May 17, 2019

The status of that is that the consultative proces s was undertaken by the Ministry of
Labour, Community Affairs and Sports. It is something that touches two ministries.
The fact is that it was a part, as you will know
. . . (Sorry.) Maternity leave is inside of the Emplo yment Act, and the Government’s intention is to bring
amendments to the Employment Act in this sitting pr ior to Cup Match.

Supplementary? No.
Mr. Premier, the next questions for you are
from the Opposition Leader in reference to your third Statement, the tabling of the government reform.
Opposition Leader.

QUESTION 1: TABLING OF GOVERNMENT
REFORM STRATEGIC PLAN

Hon. L. Craig Cannonier: Yes, thank you, Mr.
Speaker.
On the last page, page 4 —I might add that I
was glad to hear this Statement being made—the
Premier makes reference to performance appraisals,
reviews. And in the second- to-last sentence there [it
says], “A subsequent series of workshops will address
the establishment of key performance indicators
and/or performance measures.”
I am aware that there are certain departments
within government [in which] appraisals, reviews are
not required. Is it the intent of this Government, at
some point in time, through negotiations with the unions, to establish something like that, which will go a
long way in ensuring that we have accountability wit hin many of the departments? The Speaker: Thank you.
Premier.

Hon. E. David Burt: Thank you very much, Mr.
Speaker.
Mr. Speaker, I thank the Honourable Oppos ition Leader for his question. I do not know specifically
if I am able to answer it right now. What I can say is
that I would share his view and vision that, in order to
have an effective public service, there should be a ppraisals at all levels for all public officers.

Okay. Thank you.
Premier.

Hon. E. David Burt: Mr. Speaker, I am happy to give
that undertaking to the Honourable Leader of the O pposition. As I said in my previous answer, I support
the general premise that all public officers should be
subject to appraisal because that is the best way to
make sure that you manage and improve performance.

Thank you.
Any further supplementaries? No further
ques tions.
Premier, on the same Statement, you have [a
question from the] MP from constituency 19. MP
Atherden would like to put a question to you.

QUESTION 1: TABLING OF GOVERNMENT
REFORM STRATEGIC PLAN

Hon. Jeanne J. Atherden: Thank you, Mr. Speaker.
Mr. Premier, on the same page, page 4, there
is a statement that indicates that this Government has assessed employee readiness for change and ident ified obstacles such as being an overly bureaucratic
environment with a weak execution model, and deliberately put in place the building blocks to enable the
service to move towards a shared vision and purpose.
Is it possible that you might, for this House
and also for the people in Bermuda, perhaps expand on some of the building blocks that you have put in
1556 17 May 2019 Official Hansard Report

Bermuda House of Assembly place? I did try and look at your February 2019 Go vernment Reform Report, but it is not posted.

Thank you.
Premier.
Hon. E. David Burt: Thank you, Mr. Speaker. I am
happy to share on that.
One of the things of which we found, and it
was probably a bit of sobering reflection, is that there
is a survey done of public officers. And one of the things that had come back in comparison—of the
Government of Bermuda in comparison to other governments, both local and national, globally, is that we
were judged to be underperforming in just about every particular area. And the thing that was said was that
there was an overly bureaucratic environment, difficulty in advancing decision- making effectively, that things
have to go all the way up the chain before they can
come back down the chain.
And so, what it was looking at is making the
civil service nimbler and more flexible, possibly flatte ning the decision- making process, in order to make
sure that things could happen more quickly.
So, when we are talking about delivery and
putting in place building blocks to enable us to move
toward a shared vision and purpose, that is what this process is about. But I think also, what we are talking
about ultimately are some of the work streams ––
which will s ee in the document, which are tabled–– we
are talking about how do we flatten the decision-making process inside of various departments and
give line managers the ability to better make decisions as opposed to those things having to go all the way up
the c hain and back down.

Continue.

SUPPLEMENTARY

Hon. Jeanne J. Atherden: As part of the Statement
that I read, and thank you for expanding on the building blocks in terms of execution, in terms of overly bureaucratic, the other side of it was a weak execution
model. So, I wondered whether you might want to expand on that? And as I said before, the report is not
on www. parliament.bm yet.

Thank you.
Premier.

Hon. E. David Burt: Just so I can help the Honour able Member, the weak execution model and what I
just stated about the bureaucratic thing are one and the same. This prevents the ability to execute quickly
because of the fact of the challenges with being able
to make decisions, and also to make changes when
things are not necessarily working.

Yes.

QUESTION 2: TABLING OF GOVERNMENT
REFORM STRATEGIC PLAN

Hon. Jeanne J. Atherden: On page 2, it talks about
project teams. And part of the way down, it talks
about, “The officers will complete the various tasks
associated with delivery of each project.” I guess my
question is, too often, we see reference to tasks rather
than goals that we hope to achieve. And I wondered whether there is going to be any sort of change in
emphasis so that instead of telling everybody about all
of the tasks that are going to be done b y the project
teams, there is some identification of what will be
deemed a success? And I just wondered whether we
are going to get towards success rather than just work?

Thank you.
Premier.

Hon. E. David Burt: Thank you very much, Mr.
Spea ker.
Mr. Speaker, that is exactly what was meant
in my Statement when we speak about the “current
state” and the desired “future state.” That is where the
ultimate goal and the vision are. And the tasks are built upon getting to that particular future sta te that
has been defined.

Yes.

SUPPLEMENTARY

Hon. Jeanne J. Atherden: And on that same Stat ement, it is talking about the comprehensive communication plans as being developed to ensure that all
stakeholders are aware of and understand the impl ementation plans, and regular updates will be issued. I just wondered whether, as a Government , there might
be sort of some deliberate plan that says, Periodic
updates will be quarterly, monthly, or something, beB ermuda House of Assembly cause we always hear about updates. But unless you
ask a question, you are really reliant on the ind ividual,
the person who is responsible for the project or the
plan, the Minister, to decide when it is time to come
forward.
But if you had something regularly, then the
public, as well as the House, will be anticipating. It will
be on a monthly basis, a quarterly basis, and will even
prod people to get it on time.

Thank you, Mr. Speaker.
At this point in time, I do not want to commit to
a specific timeline for the release of updates to this project. What I can tell you is that the work has al-ready started. It was my specific recommendation that there be some form of dedicated team. We do not
want this to fall by the ways of previous items of public
service reform where persons have shared resources and are not dedicated to this particular matter on a full-time or a close to full -time basis. That is the way
we are doing it. The information is being communicated to stakeholders, whether those are our union par tners, whether those are the employees, but also to
the general public. And when the communications plan is finalised, which was laid out here, I will make sure to . . . I am sure that the public officer is listening,
but I will be sure to try to make sure that it includes a
schedule for the updates so that people can have that
expectation of how often updates will be issued.
Hon. Jeanne J. Atherden: Thank you.

Okay. Premier, you are going first.
Premier, you have the floor.
Hon. E. David Burt: Thank you very much, Mr.
Speaker, and good morning again. I thank my Ho nourab le Minister today for yielding.
I want to, of course, start off, and I will assoc iate the entire House, because I am sure that ever yone wants to extend congratulations to the graduating
class of 2019 of the Bermuda College. I know that
there were a number of us who were in attendance yesterday. And it was moving to see so many st udents not only graduating, but graduating with merit and distinction. And for some, they were the first in their families to attend college. And for others, and I think [we are] particularly proud for this Government, is that for 32 of those students, a Bermuda College education was made possible due to financial support
that was offered by this Government, Mr. Speaker.
One of the first things that we did when we
came into office was to make sure that we increased
money, financial assistance, to people attending the
Bermuda College. And we said that your bank ac-count should not determine your access to higher e ducation. There were many students on dual enrol-ment, which is a PLP creation, as well as, I would say, mature students who are now going back and taking heed to upgrade their skills. I even found out that a number of persons are current government emplo yees who are also taking the opportunity to make sure
that they can upgrade their skills and get certifications
behind them.
What I also want to say, Mr. Speaker, is that I
want to express my well wishes and pride for 18- yearold national football player, Kane Crichlow, for signing
a two -year contract with premiere team Watford FC.
We have seen Kane develop to the ranks of Berm uda’s national team, as he is captain at both the Under -
17 and Under -15 levels, and he is an inspiration for
our younger athletes, and to many of us adults, as
well, as to what hard work, determination and persistence look like. I want to say congratulations to Kane,
his family, his coaches for their role in getting him this far. And we wish him all the best in his future football career.
Mr. Speaker, finally, I wish to extend well
wishes, again, to Lornell Taylor, this year’s Inspiring
Woman in ICT [Information and Communications
Technology]. This is an award that is given out every year, and she is leading the way for Bermuda’s young girls in technology. And I want to extend congratul ations to all of the participants in this year’s Girls in ICT
competition. Mr. Speaker, it is estimated that over the next 10 years, there will be two million jobs globally that will not be able to be filled due to a lack of r esources in IT.
In Bermuda, we see that there are many pe rsons who are coming into the country on work permits
due to the lack of talent that we have in ICT. And what
we are committed to do is to make sure that we not only promote this as a viable industry for men, who have traditionally been in it, but also young women, as
well.
So, I am proud to see so many of our young
people interested in careers in IT, and this Gover nment will continue to ensure that these young people have every opportunity to fill the IT jobs on the Island. Thank you, Mr. Speaker.

Thank you, Mr. Premier.
1558 17 May 2019 Official Hansard Report

Bermuda House of Assembly I recognise the Minister of Health.
Minister.

Hon. Kim N. Wilson: Thank you, Mr. Speaker.
Mr. Speaker, I would ask that this House join
with me in sending condolences to the family of
Frances H. Eve Lister. I woul d also like to send condolences to both yourself, as well as the Honourable
Member from constituency 28, who obviously share the same name and relationship.

Thank you.

Hon. Kim N. Wilson: Ms. Frances Lister, who was
the wife of Allan Lister, who predeceased her, who
was actually a Chief Inspector of the Police, and act ually served as a Black Rod here, for some of the
Members who perhaps may have been here at that
time, was a long- standing member of Allen Temple
AME Church. We referred to her as Mother Lister,
actually, because of her eloquence, as well as the
stature which she commanded at the church.
In addition to that, Ms. Lister was a long- term
employee of the Bermuda Post Office here in Hami lton, working within the administration office. She
leaves to mourn, Mr. Speaker, her children, Karen, who predeceased her, as well as Allison and Conrad; four grandchildren; and one great -grandchild. And of
course, one of the notable grandchildren of hers is Mr. Roy-Allan Burch. I would ask that we send condolences. Our thoughts and our prayers are with the Li ster family, as well as yourself, Mr. Speaker, at this time. And I would like to associate my honourable col-league . . . the whole House, Mr. Speaker. Thank you.

Thank you, Mr. Speaker.
I rise on my feet on a joyous note, because I
think that if it is not a world record, I think it is a t least
a Bermuda record for the PHC Zebras, who won the
Premier League for the 12
th time, Mr. Speaker, which
is more than any other Premier League team here on
Island. And this was the second time in a row that we
have won it. But we did not just win the Premier
League, we won the Friendship and the Charity Cup,
Mr. Speaker. So, I think that this is almost . . . well, I
think it is a precursor of what is going to happen with Cup Match, where Somerset is going to win once again.

[Inaudible interjections and laughter ]

So, Somerset will take the
Cup this year. But once again, it was a hard- fought
year. It was a hard- fought c hampionship that we did.
And we cannot and will never forget Muzzy. We did it
for Muzzy. And once again, I would like to associate
the whole House with that, for the 12
th time. MP
Weeks says he does not want to be associated, but
that is okay.

[Laughter]

Thank you.
I now recognise the Member from consti tuency 19.
Member, you have the floor.
But the Minister has got a bad leg, so he is
moving a little slowly. I will make sure that I watch him closely the next time.
Hon. Jeanne J. Atherden: Thank you, Mr. Speaker.
I will start off with what I call the congrats. I
would like to have congratulations sent to the Kardias
Club, who on the weekend had their “Tea with a
Twist,” which is a fundraiser, a fashion show. It was
well-received by all of the guests. It is one of those
[events] where you have lots of hats and finery. But
also, the nice part about it is that the beneficiary this
year was the Family Centre. And they are one of the
organisations that I have a special feeling for. And I
want to say congrats to them.
On the sad side, I would like to have c ondolences sent to the family and friends of the late Phil omel Ahern, “Phyllis,” as we all knew her. I got to know
her when I was Director of Finance at the hospital.
She was one of the supervisors. She was one of
those individuals who performed well, and then when
she left the hospital, she started to do private work in
the community. But she was best known, from my
perspective, as being a golfer, a very proficient golfer, and one of those individuals who would always lend
assistance to new golfers to try and get them involved.
So, she will be sadly missed. But at least she was 89.
And I think that, you know, is pretty good. And if condolences could be sent to her family. Thank you, Mr.
Speaker.

Thank you, Honourable Member.
Minister. Everybo dy else decided it is your
turn. How is that? No one else jumped to compete
with you that time. Go ahead.



Bermuda House of Assembly Lt. Col. Hon. David A. Burch: Thank you, Mr.
Speaker.
I would like to be associated with the congra tulations, in the wider context, to those graduat es at
the Bermuda College yesterday. I particularly, though,
want to take note of the nine me mbers of the Ministry
who graduated, two of whom I will name, Dean Smith
and Danny Paynter , who graduated with distinction,
and four others with merit . They were s upported in
that effort by the Ministry. And so, I am not sure
whether those figures were included in the numbers that the Premier mentioned. But the Ministry did support them, and we congratulate them.
Mr. Speaker, I would also like to just record
for the record that, I guess, one of the most pleasant
tasks of being a Minister is actually going to retirement
parties for people who have served not only in go vernment service, but the people of Bermuda. And so, this week, I had the occasion to attend a retir ement
celebration for Mr . Brexton Outerbridge, who served in
the Ministry of Public Works for 40 years. And in my
remarks, Mr. Speaker, thinking about this, I asked
how many of those people currently at work were born
in 1979 when he started? And about hal f of them put
up their hands. So, I encouraged them, if they could
serve for half of his time, because we struggle to get
people to serve for four years, let alone forty, in this day and age, that they would be able to, you know,
have that sort of celebrat ion as well.
But, Mr. Speaker, one of the comments that
folk made was that, whilst he was short in stature, he was tall in integrity, and he stood up for his rights as a
worker at Public Works. And so, it was quite encour-aging and pleasant to see that a l ot of the young folks
who work at the Marsh Folly Depot with him were not
afraid to stand up and say that he had helped them in
their journey and employment at Public Works , and
not only by his example, but by his willingness to give
them advice and to enc ourage them. So, I extend
congratulations to him and wish him a happy retir ement for his 40 years of service to the government
and people of Bermuda. Thank you, Mr. Speaker.

Good morning, Mr. Speaker.
I would like to sadly start off by sending condolences to some of the families of a few of my constituents . Mrs. Marjorie Kathleen Mathews , of 8 Spice
Hill Road; Mrs. [Loretta Dennison Viola] Morton, of
Stacey Estate Road in Warwick; and Mrs. Smith of
Sun Valley in Warwick. I would like to send cond olences to their families. Also, condolences to a friend
of mine who–– unfortunately, I have not bee n in the
House since he passed, young Antoine Seaman, a teammate of mine of the Somerset Trojans who died
recently in a bike accident.
And also, to associate with the comments by
Minister Wilson, for my great -aunt, Frances Lister,
who passed away last week. Unfortunately, I did not
get a chance to see her just before. But I will always
remember, growing up, living next door to her. I r emember the good times that we had growing up,
swimming in her pool. As she mentioned, Roy -Allan
Burch who swam and represented Bermuda in the Olympics, we learned to swim together in that pool. I beat him a few times, but he would never admit to
that.

[Laughter]

But, yes, I would like to send
condolences to the family.
And on a lighter note, congrat ulations to (as it
has already been mentioned by the Premier ) the
graduating class of Bermuda College, the Class of
2019. I wish them many successes in their endeav-ours. Also, to the young Kane Crichlow for signing for
Watford in the Premier League. Hopefully, he can go
on to have a successful career and represent Berm uda. And also, to the Last Call singing group, Tricray
and Adrian. They have, over the past few weeks and
months, been the number -one top song on the Bil lboard 100 gospel list. So, they have r epresented
Bermuda very well in the music industry.
And lastly, next week, Sunday, a constituent
of mine, Ms. Maud e Gwendolyn Bassett , will be celebrating 100 years. So, I would like to send her birt hday congratulations for May 26 when it comes.
Thank y ou, Mr. Speaker.

Thank you, Honourable Member.
I recognise the Honourable Member from
constituency 10.
Honourable Member Dunkley, you have the
floor.

Hon. Michael H. Dunkley: Good morning, Mr.
Speaker. Good morning, colleagues and the list ening
audience.
I would like to start out by offering sincere
condolences, as my honourable colleague from con-stituency 19 did, to the family of Phyllis Ahern on her
recent passing. I first knew Ms. Ahern when she was
actually, I think, the head nurse at the hospital. And
then, as I learned golf when I was younger, she was very active, as MP Atherden said, in the golfing circles
in the community. So, she will be not only a real loss
to family and friends, but to [the] greater good she
served. She probably touched as many people in the
community as anyone we know through her work at the hospital and golf. So, may she rest in peace.

1560 17 May 2019 Official Hansard Report
B ermuda House of Assembly I would like to ask that this House send condolences to the family of Donald Frederick Stailey, or
“Freddy” Stailey, as people called him. I think the
Honourable Minister from constituency 6, where Mr.
Stailey lived, would like to be associated with this. I have known Freddy for many, many years. Many people probably know that he was one of the truck
drivers for the Supermart on Front Street for perhaps
40 years. But [he was] very involved in the farming and animal community in Bermuda. He got involved in a piece of property down there just close to Shelly Bay. And his house was really —I think the tribute gi ven by Thad Hollis said that he had more animals than
the ark ever had, down at his property. And that was true. Freddy was always around animals.
What a wonderful human being, a person who
could talk to anybody. He was a pleasure to be around because he was always very interes ting to talk
to. And it was a very heartfelt eulogy [given] by his
good friend, Terry Lamb, who was also suffering with
a disease in stage 4 brain cancer.

Wow.
Hon. Michael H. Dunkley: To see those two come
together and care for each other was a touching tri bute to the Stailey family. Condolences on the passing
of a good man.
I would like to be associated with the congra tulations to all of the students at Bermuda College.
And certainly, I think it is appropriate that the House
congratulate all of the schools and their passing- out
graduation parades this year. It is a tremendous achievement, not only to win awards, but to be able to graduate qualified in your certain area of study. So, congratulations to the young men and women who
have done t hat.
And as colleagues have said, to Kane
Crichlow for being signed on at Watford. Many young
men and women dream of getting in their passion, and football is one that many young men have in
Bermuda. But to see another young Bermudian have
a contract with a top- flight team over in the UK is pos itive, and also to be a role model for young Bermudi-ans who believe that they can get there. And I think that we should send congratulations to all of those individuals who helped Mr. Crichlow and other young
people along the way, because it takes a lot to get
there. His skills and his stick -to-it-ness have helped,
but [also] all those individuals [who helped] along the
way.
And, Mr. Speaker, lastly, I would like to send
congratulations to the Bermuda Motor Sports Hall of
Fame, which launched its hall of fame over this past
weekend. I am sure that all Members of the Honour able House would like to be associated with this. I am well aware of the work that they do, but now they rec-ognise each other. [
Timer beeps]
The S peaker: Thank you, Honourable Member.
Hon. Michael H. Dunkley: That is great, Mr. Speaker.

Thank you, Mr. Speaker.
Good morning to you, and good morning to the public.
Mr. Speaker, I would like to start off my r emarks by wanting to be associated with the remarks by the Honourable Premier for the recent graduates up at the Bermuda College. Mr. Speaker, in particular, I want to congratulate Ms . Sha rmila Harris , one of my
constituents. Her family, historically, Mr. Speaker, has really been very much in support of me in my 10 years
in this Honourable House. And I have seen Shar mila
study , and work and study and go through the hard
times. Bu t for her to get her four -year degree yesterday up at the college, I want to congratulate her. And I
take my hat off to her, Mr. Speaker.
Mr. Speaker, I also would like to be associated with the remarks from the Honourable Whip. I would be remiss, Mr. Speaker, if I did not rise to my feet asking to be associated. (Especially after his r emarks, I would not want to be associated.) But the mighty PHC deserve all of the accolades and congrats
regardless of the teams that we others support and
represent.
Mr. Speaker, also, before I take my seat, I
want to be associated with the remarks for young Kane Crichlow and his signing of a new football co ntract over in England. That accomplishment goes a
long way, Mr. Speaker, in encouraging our other
youngsters that dreams, with hard work, can come true. So, I wish him well. And I hope that he can e ncourage, through his actions, other youngsters who aspire to the same thing.
Thank you, Mr. Speaker.

Thank y ou, Mr. Speak er.
I rise this morning to send congratulatory r emarks to Christian Dunleavy. He recently was ap-pointed CEO of Aspen Bermuda. I would like to ass ociate my colleagues, Ms. Pat G ordon- Pamplin, and
Jeanne Atherden. This is a young Bermudian, a very young Bermudian, who started off in reinsurance, very
unassuming, did what he had to do. And he is bearing
results. And so, I would like to commend him on be-half of the House for his achievements in this field.
I
would like to also associate myself with the
comments made in regard to Ms. Lister. The last time I had a good conversation with her was at my father -


Bermuda House of Assembly in-law’s viewing. And we chatted and chatted. And
then she says, You know, I am from Devil’s Hole. And
I knew your mother and your aunts really, really well. We are Devil’s Hole girls.
And even though she lived in Somerset, she
believed in her roots. So, it was a very interesting
conversation.

I would like to also associate
myself with the comments in regard to Freddy Stailey. As you know, I am an equestrian. And his fields were
just across the street from where my horse is kept. And many a morning, I w ould go out, and he would
say, Mr. Simons, you’re late today! You’re late! Your
horse has been waiting for you. And so, he was really
keen on the sport and animals. And the funny thing is
that I have been told that when he knew that he could
[no longer] take care of his animals he did the humane thing and put them down so that they would not be a
burden to anyone and so that he could assure himself
that they were taken care of at a standard that he
could take care of them.
I would also like to associate my self with the
comments made in regard to the graduates of Berm uda College, and I would also say the Mount St. Vi ncent programme. I think Bermudians should reme mber that they are able to get a full degree here in Ber-muda through the relationship with the Mount St. Vi ncent programme. So, again, congratulations to the
students and also congratulations to the faculty and staff members.
We also should acknowledge the dual enro lment students, because you had students graduating
from college before they graduated from high school!

