Saga of a medical scheme that went terribly wrong
ANTIGUA and Barbuda, often caricatured by critics of the successive governments of the Bird family as “Birdsland”, is embroiled in an escalating political controversy over a Medical Benefits Scheme (MBS) that went so terribly wrong that its very character has fundamentally changed from its original design when it was created 24 years ago.
The scheme has been plagued by strong and persistent allegations of financial corruption and unauthorised diversion of monies to help fund government expenditures for the health sector, forcing Prime Minister Lester Bird to establish a commission of inquiry chaired by Sir Alister McIntyre, a distinguished Caribbean scholar.
But even before this development in July 2001, two cabinet ministers had fallen political casualties to the scandal, followed by a third while the commission was still labouring to complete its report of findings and recommendations.
The 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, earlier this year, Trade Minister Hilroy Humphreys was dismissed, but for alleged wrong doings when he was the health minister.
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$120 million (EC$2.71 = US$1) being owed to the MBS by the government which apparently used 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 with matching contributions from their employers.
But within its first three years of operation, 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 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 legal actions to be pursued by the director of public prosecutions against those accused of fraud.
The commission concluded also that the MBS had become so abused and corrupted, that urgent consideration should be given to the creation of an entirely new scheme, soley for the benefit 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 for the country’s governor-general, Sir James Carlisle, to 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 raised 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 analysts 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$28 million, not EC$120 million, 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 state without parliamentary approval.
But these measures have not satisfied the main opposition United Progressive Party (UPP) of Baldwin Spencer, who last week led his supporters in demonstrations in St John’s and called for the resignation of Bird, who he holds personally responsible for the scandals associated with the MBS.
Spencer and his UPP are also demanding that Bird arrange for new general elections 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’s Conference.
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 underway to clean up the MBS mess that started in the 1980s.
More than the tough political actions it was forced to take, including ministerial dismissals, the Bird administration also had to find US$3 million (approx EC$8 million) 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.
Right now, whether or not it has to do with internal government/party pressures, or demands coming from the main opposition UPP, Bird has carried out a cabinet reshuffle, naming, for the first time, a deputy prime minister – 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.