“Five thousand, three hundred and forty-one persons in Bermuda are without health insurance.”— The Ministry of Health“Our aim is to provide universal access to healthcare through these reforms while bending the cost curve downwards.”— Kim Wilson, Minister of Health So-called free markets left up to their own devices can produce public good, but they can also, at times, produce public or social harm. Our healthcare markets are clearly producing the latter and are certainly broken. Surely, then, when this does occur, only government intervention into these markets can restore balance and equity.It is no secret that the cost of living in Bermuda, driven primarily by the rampant growth of income inequality over the past two-plus decades, has been ruinous. Its major corrosive impact has been on the low and middle-income Bermudian families that have been its chief victims.Foremost among their concerns, has been the extraordinary rise in the cost of healthcare. They are falling behind in their ability to finance their healthcare costs, as it is the aforementioned extraordinary growth of income inequality and its effect on the costs of living eats away at their incomes and that increases their inability to pay for health insurance.The key question of the day is whether the healthcare system, as constituted in Bermuda around a largely American-style, fee-for-service model, is broken?All of the relevant evidence seems to confirm the view that it is, and that evidence, in and of itself, is fairly compelling in making the case for root-and-branch reform as opposed to the mere tweaking of a status quo that is no longer serving the public interest and/or public good.That is why the Government has proposed to place all of Bermuda’s residents into one insurance pool as opposed to the four or five major insurance pools, private and public sector, that provide health insurance coverage for Bermuda’s residents.However, it is proposed that individuals, much like in Canada and other countries that use a single-payer system or variant, who do wish to purchase supplemental private-sector coverage, will be able to do so under the prospective plan that health minister Kim Wilson has touted. The big change under this prospective reform will be that the Government will be responsible for paying healthcare claims. As to the basic consumer and businesses, this reform will provide a significant reduction in premiums for their health insurance coverage, while providing more coverage.There are some countries that have attempted to implement a pure single-payer system, that would provide free healthcare services for their citizens and have, for various reasons, most commonly cost, felt that they could not pursue that option. But note that the minister and her government are not proposing a model that would provide a system of health insurance that would be free.Persons will still, under the proposed model, have to pay a premium to access the health insurance plan or plans that will be likely adopted.The key point is that the coverage will cost significantly less and provide more needed services for the vast majority.However, it is important as the consultative period unfolds that we keep the conversation focused on the broken system itself; with the operative word being “system”.No one, including me, will contend that we do not have some of the most highly qualified healthcare professionals and infrastructure, relatively speaking, in the world. The reality is that we do. Their dedication and professionalism have been exemplary.Tens of thousands over the years have benefited from the standard of care they have provided.We also have private health insurers who have for decades in the postwar era provided a good product to the consumer through their employers with fairly good coverage. Those days are gone and the existing status quo that operated fairly optimally then is no longer sustainable, especially with a population that is rapidly ageing.Bermuda now has one of the oldest populations in the world, with a median age of 44, rivalling Germany and Japan.Accompanying that fact is that the ageing population contributes significantly to a declining health profile of the overall population, as will be highlighted in part two at a later date.Having said that, it is inevitable, if nothing substantially changes, that the private insurers will increasingly face the Hobson’s choice of adverse selection and be, either unwilling to underwrite the risk associated with ageing clients or be forced to offer plans that will result in only the affluent and highly wealthy having access to their health insurance offerings.The latter would appear to be already happening. And that is one of the key factors driving up the cost of private health insurance.In part two, I will more fully examine the model being proposed by the Government as the keystone of reform and seek to demonstrate that this direction is more consistent with best practice globally.In fact, Bermuda and the United States have been outliers in terms of the respective systems in place in both countries.Finally, as to the 5,341 persons without health insurance coverage cited earlier, once one adds in the thousands who are effectively underinsured, and who are mostly on HIP, it represents a full 20 per cent of our population who are either uninsured or underinsured.Stunningly, a full 91 per cent of those persons are black. • Rolfe Commissiong is a government backbencher and the MP for Pembroke South East (Constituency 21)