So, again, this is a wonderful
achievement. And it speaks well for what is going on
in education here in Bermuda.
And then, I would just also like to
acknowledge the seniors. There were a number of seniors who graduated yesterday, and they were so proud. They [made] career changes. And I remember
one lady who was in the culinary arts. She was so
enthused by her success, and she is about to start a
new catering business. She was featured a f ew weeks
ago in the newspaper, and that is why I remember her. But she was so thrilled. Thank you, Mr. Speaker.

Thank you very much, Mr.
Speaker, and good morning, all.
Mr. Speaker, I certainly want to be associated
with the congratulations to Kane Crichlow, specifically,
because his family have their homestead in my neigh-bourhood. But the reason why I certainly want to give
congratulations is because I know the efforts that his
parents put in and the sacrifice that they made to get
him to the place he is now. I certainly do wish him
well. But I certainly think his parents should take a lot
of those congratulations, as well.
Mr. Speaker, last week I had the opportunity
to attend the sports day at Lorraine Rest Home. It is
about the 10
th year in a row that they have had it. It
started out with just the Lorraine Rest home.

Just making sure. And I will be
joined by probably a lot of my colleagues here, as
well.
But, Mr. Speaker, let me say that it is a well -
run event because what they do is they invite all of the
other rest homes of the Island. And the competition
here is very stiff. So, I am not looking f orward to act ually going there myself.

[Laughter]

The operative word. But I
would also like congratulations to go the MC for the
day, Ms. Linda Mienzer , who keeps it very lively and
keeps things on track, as well.
Mr. Speaker, on a sad note, I will ask that
condolences be sent to the family of one of my former
constituents, Mr. Raymond Lauder. I also know him as “Jack.” He is from Kings Land in South Shore. Mr.
Lauder was very promi nent, and I will associate the
Honourable Member Scott, his neighbour, as well. Mr.
Lauder was very popular because every time I would go out canvassing in the area, I would always get a
two-for-one, because he would always be at one of
the neighbour’s houses where I was at.
So, I was able to canvass him and the neig hbour at the same time. And I think he will be sorely
missed by his family and friends.
Thank you very much, Mr. Speaker.

Thank you, Mr. Speaker.
I just want to rise and send out some congratulatory notes. Last week, Saturday evening, Summerhaven celebrated a casino night at the Bermuda
Aquarium . They were generously gifted the location,
and they were able to bring together a very healthy
and happy group of people, who certainly got a warm -
up with Crown and Anchor, so warming up for Cup
Match. And it was very well supported. I would like to
send congratulations to the Summerhaven team. They
did an amazing job with the catering and all of the entertainment. The music was great. And I certainly look forward to future fundraising events that are hosted by
Summerhaven.
In addition, I would like to send out congrat ulatory remarks to a constituent, who is an entrepr eneur. His name is Alex Jones, and he began iRepair,
which is a store that works with and fixes electronic devices. And he started on Court Street, and he has
since moved to the Washington Lane. He employs
about 10 young staff. And just recently, he has now
expanded to partner with CPR, which is Cell Phone
Repair, and they have stores and support throughout
the Caribbean. So, just to see a young entrepreneur growing and expanding in Bermuda is just a positive
note. And I wish all the best to him and to his team.
Finally, I would like to be associated with the
Bermuda College graduation. I had the privilege of
sitting on the Bermuda College Board for a little bit.
And I certainly appreciate the work that [is done by]
the staff and the faculty and the administration who
support these young people as they begin and conti nue on their journey of higher education. I wish all the
best to the Bermuda College. I look forward to a full
enrolment in the f all, and I support all the students
whether they are here in Bermuda, traveling overseas or entering into or continuing at the Bermuda College
in the fall. Thank you, Mr. Speaker.

Thank you, Honourable Member.
Now I recognise Minister Caines . Minister,
you have the floor.
Hon. Wayne Caines: Mr. Speaker, I would like to
send congratulations to the following people: As you
know, His Excellency held the Honours and Awards
Ceremony at Government House on Wednesday night
past. The Queen’s Certifi cates and Badges of Honour
were given to Ms. Meredith Ebbin for her literary work
in journalism; and Mr. Janeiro Tucker, Somerset’s
great batsman.

Yes.

Hon. Wayne Caines: And Mr. Sean Tucker, for his
service in radio journalism, as the Voice of Summer,
Mr. Speaker.
The Bermuda Police Service Long Service
Award recipient of 30 years, Detective Constable
Lennox Ince; 25 years of service, incoming Deputy
Commissioner Darrin Simons; also for 25 years, Constable Courville Hilton; and Constable Richard Merritt .
The award for 15 years of service in the Bermuda R eserve Constabulary was Section Officer, Mr. Karim Huey ; 18 years of service to the Bermuda Department
of Corrections, 18 years Principal Officer Attiba Tuc ker; Divisional Officer Luce Tride- Sterling Martinez;
Officer Carmel Amory; Officer Rajay Bean; Officer
Royden Grant; Offi cer Gladstone Headlund.
The Royal Bermuda Regiment Longstanding
Award recipients, first clas s of the efficiency medal,
Colour Sergeant Shantay Arnold and Sergeant Ke nneth Byron. The Commissioner’s first class in efficie ncy medal also went to Captain Alvin Harvey .
Thank you, Mr. Speaker.

Thank you, Minister.
The Member from consti tuency 2. I believe
you have the floor to yourself.

Hon. Hubert (Kim) E. Swan: Yes. Thank you, Mr.
Speaker.
Mr. Speaker, I would like to be associated
with the condolences that were offered on the passing
of Ms. Phyllis Ahern, whom I had known for nearly 50
years through golf. As was mentioned, she was very proficient and loved golf. She hailed from Ireland. And
if there was ever a person who came to Bermuda who
was an example of how persons should interact and integrate and contribute to better racial relations in
Bermuda, I think Ms. Ahern would be right up there amongst them. And I just want to say how much I
benefited from knowing her, how positive she was in
my development, with encouragement. And I know
many of her friends are also my friends who wou ld
attest to what I just shared about this very fine lady.
Mr. Speaker, I would like in the celebration of
this graduating season to associate myself with all of
the congratulations being offered to the graduates of
the Bermuda College. But add young Cana an Ming,
who was out there in Nebraska, from St. George’s,
who went to school with my daughter way back when
in primary school. And also, Honourable Member, MP Ming, I am sure would want to be associated with this,
as her son was part of that group, and hi s parents
Johnny and Carol Ming are very proud, as we are, of
their son.
Also, Mr. Speaker, I would like to recognise all
of those Belizeans out there, of whom my wife is one,
around the world and in Belize, whose government
successfully put forward a ref erendum for a long outBermuda House of Assembly standing issue that dates back to the 1850s. But there
is 90 -plus per cent agreement that a long- standing
land dispute between two neighbouring countries
should be settled by referenda, of which Britain was
very much a part. It was fi nally taken with agreement
that it would be taken to an international court. So,
congratulations to the people of Belize and the Belize
Government for handling this, Mr. Speaker. Thank
you.

Thank you, Honourable Member.
I recognise the Honourable Minister. Minister
Foggo, you have the floor.
Hon. Lovitta F. Foggo: Thank you, Mr. Speaker.
Mr. Speaker, I rise to join in the chorus r egarding the congratulatory remarks for all Bermuda
College graduates. And I can say that this Gover nment is showing how much progress we are making in
terms of meeting the people’s needs. When, one, we
look at the dual enrolment programme and we look at many of the seniors, senior persons or senior students
in terms of their age in comparison to young people
who ar e taking part of –– taking a part in retooling, reeducating themselves. And so, it is important to point
that out, Mr. Speaker. And again, this Government put
up $300,000- plus to ensure that we would assist people with their tuition. And so, it is panning out in a
positive way.
Mr. Speaker, on a sad note, I would like condolences to go to the Pitcher family with the passing of Mr. Glenn Pitcher. I would like to associate MP Kim
Swan, MP Renee Ming and Minister De Silva with these remarks, Mr. Speaker. Glenn was, I guess, very
well known when it comes to operating major big v ehicles in construction. And I think perhaps he even
worked under, or with, Minister De Silva. But in terms
of the work that he did throughout this Island, he will
always be remembered. And definitely, when it comes
to the St. David’s community, he will be missed, i ncluding the St. George’s community, Mr. Speaker,
because he is known very dearly to all of us. And I
see my colleague coming back. I am sure he is going to add more to what I have had to say.
Thank you, Mr. Speaker. On that note, I will
take my seat.

I would just like to also be assoc iated with the comments for the graduates of Bermuda
College. I think it was phenomenal what we saw this year with regard to the graduates. And I just want to
highlight three who are well -known to me. And they
are young women who are well -known to me. And I
sort of look forward to whatever their progress is going
to be. And that would be Ms. Alnike Looby ; Ms. Tam iyah Durra nt, who is actually going on to do a two- year
internship at Marcus’s because she is studying to be a
chef; and Ms. Kadijah Burrows , whose mom is so
proud of her.
Also, Mr. Speaker, I would like to be associated with the comments for Kane Crichlow. Suzette and
Craig Crichlow were both in my year at Berkeley. And
so, you can imagine, as ex -Berkeleyites and friends,
we, the class of 1988, we are extremely proud of his progression in athletics. I would also like to associate
Minister Foggo with that.
And although this has been said, Mr. Spe aker,
I am associating myself with the comment from last week, and that was for the retirement of Herbie Si ggins from the Bermuda Aviation. He spent his last 13 years at JetBlue, but if you have a conversation with
him, you will find that he mentored many of our young
people who are involved in aviation today. So, we
want to wish him well. I still speak to him, and I know
that I am sure he has a huge honey -do list at this
stage to which he said yes. And I would also like to
associate Minister Foggo with those comments.
Thank you, Mr. Speaker.

I want to congratulate Mr.
Cal Blankendal for taking over the Bermuda Cricket
Board. Okay, I associate the whole House.
Also, I want to congratulate the graduates.
Forty of the graduates graduated from the Technical Division, which is very good to see. And I am going to
call a few people by name: Ms . Chelsea Ray graduat1564 17 May 2019 Official Hansard Report

Bermuda House of Assembly ed from the Mount St. Vincent University programme.
Cameron Holder , of Devonshire, graduated from the
Culinary Arts . Shakur Looby , of Smith’s, graduated
from the carpentry programme. Ms. Karen Simmons
graduated from the Mount St. Vincent programme.
And Mrs. Shawnette Perot who graduated from the
Mount St. Vincent programme, as well. And what is
encouraging, Mr. Speaker, is to see persons my age
or older going up there. And it shows that it is never
too late to go back to Bermuda College to take advantage of the opportunities. Thank you, Mr. Speaker.

Yes.
Hon. L. Craig Cannonier: Yes. I want to echo the
sentiments to the Bermuda College. Every year, we
have the opportunity to speak to the success of the
college and the success of the leadership there, led
by Dr. Greene. I took note of several things that stood
out this particular graduation which took place yester-day. Number one was the ir attention to the environment.
Every year, quite frankly, I was a little disa ppointed, and I look forward to the fact that you see all of these balloons and horns and all kinds of things
going on there. We certainly had horns this year, for
sure. But quite festive, the graduation, when you see
the extent to which they go with the balloons. However, the school has made a decision that it would not
endanger the environment, by not having balloons. And so, I congratulate them on making that move, Mr.
Speaker.
The other thing that was very evident from the
graduation was the fact that there was a lot of emphasis on the trades. And we have always talked about
the fact that it is important that we continue to train our
young people in the trades. And quite frankly, anyone,
all of us who have had to hire a plumber for our
homes, I am not sure why we are not encouraging our young people to get into some of these trades, because I know the money that I pay to a plumber. And I
am like, Well, whoa! There are some serious hourly
charges there.
[Inaudible interjection]
Hon. L. Craig Cannonier: We all need to become
plumbers, eh? Or electricians.
[Laughter]

Hon. L. Craig Cannonier: But in particular, electr icians and plumbers, I am always amazed that —
[Inaudible interjections and laughter ]
Hon. L. Craig Cannonier: Yes. I am always amazed
at the living that can be made by such professions.
So, it was good to see that young people were graduating in the trades at the college.
And then, I want to go on to congrat ulate Dimitri Packwood , who spoke on behalf of the graduation class of 2019. She probably has a career in also
being a comedian. She started out by saying that her
speech was going to cover the basics like a skirt, but
be short enough to get your attention . And we all went
into a pretty big uproar laughing at that.

Yes.

[Crosstalk]

[Pause]

Hon. Zane. J. S. D e Silva: The light just came on.

Hon. L. Craig Cannonier: Yes. Okay. Thank you.
In addition, I also would like to congratulate
and thank the Worshipful Juan Wolffe for his keynote speech that he gave. And he made some pretty pr ofound short quotes. And on e of those was, Do you . . .
And I appreciated the fact that he was encouraging our young people to be themselves.

[Timer beeps]

Hon. L. Craig Cannonier: That cannot be right.

[Laughter]
Hon. L. Craig Cannonier: Apologies, Mr. Speaker.

You wrap it up.
Hon. L. Craig Cannonier: Thank you, Mr. Speaker.


Bermuda House of Assembly Again, going back to the college and the good
work that it does, it is always amazing every year to
see the number of Bermudians who are graduating
from the college there, but also those from years ago
who are senior members within the community, like the Worshipful Juan Wolffe, who had been through
the Bermuda College. And so, congratulations again
to Dr. Greene on her fine job this year.

Thank you.
Now I recognise the Honourable Member from
constituency 36.
Honourable Member.

Hon. Michael J. Scott: Thank you, Mr. Speaker.
Mr. Speaker, I just wish to be associated,
even though the House was associated by the Mini ster of Health, I wish to stand and be personally ass ociated with the condolences to yourself and to the
family of Mrs. Frances Lister.

Thank you.
Hon. Michael J. Scott: The Minister of Health commended, with great elegance, the bio and life and
times of Mrs. Lister. And I wish to be thoroughly ass ociated with Minister Wilson’s remarks for this woman
of stature in our community, who carried herself with
stature. And I know that the community in Sandys,
and cert ainly the family at Allen Temple, Pastor Howard Dill and Rev. Dr. Emily -Gail Dill and the whole
family will wish to be associated with the loss and are mourning the loss of your family member.
And I heard Mr. Famous, the Honourable
Member, wish happy birt hday to Dr. Ewart Brown, and
I wish to be associated with those offers of congratul ations on his birthday. Thanks, Mr. Speaker.

Yes.

Hon. Zane. J. S. De Silva: I would certainly like to
join colleagues in wishing the best of birthday wishes
to both the Honourable Dr. Ewart Brown and also the
Opposition Leader, Mr. Craig Cannonier. Long may
they both . . . may they see many more, and possibly
together. I am not sure which one is older, though, Mr.
Speaker.
[Laughter]

Hon. Zane. J. S. De Silva: Mr. Speaker, whilst I am
on my feet, you know, we always talk about when someone passes, we celebrate their life. I would like
to associate my condolences to the family of Glenn
“Cleary” Pitcher, who used to work for Island Construction, Mr. Speaker. Cleary was one of the— and I
say it without fear —I think one of the best bulldozer
operators the Island has ever produced. There was not anything that he could not do with that machine,
Mr. Speaker. And, of course, like many of my emplo yees before I got into politics, I do not do it as much
anymore. But we used to spend a lot of time together.
And I could tell you many a story about myself and
Cleary and some of the things that we did over the
years, Mr. Speaker.

[Inaudible interjections and laughter ]
Hon. Zane J. S. De Silva: But whilst I am on my . . .

[Inaudible in terjection]

Hon. Zane. J. S. De Silva: Yes, he was. He was a
great Liverpool fan, as am I, Mr. Speaker. And I think you know that.
But one of the things I would like to do whilst I
am on my feet is to thank St. David’s Cricket Club and all of the executi ves. Because what Minister Foggo
and I were a part of about a year ago is that they d ecided that they were going to honour some of their former members whilst they were still living. And
Cleary was honoured that night. And it was certainly
something that w ill live with me, and I am sure Mini ster Foggo, forever.
And something that I think, if anyone else in
the club life are listening, I think that this would certainly be something that they should all carry. Honour
some of their long- standing members not only in the
club, but in their communities, whilst they are still alive. So, I take my hat off to St. David’s for that initi ative, and I certainly encourage others to follow suit.
Thank you.

Yes. You can do so now.

FIRST READING

PREMIER, MINISTERS AND OPPOSITION LEADER
PERSONAL STAFFS ACT 2019
Hon. Walter H. Roban: On behalf of the Premier, I
am introducing the following Bill for its first reading so
that it may be placed on the Order Paper for the next
day of meeting: Premier, Ministers and Opposition
Leader Personal Staffs Act 2019.

Minister De Silva.
Hon. Zane. J. S. De Silva: Thank y ou, Mr. Speaker.
I give notice that I propose to move the follo wing Motion at the next day of meeting:
WHEREAS the Government undertook in the
2017 Speech from the Throne to conduct a thorough
review of transportation and to produce a Green P aper on the future of transport in Bermuda that will pr ovide various options for modernisation, which also takes into account the needs of the differently abled;
AND WHEREAS the Government recognises
that technology is modernising transportation globally and that Bermuda must examine those trends when
taking into account the future of public and private
transportation;
BE IT RESOLVED that this Honourable
House supports the recommendations and priorities
set out in the Green Paper on Transport 2019.

Members, that now brings us down to
the Orders of the Day. And Order No. 3 is the Order
that is going to be taken up this morning. And it is the
second reading of the Health Insurance Amendment
Act 2019 in the name of the Minister of Health.
Minister.
Hon. Kim N. Wilson: Thank you, Mr. Speaker.
Mr. Speaker, with the Governor’s recommendation, I now move that the Bill entitled the Health I nsurance Amendment Act 2019 be now read the second time.

The Speake r: Continue.

BILL

SECOND READING

HEALTH INSURANCE AMENDMENT ACT 2019

Hon. Kim N. Wilson: Thank you.
Mr. Speaker, the purpose of this Bill is to
streamline the way Bermuda funds its only hospital in
order to control health costs and make the necessary
amendments to effect this through updates to the
Standard Premium Rate and the Mutual Re- insurance
Fund. However, Mr. Speaker, before getting into the
substance of the Bill, I would like to pause to invite this Honourable House and the public to reflect for a
moment.
Mr. Speaker, some members of the public and
the Opposition may be asking, Is access to health
care a privilege or a right? Health care in many countries is considered a basic human right. Article 25, Mr.
Speaker, of the United Nations Univers al Declaration
of Human Rights provides that “everyone has the right
to a standard of living adequate for the health and
wellbeing of himself and his family, including food,
clothing, housing and medical care . . . .” Mr. Speaker,
the World Health Organization’s Constitution preamble provides that “the enjoyment of the highest attai nable standard of health to be one of the fundamental
rights of every human being.”
Bermuda should join the rest of the developed
world and take steps to deliver quality and aff ordable
health care for all. We can no longer accept a system which distributes health care unevenly on factors ot her than necessity, a community that permits some
persons to have greater access to care than others,
creates inequality and a two- tier system . In such a
system, we will inevitably see persons who fail to r eceive the care that they desperately need. If persons are unable to access care early, they could end up consuming a larger portion of our health care r esources. So, I submit, Mr. Speaker, that health care is


Bermuda House of Assembly a human right to which all members of our society are
entitled to.
Now, Mr. Speaker, some members of the public and the Opposition may be asking, Why now? For
years, Mr. Speaker, we have had conversations about
health care and health cost s around dinner tables, at
sports clubs and under the tents at Cup Match. We
have talked about which family member or which
friend had what experience with what doctor or what
nurse or what physiotherapist. We have talked about
the amounts of the bills and the increases in prem iums, the receipts and the co- pays, the stories and the
subtleties, the comparisons and the controversies. We
have talked about the emergencies and the not -so
emergencies, the urgent care and the nurse whose
name we could not remember , but whose kindness
we could never forget. We have had this conversation before in this Honourable House, the Senate, in our
caucuses and with our Opposition.
And it has all brought us to this moment, Mr.
Speaker. Our discussion about health care here in
Bermuda, as we have been recently engaged, is not
just a conversation about corporate profits and hosp ital funds. It is, however, about coming to look in the
mirror as a country, about who we are. It is coming to
grips about where we have fallen short and what we
can highlight that we really do well. The truth is that
we do a lot in health care extremely well, and we have
qualified professionals who are highly skilled and who
are passionate about their current patients and those
who may one day be. It is in this reflection that I come
to address this very important issue, Mr. Speaker.
So, where are we? Our current spending on
health care is over $720 million, but we are not living
as long as we should. We are knee- deep in chronic
illness and waist -high in health risk. We are eating
more than we should and exercising less than we can.
We are treating more and not preventing enough. We
are spending almost $2 million per day on trying to
keep healthy people in healthy communities. Some of
that money is being spent wisely, and some of it could
be spent a whole lot better. It is for the latter that we
are building our work around health financing reform.
Yes, Mr. Speaker, we are reforming our health sy stem.
We are changing the way in which those dollars come—from your pay cheques and taxi fares, and
construction salaries and corporate offices and hotel
rooms —and how they end up being spent on your
health in order to make your ability to contribute to Bermuda stronger. We are taking what we have been
talking about for decades and putting those energies into real action. We are, in real and significant ways,
changing how we do business here in Bermuda, for
health.
So, why now, Mr. Speaker? I can go on and
list the reasons why a stronger Bermuda in the face of a rapi dly changing and technology -driven world,
where blockchain and global economies, genetic breakthroughs and transportation strategies for our
international tourism need a much healthier population
to drive business. I can talk about how we need to
reduce our cost of doing business by lowering the cost
of health insurance to attract more international com-panies to the Island. I can even talk about how we can
compete better in sports and education if we do better
in health. And while those things are all true, maybe
this conversation is more straightforward than that.
Maybe the reality, Mr. Speaker, is that this is our m oment as a country to seize an opportunity to do som ething better, not for business reasons, but for people reasons. This is an opportunity to really put Bermuda
and its people first.
Mr. Speaker, let me lay out what is happening
and what this initiative of reform is all about. We are
putting in health care and financing reforms to i mprove our health system for the sake of our economy
and each of our families. We are starting with the way
that we pay for the hospital. We are giving our hospital a fair budget so that they can deliver the care they
need to the public. As a return for that budget, we are also holding our hospital more accountable f or how
much care they need to deliver and the quality and
patient care they provide.
As a return for that budget, we are asking for
better reporting and better negotiation of better costs,
better reviews of utilisation and better partnerships with our community doctors and nurses. As a return,
Mr. Speaker, we are looking for better efficiencies and
better health outcomes. We are demanding the best
from our hospital, and they are taking the progressive and responsible steps to achieve under those d emands.
The budget is being paid for through a fund
that all able -bodied residents already contribute to.
Whether you use the health system or not, we are
asking for a base level of social responsibility from all
of us to make sure that our communities, from our
seniors to our children, get the basic care that they
need at a cost that is affordable. Mr. Speaker, this is
our social contract. This type of social contract is exactly the type of deal that describes us as a society,
that helps to strengthen our culture, helps to define
who we are as persons, public and parties.
This is our time and our way of allowing every
member of our society to have the right to health care.
This is our opportunity to take leaps towards that un iversal health coverage goal, towards health for all.
Not every person has the ability to contribute
to that goal equally. Some within our midst must bear
the cost more than others. Some in their 30s and 40s
will have to pay for someone in their 80s and 90s.
Some workers will have to help in support of those
seeking employment. Some costs will have to shift,
and some caps will have to be put in place to control
those costs. Some smaller businesses may need more support. Some families will have to sacrifice additional funds to assist those who are in more chal1568 17 May 2019 Official Hansard Report

