A Chamber of Commerce discussion on bringing universal health coverage to Bermuda, became heated, when one audience member demanded to know how it would be funded.

“We do not have income tax here,” said the accountant who did not wish to be named. “Are we going to give the Government a high percentage of our salaries to run universal healthcare?”

In 2021, more than 28 per cent of Canadian income tax was spent on universal healthcare compared to 18 per cent in the United Kingdom.

The accountant said local physicians often took the blame for the high rate of lifestyle disease in Bermuda.

“What responsibility does the patient have for their own health?” she said.

When the meeting ended several people from the audience congratulated her on her stance, saying they felt the same way.

Panellist Elwood Fox, head of the Bermuda Medical Doctors Association, fielded her question, which came during the Chamber of Commerce’s annual general meeting, held at the Hamilton Princess & Beach Club.

Dr Fox stated that there were ways to pay for the coverage.

He told The Royal Gazette: “There are ways of doing universal healthcare. You need a balance between private and public and how it is funded. You cannot go right from zero to 100.”

He said there were methods of paying for healthcare that were cheaper than coverage from local insurance companies.

“In America, Medicare sets the rate example,” Dr Fox said. “Every year they adjust the fee schedule and rates. The physicians, insurers, and the government come together in one room to decide what is best for the patient.”

He said universal healthcare would not destroy local health insurance companies such as Argus and BF&M, because some people would still buy private health insurance.

The Bahamas established universal healthcare coverage by implementing the National Health Insurance Authority in April 2016.

Christy Butler, the chief executive officer of the NHI, said the healthcare situations in Bermuda and the Bahamas were very similar.

“We have a very sick population in the Bahamas,” she said. “There are high levels of diseases such as hypertension, diabetes, and obesity.

“We also have a very siloed and fragmented healthcare sector.

“Today, the Bermuda Chamber of Commerce is trying to answer the question how to get the utility out of the healthcare system. That really resonated with me. We cannot stand by and continue to allow care to be delivered the way it has traditionally been.”

When she first transferred from the private to the public sector in the Bahamas several years ago, 70 per cent of the population did not have access to adequate healthcare.

She said: “There has to be an impetus for change. For us in the Bahamas, that was the implementation of universal health coverage.”

However, Ms Butler said they did not just wake up one day and put it in place.

“We have been on a 40-year journey to do this,” she said. “It has gone through a number of iterations. We have had to change strategy. We have had to consult with stakeholders. We wanted to make sure that when we implemented universal health coverage, we really were representing the needs of the community.”

She said the financial sustainability of the NHI in the Bahamas still kept her up at night.

“But we also have to recognise that we could not afford the healthcare system that we had,” she said. “Our inaction would have been very expensive.”

Ms Butler said that when Bermuda did implement universal healthcare coverage, it could not just be a mirror of what other countries have done; it had to be culture specific.