Former Senate President Alf Oughton’s important contribution to healthcare reform has set the template for our present discussions. And Health Minister Zane DeSilva and Bermuda Health Council CEO Dr Jennifer Attride-Stirling have been indefatigable in their efforts to bring the main aspects of healthcare reform to the population at large.The issue is expansive, complex because of its weblike structure, and directly impacts every one of us on a multitude of levels.Considerable information has been provided to the public through the town hall meetings led by Minister DeSilva and Dr Attride-Stirling. From these meetings, two aspect of healthcare reform stand out in my mind: (1) the need to control costs and (2) the appropriate structure for providing universal, affordable healthcare.It seems that key contributing factors to costs include a debilitating triumvirate: over testing, overmedication and overseas visits. A 2010 US survey of physicians revealed the vast majority perform unnecessary tests costing billions of dollars annually to protect themselves against lawsuits.There is considerable anecdotal evidence that unnecessary testing takes place on a significant scale here as well. Once the BHC has the appropriate structures in place this should be minimised considerably.Overmedication is a subject discussed more and more, particularly as it relates to the more vulnerable in our population, the young and the elderly.Again, we do not yet have data for Bermuda but there is no doubt doctors here also are compelled to respond to the pressures brought to bear from patients who have seen a new drug advertised in the media; or, agree to try out a new drug promoted by a pharmaceutical company introduced at a seminar where the physician was a guest of that company.Despite the fact that our medical professionals are qualified by accredited international bodies, we have a penchant for flying overseas for care. There is no doubt that there are occasions when overseas treatment is essential often, however, it has more to do with patience preference and an accommodating insurance provider than medical necessity.In one extreme case, a patient insisted with his physician that he get overseas care. After sustained pressure the doctored sent the now satisfied patient to be seen by a Canada-based doctor. That the Bermuda physician had himself trained this doctor was completely immaterial to the patient.On the issue of universal and affordable healthcare coverage, there should be no compromise I see this as an entitlement. Further, those seniors who have worked to build the Bermuda we enjoy today should have the expectation they should be covered in their twilight years and have that coverage subsidised by the employed.There is something less than ethical (even if profitable) about insurance companies which take premiums from comparatively healthy workers and then effectively reject coverage to people as they get older and are more likely to require medical care. Government has taken a moral position to fill this void.Affordable health coverage can only come by having premiums being paid into one pool and having the level of payment based on one’s ability to pay. One idea raised by Dr Attride-Stirling is that medical insurance fees should be based on a percentage of one’s income. This is eminently sensible and should be embraced by all who want to see a fair and balanced structure to universal healthcare coverage.Bermuda’s healthcare costs will no doubt continue to rise if we fail to adopt important reform measures soon. The Bermuda Health Council and the Ministry of Health have a capable and dedicated team of professionals working relentlessly to bring in this reform process to fruition. They deserve our support for a radical restructuring of the status quo. I encourage you to give it to them.Walton Brown is a social and political commentator. Follow his blog on www.respicefinem1.blogspot.com. He can be contacted at walton@researchmix.com.