Bermuda House of Assembly lenging circumstances. We will have to share respo nsibility now so that the future costs of future respons ibilities can be less. We will have to share the costs of
investing more in prevention now so that we can r educe the shared costs of e mergency and acute care in
the future.
Mr. Speaker, the conversations we have been
having with our Island’s health insurers are just about
how we make this social contract of shared respons ibility a fair proposition. How providers, payers, polit icians, r egulators, researchers and religious bodies
can use their unique skill areas to put forth and i mplement timely solutions in a proactive and nonreactionary way.
As the carefully considered and evidencebased changes are being made, we are at the same
time asking our health insurance companies to co nduct business differently. We are looking for each of those companies to use more of the money that you
are paying into health insurance premiums to pay for
your health. At the same time, we are looking for our health professionals to look for cost savings within
their businesses and between colleagues so that we can move forward with fairer pricing.
Mr. Speaker, this is a change in how things
have always been. This is a change in the status quo, and we understa nd that these conversations have not
always been easy to be involved in. Yes, we are demanding to put the health of people as a higher prior ity to the health of profits. But this is not the opening
and closing of the conversation. Our teams are wor king on a number of other initiatives in collaboration
with the different members in health care. We are working on making the Standard Health Benefits a
better set of services for you, we are working on ways
to better measure quality in services, and we are
worki ng on updating our strategies and innovating our
care. We are working on prescription drugs, mental
health and maternity care. We are working on educating our youth and putting them in health careers to fill
the gaps. And we are working on bringing more care
home to Bermuda while preserving smart choice.
Mr. Speaker, we are working on communicating with the public on all the steps we are taking to
create a better system for you, their parents and our
children. So, again, Mr. Speaker, the question is
asked, Why now? The answer? This is the moment
that we should, and this is the moment when we can.
We can rise to the occasion to put partisan arguments
to the side and find common understanding of what
we need. We can listen to our seniors and give them
more fi nancial relief. We can start to stop the abuse
within our system. We can buy better, smarter and at
lower health prices. We can set an example to the
next generation of how better health is a tool for better
living. We can empower our communities and our-selves to eat better and laugh harder. We can e mbrace our challenges of mental health and give those affected their needed treatment. We can manage diabetes, cancer and heart
disease, and find ways to stop the devastating effects of stroke. We can reduce our road traffic accidents,
broken bones and traumatic brain injuries. We can
make health care more affordable for all and make sure that health is available for all.
As Bermudians, we have always sought to be
the best, and we should always want to change a nd
adjust for the better. We can change now, Mr. Speaker. We can, and we will because if not now, Mr.
Speaker, then when?
Mr. Speaker, it is in this context that I would
like for us to consider the Bill and its aims. The purpose of this Bill is to streaml ine the way Bermuda
funds its only hospital in order to control health costs,
and make the necessary amendments to effect this
through updates to the Standard Premium Rate and the Mutual Re- insurance Fund. Mr. Speaker, the
Standard Premium Rate (or SPR) is the premium for
Bermuda’s basic, mandated package of insurance,
the Standard Health Benefit (or SHB). The premium,
Mr. Speaker, is set annually following actuarial r eviews facilitated via the Bermuda Health Council.
Mr. Speaker, as this Honourable House is
aware, the Standard Health Benefit is the basic insur-ance package that all employers must provide to their
employees and employees’ non- employed spouses,
and they pay 50 per cent of its premium. By law, Mr.
Speaker, all health insurers must include thi s package
in any insurance policy. The package is regulated, as
are its fees and the premium. In addition, government
subsidises the cost towards the SHB coverage for children, indigent persons and seniors. The premium
for this mandated package, Mr. Speaker, is called the
Standard Premium Rate (SPR). It comprised of the
Standard Health Benefit component and the Mutual
Re-insurance Fund (or the MRF) component.
Mr. Speaker, the Standard Health Benefit c overs most local hospital -based care (both inpatient
and outpatient services), select diagnostic imaging in and out of the hospital (for example, mammograms)
and select medical home care benefits (such as IV
infusions). The MRF is a pooled fund into which all
insurers currently pay a prescribed premium to cover
all insured persons’ kidney transplants and dialysis, and to provide transfers to specific health pr ogrammes.
Mr. Speaker, following actuarial consideration
of the volume of services used in the past year, and
historically, as well as projections for f uture use of
SHB and MRF benefits, my Ministry learned that an
$84 standard premium increase would be needed to
sustain the current level of coverage. This was due to
utilisation increases, fee levels and unequal risk pooling. This would have resulted in t he standard premium
increasing by 23.6 per cent, from $355.31 a month to
$439.32. Such a change would have been untenable for the public and for the employers, so it was obv iously unacceptable to the Government.


Bermuda House of Assembly Mr. Speaker, everyone paying for health care
knows all too well that year -on-year increases cause
hardship on individuals, families, businesses and the
community. The Government could not sit by and allow this to happen. Actions commensurate to the problem had to be taken, and this Government has
acted. It is well known that the primary step taken to
prevent the premium increases was to streamline the
way we fund BHB [Bermuda Hospitals Board]. While
this has not been universally popular, I know it was
the only way that the premium escalation could have
been averted.
Mr. Speaker, BHB represents over 95 per
cent of claims against the standard premium across the system. If we retained the status quo, the claims would have exceeded the premium significantly. So,
our choices were to increase the premium, reduce
BHB’s fees dramatically, or change the way that BHB
is funded. And, Mr. Speaker, we chose the latter. The
option to reduce BHB’s fees was considered seriously. But it is not a viable solution, as it would not solve the larger, systemic problem that fee- for-service
makes cost containment impossible. Further, such a change could not be implemented fast enough for the
SPR to suffice. Rather, the Government took the dec ision that to get a different result we have to do things
differently, and accepted that a fundamental change
to the overall funding of the hospital was necessary
and timely.
Mr. Speaker, I want to pause here to remind
this Honourable House that this is not the first step in streamlining the hospital’s funding with a fixed- budget
model . In 2017, when the then- Government decided
to reduce the hospital’s subsidy budget by $25 million, it amended the legislation to change subsidy from a
fee-for-service model to a block grant. Now, while the
$25 million grant was a one- time reduction and th e
subsidy budget was restored to $108 million in 2018, the elimination of fee- for-service created significant
efficiencies for both BHB and the Health Insurance Department without hampering utilisation monitoring
and collaboration.
So, Mr. Speaker, I want to stress that funding
the hospital in more efficient ways is not new and has
been used successfully in recent history. We expect a
similar outcome from the change proposed now. Ult imately, Mr. Speaker, what we all want is for the hospital to be properly r esourced and funded to deliver the
quality care that we all want and deserve. And of that I
can give complete assurance, Mr. Speaker.
The $330 million revenue target was derived
on the basis of extensive discussions with BHB and a review of their financial needs and position. And the
figure was concluded on the basis that it is a realistic
funding level that will enable the hospital to operate
and deliver quality care.
In addition, Mr. Speaker, I have to remind us
all that the very origin and spirit of the Health Insur-ance Act 1970, which established the structure of our health financing, is that the standard health premium
is community rated. This seems to have been forgotten by some. However, anyone who has sat in the
seat of the Minister of Health previously is all too
aware of this fact and its fundamental rationale: The point is to distribute risk evenly throughout the community. The change we are making ensures that this
happens as was intended.
Mr. Speaker, the Bill brings amendments to
effect this i mportant, necessary and beneficial
change. In particular, Mr. Speaker, the Bill:
• requires a licensed insurer, or employer who operates an approved scheme, to pay the
MRF premium into the MRF within 30 days of
the start of the month or week (as the case
may be) covered by the payment;
• provides that a prescribed transfer from the MRF to the Bermuda Hospitals Board is to be
used to fund all standard health benefit r eceived by insured persons where it is provided
by the BHB;
• provides for an insurer, or employer who operates an approved scheme to not be liable to pay SHB claims from BHB if they have paid
the MRF premium for an insured person;
• provides for an insurer, or employer who operates an approved scheme, that has not paid
the MRF premium for an insured per son to be
liable for the SHB claims from BHB in respect
of the insured person;
• makes all dialysis claims payable by the MRF;
• provides for the hospital to bill for all non- SHB
services;
• increases the proportion of the standard pr emium rate that is ceded as the MRF premium
from $101.97 to $331.97 and adjusts relevant
transfers, including increasing the existing
MRF transfer to BHB from $13.16 to $231.33
in order to fund hospital care of insured persons;
• updates the definition of “ the general hospital ”
to provide clarification that this means only a
hospital facility operated by the Bermuda Hospitals Board; and
• clarifies the definition of inpatient and outp atient hospital services for the purposes of SHB
coverage.
Mr. Speaker, to effect these changes, the Bi ll
amends the following: the Health Insurance Act 1970, the Bermuda Hospitals Board Act 1970, the Bermuda
Hospitals Board (Hospital Fees) Regulations 2018,
the Health Insurance (Standard Health Benefit) Regulations 1971, the Health Insurance (Mutual ReInsurance Fund) (Prescribed Sum) Order 2014, the
Health Insurance (Maternity Benefits) Regulations
1971, and the Health Insurance (Mental Illness, Alc ohol and Drug Abuse) Regulations 1973.
Thank you very much, Mr. Speaker.

1570 17 May 2019 Official Hansard Report

Bermuda House of Assembly The Speaker: Thank you, Minister.
I now recognise the Opposition spokesman
for Health, the Honourable Gordon- Pamplin.
Honourable Member, you have the floor.

Hon. Patricia J. Gordon -Pamplin: Thank you, Mr.
Speaker.
Mr. Speaker, given the time, I would be wondering whether the Minister would be willing to start
lunch now.

Now, it would be the Speaker’s call
rather than the Minister’s call . So, on that note, I will
ask that we now rise and have lunch and come back
at two o’clock, with the Opposition Member leading us off.
Is that acceptable for all Members?
Yes. We will rise and have lunch.

[Gavel]

Proceedings suspended at 12:25 pm

Proceedings resumed at 2:03 pm
[Hon. Dennis P. Lister, Jr., Speaker, in the Chair]

We are resuming the debate on the
Health Insurance Amendment Act 2019 and the O pposition spokesman for Health, the Honourable Gordon-Pamplin has the floor.
Honourable Member .

Hon. Patricia J. Gordon -Pamplin: Thank you, Mr.
Speaker .
Mr. Speaker , first let me apologise to my colleagues for the weakness of my voice. I have just r ecently had throat surgery and, unfortunately, I am not
as strong as I might otherwise be. However, I will give
this presentation my very best because it is our r e-sponsib ility, Mr. Speaker , when legislation comes to
this Honourable House, we have an obligation to e nsure that we give it a good critical analysis and that we have the opportunity to discuss with significant stakeholders the terms and conditions that are likely
to be implemented by the legislation that are going to impact the community at large.
Mr. Speaker , to say that this particular legisl ation, notwithstanding that the Minister has given me a
copy of her brief and she has called in that brief for
bipartisan cooperation for the betterment of health
care in Bermuda, I would be remiss if I did not point out that this legislation was tabled last week, Friday.
Prior to that, about a week before that, the Minister
asked that we have a consultation so that we—so that
I as the Shadow spokesperson— would have the o pportunity to discuss the legislation and its intent. As I
met with the Minister on Friday —the 2
nd or 3rd of
May—the Bill was not ready. So I was sitting, listening
to a conceptual presentation by the Minister, which had no detail of what it was that we were likely to be discussing.
This is legislation that, to all intents and purposes, Mr. Speaker , will turn the health care system
on its head as we know it. And I believe that it de-serves more than the short s hrift that the Government
has afforded it in trying to railroad this legislation through within one week. However, within this past
week, after the legislation was tabled last Friday, we,
as an Opposition, have done our very best. I did not
have the opport unity until Monday (having returned
home only on Sunday) to start the consultative pr ocess so that we could, at least, get a feel for the signi ficant layers in this debate.
Mr. Speaker , it would be remiss of me if I did
not make mention of the conference t hat was held just
prior to this legislation being tabled in which we spoke
of strengthening parliamentary oversight.
Now, Mr. Speaker , the very first opportunity
that we have to strengthen parliamentary oversight and to allow the Executive to be held to account for
their actions, we have failed. We have failed because
we have legislation —significant —that has been forced
on us within one week with virtually little ability to continue —

The Honourable Member is
misleading the House saying that she . . . that we
have failed. We are following Standing Orders. Stan ding Order 29(1) says that a Bill c an be read for its
second time within seven days . We have followed


Bermuda House of Assembly that. So we are following Standing Orders. There is no
railroading . . . and everything is being done according
to policy.

Thank you, Honourable Member .
Member?

Hon. Patrici a J. Gordon -Pamplin: Mr. Speaker , I
take the point that the Honourable Whip has made. It
does not alter the fact that this is being pushed
through in very short shrift, irrespective of “seven
days.” Very little legislation that we discuss in this
Honourabl e House has the significance of impact of
this legislation. And a result of that, it deserves more,
Mr. Speaker , than for us to have less than five days to
have the necessary consultations.
However, with that said, we start with the m ajor players, Mr. Speaker . It is important to us to ensure
that we have the opportunity to discuss with the insurers, the insureds, and corporations —the significant
people who are going to be impacted by the impl ementation of this new legislation.
Mr. Speaker , I started with the insureds with
whom I was able to get the necessary meetings and the common refrain was that the consultation process
implemented by the Government has been woefully
inadequate. They were . . . I was told that initially, mid -
February, there was a meeting of the insurers who
were then told that this new legislation . . . the Government wanted to implement it with effect from
April 1. Seemingly, that was far too short a period of
time for the insurance companies to even come to
grips with the questions that they had and, therefore, one particular company, having made representation,
asked for more time and, therefore, it was pushed
back, instead of April 1, to June 1.
But what does that do, Mr. Speaker ? When
there are questions that the insurers have and t hey do
not have satisfaction in terms of how it is likely to be
implemented—this new policy —they do not have the
answers and we do not have the answers. I cannot tell
them because the Government has not told us.
Mr. Speaker , the Minister did a press conference in which, based on the information that insurers
had, some of them had gone to their policyholders
and effectively said that there were going to be changes, there were likely to be increases in prem iums that would be charged to policyholders as a r esult of the changes that were being made. The Mini ster, by way of press conference, made mention in a
public . . . in a press conference, said that it was unconscionable for insurance companies to dare to raise
rates to policyholders, given the fact that there would
be no increase in the standard insurance premium
(the SPR, the Standard Premium Rate) and there was
no increase in the cost of the Standard Health Bene-fits.
Standard Health Benefits, as the Minister indicated in her presentation this morning, is the basic level of services that must be offered in every insurance package that is offered by an insurance company—Standard Health Benefits. And those Standard
Health Benefits, Mr. Speaker , comprise standard be nefits that are available at the hospital and standard
benefits that are available outside of the hospital, but
they are prescribed and we know what they are.
The Minister said it was “unconscionable” that
an insurance company, given that this aspect of the premium and claims were not going to change and
benefits were not going to change, that it was unco nscionable for there to be a premium increase.
Mr. Speaker , what was missing in that evaluation and interpretation and what caused— not just anxiety in terms of the industry itself, but certainly for people at large— what caused anxiety, Mr. Speaker ,
was the failure to acknowledge that there has been an
increase— even if it were only the . . . sort of the normal inflationary increase —in the health care costs
that, of necessity, is going to require or coul d require
that premiums are increased. If there is a basic failure to understand that the Standard Premium is not the only thing that generates health insurance premiums
on an overall risk -rated basis, then I think that we
have got a fundamental misunderst anding of the i nsurance system. And I believe that the Government
must have better knowledge than that for the Minister
to make that kind of statement.
But I have to say that the Minister did [conduct] a town hall meeting last night and I was quite
pleased to hear that the insurance companies were
not vilified in that meeting that was held last night. B ecause I think it is important to point out, Mr. Speaker , I
do not hold a brief for the insurance companies, but I
have . . . and I will declare an interest. My background
has been in insurance for a significant number of
years. And while health insurance has not been my
focal point (my focal point has been property and casualty insurance), certainly the regulatory structure that is required in order to ensure solvency of our insurance companies is a critical and integral part of the
stability of our insurance industry.
So when we get an attitude that says that
premiums are being put up so that to all intents and
purposes those vile and evil and greedy sharehol ders
want to get some profits, when they are required by
law and regulation and statutory methodologies, Mr.
Speaker , to provide significant capital in order to co nfirm their solvency . . . so if that money is not there,
then a company fails. If a company fails, Mr. Speaker ,
they are not there to pay the claims that the polic yholder is paying for. You are paying a premium to be
able to get a claim out the back end.
So while it may be overly simplistic for the
Minister to say that the Standard Premium has not changed—the Standard Benefits have not changed—
therefore, the premium ought not to change, it just shows a fundamental lack of understanding of how
insurance works and the necessity, Mr. Speaker , for
1572 17 May 2019 Official Hansard Report

Bermuda House of Assembly there to be a solvency margin that insurance companies must hold on a regulatory and legislative basis.
So that is my presentation in that regard.
Now, Mr. Speaker , we understand what this
Insurance amendment is trying to do. And technically
what happens at the moment is that there is $355.31
which is an amount of Standard Premium that is paid
by every insured person. That Standard Premium, Mr.
Speaker , at the moment, is comprised of an amount of
$101. . . and I can give you the exact change, but just
for the purposes of this argument it is $101.97 that is
transferred from that Standard Premium that goes into
a Mutual Re- insurance Fund. Historically, the Mutual
Re-insurance Fund has been used to fund cat astrophic illnesses in respect of dialysis and things that are outside the norm when one would plot on an act uarial basis what the claims experience would be be-cause these are expensive “outside the norm” things,
so they were covered by the MRF.
So what the Government has decided to do is
instead of having the MRF continue to just deal with
that one little portion, the MRF is now going to comprise a larger portion out of the Standard Premium
and that money —that larger amount —the premium is
$355, and as I said the Minister has indicated that this
is not going to change, that premium amount —that
larger amount of $330 or thereabouts —will now go
into the Mutual Re- insurance Fund and that money
will go to the hospital as a block grant so that the hospital will have a block grant funding of $330 million
with which to cover the expenses of running the hospital.
Now, Mr. S peaker , that $330 million . . . what
has not been made clear, and the Minister I have no doubt will explain to us when she takes to her feet, is
what happens with the existing subsidies that are now
offered to the hospital, but out of the Consolidated
Fund— not out of the SPR, but out of the Consolidated
Fund—for the youth subsidy, the aged subsidy and the indigent subsidy. Is that money in addition to the
money that is coming out of the Standard Premium
that is going into Mutual Re- insurance [Fund] that is
going up to the hospital?
What is also very clear, Mr. Speaker , is that
the premium that is going up to the hospital is going to
be used to pay . . . sorry, the Mutual Re- insurance
Fund, the block grant that is going up to the hospital,
is going to be used to pay for services provided by the
hospital in the hospital —standard benefits.
Now, Mr. Speaker , we know that there are
standard benefits . . . there are items included in the
standard benefit requirement that are provided outside
of the hospital. So of the $355 of Standard Premium,
$25 (for rounding numbers) is going to be retained for
the insurers to pay the claims that relate to all of these
other things that are outside of the hospital.
Now, we did not get from the Minister an aggregate. How much did we spend last year in outside
the hospital standard benefit payments that would give us the satisfaction of knowing that the $25 figure
that has been allowed to be set aside is effectively
sufficient to cover the claims that are likely to come
from the community -offered services? The way the
premium was done before, it was certain standard
benefits that were provided in the hospital and then
there were other benefits that were provided that were
hospital and community. But we have not seen the
split between what of the hospital and community was
hospital and what was community so that we . . . I do
not know that this $25 that is being left over —that little
tiny sliver —is sufficient, Mr. Speaker .
Mr. Speaker , the question begs, what exactly
are we trying to achieve? The Minister in her prese ntation said that she wanted to ensure that there was equity in the insurance industry in terms of affordabi lity and costs and that we would have, as a result of
whatever we are putting into our health system and
the refor m of our health system, that we want to make
sure that we have more efficiencies and better health outcomes.
So if we are talking about efficiencies, if there
are significant services that are offered in the hospital (for which the hospital now is getting all this grant from
the Mutual Re- insurance Fund of $330- odd, leaving
the $25 for the community), why does the hospital not
say . . . or why does the Government not say for services that are offered in the hospital that are provided
outside of the hospital , let those outside providers
send that bill up to the hospital? The hospital has the
money. They get the $330 million from the block grant
of the Mutual Re- insurance Fund.
So since they have got the money, why would
they not take . . . for the services th at are available . . .
I want to be clear, not all services, not all ancillary
services, but the services that are provided in the
community that are available in the hospital. Let the
community send that bill up to the hospital. That is
efficiency. So that those external providers . . . you
have compiled in one place the claims experience
relating to specific areas.
So, in other words, if the hospital offers an
MRI, if the hospital offers an x -ray, if the hospital offers something that is a standard benefi t and I go to
TB, Cancer & Health to get that service done, let them
send the bill . . . so that the bill is all incorporated in
one community -rated billing so that we do not have to
slice and dice $0.30 or $0.50 out of the $25.00 that is left to go and satisfy that claim. Because notwit hstand ing the system provides that there is no claims
adjudication and with the failure for having claims ad-judication we will not know, in the absence of controls
. . . and that is just the environment and the space in
which I work from an accounting perspective, internal
controls and external controls and every other kind of control. But in the absence of controls, Mr. Speaker ,
you will not know whether you are being billed for an
amputation or an aspirin and, presumably, t he diffe rential would be significant.


