in a very constructive way. It is clear to us and to many other people that health costs are the nightmare of the future. Health care is greatly improved but the costs are beginning to confine good care to the rich. They are showing every sign of becoming an unmanageable fact of life.

There are all sorts of complicating cost factors from those people who run up insurance costs by going abroad for every problem, many of which could be managed in Bermuda, to those people who use the emergency department as their general practitioner to the fact that Government's HIP programme is landed with those people over the age of 65 whose company health insurance plan ends with their retirement thus depriving them of major medical insurance just at the time they are likely to need it most.

That causes a great deal of concern for those who retire. It also tends to produce a double standard of care. The rich can afford to pay for expensive insurance while those who cannot afford it revert to the HIP system with its limited coverage. That kind of tiered care is not really acceptable in a country like Bermuda.

Like other countries, Bermuda has an ageing population and it has a sophisticated population which demands more and more sophisticated diagnosis and more and more sophisticated treatments. These are all extraordinarily expensive today.

Bermuda's hospital costs have been held down by a good deal of exemplary volunteer labour, notably that provided by the "Pink Ladies''. But they are not alone. A variety of organisations like PALS which allows cancer victims to leave hospital and receive home care from qualified nurses not paid for by the public purse, cut hospital costs. The same is true of a number of homes for older Bermudians like the Packwood Old Folks Home which are supported by contributions. Bermuda should recognise that without volunteers and contributions, hospital costs would be higher. The hospital also receives a great deal of support from fund drives, notably the Care Campaign.

We have to wonder why Bermuda does not seek solutions outside insurance and charity contributions. It seems rather crazy to allow lotteries to go on each and every day in the bars of Bermuda at no benefit to Government but not to organise a national lottery of the "scratch card'' kind to support public projects like the hospital and sports programmes.

Then too we have a situation where doctors use the hospital's publicly paid for facilities, especially the operating theatres, without cost. Doctoring is very much a closed shop in Bermuda which does not always work to the public's advantage. Why, for instance, is there no dermatologist in a Country where people are naturally exposed to the sun? There are repeated reports in the community of the huge sums made by doctors, especially surgeons, who have free access to public facilities. Somehow that does not sit well, given public appeals for funds and escalating costs.