Patients 1st is a weekly column where the Bermuda Medical Doctors Association answers your questions about the proposed Bermuda Health Plan 2020 and how it may impact you and your family This week we had an overwhelming number of questions about the proposed Bermuda Health Plan 2020. As medical professionals, we consider it a sign that the community cares about its health and changes that might impact it.In this article we wanted to focus on our seniors, who have raised some excellent questions since the public consultation period began. The most popular question we received was also on the government website; the answer posted also comes directly from that site, unedited.Q: I am a senior who cannot afford even HIP/Futurecare at present. When the Government says that the new scheme will be compulsory does that mean literally for everyone. And if it does, then I want to know how I can finance it. It’s unlikely that Financial Assistance would fund everyone who presently can’t afford medical insurance as if it did, then there wouldn’t be so many of us who don’t have insurance as no one chooses to be without medical insurance if they can finance it either with their private funds or through Financial Assistance.A: Thank you for your feedback. We are very sorry to hear of your circumstances and, indeed, regretful that you are not alone in this situation.The aim of the reforms is to slowly, over time, extend coverage to everyone. Insurance subsidies will replace existing subsidies to ensure the funds available go to those whose financial means require it. This is why we have to reform the health system. To target the funds better so they reach persons like yourself.Patients 1st commentary: The question does not appear to be answered by Government. This is one of our concerns and prompted Patients 1st to check the Auditor-General’s comments from 2018 regarding FutureCare. We reference the Auditor- General’s comments from page 55 of the public document here: “The financial statements received a disclaimer of opinion due to serious deficiencies in the accounting records of the fund and in its system of internal controls. The disclaimer of opinion stated: I was unable to obtain sufficient appropriate audit evidence with respect to premiums receivable totalling $280,719. As a result, I was unable to determine whether adjustments to revenues, expenses, annual operating surplus and net financial assets might be necessary. “In addition, with respect to the year ended March 31, 2014, I did not express an opinion on the financial statements due to serious deficiencies in the accounting records. Since opening balances enter into the determination of the results of operations, I was unable to satisfy myself over the accuracy of the opening net assets as at April 1, 2014.” September 13, 2017So why should this concern us? If the current FutureCare plan showed “serious deficiencies in the accounting records and its system of internal controls” how can we have confidence that the proposed Bermuda Health Plan 2020 scheme — that would not just impact our seniors but everyone in Bermuda — would be a well-regulated option for all of us?In addition, on page 12 of the 2012 Report on Health Financing Structure Options for Bermuda, a 103-page document commissioned by the National Health Council that the health minister Kim Wilson referenced in support of the Government’s choice of a unified system, we discovered this commentary by the author: “There is also the countervailing possibility that in a unified system too much political and economic power could be concentrated in the public insurer. As a result there is the risk that it could abuse its authority in a variety of ways — an outcome that needs to be guarded against ...”A similar view was recently shared by Bermuda First, the consulting group appointed by David Burt, the Premier, himself. So how can we protect our seniors? We need to ensure that we take the time and not rush health reform. The deadline for public consultation is Saturday — less than a week.At the time of writing, well over 5,000 people (greater than 10 per cent of our workforce) have signed a petition against a unified scheme and have voiced their opinion that Government is rushing this through. We are left questioning why. I guess the next question we need to ask is, how many people will it take for our government to listen? To sign the petition, visit change.org and search for “Bermuda Health Plan”. Age Concern Bermuda is hosting a public town hall meeting on the proposed Bermuda Health Plan 2020 at 5.30pm on Wednesday at the Salvation Army’s North Street Citadel.• The Bermuda Medical Doctors Association is a local body of physicians that represent the concerns of community physicians working directly for the welfare of the doctor/patient relationship. Over the past five years the BMDA has grown to more than 75 physicians, which represents the majority of community doctors on the island