Bermuda House of Assembly So in the absence of that oversight that we
are losing, I think that we need to ensure that, if we
are looking for efficiencies, let us be really efficient
and do something that is meaningful and put all the
similar claims in one bucket, in one place, and then the Government knows exactly what it is that we are
dealing with.
The other thing is how do we guarantee better
health outcomes with what we have seen today? I do not see that by taking money and sending it up to the
hospital . . . says that there is going to be any better
outcome. That is what we want. We do not want to say that the hospital has got $300 million, $400 mi llion, whatever the millions are, in money, and that you
have got a pile of people going down t o the hospital
who may or may not come out with a better health
outcome. So something that we are . . . must be ensured to not miss in the process and in the equation, Mr. Speaker , are the educational aspects that come,
at the moment, as part of the servic e that is provided
by some of the insurance companies, in terms of education, telling people how to live, the things to do, getting benefits for . . . discounts if your claims exper ience is better than it might otherwise have been. How
do we get a better outcome?
How do we know, if we are talking about the
cost to the health care system, Mr. Speaker , how do
we know that in the absence of controlling provider
costs that there is going to be any more efficiency,
that there are going to be any better outcomes, and
that there are going to be any savings? [By] what we
are doing today I do not see that there is one dime of
savings. The Minister indicated that people who are paying premium . . . you know, you are going to have
to pay some more.
Now, Mr. Speaker , we know that through the
course of the past two months, subsequent to the
Budget Debate, we have heard nothing but, T his price
has gone up. The Sugar Tax has caused this to go up.
The Land Tax has gone up here, something else has
gone up over here. So every time a consumer looks at
his wallet this Government, who promised to reduce the cost of living, has somehow found a way to further exacerbate how the expenditure quotient has deteri orated on behalf of the taxpayers of this country.
Mr. Speaker , when you read that some in their
30s and 40s will have to pay for someone in their 80s
and 90s, you know, that is the way it works and we
are fine if we transport ourselves to Havana or Moscow, but we do not live in Havana and we do not live
in Moscow. We do not have that type of national sy stem or a tax support base to bolster it if anything goes
wrong, Mr. Speaker .
So my question to the Minister is this: What
happens when the $330 million runs out? Because it will. And I know, actuarially, it is stated that the $330
million is adequate, it will be sufficient, that the Mini ster and the Health Council are satisfied that the act uarial extrapolations are appropriately applied, but Mr. Speaker , when you look at the Standard Premium
which the Minister said in her presentat ion this mor ning, that the recommendation was that this premium
could have been as much as $84 different than the
$355 but for the fact that the population would not stand for it —you put a hold on that —that is like putting
a lid on a pressure cooker. At some point in time it is
going to blow, Mr. Speaker . You can only hold down
costs to the extent that you put in other things that
help to support efficiencies and savings. And one of
the first things that we have to do is to start to look at the extent to which we are able to control what costs
are going into the system.
Now the Minister mentioned in the opening
part of her presentation this morning that we all have stories about comparisons and controversies, the bills
and the increases and the negative outc omes and all
those kinds of things that happen. And it is fine to say
let the hospital survive because the hospital, notwit hstanding the money that it requires to run its day -today operations, it also is required to pay their $25 mi llion per year on that 30- year loan that they have to
Paget Health Group, which, part of that was a $2.5
million per month, that is $25 million per year . . . I am
sorry, $30 million per year —$30 million per year —
$2.5 million per month, which is $30 million per year
for 30 years . That is the $900 million that had to be
repaid. But that gives . . . that is $30 million just for the
amortisation of that principal amount that has to be paid out by the Hospitals Board. So that is part of the
$330 million, so $30 [million] is off the t able because
they have got to pay that, we know that, which effectively says that $300 million has got to be left.
The question also begs: Is the Government
required, through its GEHI contributions . . . are all of
the Government plans , FutureCare, HIP, as well as
GEHI . . . are those contributions going to be made to
the Mutual Re- insurance Fund as well in the same
amount that we are expecting from the private sector members or anybody else in the same amount of the
$330 going into the Mutual Re- insurance Fund?
Mr. Speaker , it is important to understand
why. The Minister did mention in her presentation that the questions are being asked: Why is this being done
and why now? And it would seem to me that we are almost getting the cart before the horse. The hospital
has to survive. And what happens when the $330 mi llion runs out? Clearly, the Government will have to be
the backstop.
The Government cannot allow the hospital to
fail. When the $330 [million] runs out, that money is going to have to come out of the Consolidated Fund.
And so it is important that the public is put on guard
and on notice to understand that this money will come
from them —out of their pockets, again—somewhere
down the road. You will not see it this year and you may not see it next [year ], but you will see it the following year. And, of course, we have got to have a
1574 17 May 2019 Official Hansard Report

Bermuda House of Assembly year to make the determination as to how adequate
$330 million is as a number.
But the one thing that we do not have control
over, Mr. Speaker , is the utilisation, even at the hospital, because the hospital can say that we have the
capacity to do things, but they cannot say that they
are going to provide the services because the services are predicated on peoples’ necessity to use
those services. So, even though the hospital ca n say
they have got 100 beds, Mr. Speaker , 100 beds can
only be occupied if 100 people show up. But if only 80 people show up, there are 20 beds that are there that
are not generating revenue for the hospital.
By the same token, if 150 people show up,
you then end up with lines at the hospital where then
people will decide, As opposed to utilising what I am
paying for already as a Standard Health Benefit, I will
go outside, and then that starts to put pressure on the
outside agencies to provide and pick up the slack to
the extent that the hospital may not be able to cope.
So, Mr. Speaker , if we are not holding the
costs down, if we are not centralising similar claims experiences and similar claims categories and having
those as being one part of the insurance equation,
how are we effecting any kind of efficiencies or savings in the health system?
Mr. Speaker , the hospital at the moment is using a fee- for-service [system]. And that fee- for-service
concept will go away. But when that fee- for-service
concept goes away, Mr. Speaker , how will the statist ical development be communicated to the insurers who still have to rate their premiums for their clients?
In addition to standard benefits they have to figure out what the claims experiences are and what premium is
an adequate amount of premium.
So these are things that have to be consi dered [about], Mr. Speaker , that we do not have the
answers for.
Now, if the Minister . . .

[Pause]

Hon. Patricia J. Gordon -Pamplin: I am giving it my
best, Mr. Speaker .
Okay, so, what we have noticed, Mr. Speaker ,
is that with this new block grant going into effect on
June 1—which is what the Government wants to do—
the people who have been wait -listed for various services at the hospital, who have not been able to be fitted in . . . now, for whatever reason, the hospital is a
beehive of activity so that people can get these ser-vices done. The hospital can . . . not so much to get
the services done, but be able for the hospital to get
the services provided so that they can get the r evenue
while they can still bill for it on a fee- for-service basis.
Is that the intent? Or is that an unintended cons equence?
Will we see in the month of May a significant
spike in utilisation and costs that have been utilised by the hospital in order to ensure that . . . by the hospital
to make sure that they . . . in the $300 million that they
will be getting as a block grant . . . as I said, the number was $330 [million], but $30 million has already
gone out the door to pay for the amortisation of their mortgage, but . . . Actuarial statistics are done effectively on the smoothing curves and based on an extrapolation of experiences. And when you get spikes
and peaks, then you just have to make significant adjustments and amendments for them. So, it is i mportant to know the impact that will happen with the
revenue drivers from now until the end . . . in the next
two weeks. It will be interesting to see the significance
of the additional charges that have come through the
Hospitals Board.
Now, Mr. Speaker , I am curious to know who
is being left out as we speak. When I say “who is be-ing left out” in terms of the provision of services that
we cannot put into place the checks and balances and
the procedures that ensure that there is some kind of
cost control in the provider sector. So who will be left
out if we did not do this tomorrow? Because we are
basically talking about . . . not tomorrow, but two
weeks’ time. So who will get left out? You will get
people who are uninsured who will not be able to buy
an insurance premium, an insurance policy. But those
people are covered by the indigent subsidy that presently exists. The aged are covered by the aged subs idy and the youth are covered by the youth subsidy.
So, if we took the time to make sure that this
works, t hat we put the checks and balances in place
where the checks and balances are needed, so that we are not driving up the cost of health care without
any sort of . . . like a runaway train, Mr. Speaker . If we
take the time to do that and to do it properly and effec-tively, who will lose out? I would submit that nobody
will, because, at the moment, over the course of the next month or two months or whatever time it might
take . . . let us say we bring this new system into effect on September 1, which gives ever ybody the o pportunity to understand how it is going to work.
I have been made to understand very recently
that implementation, which is scheduled to be June 1,
[and this] short time that we have had to be able to go and look at this Bill, Mr. Speaker , has not given me
the opportunity to consult as I would like with the hospital who is an integral player in this. But as readiness
is scheduled for June 1 . . . as recently as 10 days
ago I did not have the opportunity, but one of my colleagues had the opportun ity to speak with the hospital. [They] were not even aware that as of June 1 they
were not going be submitting any bills to the insurance company for payment of claims. They did not realise
it. So there is something missing in the information
flow, where t he integral and key people do not know
what they are doing, do not know what to expect, and do not know how the new policy and plan is likely to impact them. Is that what we want, Mr. Speaker ?


Bermuda House of Assembly When we know that your standard premium
rate should have gone up, but for the fact . . . and let
me just say, I have been in the seat of the Minister. I
had situations in which we had a Morneau Shepell
report which made recommendations as to what the premium should be, and made the recommendation to
choose a point that made sense in terms of what the
economy could sustain. But when you have a differential from $355 to $433, Mr. Speaker , that is [more of] a
difference than saying, We’re not going to go up an extra $10 here. We are talking about $84. And if we
cannot ack nowledge and accept the fact that $84 on
standard premium is a significant impact that has
been actuarially calculated because the statistics that
have gone into the equation have dictated that this is the output . . . so, Mr. Speaker , if that is the outpu t
and we know that we are already deficient by at least $84, but for the fact that the economy cannot sustain
it, that is the only reason we cannot implement it at
that stage.
We need to know that if we are making such
significant changes, maybe it is time to bite the bullet;
maybe it is time to be realistic about what the costs
are. Maybe it is not the time to vilify the providers of
services. Maybe it is not the time to turn the system
on its head. Maybe it is not the time to stand and hope
that what we are putting into place is going to be ad equate. Maybe we need to pause, Mr. Speaker .
I am not suggesting for a second that we do
not want to see equity when it comes to insurance
claims, but there are always going to be those, Mr.
Speaker , who are going to be able to afford to pay
whatever their premiums are and they will get wha tever standard of treatment they choose to get and they will hop on a plane and they will go to wherever
they choose to go. And, Mr. Speaker , what will ha ppen is that those others wh o are not in that happy p osition will end up having to settle for what it is that they get. Nothing from what we have seen here has said to
me, Mr. Speaker , that there is something that is going
to impact the adequacy of the outcome of what it is
that they are trying to achieve— nothing.
People are going to pay more because health
insurance . . . sorry, health costs have gone up.
Health inflation is real, and you cannot make it . . . you
cannot wish it away by failing to acknowledge that
there are extenuating circumstances that would exacerbate what premium rates are being charged for
standard premium, for standard benefits.
Let us start with putting in place . . . Now, I
think part of the presentation last night indicated that
because 47 per cent of the heal th spend goes into the
hospital, then, therefore, that is the big ticket item and
we, therefore, want to attack that first. And I understand, perhaps, in a way, that level of thinking. But
that level of thinking can only work effectively when there is an active intent to look at the contributing factors. And I believe, in this instance, the contributing factors are the ones that are causing the problems
that we have.
So until we start looking at putting controls on
the contributing factors, you know, we ar e talking
about pharmaceuticals, we are talking about things
like we heard last night in the town hall meeting, self -
referrals; we are talking about overutilisation; we are
talking about inappropriate procedures, or procedures
that might otherwise . . . when there are options. You
know, I do not question a doctor for making the de-termination as to what treatment is good for his pa-tient. However, when it comes to overutilisation, the
trends are there. It is very obvious. And there are
times that we, even as consumers, Mr. Speaker , decide that we want to go and look for a second opinion
or a third opinion or a fourth opinion until we hear
what we want to hear. And every one of those costs helps to generate additional costs to the system.
We do not have an elec tronic medical records
system. That is what we should be looking at. How
can we ensure that an electronic medical records sy stem will stop me from going to my doctor here, my
going to my doctor there, and going to my doctor there
and getting different treatments for a similar complaint
because I am not satisfied with the prognosis that
came out from doctor number one? And these are
things that happen. How can we put those checks and balances in place?
And I would submit that this is part and parcel
of the entire system, Mr. Speaker , in order to make
the system work. We have to utilise those checks and balances first and then start to look at where we are in terms of overall funding. Because you can be assured, Mr. Speaker , I will bet you dollars to donuts,
that $330 million that goes up to the hospital is not
going to come down when the other checks and balances go into place. That money is not going to . . .
the standard premium, the cost of the standard benefits is not going to decrease. Once it is up there, it is going to be up there.
So there is nothing to say that there are going
to be any efficiencies that will be gained if we do not start looking at the little things. It is the little things that
make the big things, and right now we are overlooking
the little things, Mr. Speaker .
Mr. Speaker , I do not want anybody’s mom or
grandmother to have to do without health care. But we
take care of that. If they have to go to the hospital, we
take care of that, in respect of their subsidies.
Where people are conc erned, Mr. Speaker , is
that they go to a dental office or a medical office or whatever and their co- pay has reached the stage now
where they cannot afford to go to the doctor. So what
happens is that people then become chronically ill and
wait until they c annot . . . because they do not have
the co- pay money.
So you present at KEMH because you need
the medical care, but you do not have the money to
pay the doctor. That is where we need to be looking,
1576 17 May 2019 Official Hansard Report

Bermuda House of Assembly Mr. Speaker . And that is what is impacting our popul ation every day in their pockets, Mr. Speaker . Whether
the hospital gets $330 million, $350 million, ten -
hundred million [dollars], it does not matter. That is of
no consequence to the man on the street who has to stand on the street corner, or to the lady on the street,
who has to stand on the street corner and decide, Can I go into Dr. Joe’s office because I don’t feel well? Or
will I stay here until I drop on my feet and then present
at KEMH because I don’t have a co- pay?
That is where we need to be looking. And we
need to be looking at it urgently, Mr. Speaker , not as
an afterthought, not decide how much money the
hospital should or should not have. The hospital is not
going away. The hospital is not going to fail. The hos-pital is going to survive. The hospi tal has sufficient . . .
in terms of its revenues, in terms of how they now bill on a fee- for-service. It is not the most efficient way of
billing, [with] that I agree.
However, Mr. Speaker , that is not where the
issue is. The average man on the street does not know what we are doing here today, and whether
what we are doing here today is going to impact
whether the hospital doors . . . the hospital doors are
going to be open. The Government cannot let the
hospital fail. And if it means somewhere down the
road that there is going to be some injection of additional cash, it is what it is.
But where the average person in the street is
concerned with, Mr. Speaker , is what has to come out
of his pocket today. And what the Minister has pr esented in front of us here, Mr. Speaker , does not
make any impact on how the person in the street is going to feel about what it is that is happening today.
As I said, Mr. Speaker , having socialised
medicine, which is obviously the path down which we
are going . . . that is what it looks like to me. As I said,
it is fine if we lived in Moscow or Havana; but we do
not. So we have the wherewithal, we have an insurance centre second to none with insurance minds —
both in terms of the private industry, in terms of what
we have at the He alth Council, and what we have in
the Ministry —and I refuse to believe, Mr. Speaker ,
that we cannot put our heads together and find the
solutions that are necessary.
Now I do know that based on . . . and this is
not something that is just new. But perennia l cha llenges in which there are under - or uninsured people
in our community . . . and I think, Mr. Speaker , that we
have three major insurance companies. And those three major insurance companies, between them,
should be able to come up with a methodology by which they are required—through Government,
through legislation—to absorb those under -insured or
uninsured people in their book and make that determination, Mr. Speaker .
If we really, honestly, want to look at how we
can resolve the challenges that we have with our health care system, let us look at all of the component parts, let us look at not leaving somebody behind, not
because the hospital has money, has more money
with which to operate, but because the people who
now feel as though they cannot go a nd get these extra
services are being covered by an insurance system
that requires —that forces —them to absorb those
people who do not otherwise have those privileges.
And so it would make sure that nobody . . .
nobody is actually turned away when it comes to the
hospital, Mr. Speaker . We know that if you are sick,
you go to the hospital. It is what it is. And I did hear some people challenge and question what happens,
because I did ask the Minister the question, as to, with
this new system, how will somebod y who presents at
the hospital now be billed? You know, if you show up
. . . how? You know, if there is no claims adjudication,
no nothing and you show up at the hospital, what says
that you will not go and ask for services if you have
not paid your premium? Well, the legislation is clear
that this is not . . . this will not happen. So if you pr esent at the hospital and your premium is not paid, you
will be billed. However, Mr. Speaker , it does not answer the question: To whom will the bill go?
Now I know that in certain instances if you go
to the hospital and if you have, let’s say a visitor who shows up with a cycle accident, they have to show
proof of [insurance] and have to leave their credit card
to say here’s the payment for my treatment. But if it is
Mr. Smith from down the street who does not have
insurance coverage who goes to the hospital, who
does not have an insurance premium that backs him
up for his service, to whom is the bill going to go? And how is it going to be settled?
How is the billing system going to work if it is
no longer a fee- for-service? How will we know what
will whittle away at the $330 million in the aggregate
for our claims? How will we know when that $330 [mi llion] runs out? How will we know, Mr. Speaker , that
we are serving our people?
And what we are seeing today [is] nothing
more than simply make sure that the hospital has
money to run. The hospital is always going to have
money to run. The Hospitals Board had . . . we heard
last night that there was $65 million extra— I wou ld not
say “extra,” but there were $65 million in kind of r eserves in the hospital’s books in case there was any
drain on the $330 million, that this $65 million will help
to kick in. Short of a pandemic or something in which
all hell breaks loose in terms of demand and raid on
the hospital’s services, then very clearly, Mr. Speaker ,
that demand on the hospital’s services will have to be supplemented and backstopped by the Government,
which is understood.
But we do not . . . it is not reasonable to assume p andemic circumstances. When the hospital
stresses its capital, when the hospital stresses its abi lity to remain a viable concern, they have to put in r idiculous stresses . . . what happens if a plane crashes
at the same time as there is a mumps outbreak at the


Bermuda House of Assembly same time that a ship goes down and all these kinds
of things? These are the kinds of scenarios that go
into stress testing for capital to ensure that an organ isation is still solvent. The stress tests that are r equired, that are prescribed by the regulators, will ne ver, hopefully, ever come to fruition at the same time.
So we can rest almost assured that as we
look at the system we are not forced . . . we are not a
house on fire where we have to grab the buckets or
grab our robes and run out the door. We are not at
that degree of critical that we have to do whatever
they are trying to do immediately without making sure
that Mr. Smith and Mrs. Smith can go up to their doctor on the corner and make sure that they have the
money for the co- pay, or that th e co- pay goes away,
because through the Health Council and the Ministry
they have looked at bringing checks and balances on
the service providers so that those service providers
are kept honest.
Mr. Speaker , as we go through the actual Bill
itself there ar e, obviously, some concerns that will
come up. And I think I have asked the major ques-tions. But when the Minister mentioned in her brief this
morning that we want to make sure that people get
the basic care that they need at a cost that is affordable, the one thing she did not say is that it should be in
and out of the hospital. It is not just the hospital. What
we are doing now is singularly focused on the hospital, its solvency, its ability to cope, its ability to be
funded effectively.
But even with what we are trying to do with
giving them a block grant and taking away the neces-sity for them to generate all these bills and send them up to the insurance company and get paid for it and
whatever, Mr. Speaker , it still does not account for the
fact that in all this equation as well there is also a h uman factor. There is a human factor of staffing. And
we cannot say, Mr. Speaker , albeit the Standard
Health Benefit, the Standard Health claims are mec hanised, they all are computerised, they may go from
point A to point B, there still has to be somebody who
is going to look at the level of accountability to make
sure that the charges are appropriate. As I said, we do not want to be paying for an amputation when we
should be paying for an aspirin.
Mr. Speaker , the only thing that I can say is
that when we present ourselves as legislators to the
electorate, to the public, it is important that they know
that we have their best concerns at the heart of our
intentions. And in so doing, Mr. Speaker , we have to
make sure that Mr. and Mrs. Bermuda are treated and
considered first and not as the afterthought, not as . . .
we are going to make sure the hospital is fine this
year, and next year maybe we will look at pharmaceuticals, and maybe the year after that we will look at
provision of services and maybe after that we will do something else.
We also have to look at how it is that we cannot consider the fact that somebody may be employed today who, through this system, ends up losing their
job, because we do not have a who le lot of jobs that
have been going . . . now we did hear a focus on ICT
this morning in a Ministerial Statement. But what I can
say is that to the extent that those jobs are not yet on the table, we do not have that flexibility to say to
somebody who is n ow working in an IT department at
the hospital, at an insurance company, wherever, to
say, Oh, well, not much I can do about it; it’s just the
nature of the business. And it is okay to stand on the
outside and to say to private enterprise, You need to
keep these people on staff. It’s not fair for you to let
them go; you have to keep them employed. You can
say to the hospital, You have to keep people employed, but if their services are no longer required for
the jobs that they need to do, where are the effic iencies, Mr. Speaker ?
I do not want to see anybody losing their job.
But we want to make sure that the people who are
employed are employed in a circumstance in which
they are effectively being used and that their jobs are
critical to what they are providing.
Mr. Speaker , we heard from the Minister this
morning that the revenue target of $330 million for the
hospital was derived on the basis of extensive discussions with BHB, and based on their financial needs
and positions. I understand that. I understand that fully
as an accountant. I believe that anybody who oper-ates in my space would get an understanding of that.
But that is not my concern for today. My concern for
today is Mr. and Mrs. Smith who may or may not have
the co- pay.
Mr. Speaker , there seems to be a thought
process that the only people who can be concerned about Mr. and Mrs. Public reside on the other side of
the aisle. I say, not so. I say not so. So notwithstanding what protestations we might have coming from
across the aisle in that respect , Mr. Speaker , we—
every single one of us, all of us —in this House have
an obligation to look out for the man and the woman in the street.
The one thing I learned, as I said, I thought
that perhaps in retrospect, given the pressures of this legislation and in such a short period of time with such
significance was probably a slap in the face to the
conference that was held. But the one thing we
learned, if we learned nothing else, from that conference, Mr. Speaker , is that there must be a distinct di fference between being a politician and being a parliamentarian. I say today, Mr. Speaker , our respons ibility in this place, to this Bill, to those people in our
community, is for us to be parliamentarians. Let us
look as to how we can effectively make changes to
our system that work for everybody in a parliamentary
and respectful and bipartisan way so that we know
how we can act . . . how we can go forward with the
best interests of the community at heart.
1578 17 May 2019 Official Hansard Report

Bermuda House of Assembly As it stands there are going to be challenges.
If we do not have any changes to what we are seeing,
we will challenge it, because that is our responsibility.
But, Mr. Speaker , none of us has any more
concern than the others of us that what is required in our community for good and effective health care is
not g oing to be achieved by what we are seeing here
today. We are seeing, or we will see, that there will be
more expense in terms of premiums outside of the
Standard Health Benefit, there will be no guarantees
of efficiencies and there will be no guarantees of positive health outcomes.
Thank you, Mr. Speaker .

