For insurance boss Gerald Simons, the complaint that people have paid out all their lives for medical insurance only to lose it when they most need it makes as much sense as whining that losing lottery tickets were a waste of money.

He said: “The prizes were paid out.”

And so it is with health care - the health insurance was bought and those who needed the care had it.

“There is no money from the past to pay for benefits from the future, unlike a private pension plan where money accumulates. There is nothing carried forward.

“It's like motor insurance. You don't expect anything back.”

But that is not to say he is unsympathetic to those who want a better deal. It just needs time for the players to get around the table. And he has spent a lot of time around the table recently, hammering out a new payment system for doctors.

He said: “I am sure if the health insurance association hadn't been distracted we would have turned our collective minds to the issue and made more specific recommendations to the Government.

“This problem requires a community based approach. If this problem could have been solved quickly it would have been.”

There are ways health care can be expanded he says, by increasing money paid to the mutual reinsurance fund to which every ensured person chips in $16.40 a month via their insurer, said Mr. Simons, who is also CEO of Argus.

This Government-administered fund currently covers expensive long-term stays, dialysis, and kidney transplants.

“If we increased this by $5-10 per month maybe we could use it to provide additional benefits,” said Mr. Simons.

Until actuaries, insurance underwriters and Government sit down and work out figures, it is pointless predicting what this extra cash would get the Island, he said.

He doesn't believe expanding health care will be pain free.

“I would be surprised if the community can afford the same levels of coverage that the more generous companies provide their employees on retirement.”

Some companies let former employees carry on their cover once they have retired.

Mr. Simons says this puts that company at a disadvantage compared with a competitor that doesn't.

And the profile of employees working in such companies also affects the bill.

A company with a revolving door of young expatriate staff, for instance, might spend less on its employees' health and have some left over for retirees. An older workforce will push up the cost of the package, said Mr. Simons.

He said a company of four people would struggle to pay for retirement coverage if two suddenly retired. So simply forcing every employer to keep retirees in their scheme until death would not work said Mr. Simons. “There is no simple quick fix.”

He explained his company Argus used to charge one rate for the whole community, but foreign competitors put a lower rate which was snapped up by companies with younger staff.

This gives the lie to critics in yesterday's paper who said that foreign competition would work in the consumers' favour, said Mr. Simons.

He said: “In the 65-to-100 age group, claims are three to four times that of the average working population.”

Claims from the 45-90 year-old age group are so high that standard is untenable, said Mr. Simons.

“The reason this issue has come to the fore is people are living longer and people are accustomed to a very high level of health insurance coverage.”

Gone are the days when benefit evenings are held to send people overseas for a complicated operation, says Mr. Simons.

Tomorrow: The party line