Two recent reports from the Bermuda Health Council highlighted what you probably knew already – that the cost of health care is high, and growing faster than pretty much anything else.

The reports also show that the area that is growing especially fast is overseas health care, where the cost grew by 40 percent last year. Clearly, that rate cannot be sustained.

The reports also show that FutureCare, Government's attempt to get to grips with the problem of health care for seniors, is also unsustainable as it is currently constituted.

However, the demand for health care, especially for older people, will continue to grow. That's because people are living longer and consequently are contracting long term chronic diseases such as diabetes.

At the same time, Bermuda's system of health insurance, which mandates that employers must make insurance available to its employees, make it difficult for the unemployed to get coverage.

The BHeC report on health insurance reform, proposes major changes in how health insurers charge their customers aiming to make insurance both more affordable and more accessible. But it does not solve the fundamental problem of how to control costs.

Instead, it proposes that insurers change the way they charge customers from a premium based on their risk factors (such as age and pre-existing conditions) to one based on a minimum cost per patient.

At the same time, insurers will not be able to refuse any customer, for reasons like age or a pre-existing illness.

To be sure, there has always been something invidious about the idea that insurers can take the premiums of young, healthy people for decades only to either refuse to insure them once they grow old or become ill.

But, insurers will say that this is a gross generalisation. Insurance is based on the idea of pooling risk; 100 people may each pay $1 for insurance, but if even one person gets ill and the treatment costs $100 (or $200), it will be paid out.

The insurers also calculate that if they need to charge younger people enough to make premiums more affordable for older people, customers will simply refuse to pay.

Under the BHeC proposal, it would appear that the insurers would have to charge younger working people (and their employers) more in order to reduce the premiums for seniors.

But if this ended up making the exercise more expensive for insurers (and if they had to take on more senior citizens it probably would), it is not clear that it would be viable, especially when both publicly quoted local insurers lost money on their health insurance books last year.

Instead of looking at ways of shifting responsibility for paying for health insurance around, what is needed is a genuine community effort to reduce the cost of health care.

There are several ways of doing this.

One is increasing the promotion and efficacy of wellness and preventative programmes already being run by Government, insurers and others.

A second is to find new ways of reducing the cost of overseas care. Obviously some operations and emergencies will always have to be treated overseas (high risk surgeries, burn victims and so on).

But in other cases, as Premier Dr. Ewart Brown has proposed and as already happens in some cases, overseas specialists can come to Bermuda to consult and treat patients – and do some training of local physicians as well.

More controversially, Bermudians tend to go to the very best, and most expensive, hospitals in the world, when they need treatment overseas. In some cases, that may well be justified, but others could probably be done for less money at highly regarded hospitals which don't happen to be the world's best teaching hospitals.

If this does not work, Bermuda may have to look at restricting treatments and procedures which are useful but not critical. For some 40 years, the Island's residents have enjoyed first class health care at home and abroad. But it is not clear whether this can be afforded in the future.