[Desk thumping]

Everyone else has half an hour from
here on in.

Hon. Wayne L. Furbert: Yes, yes, I respect that.
I have not heard any strong arguments about
why the Government should not move ahead with this
legislation today. To me, the arguments coming from
the Opposition were weak and fighting on behalf of
organisations that have been making millions over the
years.
Mr. Speaker , the Honourable Member speaks
about social medicine, or social insurance, or whatever you want to call it —social medicine, in particular —
and Moscow, and she referred to Moscow and Cuba.
She left out countries like—

Hon. L. Craig Canno nier: Point of order, Mr. Speaker.

I will take your point of order.
Minister . . . Minister.

POINT OF ORDER
[Misleading]

Hon. L. Craig Cannonier: I believe the Honourable
Member is, unfortunately, misleading the House. Thus
far, our [Member] has not mentioned that she was
against this Bill in any kind of way at all, but was sim ply seeking clarification. And the way that he stated it was as if we
were not in favour of the direction that they were look-ing to go.

Hon. Wayne L. Furbert: Mr. S peaker , if the Honour able Member would at least give me back my 30
minutes, I never said the Honourable Member did not
support this Bill. But the way she spoke, if anyone was
listening, it gave the impression that she did not su pport the Bill.
And what I am saying to you, Mr. Speaker , is
that they never gave any strong arguments on why we
should even delay debating this Bill today. That is
what you are saying. There is no real reason.
The Honourable Member spoke about, as I
said, Cuba. But she left out countries such as Canada
and Switzerland and other countries that do have—

Hon. Patricia J. Gordon -Pamplin: Point of order, Mr.
Speaker .

Yes, I will take your point of order.

POINT OF ORDER
Hon. Patricia J. Gordon -Pamplin: Yes, the Honourable Member must take account of the fact that places
like Canada and Switzerland have a significant tax
base that we do not have.

[Crosstalk ]

Hon. Patricia J. Gordon -Pamplin: I made mention of
that in my presentation. There is a taxation system —
[Gavel]

Hon. Patricia J. Gordon -Pamplin: —which helps to
support —
Hon. Wayne L. Furbert: Mr. Speaker , that is not a
point of order.

Thank you.
Minister, continue on.
Hon. Wayne L. Furbert: Yes, Mr. Speaker , the Honourable Member said that there are certain things the
Government should have done first. A nd it is not like
we just woke up. They were five years in Government
and the changes that they should have made, they did not make. The cost of —



Bermuda House of Assembly POINT OF ORDER

Hon. Patricia J. Gordon -Pamplin: Point of order, Mr.
Speaker .
Mathematically, Mr. Speaker —I am an accountant, as is the Member —but 14 years trumps 5
years any day, any time.

Stay with . . . stay, stay, stay on the
matter before us, please.

Hon. Wayne L. Furbert: Yes, I am going to stay right
on line, Mr. Speaker .
But the Honourable Member herself was a
former Minister of Health. And if you can think of an y
substantial legislation the Honourable Member
brought to this House to reduce health care costs . . . I
cannot recall.

Hon. Patricia J. Gordon -Pamplin: Yes, we did.
Hon. Wayne L. Furbert: And if she could stand up
and tell me which major . . . that red uced costs, b ecause the costs still went up. And there are two Members on that side, as a matter of fact Ministers of
Health, that were changing the Bill, like, left, right, and
centre. If Honourable Member s can tell us what they
did, I would be glad to li sten.
But, Mr. Speaker , we are at a point in time . . .
and sometimes you have to do something out of the extraordinary. What do I mean by that, Mr. Speaker ?
When we look at the statistics in Bermuda and see the
increase—

[Inaudible interjections]
Hon. Patricia J. Gordon -Pamplin: Out of the extraordinary?
Hon. Wayne L. Furbert: —out of the ordinary, out of
the ordinary —
[Gavel] Hon. Wayne L. Furbert: But, Mr. Speaker , when we
look at what we have, the increase in costs of health
care in Bermuda, we al l know it. There is one thing
that we all [agree on] —health care costs in Bermuda
have become extremely high.
Mr. Speaker , I remember being on the Hosp itals Board, at 23 years [of age]. As a matter of fact, I
was Chairman of the Finance Committee for 12 y ears.
And at that time the Government was giving a . . .
there was not a fee- for-service. As a matter of fact,
the Honourable Member , Jeanne Atherden, was the
Controller at the time. So, we go back there. But there
was no fee- for-service at the time. The G overnment
just gave a fixed amount. As a matter of fact, I r emember David Saul coming to us after the Hospitals Board was making some good money in those days.
We were —

Hon. Jeanne J. Atherden: Point of order, Mr. Speaker.

Thank you.

Hon. Wayn e L. Furbert: I am talking about . . . the
hospital never charged for an aspirin or charged for a
room. We know that. So if the Honourable Member
. . . all three of us are accountants, so we understand
that. So we are referring to the charge for certain services. The Government used to give an amount, whether they put claims out or not, there was an
amount. And we had to get an amount because the
Government had to budget for that amount for the
year.
And in 2000 . . . 19 . . . I cannot remember the
exact t ime. As a matter of fact, by that time the Honourable Member had left the board. But David Saul
found out the way we were calculating our total . . .
the amount the hospital should collect . . . and he . . .
if you go back, you will find that there was a t ime
when the hospital was in a deficit because the Ho nourable Member David Saul cut the budget significantly for the hospital.
But going back to [my] point, Mr. Speaker , the
cost for hospital, the cost for everything, has just sk yrocketed. This Government made a commitment to
the people of Bermuda that we would bring down health care costs. We made a commitment. Now, is
this the final stage? No. It is part of the beginning of
1580 17 May 2019 Official Hansard Report

Bermuda House of Assembly where we are headed. And so we have to move in a
direction that people understand.
Now, Mr. Speaker , if we look at the . . . first of
all, let me make it very clear. It was the actuaries that
told us that costs . . . or the premiums should not go
up, based on the model that the Government was
moving into. That is the first premise I a m trying to get
to yourselves —it was them. And so if you look at the
Standard Health Benefit, and we look at it as a circle, one big circle, take the diameter being 100 and go
around, in there was the MRF. What the Government has just done is increase the MRF. The circle has not
changed. So I am totally amazed at how, at the end of
the day, certain premiums will go up unless, Mr.
Speaker , unless the insurance company does not
want to lose their $100 million a year in profit. That is
the only reason why, bec ause the total picture, Mr.
Speaker , has not changed by the Government’s calculation on that circle. Or, if you look at the Bermuda
Health Council’s website, which is very explanatory,
there is a house and at the bottom there is this rec-tangle. And the rec tangle size did not change, it shif ted from MRF to the Standard Health Benefit, but the whole thing did not change, the top part did not
change.
So what we are paying for, the Government
said, based on this, we are going to allow the Standard Health Benef it . . . let me just get the picture out
here for you. The Mutual Re- insurance Fund was pa ying for kidney treatment, hospital care, chronic di sease, and so on and so on. What they have done is
just increase that piece of the pie. But the whole circle
did not change. The supplementary premiums that were paid in addition . . . the bigger circle . . . and the
reason why [is] because they . . . if you look at the
Standard Health Benefit Regulations in 1971, it said
that these Standard Health Benefits should go towards certain things. And these things were accommodation and meals at the standard or public ward;
full nursing services; use of radiotherapy; treatment
for alcoholism; the use of bone . . . et cetera. I do not
see in there, Mr. Speaker , where it said t hat that money should go towards profit and dividends.
We have had it wrong all this time. Never at
the time when these Regulations were put in place . . .
it talked about hearing screenings for newborns. And I
am looking in the Act, Mr. Speaker , and I do not see
where it says that “X” amount of dollars should go t owards shareholders.

Hear, hear!
Hon. Wayne L. Furbert: I do not see it. We should go
back and get that money from 1971, actually backdate
it and give it back to the people of t his country. And
accountants understand that. And we as parliamentarians understand the laws that we passed in this country where money should be allocated. We passed the
law where that Standard Health Benefit should go t o-wards. But they have been taking s ome of the money
and paying out to their shareholders.

[Inaudible interjection]

Hon. Wayne L. Furbert: Yes, they have. The supplemental was supposed to be on top of that for what-ever was additional. They could have done that.

Hon. Patricia J. Gordon -Pam plin: Point of order, Mr.
Speaker .

I will take your point of order.

POINT OF ORDER

Hon. Patricia J. Gordon -Pamplin: As I said, I do not
hold a brief for the insurance company, but I cannot
stand and allow misinformation. From the information
and the consultations that I have had, there is no
standard premium that has been utilised to generate a
profit margin. There has been an administration fee, but not a profit margin for any of the insurers with
whom I have spoken.

Hon. Wayne L. Furbert: Mr. Speaker —

Minister?

Hon. Wayne L. Furbert: I know the Honourable
Member stepped out of the room for a while, so ma ybe she did not understand, or did not hear, but if the
loss ratio is 80 per cent, where do you think the 20 per
cent went?

[Inaudible interjection]

Hon. Wayne L. Furbert: They are accountants.
Where do you think the 20 per cent went, Mr. Speaker? I am not asking you, Mr. Speaker , but the Ho nourable Member should tell this House where she
thinks the 20 per cent went.
[Inaudible interjection]

Hon. Wayne L. Furbert: Other programmes.

[Inaudible interjections ]

Hon. Wayne L. Furbert: Mr. Speaker , our challenge
is great. We know that this party had set some goals
as far as bringing down health care costs, food costs,
and a who le bunch of things. And the beginning . . .
this is our second year, we are ending our second
year.

[Inaudible interjection]



Bermuda House of Assembly Hon. Wayne L. Furbert: The Honourable Member
said, It hasn’t been working. For five years, I did not
see anything working, that i s why they are not on this
side again.
But, Mr. Speaker , the Honourable Premier
and the Members of the Progressive Labour Party
have made a commitment to bring down the cost. You
will judge us in another five years whether we have
brought down those costs —two years, three years —
you will judge us then. As long as the Honourable Member keeps on increasing [the price for] his eggs, I
will be all right. No, I am just joking. I am not talking
about him in particular.
But, Mr. Speaker , when you consider where
we fit in the whole structure of where other countries
stand as far as health care, we are . . . I know we like
to be in first place. But, man [as a percentage of]
GDP, health care costs consumed 11.5 per cent. And
the only two countries [which are close to that]—
based on this diagram —are Switzerland and the Uni ted States. Indonesia is 2.8 [per cent], Turkey is
4.3 [per cent], India . . . why can we not get our costs
down? And so the things that the Honourable Member
mentioned, as far as what the Government should be
doing, the Honourable Minister will be doing those things. The Honourable Minister will be doing those
things!

Hon. Patricia J. Gordon -Pamplin: Do it now.

Hon. Wayne L. Furbert: The Honourable Member
said, Do it now . If the graph . . . and the Honourable
Member was there last night at the forum, she saw
that particular graph where . . . as far as the hospital
. . . the hospital was out of control. I wish I could show
those on . . . through the [microphone], Mr. Speaker .
But if you see the graph of the Bermuda Hospitals
Board, look where it has gone. So that is why 43 per
cent—

[Inaudible interjection]
Hon. Wayne L. Furbert: [It’s] 46 per cent. That is why
the Minister dealt with that first. Because who held
some control over that but the Mini ster? So those
things are what the Minister felt . . . Mr. Speaker , the
Honourable Member keeps on saying that the Minister
. . . they should have done something themselves, but
they did not.

Talk about what you are going to do.

Hon. Wayne L. Furbert: They should have done
something themselves, but they did not. This Gov-ernment under the Minister of Health, Kim Wilson, is
making a big effort. Now there is never any [gain wit hout any pain] also, I must say that.
Hon. Patricia J. Gordon -Pamplin: Point of order, Mr.
Speaker .

Take your seat, Minister.
Yes, Member ?

POINT OF ORDER

Hon. Patricia J. Gordon -Pamp lin: Yes, the Honourable Member indicated that we should have done
something. What we did in trying to bring down the
cost of health care, Mr. Speaker , the premiums, we
looked at the reimbursement of diagnostic imaging.
The minute these guys got into power they put it back
up and they donated an extra couple million dollars to
the hospital and to another private entity in terms of
equalising diagnostic imaging. We tried to do things to
help decrease the cost of health care.

Do not get distracted.
Hon. Wayne L. Furbert: But when some of their other
friends s peak, they do not want us to touch them.
So it is not fair, Mr. Speaker , attacking one
individual. What if you attack one of your children and not the rest of them? And said, I am going to make
some cuts on . . . you have got five people in your
family an d you are only going to cut one child. What
1582 17 May 2019 Official Hansard Report

Bermuda House of Assembly [about] the other four? No, it is supposed to be comprehensive amongst the whole family. This is a unified
approach on how we approach health care costs.
And so the Honourable Member says that as
far as our seni ors . . . our seniors, because they are
getting old, they should pay . . . I was not sure what
the Honourable Member was saying. I will be honest
with you. But what she implied was that because you are older you should pay more, and if you are younger
you should pay less. I could be wrong.

Let him just follow his point.

Hon. Wayne L. Furbert: So what is wrong with putting everyone in the same pool and finding a balance
between some that are sick and some who are not?
And we . . . and the whole view of those who . . . as a
matter of fact, the Bible says that we could bear the infirmities of the weak.

Whoa!
Hon. Wayne L. Furbert: So when you bear the infi rmities of those who are weak you have got to take
care of those who are weak.
So you put the weak on the side and take the
strong and put them on the other side—that is not
balanced, Mr. Speaker . Pooling us all together so we
could get our health care costs down overall could be the answer. And so the Minister is working towards a
resolution, something that this country can be proud
of. And there is nothing wrong in having social bene-fits and medicine and any other things we do. What is
wrong [with that]?
The Congress in the United States is debating
on, or they were (as much of the debate as I heard on
the radio and television this afternoon), about pr escription drugs, bringing down the cost of prescription
drugs. There is nothing wrong with that, Mr. Speaker ,
and there is nothing wrong with people maki ng money
either. There is nothing wrong with that. But we have got to find a balance for those who cannot afford it.
There are people out there who cannot afford it and
you talk about co- pay. Yes, we can deal with that too.
We can deal with those things. B ut this is the first step
. . . two years . . . June, July 17
th . . . it was a bad day.
I am sure you do not remember that date. But, Mr. Speaker , this Government will stay
the course and we have got some more time to put more legislation in place to bring down what we promised this country. We promised that we would bring down the cost of health care, and that is the direction
this Government is heading [in].
Thank you, Mr. Speaker .

Yes.

Hon. Derrick V. Burgess, Sr.: The Throne Speech of
2018 addressed the cost of the health care in Berm uda, and it is the objective of this Government to make
it more affordable, make health care more affordable,
by expanding access to coverage at better rates.
Mr. Speaker , we spend over $11,000 a year in
health care costs for each person. This we cannot
continue in that fashi on. This Government is addres sing it, maybe not to the satisfaction of some, and we
understand that. But change can be hard and painful
sometimes. But after you go through that pain it is al-most like you are training for a marathon. If you have
never run before and you run outside of your lane, you
will get tired, sometimes you may even faint. But as
you get stronger, you can last longer, Mr. Speaker .

[Laughter]

Hon. Derrick V. Burgess, Sr.: Oh yes, you can, Mr.
Speaker .
Mr. Speaker , you know, in the 1970s, the early 1970s, when health care insurance was put in
place, it was enacted in this Parliament. And I think the Minister at the time was Quinton Edness. He was
the Minister of Health. Mr. Speaker , legislation was
put in place that employer and employ ee [each] paid
50 per cent for health care.
Mr. Speaker , I will venture to say for the next
10 years after that was enacted, insurance companies
made millions of dollars in profits. Do you know why,
Mr. Speaker ? Because blacks and poor whites did not
go to the doctor every year for annual check -ups,
things that were covered under the insurance plan. It
took many years for that to get into our DNA, or into
our culture, like we do today. We go to the doctor ev ery year for a physical. We go to the dental hyg ienist
twice a year. All those things we did not take advantage of regularly, because we were not used to it.
We suffered through our pain. We just worked . . . we
went to work in pain. And a lot of older folks today,
they still do that, they do not run to the doctor.


Bermuda House of Assembly But things have changed and, unfortunately,
insurance companies are there to make a profit. And
each year they want to increase that profit. And really
it does not matter who pays, as long as they make the
profit. And two of the most expensive places in the
world for insurance coverage are the United States
and little Bermuda. Even though both [countries]
spend the most in health care costs, we do not live as
long as those that spend much less than us. We live
less. We do not live as long as they live, Mr. Speaker .
So really, spending a whole lot of money on health
care costs does not necessarily mean that you are
going to live longer.
This Government is trying to educate our
people to get some good habits because, Mr. Speaker, we spend over 10 per cent of our health care cost
on diabetes and kidney disease—two diseases that
we can, if we ate and changed our way of living,
change our way of how we consume our food, we
can—
Hon. Derrick V. Burgess, Sr.: —we can save a substantial —

I am sitting up here in all this —

Hon. Derrick V. Burgess, Sr.: —amount in dollars if
we were able to change our lifestyle in terms of our
diet.
Mr. Speaker , it was Dr. Brown who said in this
Parliament, If we cut all health care costs by 10 per
cent today, we will save over $70 million a year.
Mr. Speaker , we have not asked the doctors
to cut their rates, even though the workers of this country are working at the 2013 rate of pay. Because,
remember, wages were frozen. They had a furlough
day. And when t hey did get an increase under our
Government it was only for two years. So they are still
working about five, six years behind that rate. But
health care costs continued to increase. In fact, under
the previous Government, health care costs increased
by at least 38 per cent. That is a substantial amount.
Mr. Speaker , in 1974, under the household
expenditure, when you compared it to gross wages,
we paid (in 1974) $12.92 for health insurance. And in
2013, that is up $197.87. Mr. Speaker , today in 2019,
I am sure it is much more. We all know that it is because the costs have increased substantially.
Mr. Speaker , we got an actuarial report. And if
we continue, as the report says (in my words), if we
continue on the path where we are going, we would
have to inc rease the insurance payments by $84. And
this Government said we are not going to do that. We
have got to change the way that we pay for health
care. And by doing what the Minister and her staff
have come up with, we do not have . . . we are not
going to t ake that up to that rate.
Mr. Speaker , in fact, right now up until when
this Bill will be passed tonight, right now the . . . when we . . . it is $355.31 (the Standard Health premiums)
Two hundred and two dollars and sixty seven cents goes to the hospital and others; $50.67 goes to a dministration and profit; and $101.97 goes to the MRF.
Mr. Speaker , what we are doing . . . out of that
$355.31, $331.97 is going to the Mutual Re- insurance
Fund. No dollars are going to administration and profit. In fact, out of the $331.00, $1.51 goes to admi nistration and oversight, and $23.34 is going to the
SHB health care, Mr. Speaker .
So Mr. Speaker , there are other things that,
as a group, we should be attacking, because when we look at drugs . . . generic drugs are put there to help
decrease the cost of health care. But I do not know if
you all saw 60 Minutes on television Sunday night.
There is a case before the Supreme Court of the Uni ted States because these generic drug companies are
making a mint. In fact, one of the leading lawyers that
is leading this case, was paying $20 for a drug because of a skin condition. That drug went up to
$1,800— over 8,000 per cent! Then there is another
drug for asthma treatment, very common to some of
our people in Bermuda. It went fr om $11 a bottle to
$434. And these are generic drugs! And then one for
cholesterol went from $27 to $196 per bottle.
Mr. Speaker , the report says that in the United
States, 90 per cent of all prescription drugs are filled
with generic drugs. This is supposedly making health
care cheaper. We do not produce any drugs in Bermuda and so we have got to bring in these generic
drugs. Nobody is attacking that. They are saying the
Governments are responsible. You think the PLP
Government is responsible for things f or which we
have no control over. That is what we are facing. And I just hope that this case in the United States is very
successful because that certainly would affect us. And
maybe we have to look at different places to bring in
drugs from, provided that they conform to the standards that are set out by the World Health Organiz ation, Mr. Speaker .
Mr. Speaker , in fact, I . . . you know, I have
said to my colleagues that maybe we should be looking at other places to get health care when we have to
go overs eas. I know most people who require treatment go to the United States. But I would think . . .
now I have not done the research, but I would think Canada is much more reasonable, and certainly the
UK is much more reasonable. And I think we have to
start se nding people to the UK because, for example,
if someone has a conviction for a seed from 30 years
ago, and they need to go overseas for treatment, they have to get a waiver. And the way things are in anot her country, it is not so easy.
So when people call me I say, Well, you need
to tell your doctor to refer you to the UK, because you can go home and get treatment —we are British,
whether we like it or not. So they cannot . . . they do
not stop you from going home. So we need to look at,
particularly for that particular purpose, because the
1584 17 May 2019 Official Hansard Report

Bermuda House of Assembly UK has got some fine health institutions in existence
and we should use them, Mr. Speaker .
So, Mr. Speaker , I certainly support the Mini ster, my Government, for taking a stance and, certainly
the staff of the Health Minis try, for trying to find ways
to decrease the cost of health care in this country.
Yes, it is going to be painful. But insurance companies, as you can see, Mr. Speaker . . . I have heard
from some people that have gotten notices from i nsurance companies where the insurance has gone up
over 20 per cent.
And people —some people —are blaming the
Government because they do not know better, instead
of trying to find the facts. We are trying to contain the
costs. And why would the insurance companies i ncrease their rates? For more profit. You see, I think I
heard it on TV the other night. Some companies have become too big to care. And so, really, they really do
not care about . . . they will probably write in the paper
the way they love to write me up. And I will get a r ebuttal that, Yes, we care. Care about what? Profits!
Yes.
They have got to stop thinking that every year
they have got to make a bigger profit on health care.
Health care is a human right, something we should
have, and it should not be made for prof it. Our people
deserve that health care. It is not a privilege; it is a
right we should have —all. And you should get that
health care service, and that is our objective, regar dless of your financial position. Our folks should have
treatment afforded to the m whether they are rich,
whether they are middle class, or whether they are
poor or homeless.
And that is the objective of this Government,
to make sure that people are serviced, whether they
have got insurance or not. We cannot have our people
going to the hospital and because they are not insured
they are not going to get service. That is not the case.
And we do not want to make that the case because
some people are homeless because of the circu mstance of this country, some people are poor because
of the circumstance of this country, and we cannot let
them suffer because of some of the circumstances
[are the result] of some of the history in this country.
Mr. Speaker , health care to working men is
young in Bermuda— when I say “young” [I mean] enacted in the 1970s. A lot of other folks had that before
we even got that, like pensions. And it has gotten out
of hand because, just like in the United States, when
the private sector is involved your health insurance
will be as expensive as it is.
Thank you, Mr. Sp eaker .

