A remodelled healthcare system focused on outcomes, an independent education authority, moves to lower the cost of living and immigration policies to address the island’s talent gap are among the proposals in an advisory group’s plan for Bermuda’s future.
BermudaFirst revealed Future State Report, the second phase of its national socioeconomic plan, in a press conference at the Bermuda Underwater Exploration Institute yesterday.
The group claims in the report, which was commissioned by David Burt, the Premier, that the priorities it identified “will enhance the lives of Bermudians and provide citizens with the tools and opportunity to realise their full potential”.
The report points out shortfalls, particularly in the island’s education and healthcare systems, and spells out recommendations to address them.
It also challenges Bermudians to show the courage in leadership and willingness to change that is necessary to meet the challenges the island faces.
“If we are going to change Bermuda’s trajectory, we will have to change our mindsets to deal with the social and economic realities of the 21st century: a shrinking and ageing population, an underperforming education system and healthcare costs that are spiralling out of control,” BermudaFirst states.
Philip Butterfield, chairman of BermudaFirst, described the 31-page document as a “guide book” to where Bermuda needs to go to address its challenges.
The report would not just sit on a shelf, he said, as the next stage would involve Mr Butterfield and his colleagues working with government officials to help to bring about positive change.
“The downside risk of not doing the job well is unacceptable,” Mr Butterfield added. “I’m not in the quick-fix business and I don’t believe any of my colleagues are, but I do want to begin serious work as soon as possible.”
BermudaFirst’s roots in lie in a think tank led by reinsurance veteran Don Kramer, comprising business and political leaders and formed in 2009 with the aim of finding solutions to the island’s economic challenges.
The group was resurrected by the Bermuda Government in 2017, this time with no politicians and led by Mr Butterfield, the former chief executive officer of HSBC Bank Bermuda. Other members represent sectors including business, charities, unions and education.
The report identifies four global trends impacting life in Bermuda: rising inequalities, the rapid rate of technological change, tribalism and climate change. Action on education, healthcare and talent/immigration are seen as “critical priorities”.
BermudaFirst said the public education system was failing to prepare young people for today’s job opportunities. “If we fail to act decisively now, our passivity will be viewed as the most significant missed opportunity in the history of the island,” the report states.
It adds that the public education system “lacks accountability at all levels” and calls for an independent authority responsible for performance management of educators and a requirement that all teachers be internationally certified by an approved list of institutions.
The report describes today’s healthcare system as “not sustainable from the perspective of cost, service provision or capacity”.
It calls for changes leading to a patient-centric, outcome-based billing model focused on value rather than price, and including regulation of healthcare providers.
“Bermuda’s model of healthcare must evolve to focus more on outcomes and value and less on the perverse incentives tied to a system that revolves around reimbursement of service,” the report states.
“Any model that simply pays without due consideration of actual results leads to excessive utilisation at an ever-escalating price.”
It calls for a national health education programme aimed at encouraging people to eat better and exercise more, to combat preventable, lifestyle-based diseases that generate a large portion of healthcare costs.
Among its recommendations, BermudaFirst calls for reform of the Standard Health Benefit, the basis of how health insurance premiums are set.
“Instead of SHB solely depending on a fee-for-service model, create a pooling system that aligns residents to insurance packages based on their income,” the report proposes.
“This model will require Government to regulate fees and insurers to establish set rates.”
BermudaFirst believes its proposals would reduce healthcare expenditure by 10 to 15 per cent and result in a healthier population.
The report also touches on the impact of demographic trends and projections that show the workforce will shrink as the non-working-age population grows. BermudaFirst would like to see a “a growing population with enhanced immigration policies that expand opportunities for Bermudians and make Bermuda a destination of choice for diverse talent who will be a productive part of our community”.
The group stated that “in the past, immigration policy and other means were used nefariously to maintain white numeric superiority”, but that today’s immigration policies had to be market-based and diverse.
Some roles in the public and private sector had to be filled by those whose skills and expertise met global standards if the island wanted to remain competitive and innovative, BermudaFirst argued. This would inevitably sometimes necessitate bringing in workers from overseas.
The group’s top three recommendations for immigration reform that would produce “more jobs for Bermudians than the present immigration regime” are:
• Aligning the Government’s goals (eg GDP growth, attractive international business domicile, increased population) with immigration policies
• Shifting the mindset of the Immigration Department so that it recognises the needs of the business community, and the balance BermudaFirst is seeking to achieve
• Resolving the issues associated with family and long-term residency
Another priority was lowering the cost of living, particularly by decreasing the costs of staple food items, energy, healthcare and rents.
It suggested that the Government could help by reviewing tax policy as taxes contributed to the cost of items such as energy and food.
Other priorities mentioned were moves to strengthen the island’s charitable sector, the provision of affordable housing for at-risk populations, a better transportation system including public and private elements, amendment of the 60:40 rule to stimulate inward investment, and implementation of a debt management programme to deal with the Bermuda’s currently “unsustainable” debt level.
“Quick-win” recommendations include liberalising ownership restrictions on commercial real estate to encourage a positive response to economic substance requirements, allowing hotels to have a minibus licence and allowing the importation of second-hand electric cars.
Eight working groups and more than 90 people worked on the BermudaFirst project.
“I would argue with anybody that our set of recommendations are the appropriate solutions to many of the issues that challenge our society,” Mr Butterfield said.
He was optimistic of political and community support for the changes. Step one was a meeting with Diallo Rabain, the eduction minister, yesterday lunchtime, he said.
“We’re in this for the long haul,” the chairman added. “We recognise that we are not elected officials. We do know that we have opinions and points of view based on our experience that we think are worth sharing.
“To the extent that there are opposing or competing points of view, they can be reconciled. You can build bridges on parallel paths.”
• To view the Future State Report, click on the PDF link under “Related Media”