Responding to Carla Seely’s insightful column on universal healthcare on November 30, 2024, I note that she stopped short of saying Bermuda shouldn’t do this. But here are four good reasons why we should perhaps avoid embracing full-scale universal healthcare:

1, Long wait times

2, Ageing population

3, Ailing population

4, Declining birthrate

Concerning No 1, there is no rocket science involved. The long wait times are largely owing to higher demand for services, and this will only increase as our population ages (more on that below) and by direct effect of instituting universal healthcare, since more people will automatically become eligible for — and take advantage of — healthcare services.

As Ms Seely rightly concludes, a combination of those two factors will add strain to an already stretched environment and can easily lead to inaccuracies and inefficiencies that we can ill-afford with something so massively important as the nation’s healthcare. Additionally, while we have a small population, there are growing health concerns of the chronic sort — cancer, diabetes, dementia.

All of these were highlighted by Bermuda Health Council chief executive Ricky Brathwaite in his op-ed on the same date, and they all have a greater adverse impact on our seniors because we are an ageing population — which I and many other contributors have alluded to in recent years.

And that takes me to point No 2. It has been spoken about at length and I believe steps are being taken to mitigate the effect our ageing population is having on Bermuda from a financial perspective. I will save the discussion on the efficacy of said steps for another day. But from a health perspective, there is no disputing that as we age, our bodies deteriorate.

The inevitable knock-on effect is that more facilities, staff and services will be needed to provide healthcare to seniors, let alone the rest of the population. In short, Bermuda is very top-heavy when it comes to age, owing to the baby-boomers generation, the youngest and oldest of which turn 61 and 79 this year. Is Bermuda positioned to handle the diseases and ailments that become more prevalent — or, at the very least, harder to combat — with age? Are we ready to accommodate the negative correlation between fragility and agility that exists with ageing?

Concerning No 3, indulge me for a moment. The introduction of the sugar tax was meant to improve the overall health of Bermuda’s people. But I think it has caused more hurt to wallets than help to waistlines. In other words, vendors are getting wealthier and not many customers are getting healthier. Perhaps similar can be said of the much older “sin” tax.

The point being that individual choices are what have greatest impact on individuals’ health, and Bermuda, by and large, has been making unideal consumption choices for quite some time — myself included. And although evidence of the push for better eating can be seen on menus offering low-caloric, low-cholesterol, gluten-free and vegan options at a wide array of food vendors and restaurants, the vast majority of people on this island are not jumping at the bit for a bite, so to speak. To add insult to injury, healthier options usually amount to heavier costs at the grocery stores.

But aside from food and beverage intake, the financial hardships experienced by the average Bermudian, paired with an increase in cannabis use, has directly and indirectly led to increases in mental, social and spiritual health issues. And while there is certainly an emerging culture of self-care, it is largely the realm of the young to middle-aged working population and even with that demographic, it remains the minority.

So that’s a small window into what’s to come in the near and distant future health-wise. As for the here and now, the main group to which our “ailing” status can be attributed is the senior population, primarily by virtue of age. Let’s hope the mindset of the younger generations continues to trend in a healthier direction.

Concerning No 4, it has long been known that Bermuda’s birthrate is nowhere near what it was in the previous century. With fewer people in the working population, it is already becoming more and more difficult to support the senior population, which is largely unemployed. If we now introduce universal healthcare into the picture, it would create an extra burden on the overtaxed working population as taxes would be required to fund such a system.

So, naturally, the question must be asked: will the tax that gets introduced be less than existing health insurance deductibles?

It is a legitimate concern, especially when you consider those unemployed and underemployed for reasons other than age would also need to be covered. And to add insult to injury, the very government proposing this plan has proved to be unwilling or incapable of expanding the workforce through immigration reform, tax innovations and/or repatriation policies/incentives — the former two being highlighted in an op-ed One Bermuda Alliance candidate Sophia Tessitore on that opinion-laden day in November.

So Bermuda finds itself at a crossroads. Something obviously has to be done before the healthcare system implodes, but changing course for the sake of it is not enough. We have good reason for change, we have resolved to change, but do we have the resources for change? It is the third “R” — resources — that is the most important of the three when undergoing massive changes in policies and operations. Unlike with education reform where the third “R” is astonishingly missing from plans being rolled out, it is imperative that people and procedures are in place to handle the changing environment and workload expected from a major healthcare system overhaul.

We are all familiar with the phrase “Proper planning prevents poor performance”. Perhaps just as popular is “Those who fail to plan, plan to fail.”

When it comes time to reflect — that’s the fourth “R” — on the impact of change, there will be meaningful success only if the tenets of those adages are upheld. Inspired by Ms Seely’s mention of Medibank Private, a private-sector health insurance service provider which aims to cover Australians’ health services excluded in universal healthcare in that country, perhaps the best way forward for Bermuda is a hybrid of its own. You can never foresee all of the potholes that lie in wait, but before the car leaves the lot, here is a non-exhaustive road map of areas — in no particular order — to consider before taking this new healthcare coverage journey:

1, Frequency of ailment/condition

How prevalent or prominent the matter is — because of genetics, physical environment, economic environment, lifestyle choices, etc.

2, Severity of ailment/condition

Is it addictive, chronic, life-altering? Mortality rate?

3, Preventability of ailment/condition

Ways to prevent/guard against that are free or cost-effective — eg, Campaigning … the signs that used to hang on buses warning of the dangers of drug use were a brilliant example of free advertising; perhaps the same idea can be used to encourage good eating and exercise habits. Mitigation is the goal where elimination is impossible or unlikely.

4, Remedy for ailment/condition

Ways to fix/help and associated costs — availability of and accessibility to resources: specialists, equipment, locations, medications. This should also encompass methodologies: how to treatment practices most efficient?

5, Linkability of ailment/condition

Does the issue lead to other issues, hidden or revealed — eg, addictions, mental instability. Can the ripple effect be managed or avoided? If not, what is the associated additional treatment cost?

In closing, I recently had the opportunity to talk with an MP on various issues the island has faced and is facing. Naturally, I brought up the issue of universal healthcare — since my thoughts had been mulling over the matter for nearly two months — and I agree with the main sentiment of her response which I’ll paraphrase:

Before taking flight, we want to ensure the flight plan is trustworthy in order to maximise the likelihood of landing the right way at the right time and in the right place.

• Anthony Lee is a former actuarial associate who holds a BSc in Finance as well as a Postgraduate Diploma in Education certification in Mathematics