Good afternoon.

Hon. Michael H. Dunkley: Mr. Speaker , I start out by
asking the question, How does this Bill decrease the cost of health care? Because that is where the Ho nourable Member from constituency 6 started. And he
went on in his presentation with some emotion and he
talked about this Government’s commitment to bringing the cost of health care down. And so far in this
debate, which started about twelve o’clock, I have not
heard any fundamental understanding of this Bill on
how it will bring the cost of health care down.
I have heard a lot of conversation so far (and I
am sure this debate is going to go on for some time). I have heard a lot of conversation up to this point in
time about many different things that are not inc luded
in this Bill, but I have heard nothing, if very little, to show me how this Bill is going to bring the cost of
health care down. And that is the underlying problem that my colleagues and I have with this Bill. And it is
the reason why there is a lack of support for this Bill.
Mr. Speaker , my honourable colleague who
speaks for Health made a very commendable presen-tation this afternoon, just coming back from a proc edure herself. I know how she is committed to it. I know
she is committed to this House and the people she
serves. And she came back and did a wonderful
presentation after listening to people, consulting with
people, and bringing information to this House.
And I am going to start where my honourable
colleague started out because, Mr. Speaker , there has
been a lack of consultation; there has been a lack of
input. People involved in the industry have just been
advised of what Government is going to do. And this Government hangs their hat on consultation, listening
to people, moving forward together. But we have seen the track record over the almost two years, Mr.
Speaker . The track record has been veiled in consu ltation, but it is, We are going to tell you what to do and
we will move forward from there.
This important Bill, as my honourable colleague said —and it bears repeating over and over
and over again, Mr. Speaker —this important Bill has
been rushed to the floor of Parliament because time is
not on the Government’s side. They gave a commi tment to June 1
st and they have to make that commi tment to June 1st. Hence, here we are today with the
Rules of the House being pushed to a seldom -used
Rule to allow it to be debated without the two required
sittings here. And perhaps some of that, Mr. Speaker ,
is because it is 25/11. That is not good for democracy in any way because this, Mr. Speaker , is a significant
piece of legislation.

Speak to the Bill, speak to the Bill.



Bermuda House of Assembly Hon. Michael H. Dunkley: Everyone in Bermuda is
concerned about their health. Everyone in Bermuda is
concerned about their cost of health care. But what is
happening today is not informing, it is not listening, it is telling, just telling people, Mr. Speaker . And what I
find most amazing about it is . . . because I would say
a couple of weeks ago this started to really f erment
behind the scenes and then bubble out into the public and information has slowly come out.
First, the Minister made some comments.
Then some of the insurers made some comments. Then the Minister went back and then we get into,
what I would call the straw man about who is guilty
about this —the insurance companies making too
much money. We go back and forth. And all through
this, up until today bits and pieces of information have
leaked out. And I was quite surprised, Mr. Speaker , to
see and to hear l ast night in the public meeting we
learned about a $65 million, what I would call slush
reserve that is there just in case.
So, through this period information has just
trickled out. And I say that because this is a significant
change, and I do not think that the people of Bermuda
really understand what is going to take place— and I
will come to that in a minute.
The PLP needs to own this change. They own
it today because it seems that their benches in unison
support the change. But they need to own the ch ange;
they need to manage the change, Mr. Speaker . And
this is very key because this is a fundamental change
to the way that health care has been managed. And I
have not heard yet, Mr. Speaker (and I will get to that
more) how this change will be managed effectively.
The PLP also as the Government need to understand what the impact of the change is going to be.
And I have not heard that up until this point in the d ebate as well, Mr. Speaker .
Now, Mr. Speaker , let me address for just a
few minutes the cost of health care. And I will admit
that generally our health care in Bermuda is quite
good. We know we have one of the highest costs of
health care in the world, but generally the care we get
is good. We have got some excellent professionals at the hospital a nd out in the community taking care of
Mr. and Mrs. Bermuda who we all care so much about.
And you know, Mr. Speaker , one of the interesting things ––and it causes me to just smile quietly
for a moment about these types of debates ––is how
everyone says what the other guys have not done and
what they have done and vice versa. Well, Mr.
Speaker , when you point a finger at someone else,
four fingers always point back. But here is what I can
say; health care costs in Bermuda are expensive.
That is a fact. We all agree on that.
Health insurance premiums in Bermuda . . .
and the Honourable Member from constituency 5 who
just sat down talked about health insurance premiums
back in the 1970s and how much they have changed. Mr. Speaker , I just look back over the past 10 or 20
years. Health insurance premiums have doubled in the last 10 years —10 years. Now reflect on that i mpact. And we will say it off the cuff in the debate but, Mr. Speaker , it is important that we reflect on that i mpact, reflect on the impact to the p eople we serve,
those people paying those insurance premiums.
There is no way that their cost -of-living increases or
the increases they would get because a business is
doing well or they have done well or they have been
promoted . . . there is no way that those cost -of-living
increases, or whatever raise they earn, will keep up
with the increasing cost of health care.
Mr. Speaker , in my company . . . and I have
no interest in health care, so I speak without any con-flict in any way about that. In my company, Mr.
Speaker , I have watched the rise in what we pay for
health care by law. And we have always paid a slight bit more than the 50 per cent that we have to pay —
that is something that my grandfather started back in the 1970s. And, of course, when you give people
something which they deserve, you do not roll it back. But, Mr. Speaker , in the company that I have worked
in for 40 years now, we pay $1 million a year for
health care —a million dollars!
When I started out in 1980, I could never i magine I would be standing here in the House of A ssembly in 2019 stating that figure, Mr. Speaker . It is
unsustainable. And so we support every initiative to
bring down the cost of health care. But, unfortunately,
myself and many Members of this House— probably
on both sides —will question the success of the direction we [are going] because we have not seen it yet.
But we point fingers.
Now, Mr. Speaker , the worker cannot afford it.
The employer cannot afford it. I have already heard
over the past couple of weeks and months as these
changes have been muted coming out in the comm unity, how some employers are looking at ways to stay
in business because of the rising cost of taxation
(which they have to pay) and they are reducing ben efits to their employees. Clearly, that is not w hat we
want. Clearly, that is not acceptable.
And you know what is amazing about it is that
over the last couple of days I have talked to people in
the street. I have talked to people that I work with at
Dunkley’s about health care. And very few of them
know how much they have actually paid. Very few of
them have calculated the changes over time, Mr.
Speaker . And I do not care if you can afford to pay it
or if you cannot afford to pay it, it is shocking and
eventually it knocks on your door where enough is
enough. It is unsustainable for Bermudians, Mr.
Speaker . It is unsustainable for the man in the street
who is struggling to get ahead. This is sugar tax number two.
And why do I say that, Mr. Speaker ? Because
sugar tax number one was well -intended. Sugar t ax
number one was done without adequate consult a1586 17 May 2019 Official Hansard Report

Bermuda House of Assembly tion—no listening, just advising. This is sugar tax
number two. It is unsustainable for a successful Bermuda going forward because of the pillar of our community which brings in the revenue, which props up
our GDP, which really is a miracle GDP, but some people would classify it as a false GDP, Mr. Speaker—international business. If we did not have intern ational business here, Bermuda would just be paradise.
It would not be a successful paradise; it would be p aradise struggling to get ahead.
So, Mr. Speaker , health insurance costs with
international business —who can move anywhere they
want in this world, who do not have to be anywhere to
do business . . . they need certain things, yes. They
need quick access to the markets, quick access to get
regulation, they need a lack of bureaucracy going forward, they need to be able to have good service —
Internet and things like that. They need to be able to travel and stuff like that. But the cost of health care to
an industry that is a pillar of Bermuda not only impacts
the people of Bermuda, it has international business
questioning, Well, wait a second, is this the right way?
Now, Mr. Speaker , I have questions for the
Honourable Minister and the civil servants who work so hard. And we do not always agree with the policy. I
would like answers. How do the ABICs and the ABIRs
feel about this policy? What has been the communic ation with them? How does the hospital feel about the
implementation of this policy? What has been the
pushback from within the various sectors of the community?
Let us face it, Mr. Speaker , if we could get
something for nothing, we are all going to want that
nothing from us to get that something. But, Mr.
Speaker , at the end of the day somebody has got to
pay. And what we are doing here is . . . I see Go vernment rushing into something without any measure of success being able to be seen by us on the Oppos ition benches, and they are just fighting to say that,
We’re going to move forward. We’re going to reduce
the cost of health care. And I am concerned, Mr.
Speaker . I am concerned because I do not see how
this is going to be successful.
Now, look, the cost of health care, general
health care inflation . . . from my research it shows
that it is 6.5 per cent this year. So, if the Government
believes that the cost of health care should not go up,
what do we do about that 6.5 per cent increase ge nerally in health care inflation? And if the Minister can
correct those numbers or prove that number correct
when th e time comes, I would like to hear it. But if it is
6.5 per cent, who is paying for that 6.5 per cent? Is
the hospital paying for it? Are we going to pay for it
down the road somewhere else? Is it coming from that
slush reserve that I referred to, Mr. Speaker ?
Last year we know the Government took a lot
of stick for increasing the Standard Premium Rate by 6.4 per cent —6.4 per cent. They took a lot of flak
about that. So when the actuarial came back this year and said that we would need to increase the rate by
$84— $84—I am not surprised that the Government
balked and said, That is not the way that we are going
to go. And that is acceptable. But when you are listening to the rationale for going in the direction we are
going, it does not make any sense to me.
So they devised this block funding. And I have
sat here since twelve o’clock (with the lunch break) and I am still looking to see how this is going to work,
and I am still waiting. The Minister’s brief did not i nclude it.
So I want to know, Mr. Speaker , $330 million
is given to the hospital —a significant amount of money. What is in place to make sure that it works effectively? Mr. Speaker , what is in place to make sure that
it is efficiently used? What changes are put in place to make sure that this money is spent in the appropriate
way, that there is no waste, there is no overutilisation,
and there is control over it? I am still waiting.
But what do I hear, Mr. Speaker , on the eve of
this important debate? I hear there is a slush reserve.
Now, Mr. Speaker , $65 million . . . that is a lot of money. Even when you talk about Government budgets
and all, $65 million— a slush reserve, we heard last
night —is not mentioned in the brief. The slush r eserve, we hope we do not have to use it, but it is there
if we need it . That is more than $1,000 that every
Bermudian has put aside to pay for something if it does not work. Can you imagine those Bermudians in
need, what they could do with that money? How
they—the man in the street that we all love and we
talk about —could re duce the cost of their groceries if
that money was actually put aside for healthy living?
Not in some slush reserve where we just heard about
it, but now it is available and now, if we have to use it,
we will use it.
Mr. Speaker , when I heard that [last ni ght] all
the support that I thought about giving to the Bill went
out the window in that nice heavenly breeze we had last night. It was gone, and it is not coming back. It is
not coming back, Mr. Speaker . One thousand dollars—more than $1,000— per person is put aside.
Now, Mr. Speaker , we hear Honourable
Member s on the Government benches talk about how
they want to reduce the cost of health care. But when
[the OBA] Government came forward with real change
to help by capping costs for services given out there ,
as soon as the PLP became the Government they
were pushed into a corner and they paid out millions
of dollars to people who threatened them.
Mr. Speaker , they were threatened, they
blinked, and they paid. No, no, Mr. Speaker , let me
correct that —

The Sp eaker: Well, well, let us not —

Hon. Michael J. Scott: Mr. Speaker —

Ah, ah, ah, ah, I got it.


Bermuda House of Assembly Let us not make accusations that you cannot
support. So, if you cannot support that there was a
threat, do not put it out there. You were on a good line
and length until then. You were on a good line and
length. So stay on the line and length that you were on.

Hon. Michael H. Dunkley: Yes, Mr. Speaker , I will
support that there was a legal suit, so Government
paid out to settle the suit. That is what I was referring
to, Mr. Speaker .

Okay. Move on.

Hon. Michael H. Dunkley: Yes, I will move on, Mr.
Speaker .
And, Mr. Speaker , to change the direction of
trying to deal with one of the challenges . . . and
Members on both sides of the House have talked
about utilisation of services. The Honourable Member
who spoke just before me talked about utilisation of
services. But what happened? So what did we see at
the Bermuda Health Council? The CEO is removed so
they can go in another direction, Mr. Speaker .
Well, Mr. Speaker , this is the start of a change
to a single payer system.

POINT OF ORDER
[Imputing improper motives]

Hon. Michael J. Scott: Mr. Speaker , point of order.
Mr. Dunkley must stop imputing improper m otives gamely and continuously, please.

Well, well, wait, wait, everybody take
your seat.
So far this day has been on track. Do not get
yourselves sidetracked on something that you should
not be walking on. Stay on point where you are. And I
do not think it is clear yet why certain individuals may or may not be where they were beforehand. It is not
for us to sit i n this room and make that judgment. So
until it is made open and clear, I would ask us to stay
away from that.
You have the floor.

Hon. Michael H. Dunkley: Mr. Speaker , I am not going to comment on that matter because it is for the
courts.

Amen.

Hon. Michael H. Dunkley: Now, Mr. Speaker , I hear
the Honourable Member say on that side, Amen. And
while I have confidence in the Government to provide
many services, one area of confidence that is lacking
is to provide the oversight of a block grant going to the
hospital without any background shown today of how
it is going to be managed, controlled, and where the
efficiencies are going to come from.
Mr. Speaker , we would have to be foolish to
stand here today and voi ce support for this Bill without
fundamental questions being answered. We cannot
just blindly follow behind a 25/11 Government and
expect, Okay, $330 [million] goes to the hospital and
they will manage it in the most appropriate way. What
systems have changed down there? Who is respons ible for that management? How is it going to be controlled?
You know, one of the things that I have not
heard discussed in this debate as of yet, Mr. Speaker ,
is the fact that we have seen over recent years the
use of the hos pital increase drastically. And I think
everyone [can state] their view of why that has happened, but one of the reasons why I have seen it hap-pen, Mr. Speaker , certainly in my company, is the fact
that doctors charge a co- pay for a doctor’s visit. So a
lot of people say, Well, you know what? I am not worried about going to my doctor. I need to get an appointment. I have got to wait in the doctor’s room, and
then I have got to pay money out of my pocket, and it changes for every doctor. I am just going to g o to the
hospital. So we have seen services at the hospital be
called on with more and more demand.
And now, with this change to a single- payer
system where a block grant is going to go to the hospital with its already increased usage, how is it going
to be managed? That is a real concern.
So in doing this, Mr. Speaker , the Gover nment, in my belief, is quietly and conveniently putting
an increased burden on the private sector. Gover nment is taking the burden that they should [accept] —
[this is] why people pay taxes for the indigent, for
those who need help, for young people, for older people. They are shifting [this burden] onto the private
sector and they are saying it is okay to do because
the insurance companies are making too much profit.
Now, Mr. Speaker , if the insurance companies
were making too much profit, where are the discussions that they have had with the insurance compa-nies to discuss this? I have not heard about it. The
Minister was very strong, very strong, in her com1588 17 May 2019 Official Hansard Report

Bermuda House of Assembly ments about the insuranc e companies. But at the
same time, if you are going to be very strong in those
comments, I want to know what discussions you had
with them to show your discontent and to show how
they would work together. I have not heard it, Mr. Speaker . That is a straw m an in my view.
This Bill does nothing to address the fund amental costs of health care in Bermuda. We have not seen it yet. In fact, and I am going on record today,
because Hansard is a beautiful thing, Mr. Speaker . It
is a beautiful thing. I will go on record today that this
will be a backward step and it will lead to more i ncreases in health care.
This Bill, Mr. Speaker , further enables health
care providers to overutilise with little oversight —few
checks and balances. If we want to deal with the cha llenges facing health care today, we should start with
overutilisation. We have great discussions about
health care in this Honourable Chamber and in our
caucuses, and I am sure you do in the PLP as well.
The factors that contribute to the cost of health care . . . overutilisation is one of them. Medical technology
and innovation is expensive, and we are paying for it; spending on drugs (the Honourable Member from
constituency 5 talked about spending on drugs). But
you know what? There are many generic drugs that, if Government mandated the use of those, we could save money.
Another reason why we see a real increase in
health care is that there is very intensive diagnostic
testing that is done. And quite often, Mr. Speaker , in
my view it gets a bit defensive, because it is done
over and over and over again trying to look for a rea-son behind it, but that is unsustainable.
Of course, we know our demographics are
impacting us in a real way. Now we have the baby
boomers starting to age a bit. Our senior population is
growing, and their health care costs are quite a bit
more, much more, than the younger people. And the
younger people are the group that is going to pay
more disproportionately for this than older people. And
younger people do not use health care as much as
older people because they do not need to. Plus, when
you are younger you feel that you are invincible—I
have a little ache and a pain, I’m not going anywhere.
Mr. Speaker , we also know that our lifestyles
and other high- risk behaviours are a drastic dra g on
the cost of health care, whether it is obesity, our phy sical inactivity, whether it is our diet, and then there is the general inflation that I referred to.
So, Mr. Speaker , if we had a Bill that came
today which addressed those fundamentals —even if it
was just two, three or four of them —rather than a
block grant to a hospital like, We’ll give the money to
them, they are the experts, they’ll deal with it, and we feel comfortable, I think you would see more support,
Mr. Speaker .
Now Mr. Speaker , during their election campaign the Government was very vocal in talking about Two Bermudas. Well, Mr. Speaker , I believe this will
help create more of Two Bermudas in our community. Do you know why, Mr. Speaker ? Because you are
shifting the cost to the working c lass to make them
pay the bill. Included in the Government taxes that continue to go up there is a lack of check and balance
and, at the end of the day, the working- class people
are going to pay the bill with no guarantee that they
are even getting value f or money.
Now, Mr. Speaker , it is time that we stopped
the talk of the straw man and blaming somebody else. We have to have real talk, because in a year’s time
we will be back here again. A budget will be passed,
health care will be a hot topic again, and we will know
what has happened in the months to come with that
$330 million block grant. And I would love to see my
suspicion and my research proven wrong, Mr. Speaker. I would love to see that it is successful. But I just
cannot see it, Mr. Speaker . I se e a hospital that is going to be overwhelmed by people going down there. I
see hospital staff that are going to be overwhelmed by
what they have to do. I see a lack of control for money that needs to be put in certain areas. And I see Mr.
and Mrs. Bermuda, who we all care so much about,
paying for something that we cannot afford anymore,
Mr. Speaker .
This is a step in the wrong direction, and we
need to think more clearly about it. And before the Government even asks us to support this Bill, they
need to explain how this is going to be productive and
get some buy -in—not only from us, but from the people they serve who are really starting to raise questions. Because they are tired . . . people are tired of
being taken for granted, Mr. Speaker . They know the
health premium is going to go up again. And we can
blame the insurance companies when 15 per cent is
passed on, or 20 per cent is passed on, Mr. Speaker .
But that does not change the fact that more money is
coming out of Mr. and Mrs. Bermuda’s pay cheque. They are not going to get a raise to cover that in most
cases, Mr. Speaker , and ends are going to get tougher to meet.
More people will leave the country. When the
PLP was in the Opposition, they talked about people
leaving the Island and going to the UK w herever they
can go. People will be leaving the country. And we
have a responsibility not just to pass something that
sounds good, but to show how it is going to work well.
And I will take my seat now and wait for that
rationale, for that reason, for that understanding to
come. And if it is not heard, Mr. Speaker, this Bill can-not be supported.

