"Beware of what you promise" in elections is the lesson to be learned from the current debate on Future Care, Government's programme to provide affordable health care to senior citizens.

When the Progressive Labour Party promised Future Care in the 2007 general election, it was patently obvious that the idea had not been thought out and, as importantly, had not been costed properly, if at all.

Now the ramifications of that policy are coming home to roost, although hard facts remain hard to come by.

There is no doubt that the provision of health care to senior citizens is an enormous problem, complicated by three factors. The first is the fact that insurance companies hike premiums for retired senior citizens who are no longer covered by their employers' health insurance schemes to unaffordable levels of $15,000 to $18,000.

This is controversial because patients, having paid health insurance for all of their working lives, and probably not needed it to any great degree, find themselves without it when they need it most. The insurance companies counter that if working people did pay premiums to cover their old ages, they would find themselves paying massively more through their working lives.

The second factor is that Bermuda expects a very high standard of health care — much higher than that provided by many countries that offer universal health coverage. This is the same debate that is occurring in the US. If you want affordable and universal health care, you may not get flown off to Johns Hopkins for an operation and you may not, at the other end of the scale, get unlimited doctors' visits.

You may wait months or even years for an operation which is not judged to be life threatening. The third factor is that health costs, at least at the present time, and for the last few years, have been increasing at an extraordinary level- as much as 15 percent a year. No one seems to be able to explain why this is so, but at least some of it is tied to malpractice insurance costs, advances in technology which save lives but come at vast cost, along with increases in the cost of medication.

All of that means that senior citizens on fixed incomes are facing an increasingly difficult time, which has, ironically, been exacerbated by the muddle surrounding Future Care.

Because Government partially introduced Future Care this year, only about 3,000 of Bermuda's estimated 8,000 senior citizens are covered by it, and they pay up to $3,000 a year in premiums. If the cost of medical care per senior citizen is a highly conservative $10,000 a year, and even if $3,000 per patient is taken off that cost, the cost of Future Care this year is $21 million without adding administration costs. But Government has only set aside $10 million.

If all senior citizens signed up to the programme today, it would cost a conservative $56 million a year to the taxpayer after taking out premium contributions. But the costs are likely to be much higher. If the medical costs are $15,000 per year, as some insurers say, then the net cost to the taxpayer would be $96 million.

If medical inflation continues to rise at current rates, and if meaningful but politically unpalatable steps are not taken to control services and coverage, the cost of this programme will balloon into the hundreds of millions of dollars.

That has not happened yet, and it is not clear how many more seniors will be allowed into the programme this year. But private insurers are leaving the sector now since they cannot compete with a Government-subsidised programme, so some senior citizens will have no insurance whatsoever, surely not what was intended when Future Care was announced.

The blame for this mess lies squarely with the Progressive Labour Party Government, which made an ill-thought out campaign promise that it can only now fulfill at vast expense in the middle of a recession when tax revenues are already slumping. This is how good intentions go wrong.