There's no question that Bermuda must do a much better job providing affordable, accessible and improved health care options for its seniors. Unfortunately, it's now clear that Government's FutureCare programme, at least in its current form, is not the answer.

FutureCare emerged in the 2007 election campaign when Premier Brown promised to "provide every Bermudian above the age of 65 with guaranteed health care" for the remainder of their lives. It was a promise made without a plan and without a strategy for how to pay for it. When the United Bermuda Party challenged Dr. Brown on the cost of FutureCare during the campaign, he gave an answer that perfectly captured the political opportunism behind his announcement.

"We don't have a figure yet," he said. "But guess what? Whatever it costs, we'll do it."

Well, guess what? FutureCare is fundamentally flawed. Even the Government now knows – but is reluctant to admit – that FutureCare in its present form is unfair, unaffordable and unsustainable. It's unfair to seniors who were excluded from enrolment and confused by Government's inadequate communications. It's unaffordable because there was not enough money in the budget to include all seniors. It's unsustainable because the long-term cost of FutureCare could seriously undermine Bermuda's financial stability.

Government must now face reality and embark on a serious FutureCare makeover that will improve seniors' health-insurance options without creating overwhelming financial problems for current and future generations.

We are not exaggerating when we say that FutureCare looks more like future shock. Based on health care cost and population trends, we project taxpayers in 20 years could be facing a FutureCare bill of $1 billion a year. Here's why:

¦ Seniors are a steadily increasing proportion of Bermuda's population, growing from a projected 8,313 seniors in 2010 to 14,500 in 2030.

¦ Younger workers – who will shoulder the burden of higher taxes and premiums in the future – are a steadily decreasing proportion of the population.

¦ Health care cost inflation has been running double to triple the inflation rate. HIP premiums doubled in the last six years from $108 per month in 2003 to $208 in 2009-an increase of more than 15 percent each year.

¦ Bermudians have high expectations for health care coverage.

The graph illustrates the potential cost scenario for FutureCare in its present form if current trends continue.

We based the graph on three assumptions:

¦ The growth in health care costs in Bermuda will increase at about 8 percent annually.

¦ The 65-and-over population in Bermuda will grow at the rates projected by the government Department of Statistics between 2010 and 2030.

4$1,200 per month per senior in 2009 is a realistic premium estimate for major medical comprehensive health care, given both current experience in the private sector and comments attributed to government's consulting FutureCare actuary.

People may take issue with the individual assumptions, but the combination of factors noted above leads us to conclude that FutureCare in its current form is unsustainable and unaffordable.

The United Bermuda Party makes no apologies for raising hard questions about cost. Unless a social programme like FutureCare reflects reality, it will disappoint the very people it's supposed to help. Consider the case of Mrs. Smith (not her real name) as one example of the anxiety, fear and discrimination felt by seniors betrayed by the political promise of FutureCare.

Mrs. Smith was made redundant at age 67 from a senior position in the hospitality industry three months ago. She lost her health insurance and as a cancer survivor was desperate for coverage.

She could not afford private insurance and could not get financial assistance because she owned her own condo, even though she had a substantial mortgage.

Mrs. Smith remembered the Premier saying that all seniors 65 years and over would get FutureCare, but when she applied she discovered she had to be a member of HIP as of April, 2009. Mrs. Smith did not see any advertisements outlining this requirement, and when she challenged her disqualification, she argued that the Premier's promise was made without conditions attached. Her pleas fell on deaf ears, and she has been without insurance for months. This is emotionally draining on her and has begun to affect her health.

Mrs. Smith is not alone. When the Government effectively eliminated the HIP programme for seniors to make way for FutureCare, some private insurers followed suit by dropping HIP coverage for those over 65. Many seniors were left with no affordable programme. This is the crack that many seniors have fallen through, and it's discriminatory. Seniors who were able to enrol in FutureCare – some 3,100 in total-have the benefit of taxpayer-subsidised major-medical coverage while the other 5,000 seniors do not. The situation is particularly difficult for seniors who cannot afford private coverage, as they no longer have access to a basic and affordable HIP plan.