—and logical in his approach.
This Bill also makes logical and strategic sense, Mr. Speaker in its changes.
While it may not be favourable for the insurance industry, it does, however, Mr. Speaker, make
sense. And I do not envy the Minister of Health for the
decisions she has had to make. But I do know that we
have a very excellent actuarial team. And the Oppos ition should know that as well, because I am sure they have worked very closely with them as well. And so they would have studied this and made decisions in
regard to how this would impact our health care sy stem.
Our current health care system, Mr. Speaker,
is unsustainable. With 75 per cent of our people being
overweight and obese, and a 35 per cent rate of
chronic disease, Mr. Speaker, it is costing us way too
much.
I did attend the town hall meeting last evening
as well, Mr. Speaker, and many of the questions that
were raised today were actually answered in the town
hall meeting last evening. Last evening the present ation was very detailed and many peopl e were there
and they had the opportunity to ask questions. I think
they did a phenomenal job in their presentation because we thought that the questions would be at a
much higher volume. We know that all insurers, Mr.
Speaker, have to pay into the MRF [ Mutual Re -
insurance Fund] , and that includes [GEHI], that i ncludes Argus, BF&M, Colonial —all of them. They will
have to pay into the MRF.
Mr. Speaker, we currently have a “sick care”
system, and not a health care system. Quite frankly, Mr. Speaker, I work in the health care field and I am
run off my feet every day having to deal with health
issues. We talk about “utilisation.” Mr. Speaker, we all
have a responsibility in utilisation. I have an uncle who
is homeless. Prior, he was living in a home and the
home burnt down. He had to get help because he had
nowhere to stay, and he did not really take advantage of the health care system because he had no insur-ance.
Once he was able to get help through FA [F inancial Assistance], and he got insurance, he then had t he opportunity to be part of our health care sy stem. And he had not been in our health care system
since he was a child. When he was young he had an injury which
impacted his vision, his eye, and so now that he had
insurance he was able to get follow -up treatments and
follow up in regard to his vision. He was stabilised, you know, he had cataract surgery, he was stabilised, and he is doing well. However, I noticed that they kept
making appointments for him every two to three
months and his vision was stabi lised. And I said, Why
do you have to keep going to this doctor every two to
three months when your vision is stabilised? You tell
me that you are seeing better than you ever saw be-fore.
He said, Because they kept telling me to
come back. They kept making appointments for me.
So I called and asked, Why are we making
appointments for him? He does not need to come.
And so, you know, in all of this we all have r esponsibility for utilisation. If that means advocating on
behalf of other people, advocating for ourselves, we
must do that. We cannot continue to do things the
same way, or just continue to kick the can down the
road. We cannot continue to fund an open cheque. We have to be more efficient in hopes of making
health care more affordable for Mr. and Mrs . Berm uda.
Care will still be available outside of the hospital. There is a misconception that care is not going to
be available outside of the hospital with this change that we are going to make. Care will still be available.
Currently, Bermuda’s funding mechanism for health
care is extremely complicated. We saw this chart last
night. It is extremely complicated and it is . . . we understand why . . . how things could go missing and
things [could be] misunderstood.
For a country of our size, this could be much
more simplified, and this is what we have attempted to
do, Mr. Speaker. So taking a block payment of $330
million is making the process simplified. It does not
mean claims are not going to happen! Claims are still going to happen.
If this system was easy, it would have been
fixed by now, Mr. Speaker. Would we rather have an $84 increase in our premium? Because that is what
actuaries were proposing to maintain a status quo.
Honourable Dunkley’s insurance . . . he would have
had to pay more, it would have gone up. But we as a
Government are keeping our commitment of what we
can control to keep health care costs down for our
people by maintaining the current extended premium
rates. The money that we are spending for the people
of Bermuda is going toward your health care. No
where else! Our health care system has to start cooperating to make health care more affordable. The i nsurance companies should be a part of this cooper ation.
The change of a block payment will hopefully
encourage the hospital to put in place controls and to
also make our system a little bit more efficient. And because we have control of this, we know that the
1590 17 May 2019 Official Hansard Report

Bermuda House of Assembly majority of our health care costs, 46 per cent, goes
toward the hospital care. So we are going to use this
as an opportunity, and also an incentive, to keep people in Bermuda healthy.
The hospital has all sorts of expertise. They
sat around the table, I am sure, and the insurance [people] have sat around the table, I am sure, looking
at how we could make our health care system more
affordable. They continue to do this, I am sure, within
the health care reform meetings.
Insurance companies will now have to get a
little bit more creative, and they cannot expect to do the same things the same way and get a different ou tcome. So why a ddress the hospital? I am quite sure,
actually, like I explained before, that we have more
controls over the hospital, Mr. Speaker, and if we can
work with the hospital so that they can create pr ogrammes within the hospital to try to get health care costs down . . . we actually have a very effective pr ogramme right now, which is the Enhanced Pilot Care
Programme, and I am hoping that the hospital with all their expertise will come up with some more pr ogrammes to also help to actually deal with health a little bit better and to make people more healthy rather
than us becoming more sick.
So we are trying to address this issue. We
want to be able to preserve health care for the future. There are two questions. Should Government be in
the business of subsidising administration costs and
profit? How are we going to change the behaviours of
our people and of our system, [which is] causing their
health care costs to be so high? How are we going to
do this? We have allowed health care to become a business of profit. And if you follow health care all
over the world, particularly in the United States, health
care is a big profit business. And so we have to try
and figure out how we are going to pull in the reins
now. If we don’t, we are going to be in big trouble,
Bermu da.
To the people of Bermuda [I say], shop
around. Shop around for your health care needs. You
know, a lot of times we get on social media and we
will complain about things but we do not really go to the source to try to get health care costs down. Okay?
And even if we shopped around, we might even find
that some of the cost savings are not a big, significant difference, but that should still not stop us from shopping around.
It is not an option to do nothing, Mr. Speaker.
It is not an option. We have to continue to protect the
citizens of our country. We have to continue to make
our citizens responsible. And practicing healthy b ehaviours we should be incentivising. We will stay the
course because our ultimate goal is to provide natio nal health care. As yo u will see in this Bill, there are
many other changes as well which ––I mean, actually,
great changes.
So we have to continue to run the course and
believe that we are making the right decisions. You know, sometimes we will speak as though not much
time, n ot much effort, not much thought has gone into
a particular Bill, but it has, Mr. Speaker. It has. And we
will see, just like how the Progressive Labour Party,
so many years ago, enacted pensions for our people, we will see in the years to come, how this w ill be helpful to us as a country. Thank you, Mr. Speaker.

Thank you, Honourable Member.
Does any other Honourable Member wish to
speak? We recognise the Honourable Member from
constituency 19. Honourable Atherden, you have the
floor.

Hon. Jeanne J. Atherden: Thank you, Mr. Speaker.
Mr. Speaker, I think I am glad I am starting
where the Member left off, because I think this whole
question of the Bill and where we are going, to me,
gets right down to what is the intent. And when I look
at the information that was put out by the Minister, it
seems to me that it is all centring on universal health
care for all. And when you look at it and look at the information that has been put out in her brief, et
cetera, it is the social contract, et cetera, and I just
think that the people of Bermuda need to understand
what this means, because I have always maintained
that everybody in Bermuda should have access to
health care.
And I have always maintained that we should
be looking at ways in which we ma ke sure they have
access. And I know that when I used to be the Mini ster, we used to talk about the potential 6,000 individ uals who were out there who were uninsured or underinsured, and I used to say to myself, Okay, we have
indigent subsidy. We have age subsidy. We have
youth subsidy. There has got to be a way that we can
turn around and deal with these 6,000 people.
And I always used to say, If we could somehow give an insurance card to these 6,000 people to
say, ‘Here you are. This is your card. When you are ill,
go to your doctor and have whatever illness taken
care of. Do not go to the hospital where you are going
end up being charged $2,000 for a doctor’s visit that
you could pay $200 for. And I thought, Why can’t we
do that? When I heard that this current Government
was working on something that we had hoped to work on, which was the unique patient identifier, I thought,
Great! That might be the beginning of trying to figure
out how to have universal health for everyone.
But, now that I see what is being introduced,
my concern is, I believe that we are putting the cart before the horse. I believe that we are coming up with
something that says that you are going to have un iversal health [coverage], but I still cannot see with all
the stuff that is in h ere, how it is going to get down for
the people who we need to get to. I cannot see how the person who is underinsured, or the person who does not have insurance because he is not working, I
can’t see how he is going to be better served.


Bermuda House of Assembly So, for me, I am saying, Mr. and Mrs. Bermuda, look carefully at what is going to happen because
there are some unintended consequences. And when
I get to talk about some of the other things that are happening, they will see. On the one hand, there has always been two issues that we have had to wrestle
with. I acknowledge, we all acknowledge, $770 million
(or whatever, those huge numbers), we do not want to
be at that level because I know this is the type of thing
––you do not mind having your . . . the cost of . . . the
amount of money that [Bermudians earn] high because then you can say you have got the richest peo-ple in the world. But you do not want your health i nsurance to be high because then you are saying, Hey,
we are too expensive.
But what we have to look at, Mr. Speaker, is
the fact that if we are going to bend this curve, you have to bend the curve one of two ways. You have to
bend the curve in utilisation, or you have the bend the
curve in terms of the cost that you charge for that. So
when I look at the things that are here, I am really
concerned, because I see lots of things that talk about
putting money in this pocket and putting it there and
whatever else, and I do not see anything that talks
about bringing the cost of health care down, so I am
going to go through, Mr. Speaker, and I am going to
pick out a number of things in here that I believe Mr. and Mrs. Bermuda need to understand and what this
says.
I have no problem with saying health care in
many countries is considered to be a basic human right. Under stood. I do believe that in Bermuda we
should try and make sure that everybody has access
to health care. And that is why I am reminded, and I
had forgotten all about this, when you used to have
. . . down at the hospital, you used to have a clinic that
people who did not have insurance could go to, they
could go down there and they could be seen by staff
that cared about them and whatever, and all of a sudden someone made it like a dirty word as if to say,
You can’t go down there. And so I am saying, Mr.
Speaker, we have to make sure that when we do
things we do not have unintended consequences that
were unforeseen. Or, if someone had a plan, then you
need to understand what their unintended cons equences were and make sure that you are not hoo dwinked.
Now, Mr. Speaker, there was an indication
that we do not want to have persons who fail to r eceive the care that they desperately need. That is
what I said. That, to me, was why you had the subs idies. You had age subsidies [and] indigent subsidies,
and that is w hy I always felt that they were put toget her to try and make sure that these people were covered. But maybe they were not achieving as much as
we wanted. So, when you start talking about current health care spending, over $720 million––which it is
rather unfortunate, but [that is what] it is ––and when
you have it being stated that how we reduce the cost of doing business is by lowering the cost of health i nsurance, I totally agree with that. But I do not believe
that you are going to say that this is going to attract
more international business to Bermuda. What it is going to do is make sure that everybody that is on the Island can then pay for their health insurance and
make sure that, generally, Bermuda becomes less
expensive.
And I totally agree with the Minister indicating
that it is time for us to do this because we want to
make health financing reform to improve our health system for the sake of our economy and for our fam ilies. I buy into that. I think all of my party buys into
that. We are aligned as it relates to that. But where we
get into this issue is how do we make sure that the
cost of health care is improved.
I have a real concern when I see it stated that
holding our hospital more accountable for how much care they need to deliver, and the quality of health
care they provide . . . I support that. I think we all su pport that. But I think we are also forgetting part of this.
The hospital is a provider and, in some respects, the hospital is subject to the demands that other people
put on them. A doctor has to send you down to go to
the hospital, to say that you are ill, and to ask you to
be admitted. When the hospital does lab tests, any of
the lab tests that are done for the hospital inpatient, are not charged outside. The only services that are charged are the ones that outside physicians order.
So, in some respects, we have to understand
that they are not like some providers where they can generate, by and large, their revenues, where they have control of their revenues. And so, to suggest
they are responsible for how much care they need to
deliver, I think sometimes it is not having us look very clearly at the way they operate.
From the perspective of better reporting and
better negotiation of cost, I think we all buy into that. I
think we all agree. And I just cannot see how chan ging this money from one pocket to the other is going to
prevent the Government from saying that right from
the get -go. Because I remember when we were the
Government, we had discussions with the hospital
about doing that. They had a study done, I think it was
by KPMG, where they went through, they looked at all the costs, they brought down a number of their fees,
they looked at ways to better utilise the service, so
this is not something that does not happen. And for
this current Government to do that, I glory in that, because the better that they can be in what they do, the better we can make sure that the costs that we have to pay for these services [can be reduced]. So, better
utilisation and better partnerships, I thi nk we are all
into that.
But, as I say, the hospital did that before. But
what I am concerned about is the suggestion that
looking for the hospital to be better, and then to turn around and not talk about the other providers, that
worries me. Because if yo u turn around and you look
1592 17 May 2019 Official Hansard Report

Bermuda House of Assembly at the amount of money that is being spent, if there is
$700 million that is being spent outside, in total, and if
we are saying that the hospital is $330 million, then
there is still money which is almost more than that
money wh ich is being spent. And I know some of this
is being spent overseas, and we cannot always control what is happening overseas. So when you start to
look at the suggestion of doing these changes, getting
the basic care at a cost that is affordable, I do not
think that anybody on this side of the House disputes
that. But you have to start looking at what is afforda-ble.
And when I look at what the Minister said, I
looked at three things. She said that we are asking for a base level of social responsibility for all. And I do not know whether the definition of “social responsibility”
has ever been put out there so that all of Bermuda
understands. When you say “social responsibility,” I
believe that this Government needs to come and
make clear what they mean by soc ial responsibility for
all.
And when you start to talk about the basic
care, it is important for us to have clarity on how is
basic care defined because depending on what you
put in there determines how much you have to spend
and also how much is going to be available. And then
we are talking about the cost that is affordable. When
we started to try and look at the cost that some services should be, we changed it. Then all of a sudden,
the next thing happened. The current Government
came in and increased i t. So I am saying to myself, If
we brought it down to something that is affordable,
what was the basis on which it went up? And if your
premise is to make it affordable, and you come up with something that made it affordable, then why
would you backtrack?
But, Mr. Speaker, in terms of the Minister ind icating that . . . in terms of it is the time to allow every
member of society to have the right for health care, I
do not think that anybody disagrees. Where we get
into this disagreement is the way it is bei ng done. B ecause if you are not clear on why you are taking all
this money from the standard premium . . . the Stan dard Health Benefit [SHB], and moving it over, and sa ying only $25.00 of the amount is going to be trans-ferred over the hospital, it leads on e to require some
clarity on, How was this identified? I have not heard
anyone indicate the basis on which this amount was
created.
I have looked and I know that I have seen the
BHB [ Bermuda Hospitals Board] accounts which indicate that even . . . and I m ean, the last lot of accounts
of 2014 that indicate for the whole BHB that it was
$305 million. And I am saying that the Minister is sa ying that it is going to be capped at $330 million, and I
still cannot figure out how you get from $305 [million] to $330 [million]. But then actually when I go and I
have the actuarial report, the actuarial report shows that when you are looking at BHB it is sort of like $163 million, and I presume that is without looking at things
like for the renal dialysis. But I think i t is important for
the Minister to clarify the basis on which this amount
of money was moved out.
The reason I say that is because if you do
that, if you make it clear how the $330 [million] was allocated, then I think you can get into a better understanding of how much was put for the hospital -based
expenditures, and how much was left for the rest. B ecause nobody has made it clear to Mr. and Mrs. Bermuda that all those other things that are not at the hospital, they are still going to use those services.
They are still going to have to pay for those things, or
have those things paid for out of their insurance. And
if the insurance does not have the money there, the
insurance companies are then going to turn around
and say, Hey, we have to decide to charge y ou more.
And we need to make sure that there are
some actuarial basis for splitting $ 330 [million] and
taking $25[.00] and all the rest going out. And I have not heard anybody . . . and I hope the Minister will
explain that because without that, you have what I feel
like is a money grab. A money grab that says, We can
take all this money and we can put it over there and
we have it available to do things —

[Inaudible interjections]

Hon. Jeanne J. Atherden: —and we have it available
there to do other things.
And the reason I have this concern is because
everybody forgets that the Government is also one of
the payers. Okay? The Government is a payer b ecause the Government pays for indigent, aged and youth [subsidies], which means that they are also persons who [get sick] and have claims that need to be
paid. So let’s not forget that. Okay? And that is why it is important to have some clarity on how this works
because we will have a better understanding of the splitting of the money.
Now, Mr. Speaker, when I look at the suggestions that the costs will have to shift, and some caps will have [to be] put in place to control costs, I buy
that. But I do not see enough indication about how
that is going to work, because that is where Mr. and Mrs. Bermuda is going to get the bang for their buck.
They are going to get their bang for the buck by hearing how these costs are going to be controlled. They
are going to be getting the bang for their bucks by
hearing the caps that have been put in place because
we know . . . and I can say that because I actually
read the last actuarial report, if you can allow me for
one second, Mr. Speaker.
The last actuarial report indicated that there
was this utilisation and they said, “The utilization re presents the overall expected cha nge” and “It may
arise due to numerous factors such as ageing of the
population, the introduction of new medical technol oBermuda House of Assembly gies, a shifting in the case mix” and the “increase in
the disease burden.”
So if we are not addressing the issue of util isation, then this cost, which we are trying to control, is
never going to change. All we are doing is just chan ging the pocket in which the funds are going to be paid
out of.
And I worry that the Bill, per se . . . I do not
believe that it actually goes anywhere in t erms of sa ying, increase the costs. And I know that the Gover nment had always had its strategy in terms of the N ational Health Plan, and it always had a strategy of Universal Health Coverage. And I see that as som ething that is being put through. But I do not see
enough in this plan to indicate how you are going to
make sure that Mr. and Mrs. Uninsured/Underinsured
Bermuda are going to get the benefit of that.
So, Mr. Speaker, I just have a concern that
there is not enough and maybe when we start to get
into the debate itself I will raise some more questions
because I think the people of Bermuda need to know
what is the social contract [and] they need to know
what their Government is trying to do with respect to
creating fairer pricing. The Minister said t hat she
wanted to move forward with fairer pricing. As I say,
we reduced the cost of MRIs and they went back up.
So in terms of the change of the status quo,
[this is] very important. But if you are going to put the health of people as a higher priority t han profits ––I just
found that this was rather interesting because, I mean,
if I read that statement again, “ we are demanding to
put the health of people as a higher priority to the
health of profits.” And I think of the MRIs, the increases that we went do wn, and I just think, Okay, how
does this, if you will, . . . how does this tie into the actual reality?
I think the current Government did not support
our efforts to get fairer pricing, so now it is going to be
important for them to demonstrate to the people of
Bermuda that they are behind this and everybody is
going to be looking to see what they are going to do.
They have to walk the walk and not talk the talk. So,
Mr. Speaker, I will just say that I look forward to some more discussion when we have the individual . . .

Committee? In Committee?

Hon. Jeanne J. Atherden: Committee. I look forward
to when we have the Committee, but I just think that
there is a real concern because the Minister talked about providing a prescribed transfer from the MRF to
the Hospitals Board, and then about an employer who
operates an improved scheme, not be liable to pay
[SHB] claims, that seems to imply that claims will still have to be moved from BHB to the insurer. And yet
somewhe re else there was an indication that was not
going to occur. So there are some specific things in there that I think need to be flushed out because
sometimes when you get out and ask questions, afterwards what you say in one place doesn’t tie in to
the other.
And then this whole thing about dialysis
claims being payable under the MRF, the devil is in the details, Mr. Speaker. And I just have a worry that
other than moving toward the concept of universal
health for all, I do not think that there is sufficient to
make Mr. and Mrs. Underinsured Bermuda feel that it
is going to happen. But I do think the other people who are insured need to worry, because what is going
to end up happening is that with the amount of money
that is going out for BHB, the insurers are going to
have some real challenges as to how much money is
going to be left over.
And I carry no brief for any insurance company. But I do think that until the people see what is go-ing to be covered, they are not going to have any
clarity on why that s plit took place and whether it was
a reasonable split. And I have not seen anywhere,
anything that said from the MRF or from the actuaries, et cetera, how it was going to happen.
And I do not want to get into this whole thing
about profit because there ar e still going to be claims,
there are still going to be reconciliations, there are still
going to be issues that take place. And we know . . .
and I know before, because I have to acknowledge that the former Government . . . we were going to put
all the mo ney into a pot to be used for everybody. So
that is not unheard of. But this is different. This is put-ting all the money into the pot and now starting to say that you are going to make the decision on how the
pot is being used. And I am just . . . I find i t . . . I find it
strange. And I am waiting to see, because, as I say, it really worries me that you end up having what I call a
cash grab.
But, Mr. Speaker, I think I . . . how much time
do I have left?

You have got a few minutes left.

Hon. Jeanne J. Atherden: Okay, well, then if I have a
few minutes, let me finish off.
If you start to look. . . and I hope the Minister
will explain how we came up with $330 million, esp ecially because after that there was an indication that
you might have $65 million also there, just in case.
Because if the hospital itself . . . and as I say, I know
these accounts are old. But if the hospital itself was not operating at that level, then I will be curious as to where it is coming from. But I also will be cur ious as to
how it works, because I happen to have the report of
the Auditor General which was talking about concerns
about reconciliation of accounts of knowing claims
and how things were actually paid for. And if now you
are going to have all of this mone y going over there,
you are going to have even more responsibility to
make sure that the funds are properly accounted for.
1594 17 May 2019 Official Hansard Report

Bermuda House of Assembly And if we are going to bend this curve, you
have to know what people are having the services for.
And the previous speaker talked ab out the Enhanced
Care Pilot down at the hospital. Well, that reminds me of the programme that we instituted in terms of the Mutual Re- insurance Fund , which I have not heard
anybody talk about recently. If we do not institute
some of these programmes and te ll us how we are
doing, then there is nothing that you could do, if all the
money gets there, but you do not look at the results
that are being created.
Mr. Speaker, more importantly I feel that the
Minister, the Ministry, and the Government have to
look really closely at value for money, look really
closely at overutilisation, and look really closely at
things like interest —conflicts of interest. Because
whether we like it or not, it has been well established that if you have the ability to be able to generate the
utilisation of your service, many times (and I am sa ying in the health industry) it results in overutilisation.
And it already has been established. It has been es-tablished [by] the auditors. It has been established
about overutilisation. So I just think that we have to be
aware. And all of our colleagues have to ask the question, we have to make sure: Is this the right thing?
I know we cannot change it because they
have the numbers, but that does not stop Mr. and Mrs.
Bermuda from making sure that the right amount of
money gets left with their private insurers. Gover nment has a plan, private insurers were there, we need
to make sure that the right amount of money gets
left—

You said that already.

Hon. Jeanne J. Atherden: —becaus e it is very important that there is a rationale for this.
Mr. Speaker, I will look forward to hearing the
Minister at some point in time tell us more about how
the uninsured and underinsured people will get to
have universal access. I will be really pleased to hear
the Minister tell us about how she is going to make
sure that the cost of health goes down, and make sure that the professional that she has mentioned in this
report starts to make their contribution to reducing the
cost of health. And I would like to think that we will be
able to get some of the other questions answered.
Thank you, Mr. Speaker.

Thank you, Mr. Speaker.
Mr. Speaker, it is very interesting that we have
had Members on the other side stand up, give
speeches, say that the Minister did not give them an-swers, and that they were hopi ng that somebody else
on this side would help provide them with those an-swers. But then they get up and leave the Chamber.
So how genuine are they about really wanting answers, Mr. Speaker?

Okay, Mr. Speaker, the thing
is, one thing we know about . . . and I want to put this
in ways . . . because the Minister has actually answered all the questions that the Opposition asked.
But it must seem as though they must not be able to
understand what the Minister is saying. So let me try to put this in a way, shape, form that they can actually
understand it, and makes it a little bit easier to understand.
So instead of talking about it from the tec hnical point,. . . few t hings are more important to our
personal health than our heart health, our cardiovascular system. And this is why you will have public service announcements saying, Always get your blood
pressure checked. Get your heart checked, because
your blood pressure allows physicians, health care
professionals to get a snapshot of what is going on
with you. Right? If something is out of balance, or if it
is not.
So, the thing is that your blood pressure is
made up of two numbers: systolic pressure and diastolic pres sure. All right? This is 120/70. Now, the sy stolic pressure, Mr. Speaker, is when the heart contracts and pushes blood throughout your arteries, the
pressure that is created from that action, that is your
systolic pressure. That is that 120. And then the d iastolic is when the heart relaxes, or the cardiovascular
muscle. Mr. Speaker, I need to put a disclaimer that I
did do St. Johns for a few years and I am now dating a nurse, so I do know what I am talking about.

