Healthcare reform a scary proposition
As a child growing up, Hallowe’en was my least enjoyable celebration. Although candy and chocolates were part of the bounty accumulated during a night of trick-or-treat, it was those fun-loving children masquerading as witches and ghosts that scared me the most.
But the good thing about this annual event is that it can be endured for one night a year and its practice is merely a fantasy, a horrible nightmare, if you will, that will not recur or have a devastating impact on one’s future wellbeing. This Progressive Labour Party government is doing its best to create a Hallowe’en-style nightmare by policies and tax-increasing measures that ultimately burden its residents with a higher cost of living, specifically within the realms of its healthcare reform plan.
Unlike Hallowe’en, it has the potential to be a recurring nightmare and can have a devastating impact on one’s future wellbeing.
The Government and its detractors can agree on a few things:
• The cost of healthcare is high and is trending up with no end in sight
• Our senior population represents the highest healthcare costs and persons over the age of 65 will make up 25 per cent of residents by the year 2026
• The number of working population and the birthrate are shrinking, which places the burden of cost of healthcare on a declining number of people
• A faltering economy and immigration legislation that is protectionist rather than pragmatic to address the declining number of working-aged residents contributes to a shrinkage in able-bodied persons that can undergird the healthcare sector
• The Standard Premium Rate remains unchanged from last year, but holds no guarantee that it will stabilise or not rise exponentially over the coming years
• The Government’s promise to control costs in the healthcare sector has not been realised and this redistributing of the funding does not address that fundamental challenge
• The proposed healthcare reform does not guarantee its users the same level of services and products they enjoy under their existing plan
These are just a few issues that have arisen from discussions held at town hall meetings sponsored by the Government and held at the kitchen table of Mr and Mrs Bermuda.
On September 16, I attended a town hall meeting at the St James Church Hall in Sandys and the questions of the attendees reflected the concerns of the wider population of residents on the island.
The Minister of Health, Kim Wilson, and her team did their best to provide answers, but there were more questions left hanging to make anybody feel uneasy about the remedies for an out-of-control healthcare system that needs reform, not total restructuring, to cure what ails it.
Here were some of the questions;
Question: Why were there no plans for under/uninsured persons?
Answer: Too expensive because no risk-pooling. It would marginalise the poor as second-rate.
Observation: At the beginning of the night, the number representing the under/uninsured was at 8,000. By the end of the night, that number had crept up to 12,000. Which number is it? How many of the underinsured voluntarily chose the HIP option of health insurance, as they did not deem themselves needing a comprehensive, major medical scheme?
All four leading healthcare insurance providers are on record as being willing to consider a plan to underwrite those who are not insured because of unaffordability or unemployment. Why was this proposal not explored by the Government?
Question: Will there be different levels of coverage?
Answer: No difference in tiers. Any further coverage, consumer will need to purchase additional private coverage.
Observation: The mere fact that consumers require supplemental coverage, whether they can pay for it or their employers provide additional medical services creates a two-tiered system of healthcare.
Question: Does the new insurance plan cover you when unemployed?
Answer: Financial assistance was the remedy in old plan and in reform, subsidy included if people unemployed.
Observation: Not everyone unemployed or made redundant in the old plan could qualify for financial assistance and there was no economic impact assessment presented that would demonstrate the potential cost to the taxpayer to underwrite that demographic of the population.
When considering the consultation invested by this government to get as much feedback from industry professionals and the residents at large, there is a fundamental flaw in its approach.
Like its attempt to drive through legislation that would reduce the authority of the corporations of Hamilton and St George, consultation was merely a gratuitous attempt to show the appearance of seeking feedback, when its ultimate plans were already etched in stone.
The public see through this phoney quest for gathering advice and input from stakeholders, and have had it with going through the charade.
As an act of good faith, the Government should inform the electorate that their buy-in for major structural change in the healthcare system is not needed or valued, so just fall in line.
Socialised healthcare is the long-term goal of this government and no matter how one dresses it up, increased taxation to underwrite this future reformation will be the order of the day.
Even this first step towards this goal, proposed to be implemented in a soft launching in August 2020, in the words of the Bermuda Medical Doctors Association “would not lower healthcare cost without negatively impacting the quality of care and waiting times of services”.
So, this government’s promise to lower cost while increasing service is a fallacy.
Another consideration that the Government has been silent on is the unintended consequence that will result in this single-payer system that it will be introducing.
Wisely, the Government has confirmed that it will not be taking on the responsibility of collecting premiums, but will outsource to another entity that has the expertise to administer this system.
But that private company will be interested in turning a profit, in addition to the layer of governmental oversight and administration that will be a factor, resulting in additional cost.
But what is universally more troubling is that this reformed system will eliminate the private insurers from the bulk of their healthcare business.
How many international businesses will opt to get healthcare coverage from overseas providers, arrange for doctors’ visits, purchasing of pharmaceutical products, specialist visits overseas, thus leaving the local providers with a smaller piece of the healthcare pie?
With reduced business, there is a reduced need to provide healthcare-related products and services resulting in a reduced need for employees. Do I see redundancies in the healthcare industry’s future? It is inevitable.
An economy that is in serious decline and a working population in decline, reducing the number of persons able to carry the burden of an ever-increasing cost of healthcare, make for a formula for disaster.
But rather than end on a sour note, there is hope for the average Bermuda resident looking for relief in their monthly costs.
The Government should look to halt its fast train ride to universal healthcare and solve its original overarching problems related to healthcare.
Those problems are twofold:
1, Solve the under/uninsured persons challenge and lower the overall cost of healthcare. The Government can do this by having an honest discussion with the four leading healthcare providers on the island and challenge them in concert with the Government to underwrite the healthcare costs of the under/uninsured
2, Conduct a comprehensive island-wide review of those that fit in this category — that number could be closer to 8,000 than 12,000 — so that an accurate plan can be formulated to take care of their needs. Second, plough through the hard work of regulating the cost of products and services provided by practitioners. Put stricter limitations on the overseas referrals and ordering of diagnostic testing that are big ticket items on this country’s healthcare bill. Regulate and put a ceiling on co-payment requirements for doctor and specialist visits. The Government has proposed a $25 copay ceiling, but that may be unrealistic. Don’t come up with an arbitrary price point for copayments, but negotiate with the key stakeholders such as the Bermuda Medical Doctors Association so that there are charges consistent throughout the entire industry.
We can avoid the Hallowe’en-like scares within healthcare reform that can be a recurring nightmare and have a devastating effect on the country’s future wellbeing.
• Marcus Jones is a One Bermuda Alliance senator
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