The Health Minister's recent pledge to revive the basic HIP plan when Parliament reconvenes in November is a step in the right direction. But until then, seniors who lost their coverage will remain vulnerable should they fall ill.

But seniors are not the only ones who should be concerned about FutureCare and the cost of future health care coverage. It will be particularly challenging for Bermudians currently under 50 who will have to shoulder the burden in increased taxes and premiums. They should be very concerned unless significant changes are made now.

There is no free FutureCare. Someone has to pay for the dramatically higher medical costs of seniors. Under the HIP programme, it was the taxpayer: between 80 and 90 percent of the hospital costs of those aged 65 and above were paid directly by a government subsidy.

While this has been acceptable for a basic hospital insurance plan like HIP, it becomes much more burdensome when you move to a comprehensive or major medical plan, which is the premise behind FutureCare. Providing additional benefits, such as unlimited doctor's office visits and higher prescription and diagnostic benefits, means higher claims costs and higher premiums.

Compare the much lower monthly HIP premium – $208 – to that of GEHI, government's major medical plan for the civil service – about $500 to $600 – and it's easy to see how additional benefits increase premiums. So what's to be done? There are several important factors that will influence the success of any FutureCare programme, and Government must do a more effective job at managing each of them.

The first is health care cost control, a serious problem raised in the 1990s in both the Oughton and Arthur Andersen reports on Bermuda's health care system.

Over the past ten years, the PLP Government has failed to contain health care costs. If health care inflation continues to grow at eight percent for the near future, even moderate benefits packages will soon outgrow Bermuda's ability to afford them. The second factor is adequate data collection and analysis. It is impossible to reliably estimate the cost of a particular healthcare-benefit programme and make reasonable budget projections without reliable data reflecting claims experience and use of services. The Department of Social Insurance has not had an adequate system, and government actuaries must go to private-sector insurers for information.

The third factor is the importance of how Government communicates with the public. Government's FutureCare program affects the lives of all Bermudians in an extraordinarily personal way, and they deserve nothing less than absolute honesty from their Government on this issue. Getting FutureCare right will not be easy, but Government can make a fresh start by admitting that up front. Government must lay out the real costs of various benefit options and involve the public in determining what is affordable for both individuals and the country as a whole.

Clearly, Bermuda needs to provide a better health care package for seniors than the basic hospital HIP plan and its limited benefits. It must be affordable for seniors, which means it will have to be subsidised, but it also must be sustainable and affordable for the rest of the community. This will require more effective dialogue among health care providers, Government, seniors' advocates and private-sector insurers, all of whom have a role to play in determining the best way forward.

Here are some specific ideas the United Bermuda Party believes can help Bermuda reach that goal:

• The benefits, premium, subsidies, eligibility and enrolment factors for FutureCare must be carefully re-examined, based on seniors' needs, fairness and actuarial/financial soundness. This analysis may lead to means testing and different premium levels for seniors, depending on their financial circumstances.

• Government must work more effectively with private-sector health insurers to understand the claims experience for seniors and develop a better means to collect and track health care data.

• Government, private employers and unions must discuss how employees, once they retire, can continue on their existing or a modified benefits plan. This will help reduce the overall number of seniors who need FutureCare coverage.

• Private-sector insurers should offer convertibility options so that working seniors who retire can retain affordable coverage.

• Government should reinstate the inexpensive and basic HIP plan for those over 65 for at least the next five years to allow two levels of coverage for seniors. Not every senior needs major-medical coverage or wants to pay the higher premiums.

• Government must take some hard decisions and get a grip on spiralling health care costs. The Bermuda Health Council has been ineffective in this regard, and its legislative mandate should be reconsidered.

• Medical savings plans (similar to pensions) that allow younger employees to put aside money for heathcare coverage on their retirement or in the event of a catastrophic health problem should be pursued.