Former PM Ralph Gonsalves on Monday expressed deep skepticism and strong opposition regarding the current administration’s proposal for National Health Insurance (NHI). He argues that the plan is financially unsound for a small economy and views it as a mechanism to shift government costs directly onto workers.
Gonsalves said that the math behind a domestic NHI scheme does not add up given the country’s economic scale. He notes that the current contribution income for the National Insurance Services (NIS) is approximately $90 million annually, whereas the country’s recurrent health expenditure exceeds $100 million.
He calculates that a 1% deduction from salaries yields only about $900,000. Consequently, to raise a meaningful amount—such as $10 million to cover a fraction of health costs—the government would need to impose heavy levies, potentially as high as 5% from employers and 5% from employees. He further characterizes the NHI proposal as a strategy by a “right-wing party” to “unload” health expenses, which are currently paid for by general taxation, onto workers through direct salary deductions.
Gonsalves contends that St. Vincent and the Grenadines lacks the necessary population size to support such an insurance scheme independently and explicitled states, “The base of workers we have is just too small to sustain a standalone national health insurance fund”.
The Opposition leader stated that for health insurance to be viable, it must be done regionally to spread the risk, rather than relying solely on the domestic workforce and mentioned that NIS officials and studies have advised that if such a scheme were introduced, it must be strictly segregated from the NIS pension funds to protect them.
Instead of a tax-heavy NHI, Gonsalves advocates for alternative methods to finance and provide high-quality healthcare and suggested working in conjunction with private sector insurance entities to manage risk and costs.
He highlighted the success of utilizing medical missions to provide expensive care at no cost to citizens and cited the World Pediatric Project (WPP) as a prime example, noting that under his administration, the WPP conducted over 110,000 consultations and 10,000 surgeries for free.
To illustrate the value of this approach over insurance, Gonsalves mentioned that his own granddaughter received surgery in St. Vincent through the WPP for free, a procedure that would have cost $50,000 USD in the United States.