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 familySome really thought-provoking questions arose this week from the healthcare providers’ consultation meeting with the Government. 1, If Government has chosen a single-payer financing scheme isn’t this a government-endorsed monopoly and shouldn’t the rights of the medical community, insurers and patients override the mandate of a monopoly? How does a monopoly differ from nationalisation?2, What would happen if all the dentists and doctors and allied health workers “opted out” of the proposed healthcare system?• MonopolyThis is defined as a situation where a single entity is the sole producer, provider or seller of a product or service in an entire market. It is characterised by a lack of competition. • NationalisationA rather invasive option, nationalisation allows a government to directly control the firm’s behaviour and thus minimise its negative effects on society.However, since this kind of policy is diametrically opposed to the idea of a free enterprise economy it has become extremely rare in practice.Monopolies and nationalisation are characterised by a lack of competition, which inevitably results in lower production outputs and/or higher prices. What have doctors experienced in other countries with a nationalised system? Less time with the patient, longer wait times for surgeries etc. What does a “higher price” mean?This could mean that your $544 Bermuda Health Plan 2020 either becomes a lot higher or your level of benefits becomes a lot lower — we just do not know. Is there a “consumer protection law” in Bermuda? Absolutely.You can find it on www.gov.bm One of the first three points is to “encourage fair competition between businesses”. In addition, in the Consumer Protection Act 1999 the third point states: “Unconscionable acts can be just as damaging and include excessively one-sided contracts that benefit only the trader: grossly overpriced products and …. entering into a contract with a consumer who you know lacks the capacity to understand it.”So does this mean patients have the right to opt out of the healthcare scheme? According to the Government website, no. How does the Consumer Protection Act protect you? It is an interesting question.It is a question that led the medical community to ask questions as well. Can doctors and dentists and allied health opt out when patients cannot? • Opting outBermuda Health Council adviser Ricky Brathwaite advised the dentists and insurers present at the “consultation” meeting this week that they could put forward recommendations to “opt out” of the proposed health scheme “if they didn’t like it”. Interesting. Patients cannot opt out but it sounds like doctors can? How does such a system make our patients healthier?The BMDA, dentists and Pharmacy Owners Association are against the single-payer government-endorsed monopoly.Save the date: February 7 from 12.30pm to 2.30pm. Patients1st is helping you have a voice. 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