THE SPOKE IN THE WHEEL

Apr 13, 2014 Features / Columnists, Peeping Tom

Why should the proposed issuance of health cards by the government of Trinidad and Tobago for its nationals and the suggestion that perhaps visitors should take out health insurance be such a big problem for Guyana and the rest of Caricom?
The reason it seems is that if it becomes a requirement that foreigners should have health insurance before going to Trinidad and Tobago, this requirement will constrain free trade throughout the region. And if the proposed health card is issued for nationals in Trinidad and Tobago, it is being presumed that this can be used to deny Caricom nationals emergency health care in the twin-island Republic. This, it is further presumed, will have serious implications for the Caribbean Single Market and the Economy (CSME) and regional integration.
But are these presumptions valid?
This column examines the alarm bells that have been sounded following the death of a Guyanese man in Trinidad for what his family says was the refusal of medical officials to treat him because he was a foreigner.
That version is being denied by the government of Trinidad and Tobago. Its take is that the man left following a financial guarantee form which was given to his family to sign.
This column argues that the proposed issuance of a health card and even the suggestion, if true, about health insurance for non-nationals, does not at all change anything in relation to the CSME, nor does it place any constraint on freedom of movement within CARICOM.
Let us not delude ourselves about why progress has been stalled in relation to the CSME.
What is keeping back the CSME is not the absence of political will or the sharing of economic benefits. What is holding back the CSME is the very issue that was thrown into the limelight this past week by the death of the Guyanese in Trinidad; it is the charge that will accrue to their treasury and particularly their social services, as a consequence of increased liberalization through the CSME process. This is the spoke in the wheel.
Trinidadians will turn against their government if every Tom, Dick and Harry from outside the twin-island Republic is allowed to freely utilize their social services, services that are paid for by the people of that country.
Leaders have to factor in this consideration when they make decisions, and this is no doubt the reason why there is talk about a health card being introduced so that only nationals of Trinidad and Tobago can access free public health care.
Instead of Guyana complaining about the possible effects of these internal measures on regional integration, we should be thinking about introducing our own health card. Right now, a great many persons from Suriname seek treatment in public health hospitals in Berbice.
Instead of stamping out this freeness, we feel proudly, naïvely so, to say that we do not turn away any person from any foreign countries from accessing free health care. We should grant access, but not free access.
Right now, non-nationals are benefiting from public health care in Guyana. There are even persons from as far as America who come here to make use of Guyana’s free public health services. Even though these persons have health insurance, they are still required to pay a portion of the prohibitive health costs that are charged by American hospitals.
As such, many of them fly here to have medical care. Many also come here to have their dental work done both at public and private health care providers. We must never assume that we can sustain free public health care to non-nationals. We cannot.
Guyana should therefore join Trinidad and Tobago in moving towards a system of health cards for nationals. With this card, persons should be entitled to free public health care. All non-nationals should be required to pay, but they should not be denied treatment.
Trinidad and Tobago is not saying that it will deny anyone from outside of that country treatment. Indeed, there is no prohibition on persons receiving emergency health care. But if that country desires to move to a system of health cards to ensure that only its nationals can access free health care, this is not a right that should be denied the government of that country. For unless it does this, it will find, like Guyana will eventually find, that persons will come from all over to get in on the freeness.
The issuance of a health card is not a measure that in any way conflicts with any of Trinidad and Tobago’s obligations under the CSME. Neither does encouraging non-nationals to secure health insurance in any way conflict with the free movement of persons. In fact, all Member countries of Caricom can refuse entry of non-nationals from the Region if they can establish that entry of a non-national will place a charge on public funds.
Guyana, therefore, should not be sounding any alarm bells over what it perceives as the intention of the Trinidad and Tobago government to move towards a national health card and to encourage health insurance for non-nationals visiting or living in that country. Guyana should do the same.