Comments on: Column: Health Plan, What’s In A Name?

By: Provider

Provider — Fri, 27 Dec 2019 12:03:18 +0000

The article has a lot of information. It is written for a different audience than those who need the information on this website. Unfortunately, the average person who is confused about “what is in a name?” leaves this article even more confused and less confident that the government really want s them to be clear. The basics about internet article writing has been ignored. Too Long, Language too complex, analogies to vague and purpose lost. Not a good sign as a leader in public policy. This doesnt mean what he is saying is wrong its just not very clear. Secondly when one reads it one is not clear on the purpose of the proposed change and what other options have been considered to address the root problem. Is it the cost of healthcare, is it to cover the uninsured and underinsured, is it to create incentives to reverse chronic diseases, is it to improve quality, is it go get control of insurance dollars to offset other expenses the government has? WE DONT EVEN KNOW WHAT IS BROKEN SO WE CAN FIX IT!…. Who is complaining, patients? Poor? the Business? Doctors? PLP members? People? What are we doing and why? Lastly…WHO IS PAYING? There is no way we can get more for less. More will always cost more.

By: B to M

B to M — Sun, 22 Dec 2019 02:32:22 +0000

The wealthy Bermudian couldn’t care less about this change unless they own a business. Business owners will face increased costs for their employees who will require the supplemental insurance coverage they enjoy today, plus this new, more costly plan. This will hurt the working middle class most. And it’s going to cost a bomb to administer.

By: Ricky Brathwaite

Ricky Brathwaite — Sat, 21 Dec 2019 22:25:32 +0000

The government inherently does not provide healthcare services so using the economic term to describe their regulation of SHB or for them to serve as a payor would be to oversimplifying the term monopoly. This would imply that government also has a monopoly on public education or that the BMA is a monopoly as it has regulatory oversight over all international business. I doubt international business end consumers would identify the BMA as restricting their options on what reinsurance companies they choose. But I do understand that you are referring to the idea of one entity having signicant ability to set some of the fundamentals of a market. However I would argue that setting the rules of play does not make an entity a monopoly in the economic sense. But yes I do appreciate what many people are voicing concern about.

By: Listening

Listening — Sat, 21 Dec 2019 12:07:43 +0000

Many people will agree that there should be a basic level of health insurance coverage for the whole population. Where most people disagree is that the Government has already decided to provide this basic coverage using a “unified system” where Government is the monopoly – the only insurance provider offering the basic health insurance plan.
Even if the plan is administered through a third party, Government is the provider, payer, decider and owner of the plan. That is the part of the Bermuda Health Plan that gives most people pause.

By: Ricky Brathwaite

Ricky Brathwaite — Sat, 21 Dec 2019 04:25:32 +0000

Yes the proposed scheme will more cleanly delineate what is Standard Health Benefit and what is Supplemental. The actuarial modeling that has been done to date on one of the larger plans does not show an increase in premium due to changes to the SHB. However as is currently, this outcome will differ for the various groups or all individuals. It would be premature to come to either conclusion for all. As occurred with the change in hospital funding, some premiums increased and some decreased. This is where strategic discussions on how best to mitigate the impact of change must occur and was the impetus for having a specific working group just on creating an effective transition roadmap.

By: Ricky Brathwaite

Ricky Brathwaite — Sat, 21 Dec 2019 04:16:07 +0000

Thats a fair comment regarding pursuing various options. No option is perfect. People point to Switzerland as the gold standard, but it really is so dependent on so many factors as to what types of pieces can work in a country. But your point is taken. The only caveat to what youve suggested regarding letting market forces create the balance is that you cannot guarantee that government could offer a lower price for supplemental because you would still need to take into account whether the people in the different insurance pools can be treated as apples to apples. The larger the pool the better you can forecast cost and reduce uncertainty in your projections. To date the smaller government pools are only able to be kept less expensive despite its higher risk, because the private sector and in extension the broader working public subsidizes with significant millions of dollars. I think the intended point of having the consultation was to have these types of points discussed as what you are saying. Unfortunately to date there have not been alot of solution discussions on the myriad of topics where gaps exist in our system. And part of that is as you may have felt, not the clearest and easiest to understand explanations and messaging at all times.

By: Ricky Brathwaite

Ricky Brathwaite — Sat, 21 Dec 2019 04:01:01 +0000

The intial proposal that was put out to the public modelled covering 100% of the cost of overseas care that was identified by medical staff as being medically necessary. So it was proposed that overseas care would be treated just as equitably as local hospital care as long as it was medically necessary. As you are aware, if you are insured now and go to KEMH for an urgent issue, there are no copay. So in some ways maybe there shouldnt be panalties for needing care that just happen not to be offered on island. So, not sure where the conversation of overseas coverage at 60% or 80% came from as those were not put out for public consultatiob.

