Lawrence Gonzi was flanking Health Minister Louis Deguara and former finance minister John Dalli back in 2003, when government was discussing healthcare financing proposals distinguishing “between those who can and those who cannot pay”.
At the time, Gonzi was minister for social policy and he was flanked by the other two ministers in Eddie Fenech Adami’s Cabinet months ahead of the decision to raise VAT by 3% to finance public healthcare.
Deguara had repeatedly stated in public he was working with his two government colleagues on proposals that were to be presented to Cabinet given that the health system was “unsustainable” and the situation was “alarming”.
In August 2003, Deguara wrote on The Times about the unsustainability of the public health system.
In an interview the following week given to The Malta Independent on Sunday, Deguara had also hinted that health services would be means-tested so that there would be some kind of payment by those who afforded it.
“When I wrote my article I said that any measure we take will aim at guaranteeing a viable system for all those who can’t afford to pay for health services,” Deguara had said.
“They’re only proposals, I still need the Cabinet’s approval,” Deguara had said.
At the time, Deguara had insisted he was not the only minister behind the proposals being pushed for Cabinet’s approval; but he was flanked by Dalli and Gonzi.
In the same interview, Deguara had also hinted, as the Health Financing Reform report revealed by Sant suggests, that abuses could be tackled through some kind of payment for services.
“Isn’t it high time we do something about it?” Deguara said about abuses in the healthcare system.
“I’m not saying people will have to pay for health services because there are many measures we can take… These are only proposals. Once they are accepted we start discussing them with the people concerned. … Mind you there is an ad hoc committee made of representatives from the Finance Social Policy and Health Ministries behind these proposals; it’s not just a Health Ministry thing. I didn’t just wake up and write an article. One has to look at it from different angles.
“What is sure in these reforms is that we will definitely help all those who are unable to pay for health services, they will keep getting health services for free, that’s for sure. When we opposed Labour’s introduction of a 50c charge on drugs, we weren’t really opposing the charge but the fact that it was imposed across the board when not all the citizens should be paying it; single parents, pensioners etc. You have to make a distinction if you really believe in the value of solidarity, between those who can and those who cannot pay. We won’t propose measures encouraging everyone to take private insurance because it doesn’t make sense, or if we do then the government will pay for those who cannot afford it.
“One has to understand it is not a question of deterioration, it is a question of not coping financially with the expansion of health services. Everyone wants a health centre in his locality without knowing what it entails. Does anybody know that to train a nurse in the BSc course costs us Lm10,000? We’re after quality rather than quantity, but is anyone aware of the costs? Does it not make sense to take precautions today to be able to cope? That is what we’ve been doing.”
In another interview to The Times on 27 November 2003, Deguara had said: “You can do what other countries are doing and create a health fund and offer services only for the value collected. If the government collects Lm60 million from the health fund the same value has to be provided in services. It does not make sense and we cannot afford to keep introducing new services without considering costs. For example, at the moment we offer hip replacements at Lm500 per prosthesis. Now there are ceramic hip replacements which cost twice as much. Does that mean we should go for it straightaway without considering the increased budgetary repercussions?”
Asked if the health sector would ever be sustainable, Deguara was not as categorical as Gonzi is being now about free health: “It depends how realistic our demands and expectations are. One gets what one pays for. On the positive side, we have to remember that once the hospital is completed the deficit will go down by Lm50 million a year. But we never will be sustainable if we retain the existing systems.”

Dalli: What was unaffordable then is affordable now
Asked what he had in mind back in 2003 when he was in charge of finance, John Dalli said yesterday night that government was looking at “different scenarios and options”.
“I won’t tell you what I had in mind,” Dalli said. “But we were discussing mostly Mater Dei and I was looking at ways of allocating specific taxes against a specific financial system of control. The circumstances today are totally different from five years ago. What we could not afford then we can afford now.”
Dalli’s last point is highly debatable as Deguara himself complained back in 2003 that healthcare costs were increasing alarmingly every year given the new services available, the state of the art technology involved and the rising costs of medicine.
Yet according to Dalli, even government revenue has gone up, so what was no longer affordable then is affordable now.
A spokesman for Deguara acknowledged the fact that the health minister was talking about the sustainability of the public health service.
“It’s clear this was on the government’s agenda, as it was all over the world, but it doesn’t necessarily mean that health services had to be paid for,” he said. “And payment was never discussed in Cabinet.”

Crying wolf over healthcare
Just as it is not the first time government has discussed healthcare financing, nor is it the first time that the Opposition is crying wolf about government introducing fees for healthcare.
In January 2001, Labour’s health shadow minister Michael Farrugia claimed a new tax on certain health services was about to be introduced that would have made them even more expensive than private services.
Farrugia had come out claiming government was about to introduce a Lm5 tariff for basic clinical tests, a Lm10 fee for ECGs, Lm2 for functional lung tests, Lm5 for stool culture, Lm5 fee for Hepatitis B tests, Lm10 for Hepatitis A tests, Lm10 for complete blood counts and between lm2 and Lm4 for blood tests, among others.
Farrugia had said this was going to be “the first in a series of new taxes” that were about to be introduced over and above the budget measures.
The health minister however quickly trashed the Opposition’s allegations by specifying the payments were not introduced in the normal health service but for commercial companies requiring their recruits to undergo health tests through the Department of Occupational Health.