Data and decision-making: The peril of proportions

In the early 90s, a Dutch minister of defense who had hardly spent a full day on St. Martin (South) which he was visiting for the first time, stated at a press conference that there were about 10,000 “illegals” on the island. He was of course referring only to the Dutch-controlled half of the island.

Where did he get those numbers from? If he knew the number of undocumented immigrants on the island, it stands to reason that one way or the other they have been counted. If they were counted,  it means they have been identified. And if they could be identified, why were they not put on the next flight out of the island?

I cite this as an example of how officials sometimes use data they cannot back up objectively to create a narrative that serves their own agenda. In the case of the Dutch, such obviously inflated figures was the rationale for the imposition of the Franco-Dutch Treaty, which was aimed at “controlling illegal immigration” through SXM Airport.

Data is the bedrock of good governance, yet in small, complex, and highly mobile societies like St. Maarten, reliable statistics often remain elusive. When crucial national decisions, such as the implementation of a National Health Insurance (NHI) scheme, rely on contested figures, the policy discussion itself becomes fraught with speculation and political posturing rather than grounded fact. The ongoing debate over NHI viability serves as a stark illustration of how demographic uncertainty can paralyze critical reform.

𝐓𝐡𝐞 𝟏𝟓 𝐱 𝟒 𝐂𝐥𝐚𝐢𝐦: 𝐕𝐨𝐨𝐝𝐨𝐨 𝐀𝐫𝐢𝐭𝐡𝐦𝐞𝐭𝐢𝐜?

The most frequently cited barrier to the financial sustainability of a National Health Insurance system is a specific demographic breakdown repeatedly voiced by political leaders, notably our Prime Minister, Dr. Luc Mercelina. Being a surgeon, he knows that life and death hinge on precision. His claim therefore becomes authoritative. In this case, he segments St. Maarten's resident population into four groups, leaving a startlingly small working base:

1. 𝟏𝟓,𝟎𝟎𝟎 residents are under 18 (dependents).

2. 𝟏𝟓,𝟎𝟎𝟎 residents are elderly (retirees/dependents).

3. 𝟏𝟓,𝟎𝟎𝟎 residents are undocumented or illegal immigrants (non-contributors).

4. This calculation leaves only 15,000 legal, working residents to shoulder the entire financial burden of the NHI system.

The core argument stemming from this oversimplified voodoo arithmetic is that the dependency ratio—the proportion of non-wage earners to wage-earners—is simply too high. According to this model, the contributing base of 15,000 cannot generate sufficient premiums to cover the health costs of the other 45,000 inhabitants.

𝐎𝐟𝐟𝐢𝐜𝐢𝐚𝐥 𝐃𝐞𝐦𝐨𝐠𝐫𝐚𝐩𝐡𝐢𝐜 𝐃𝐚𝐭𝐚 𝐯𝐬 𝐏𝐨𝐥𝐢𝐭𝐢𝐜𝐚𝐥 𝐂𝐥𝐚𝐢𝐦𝐬: 𝐓𝐡𝐞 𝐅𝐚𝐜𝐭𝐬

While political rhetoric often favors round, alarming numbers, official statistics from bodies like the Pan American Health Organization (PAHO/WHO) and the St. Maarten Department of Statistics (STAT) paint a far different, though still challenging, picture. Based on recent demographic projections (2024 estimates, using a registered population of approximately 43,350):

𝐓𝐡𝐞 𝐑𝐞𝐚𝐥 𝐃𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐜𝐲 𝐂𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞

The data suggests the registered, working-age population (15-64) is over 30,000—twice the 15,000 contributor base cited in the political argument. This significant discrepancy suggests the NHI discussion is being framed by data that overestimates the fiscal burden while drastically underestimating the potential legal contributor base.

𝐓𝐡𝐞 𝐔𝐧𝐝𝐨𝐜𝐮𝐦𝐞𝐧𝐭𝐞𝐝 𝐕𝐚𝐫𝐢𝐚𝐛𝐥𝐞: 𝐀 𝐒𝐡𝐢𝐟𝐭𝐢𝐧𝐠 𝐄𝐬𝐭𝐢𝐦𝐚𝐭𝐞

The most volatile figure remains the 15,000 illegal immigrants claim.

• Historical Context: Throughout the 1990s and early 2000s, Dutch and local officials frequently used large, high-end estimates (ranging from 10,000 to 40,000 before 2002) to highlight the broken nature of the immigration system.

• Recent Economic Analysis: More recent, detailed studies, such as the Labor Market Analysis, suggest the current number of undocumented persons is less than 10,000, with most of this group actively working. While this is still a massive number for an island the size of St. Maarten, it directly challenges the 15,000 claim and confirms that the undocumented population is a crucial component of the labor force and economy.

𝐓𝐡𝐞 𝐂𝐁𝐂𝐒 𝐏𝐞𝐫𝐬𝐩𝐞𝐜𝐭𝐢𝐯𝐞: 𝐌𝐢𝐠𝐫𝐚𝐭𝐢𝐨𝐧 𝐚𝐬 𝐚 𝐒𝐨𝐥𝐮𝐭𝐢𝐨𝐧

The findings from prestigious financial institutions further complicate the narrative that population density is purely a burden. The Central Bank of Curaçao and St. Maarten (CBCS), which analyzes regional fiscal stability, has released studies on healthcare sustainability in comparable jurisdictions (like Curaçao) facing similar aging populations.

Crucially, the CBCS analysis suggests that one viable policy intervention to sustain a national healthcare system is to reshape population dynamics by attracting working-age migrants to expand the pool of contributors.

This contrasts sharply with the political narrative that focuses on excluding immigrants. For the CBCS, a controlled, working migrant population is not a liability, but a necessary fiscal tool to lower the old-age dependency ratio and boost the premium base.

𝐓𝐡𝐞 𝐃𝐚𝐧𝐠𝐞𝐫𝐬 𝐨𝐟 𝐔𝐧𝐫𝐞𝐥𝐢𝐚𝐛𝐥𝐞 𝐅𝐢𝐠𝐮𝐫𝐞𝐬 𝐢𝐧 𝐏𝐨𝐥𝐢𝐜𝐲

The reliance on disputed or outdated data to address complex social and economic problems poses significant dangers:

1. Misallocation and Policy Paralysis: If the government believes the contributor base is only 15,000 when it is closer to 30,000 (before considering undocumented workers), it will unnecessarily delay or implement an NHI system with punitive contribution rates based on a worst-case scenario. Conversely, underestimating the actual cost burden of an aging population could lead to system collapse. In either event, incorrect data leads to poor resource planning and failed reform.

2. Erosion of Credibility: When policy is driven by political numbers that contradict official Census figures, public trust in both the policy and the administration suffers. This undermines the buy-in necessary for a successful NHI implementation.

3. Scapegoating and Social Division: The persistent use of high, unverified numbers for the "illegal immigrant" category fuels anti-immigrant sentiment and scapegoating. This diverts attention from structural issues (like inefficient tax collection, which the IMF has often highlighted in its reports on Caribbean fiscal management) and prevents the government from exploring pragmatic solutions, such as selective regularization or amnesty programs, which could convert undocumented workers from non-contributors to formal tax and NHI payers.

For St. Maarten to transition from endless debate to effective policy implementation, decision-making must shift from reliance on politically convenient estimates to an investment in robust, continuous, and unified national data systems.

Only with verified figures on the true resident, working, and dependent populations can the financial sustainability of the National Health Insurance—or any other major national project—be assessed honestly.

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