By: Ricky Brathwaite

Ricky Brathwaite — Sat, 21 Dec 2019 03:54:58 +0000

Hopefully this is not what was interpreted as the point if the article. The purpose was to provide a bigger view if the intent of the proposed changem The reality is that everyone is getting some type of care now, insured and uninsured. Whether that care is the right care at the right time in the right setting is a totally different issue. But make no doubt about it, when and where someone receives their care impacts us all.

By: Ricky Brathwaite

Ricky Brathwaite — Sat, 21 Dec 2019 03:50:08 +0000

Having a goal of a less fragmented and more efficient health financing system is about everyone and not just those that are uninsured. The money that is currently spent in our system is not done with adequate oversight, accountability or per consistent standards. Theres good in our system but its like puzzle pieces that no one has taken the time to make fit right.Everyone could be getting better value for the money. So this is definitely not just about providing coverage for those that do not currently have it. And i believe that some of that bigger message is getring lost in this notion that this is all about reallocation or shifting of money.

By: Mb

Mb — Sat, 21 Dec 2019 01:13:24 +0000

Seriously Googamuga?? Choose not to be uninsured?? People Don’t want to work?? I don’t imagine this is the case for anyone except those with mental, substance and other issues … but I guess you in your lovely perfect world see that as ‘refusal’
Put your MAGA hat back on and crawl back to your trumpian right wing world, please, if you have nothing constructive to offer in this debate

By: Kevin

Kevin — Fri, 20 Dec 2019 23:11:41 +0000

Unfortunately trying to fix the problem of inadequate healthcare of those who cant afford it and putting the cost on those who are paying for what they want. The down side is those who are paying will have to more for what they want …this is a another fantastic brain child of the plp ….they cant get their way out of a wet paper bag ….they simply should resign if they were employees and had a management team they would have been fired for lack of performance

By: Googamuga

Googamuga — Fri, 20 Dec 2019 21:40:57 +0000

Dr. Brathwaide,
Of the 5000 so called uninsured do you have any way to ensure that they will pay into this new scheme? How many choose not to be insured because they do not want to work but yet want all the benefits? Why should the working people have to pay for those that choose not to work. How do you propose to change that – by changing the health insurance system.
May I suggest that some real costs be given and what the scheme might cover so the public can make an informed decision.

By: Goose

Goose — Fri, 20 Dec 2019 18:40:26 +0000

Medical bankruptcy won’t stop as a result of the Bermuda Health Plan unless it covers 100% of overseas care. The kid in the papers last week had a $300,000 hospital stay after an unanticipated emergency.

If the Bermuda Health Plan contains coinsurance for US care at 80% then he’d have to pay $60,000 out of pocket. If the Bermuda Health Plan only covers 60% then he’d have $120,000 to pay out of pocket.

How many of the 20% that are underinsured or uninsured can afford to pay $50k, $80k or $100k out of pocket to access life saving care in the US? The entire premise for a Bermuda Health Plan collapses if those that currently need the benefits can’t afford to access them.

By: clearasmud

clearasmud — Fri, 20 Dec 2019 15:38:32 +0000

Well written Article but it fails to explore any other options that could reach the same intended goal. IMO a better way forward would have been for the government to establish the new minimum and a price for it, offer supplemental coverage and price it then require the private insurers to do the same. Everyone would be able to see what is on the “menu” and the cost. If private insurers offered the exact same coverage at higher cost then we would see a natural unforced move to the government plan.To keep their customers the private sector would have to lower their cost to be competitive or exit the business, but this would be by choice.
While I think the logic for what the government is planning is sound I am not convinced that they can accomplish it via the route they are taking.

By: sandgrownan

sandgrownan — Fri, 20 Dec 2019 15:12:31 +0000

Curtis is looking at the balance sheet. He’s horrified by what he sees. This is about taking a chunk of healthcare costs off the books because Bermuda is broke.

This is a PLP owned mess.

By: Nunya

Nunya — Fri, 20 Dec 2019 12:18:52 +0000

78% of the working population currently has major medical coverage (as per the Labour Survey released yesterday). This proposed scheme will reduce coverage for that 80% and force them to pay out of pocket for supplemental insurance to ensure that you retain the same level of coverage that they have now.

In other words the vast majority will see their healthcare costs increase under this plan. No long, fluffy articles like the one above will change that basic fact.

On top of that this change does not address the $700mn we pay on healthcare annually. It just shifts the cost onto the already strained taxpaying public.