, for the first time, a deputy Prime Minister -- a portfolio given to senior cabinet colleague Robin Yearwood.

With the reshuffle has also come another blast at "some outrageous acts of the past", in a clear reference to the operations of the MBS, and a pledge to ensure "greater accountability and transparency" in government.