My husband and I have begun to do our research to determine where we would like to retire. Bermuda is definitely high on the list, but there are several factors that are not ideal for retirees, one being the lack of affordable healthcare.

As we all well know, there has been a big push from the Government of Bermuda to implement universal healthcare (that is, healthcare that would be available to all residents and citizens).

The idea is intriguing, and if it were to be properly rolled out, it could be quite the game-changer for healthcare in Bermuda.

So, what do I know about the subject? As I have lived in two countries with universal healthcare, I know a bit.

By now, most readers know I grew up in Australia; but what readers may not know is that on February 1, 1984, universal healthcare (i.e. Medicare) was rolled out in Australia.

I remember it being quite a debated topic in our home, with my parents not being especially thrilled, and my grandparents being livid. The government-funded Medicare programme was touted as being “not only a cheaper and simpler system, but also a fairer system” (Australian Tax Office, 2020).

So why would my parents and my grandparents be less than thrilled with a universal healthcare system? Two words: “government funded”.

This means that if you don’t have a government with not just a positive balance sheet, but also a surplus, “government funded” actually means “people funded” and that funding is through taxes. To ease the backlash that would have come from introducing another tax in Australia, the government instead called this a “Medicare levy”.

Initially, the Medicare levy was a 1 per cent tax on income to help fund the universal healthcare system; that levy increased over the next 40 years, and it is now 2 per cent on overall gross taxable income (AAP Newswire, 2024).

In 2023, an article published in The Medical Journal of Australia blasted the Australian government for its poorly managed Medicare programme, noting that the system has become one of exclusions and copays, therefore highlighting the false claims of a cheaper, simpler and fairer programme.

The article argued that underfunding is still is a major issue that is then passed along to the taxpayer with each increasing levy. Furthermore, the Australian government failed to balance the cost of providing comprehensive services while keeping the levy at a manageable level for taxpayers, and it did not plan for rising costs related to an ageing population, expensive medical technologies and an increasing demand for services.

Moreover, due to their lack of planning and understanding of how to actually run the system, the need for services continues to outpace funding, which has led to issues with long wait times, rationed services and cuts to the overall programme.

The article furthermore suggested that although Medicare is designed to offer everyone access to medical services, quality of care can be inconsistent.

High demand can lead to overworked healthcare providers, lower patient satisfaction and even errors in care. In some cases, healthcare professionals may have limited time to spend with patients due to high patient volumes, which affects the quality of diagnosis and treatment.

Lastly, the article noted a significant failure of the Medicare system which has angered all Australians: the growing gap in out-of-pocket costs.

Although Medicare covers a broad range of medical services, it does not cover all aspects of care, such as dental, optometry and some allied health services. This means that many Australians still face high out-of-pocket expenses, particularly those who require frequent treatments or specialist care (Angeles, Crosland & Hesher, 2023).

What the article didn’t mention, however, was that increasing out-of-pocket expenses and exclusions have led to the introduction of Medibank Private, a secondary (albeit private) health insurance that individuals can apply and pay for independently to ensure that all healthcare is covered.

From my perspective, the universal healthcare programme that was once touted as “not only a cheaper and simpler system, but also a fairer system”, should be advertised as “not cheaper”, “simpler for whom?” and “not at all fairer”.

Now, shifting from Australia, it is interesting to note that when I researched universal healthcare programmes in countries with a small population, information was extremely difficult to find, which leads me to suspect that it boils down to the following:

1, Governments have done their research and determined that it is not feasible due to limited population numbers

2, The present healthcare system, although not perfect, is adequate for the population size.

Moreover, an article published by T. Alafia Samuels on the website Global Governance Project noted challenges related to the healthcare systems throughout the 30 Caribbean countries, specifically the limited population and limited expertise available within each nation to support a universal system.

So the question has to be asked: if universal healthcare has been problematic in a large nation such as Australia, which has the population to support it, and if at first glance it doesn’t appear to be feasible for smaller populations, under what circumstances would universal healthcare be successful?

First, it is important to remember, the goal of universal healthcare is affordable healthcare for all. This means that some of the greater benefits are found for low-income earners, limited income earners or within developing nations.

Universal healthcare can help address widespread health disparities, offering essential services that might otherwise be unavailable within certain segments of a population. For example, in countries with high levels of infectious disease or child mortality, a public health-focused system can reduce preventable deaths and increase life expectancy.

In addition, it can be economically efficient for lower-income earners, who can save money in the long run with universal healthcare, as basic services and preventive care are available to everyone, which reduces the need for expensive emergency care and long-term treatments for conditions.

Furthermore, universal healthcare can reduce the social divides that exist where wealthier individuals can afford private care, whereas the rest of the population may go without basic healthcare. Research suggests that a more equitable system helps to reduce social unrest and inequality.

At the end of the day, universal healthcare can be a great programme if a government does its research, understands what barriers might exist, develops a sustainable plan to overcome them and has the financial means to back the programme without penalising its citizens and residents through levies or taxes.

Otherwise, I suspect it will be an ill-fated project that costs taxpayers more money for fewer services, along with being an example used in medical journals for years to come of a poorly managed universal healthcare system.

References

AAP Newswire, 2024. Low income earners to benefit from Medicare levy change. Available from: https://www.countrynews.com.au/national/low-income-earners-to-benefit-from-medicare-levy-change/ [Accessed 17 November 2024].

Angeles, R., Crosland, P. & Hensher, M. (2023). Challenges for Medicare and universal healthcare in Australia since 2000. The Medical Journal of Australia 218 (7): 322–329. DOI: 10.5694/mja2.51844

Australian Tax Office, 2020. The history of Medicare. Available from: https://www.health.gov.au/medicare-turns-40/history#:~:text=In%201983%2C%20the%20Australian%20Government, it's%20also%20a%20fairer%20system [Accessed 17 November 2024].

Samuels, T. (n.d.) UHC in small island developing states. The Global Governance Project. Available from: https://www.globalgovernanceproject.org/uhc-in-small-island-developing-states/t-alafia-samuels/ [Accessed 13 November 2024].

• Carla Seely has 24 years of experience in the financial services, wealth management and insurance industries. Over the course of her career, she has obtained several investment licences through the Canadian Securities Institute. She holds ACSI certification through the Chartered Institute for Securities and Investments, UK; QAFP through FP Canada; and AINS through the Institutes. She also holds a master’s degree in business and management