[Inaudible interjections]

Sorry. Sorry. Sorry. I will get
back —

[Inaudible interjections and laughter ]



Bermuda House of Assembly Mr. W. Lawrence Scott: So, Mr. Speaker, but when
the heart muscle relaxes and fill s with blood, that is
where the diastolic pressure comes from. And toget her you get that 120/70. All right?
So, now, Mr. Speaker, let’s just say . . . and I
will put some things in perspective. Right? [At] 120/70,
or 120 and below, is your normal blood pr essure. An ything around 130 to 139, that is your Stage 1 high
blood pressure; 140 or more is Stage 2, hypertension;
and 180 would be basically hypertensive crises. So
now, with that, let’s just say that the health care indus-try in Bermuda was a person. And this person has
now gone to get their blood pressure taken. If the
blood pressure of this person (of the health care i ndustry) was taken right now, it would be 140/80. So
now, as I said before, that would be Stage 2 hypertension.
Now, let me break down t hat 140/80 for you.
All right? That 140 means that for every dollar, for
every premium that is paid, the Government has to
pay $1.40 for health care costs. Now, on the other end, for every dollar, for every premium that is paid,
the private sector has to p ay $0.80. So now what we
are seeing is that the private sector somehow is ge nerating $0.20 worth of profit for every dollar that they get, and the Government has to spend $0.40 on top of
every dollar that they get.
So now, what does this look like, Mr. Speaker? This looks like the private insurers are now gener-ating somewhere in the area of around $80 million per
year in revenue. And if we were to take those numbers, if all things remain equal, that would mean that
the Government is spending $160 million o n health
care costs.
Now, how does this happen, Mr. Speaker?
How does this happen? Because nobody on the other
side seemingly understands this point that I am ma king, because the thing is that private insurers can pick,
choose, and refuse who they want to provide health
care to. So all the healthy, young individuals, or all the healthy individuals in society, in the community, all the
people who play football for PHC, all those members
who do martial arts with the Harto School on Cobbs Hill, those members will probably get health insurance
in the private sector, no problem. But once members
in society start getting to a point where they start to infringe on that 20 per cent profit, when they start
costing more than $0.80 on every dollar, whether it is
because of existing conditions, whether they get into an accident or they get too sick, or because they fall
on hard times, what ends up happening, Mr. Speaker,
is . . . if the private insurance companies cannot i ncrease your premium to cover that, to keep that 20 per
cent profit, they drop you.

Hon. Jeanne J. Atherden: Point of order, Mr. Speaker.

I will take your point of order.

POINT OF ORDER
[Misleading]

Hon. Jeanne J. Atherden: The Member is misleading
the House. These are businesses. They have ranges of people who are a part of the business. Nobody
goes there and says, Okay, I am going to only have
those six people. And you are covering the others.
They are businesses! And what you see is what you get.

I am being mindful, Mr.
Speaker.
So, Mr. Speaker, I am going to keep going on
the track. Right? So, what ends up happening, Mr.
Speaker, is that you then end up having premiums
raised. Regardless of what the Honourabl e Member
said, those premiums continue to rise.
Now, the thing is that there are members in
society who can afford to pay these increases in pr emiums. And if they can’t afford the increases in prem iums, they have one of two choices. They can either go wit hout health insurance, or they can look to more
affordable health insurance, which is your public
health insurance product. All right? Because, reme m1596 17 May 2019 Official Hansard Report

Bermuda House of Assembly ber, the members who are part of the government
health insurance, sometimes, more times than not,
are unabl e to pay for or afford the increasing prem iums.
So now what ends up happening, Mr. Speaker, and this is where we come over to the government,
because most persons on government insurance are
65 and older. All right? So that means that they would
most like ly be on a fixed income and so on and so
forth. But now, what I am trying to do is this, Mr. Speaker. And this is where I am going to get to where this $330 million comes in. [The] $330 million is to
help stabilise that “blood pressure.” Meaning, we are
putting something in place which should stop the i ncrease in premiums. Now, once you have stopped the
increase in premiums, and it stabilises, then after it is
stabilised we can go to the next steps to try to help
reduce those premiums. All right?
Now, I und erstand that the Opposition is fin ding it hard to follow what I am saying because they were in Government and they did nothing about it. All right? They were in Government and they targeted
individuals. They were in Government and all they
wanted to do was talk about, Oh, it was the PLP’s
fault. It was the PLP’s fault. Mr. Speaker, one thing
this administration can do right now is just deal with
the situation. This administration is saying that we can no longer sit by and do nothing. We must do som ething. W e have sat there and we are going to put in
place transformative policies, transformative legisl ation, that makes sure that we have members of this
society that have a better quality of life, all right? That
we have a better quality of life.
And so what happens is this, Mr. Speaker.
Now that we are putting this policy in place, we are
going to pass this Bill, put it through. The role of this is
to stop the increase of premiums. Now, there have
been insurers that have done the supplemental pr emium increases , but your primary premiums, this is
what should happen, and it is my understanding that
this will put a cap or moratorium on the premiums. But
now, there are supplemental policies that can be i ncreased, and that is what is going on. That is what
insurance companies are going through and where
members are getting letters saying that, Oh, a 20 per
cent increase in this, and a 20 per cent increase in
that. That is my understanding.
So, Mr. Speaker, the one thing . . . and the
thing is this. And this is what I find very interesting.
We have all agreed . . . and I am repeating this to
prove a point. We have all agreed in this House that health care costs are too high. And now that the Go vernment is doing something to address that situation—

And, Mr. Speaker, I am di sappointed in the Honourable Member that just took her seat, trying to [impute] improper motives and sa ying something about a “cash grab.” And I am hoping
that it is because of a misunderstanding, or not fully understanding the concept in what we are doing here
today, the concept in capping the premiums, the
standard premiums. And then what I found dishear tening is that the Opposition is now talking about the
hospital is unable to manage funds. So now, all of a
sudden, they now have no trust —

Hon. Jeanne J. Atherden: Point of order, Mr. Speaker.

So it was Auditor’s perspective.


Bermuda House of Assembly Hon. Michael J. Scott: Sorry, Mr. Speaker. Point of
clarification.

POINT OF CLARIFICATION

Hon. Michael J. Scott: I took an express note of the
Honourable former Leader of the Oppositi on, Mr.
Dunkley, make that very point. It made me make a
note: What is the reason for this lack of confidence,
suddenly, by the usual supporters of the hospital, ha ving no confidence in their management style? It was

This Government is firing on
all cylinders, Mr. Speaker. This Government is f ocused on improving the quality of life for individuals in
this country.
Mr. Speaker, we have a majority —25 seats —
here. Not because we provide lip service, but because
we listen, we understand, and we act. While there is a
lot of noise coming from the other side, while there is
a lot of you should’ve , could’ve, would’ve, we are actually doing, Mr. Speaker.
So, Mr. Speaker, I commend the Minister for
bringing this, for taki ng this bold step, for taking this
necessary step, and it is a first step to reducing the cost of health care in this country. This is not som ething that can be done overnight. This is not som ething that can be done with one Bill. It is going to take
multiple steps. It is going to go through multiple phases, Mr. Speaker. This is not like the airport where they can sole- source it, Mr. Speaker, without any real r esearch.

So, Mr. Speaker, one thing
is for certain. There are Members who talk about Mr.
and Mrs. Bermuda, and then there are Members who
are in this Chamber who are actually doing things for
Mr. and Mrs. Bermuda. There are Members who like
to talk about that the sky is falling, and then there are
Members who are showing them that it is just smoke and mirrors on that side. Talk is cheap, Mr. Speaker, and we are actually doing things. And, Mr. Speaker,
one thing I know about —

One thing I know about
Bermudians is that we do not necessarily like change.
But we always want things to change. So, Mr. Speaker, this might not be . . . and change is difficult for
many people. Change is not the easy decision to
make, Mr. Speaker. The easy decision is to continue to go with the status quo and just complain in our li ving rooms.

[Inaudible interjections]

One of the more esteemed
Members in this Chamber has said that I sound like my father.
And one thing that my father has said, Mr.
Speaker, time and time again, and it has been quoted
by the Members in the Opposition, is that with thi s
PLP Government one thing I want to make abundantly
1598 17 May 2019 Official Hansard Report

Bermuda House of Assembly clear, is that the haves can continue to have, but the
have- nots need to have more.
[Desk thumping]

Thank you.
Does any other Member wish to speak?
No other Member?
I recognise the Honourable Member from
constituency 9, Honourable Member Moniz.

Hon. Trevor G. Moniz: Thank you. Thank you, Mr.
Speaker.
Perhaps something upon which we all agree
is that the health system is a complicated beast. We
see an attempt today, and I am not quite sure what it
is, one of the things I am trying to find out is whether
the Minister has tabled the most recent report from the actuaries, Morneau Shepell.
Can she answer that?
Has the Minister tabled that most recent support? Is that publicly available? Mr. Speaker?
She is not answering, so I assume the answer
is no. Perhaps I will answer for her. I see there is a report from last July, but not any recent support. So,
of cours e, on this side we like to look at the analysis of
policy changes, particularly strategic health policy
changes to see why you are doing this.
Now, we see, you know, some sort of warm
and fuzzy stuff in the Minister’s brief where she talks
about social contracts and everybody would like to
have better health care, everybody would like to have
better access. And we all agree on that. I do not think
there is anyone who would not agree on that. But of
course, the question is: What are you going to do to
get that? I think one of the things that we agree on is
that we need some serious health reform. And the
Minister in her brief said that we were going to have
some proposals coming forward for actual health r eform.
But what we on this side see today, I think,
(and maybe I will just speak for myself) . . . we see it
as a bit of a shell game. We are moving things from
one pot to another pot, and somehow the Government
is trying to present this as solving a problem. We do
not, on this side, see that the problem is being solved.
Somehow, we feel that it is going to be the average
working person who is going to pay a higher tax for
their health. Their health premiums are going to go up.
Now, on the other side, they are saying No,
no, no. That is not going to happen. T he health insurance companies will pay all of this. And somehow
when they look at it, on the Government’s side, when they look at the health system, they see the hospital
and they see the insurance companies. They do not see any other providers. They seem to be totally blind
to the people who are providing the services.
And one of the things that concerns me . . .
you will remember under the previous administration
of the PLP we had a new hospital built, and then [with] a cost, ultimately, of upwards of thr ee quarters of a
billion dollars. And now we know that that hospital was
too small. So parts of the old hospital that we were
going to get rid of, we now keep. And there are still
logistical problems at the hospital. We constantly see
complaints, letters t o the editor, and complaints that
people are in beds in the hallways and they are ha ving to wait for long periods of time before they can be
put in a room because all the rooms are single rooms
so they can accommodate much fewer people than
the old hospita l could.
So these are some of the challenges that we
face. And the Government just does not have a good track record. We know that the Government made a
payment to the hospital and they made a payment to
Doctor Ewart Brown’s company. I think Dr. Brown was
getting $1.2 million. And, Mr. Speaker, we were told that that payment was made. It was in the public domain from the Minister, I believe, that it was paid because he sent a letter before action. That was what
the Minister, I believe, said, the Government said. It
was in the paper. He sent a letter before action, so we
agreed to pay him off and they hoped he would keep
his clinic open and he then said, No, I am not going to
keep it open. I am going to close it. It may not have
made economic sense to have th at clinic open in any
case, but I cannot speak for him.
But you can understand if we on this side, and
the public in Bermuda, do not have a great deal of
confidence in how the Government operates. We
have heard recent reports that the Premier himself
was i ntervening on behalf of Dr. Brown. The Premier
has—

Hon. Wayne Caines: Mr. Speaker —

Well, ah! Ah! Ah! Ah! Ah! Sit down, sit
down, sit down, sit down, sit down, sit down, sit down, sit down, sit down, sit down!
Member, I have been careful t o make sure
people stick to what is factual and not bring stuff in this debate that are innuendos or hearsay. I am going
to remind you to do the same. Because everybody
has been pretty good on staying on point to this debate, and this debate has the potent ial of going off
course. And I am not going to let it go off course.

So, stay on track, please.



Bermuda House of Assembly Hon. Trevor G. Moniz: And the Premier will have his
chance to say his piece on it. Thank you. I will not
take that any further.
But we have a lot of difficulties here. We have
no idea what analysis was put into this. What we have been told, essentially, is that the Government were
told in a Morneau Shepell report that the SPR, the
standard premium rate, was going to have to go up by
a substantial sum of money. And it already went up by
a substantial sum last year. And Government were not
willing to do that. So, they are saying, Well, how can
we get out of making this increase that Morneau
Shepell tell us that we are going to have to make?
And so, they came up with this, in their view,
clever gimmick of moving money from one pot to the other and presenting it as a health reform. We on this
side do not see it as a health reform; we see it as
something that is going to cause more problems than it solves. It is being presented as a package. And, as I
said, the Minister said in her brief, in very vague and
warm and fuzzy terms, that all of these w onderful r eforms are going to follow.
We on this side have not seen any sense of
that. The only thing that the Government had was a
health report from 2012. The 2012 report was very
similar, in my view (and this is my opinion), to the Mi nister’s brief today. It had a number of statistics in there
and numbers comparing, trying to compare the expenditure that we in Bermuda have to other countries,
and again saying there should be universal health
care, which is an extraordinarily expensive thing. As
we all k now, particularly when we are living out here in
the ocean, there are a lot of treatments that you can
only get overseas, whether it be open- heart surgery,
whether it is dealing with premature babies. There are
certain treatments that you just cannot get here and
we have to get them abroad, you know. So, there are
certain costs that we face that they may not face in
other onshore centres, particularly ones the size of
Bermuda.
We on this side just do not see [it]. Now, they
come along and they say, All rig ht. We are going to
give a block grant to the hospital, as if somehow that
is a health reform, as if somehow that is going to pr oduce an efficiency from the SAGE Commission or something like that. You know, some sort of efficiency is going to come out of i t. And we do not understand
how it is going to produce any efficiency. All you are
doing is saying instead of you billing and us having
oversight of those bills through the Health Insurance
Commission or the Health Insurance Board, now we
are just going to give you a block grant.
It looks like there is going to be, on the face of
it, less oversight. That is not a question of trust. Ev erybody sits at home and checks their bills. I am sure that Member who accuses us of having a lack of trust checks his bills when he gets them at home and sees,
Well, is this the right amount that I am paying? Everyone does that. So, it looks to us on this side like there is going to tend to be less oversight of the amounts
that are being charged.
Now, you know, I am sure the Government
will say, Well, there isn’t. We’re going to have this sy stem. The Health Council is going to get more people.
We just do not know how it is going to happen. And I
am afraid the Government have given no adequate
explanation of any way in which this is going to improve the efficiency of the health system.
Now, we have had a number of people on the
other side say a number of things, which are similar, but not quite the same. Particularly I get concerned
when people who are not Cabinet Members purport to
speak for the Government and say, This is what we’re
doing. And you would say, Well, you know, I really
look to the Minister to see what the Government is doing. The Minister speaks for the Government on
Health. And that is the person I want to answer on it.
Because other people may say a similar thing; it may
have a slightly different spin on it.
[Inaudible interjections]
Hon. Trevor G. Moniz: So, we really need to know
where we are going on this. There needs to be a su bstantially better explanati on of where we are going.
There is not a good track record in this Government
with managing the health care system. As you know, we were not happy with the sugar tax. And again, you
know, a tax is going to be passed on. The taxes are
passed on. The way I s ee this particular switch, it is a
tax. Because what is happening now is that the average working person is paying a greater proportion of
his income into the MRF. And I do not see how that
can be anything other than, ultimately, a tax on that
particular i ndividual.
Now, at the same time, what I do not see in
the Government, is it saying, well, how are you . . . If
you make the system more efficient, Mr. Speaker, it
just seems to make sense to me that you are going to
want to make the whole system more eff icient. The
hospital represents less than 50 per cent of the health
costs in Bermuda. And presumably, you would want to address the whole system. You would have to have
some sort of agenda if you said, Well, we’re only g oing to look at part of the system. We’re not going to
look at the majority of it. We’re just going to look at a
minority. That would not make any sense to me at all.
And, you know, they like to have these polit ical targets, spin, Oh, we’re going after the insurance
companies. We’re going a fter the insurance companies’ profits. Well, I do not think that is what you are
doing. I do not think that the man in the street or the
woman in the street is going to be fooled [by] that. I
think that they will see that you are not really addres sing what is at issue here at all. And what we are seeing out there . . . and this is the interesting thing. Di fferent Members have been saying, to me, what seem
to be opposite things. You know, some people are
1600 17 May 2019 Official Hansard Report

Bermuda House of Assembly saying, Oh, well, on this side we’re trying to figure it
out because the Minister clearly has not explained
what the programme is, going forward, except in very broad- brush terms. So, we have a hospital that is too
small. We know that already. But on the other hand, we have people on the outside who are provi ding se rvices, like diagnostic imaging services and now dial ysis services, which we have being provided outside of the hospital.
So, the point here is, does Bermuda require
more services than the hospital can provide in those areas? Is the hospital’s CAT scan, the hospital’s MRI
not sufficient for Bermuda’s population? Do we need
more services than that? I suspect that the answer to
those questions, from my short time as Minister of Health, is no. We do not require any more than that.
But people see those as being an opportunity to make
money. And those are people in the private sector. Those are doctors (in some cases, non- doctors) who
are going to open their own, what they call, hospital.
They are going to open their own hospital. They are going to have t heir own diagnostic imaging.
Why are they doing it? Well, they are entr epreneurs. They are doing it to make money, put money in their pocket. Whether it is Dr. Brown, whether it
is Mr. Thomas, any of those people, they are all doing
it because they see an entrepreneurial opportunity to
make money.
Now, the problem is this. You have to size it
right for the hospital. You have to have the hospital
operating as near to full capacity as you can without it
being over capacity. You have to have it at its opt imum utility. You have two things that could happen
that are bad things. You can have overutilisation of the hospital, where they have got people sitting in
hallways and they cannot find rooms for them, and
people in the Emergency [Department] there waiting
hours to get any sort of service. You constantly hear
these sorts of complaints.
On the other hand, you can have people going out to private services, going to Dr. Brown’s MRI
or CAT scans or Mr. Thomas’s hospital or somebody
else’s scan. You can have them going out to these
other people. And this is what was extremely confusing, because recently the Health Council said . . . all of
a sudden, they said, Well, we’re putting a moratorium.
We’re not going to allow any more services.
And it just came out of the blue, and ever ybody said, What?
And everybody said, Well, for how long? How
long is that going to be?
And they said, Well, until further notice.
What? Until further notice when? When is that
further notice going to come?
I mean, it is the most ridiculous thing I have
ever seen, just announcing out of the blue . . . again,
what tends to happen with this Government is that you
get these sudden pronouncements that seem to come
out of nowhere. It is the same as this Bill we are see-ing today. We are constantl y on the Opposition side
getting complaints from the public, from insurance companies, et cetera, that there was not proper consultation. And we say, Well, surely, Government did
all sorts of analysis. They have actuarial reports. They
have got all sorts of analysis to show this is the way to
go and to bring in the stakeholders , whether they be
the public, the doctors, health care providers, whether
they be the insurance companies. They have consu ltation. They have got reports to back up what they are doing.
But none of that looks to have happened! It
looks like they are just panicking. And so, they are
pulling some sort of sleight of hand.
It is very similar to the thing, in my view (and
these are my thoughts), that we saw during the budget. You know, the Government did not know how to
balance a budget, so they said, Well, we’re not going
to pay any more money into the Sinking Fund. Which
may or may not make sense, but it looks like a kneejerk reaction to cover up a situation you found yourself
in. You ar e figuring, Well, I don’t know how to get out.
Let’s do a Hail Mary here.

Now, stick back to this matter here.
You had a little drift for a while. Now come back on
point.

Hon. Trevor G. Moniz: Well, that is what we see
here. We do not see the underlying analysis of why it is done.
The Government is saying, Oh, well, we’re the
good guys. You’re the bad guys. We’re doing this because we want to reform the system. We want universal health care. We hate the insurance companies, and we figure we’ ll get them this way. But overall, it
just does not seem to have been a decision that was
arrived at in a rational fashion. And it looks like it is a
lot of political spin, unfortunately, and could have neg-ative results for the average person in the street in
terms of their insurance premiums and the type of i nsurance available to them.
And the Government does not seem to be
aware of that. Of course, if the Government has a
problem going forward, they again are going to try and
spin it, saying, Oh, it’s th e terrible insurance companies causing the problem. It’s that awful Opposition. I
mean, you do not accept sometimes you have managed something very poorly and you have done it in a
knee- jerk fashion.
And we may all regret the hasty action of the
Government in this regard, when we think that proper analysis and study has not been done. And the Mini ster certainly has not tabled in this House anything that
would show that this course of action was recommended by the experts upon whom the Government
should be relying. Thank you, Mr. Speaker.

But I certainly felt it necessar y,
Mr. Speaker, to get on my feet and support the Mini ster for bringing this Bill forward. It is well overdue. Let
me say that health insurance is a right and not a priv ilege. So, it is something that this Government has
taken on.
But, Mr. Speaker, before I probably go any
further, let me make a sort of a declaration. And I am
sure you have heard the statement, Don’t bite the
hand that feeds you. I am going to now say today,
Don’t eat the hand that fed you. I have for 16 years
worked for a company that one line of their business
was health insurance. So, I want to be very clear that I
am not trying to bite the hand that fed me.
Mr. Speaker —

However, Mr. Speaker, the
Honourable Member from constituency 23 i n her earlier remarks made a statement that we did not appear to understand health insurance. I do not know why
she would have said that because we are getting a dvice from the experts, really. So, we are just putting it into play. And I hope that is what s he understood, as
well.
I think it is a shared responsibility, health i nsurance. It is a shared responsibility. And we are look-ing for really fairer pricing, as well. So, I think it all
goes hand in hand.
As I said, I am not the technical person on
healt h insurance. But I did have to do some hom ework, obviously, to get on my feet and speak on this. And one of the things that I came across in my r esearch was another line of business that companies, [similar to] what we are talking about, are going to.
And it is the motor insurance fund. Now, the reason
. . . I am bringing it up for a reason. I am making a
point on that, which is that sometime in the early 1990s the big four, as I call them —Colonial, Argus,
BF&M, Freisenbruch- Meyer —obviously felt that they
were losing money by having to make pay -outs to
people who were uninsured in accidents. So, they
came up with this fund, jointly. And sometime around 2007, I believe, they made a Memorandum of Understanding for the then- Government, which would have
been led by a friend of ours, of course, whose name I
will not call at this time.
But the amount of money that can be paid out
started at about $250,000 and went up to about
$750,000. So, you would ask, Well, why am I bringing
up the motor insurance fund at this time? Well, what I
am saying is that the “big four” were not even forced into doing that. They were not forced to do that. That
is something that they came up with. Why have they not, at this point in time, thought about health insurance and doing somethin g jointly to bring down the
cost of health insurance?
Let me also say, Mr. Speaker, as I said, the
health insurers did have an opportunity to come up
with a plan that will cover everyone, regardless of the ability of that person to pay. One of the things that we
know, and it was sort of disputed over on the other
side, is that the health insurers can pick, choose and
refuse. You can say what you like; they can, and we know it. We have heard of cases where people have
not been able to get insurance because either they
have had prior medical conditions that the insurers do not want to take on . . . so, let us not be blind to it and
think that they do not have that opportunity to do that.
So, where do those people who do not have
the proper insurance go? To G overnment. It is us. It is
definitely going to fall on Government. So, we felt at this time that there needs to be some reform in health
insurance. And this is a first step that the Minister is
taking. It is not the be- all and end- all. It is, to me, I
would use the term “ work in progress .”
Let me really get to the end of where I want to
go, Mr. Speaker, which is that I want to let Mr. and
Mrs. Bermuda know, because I am sure they must be
a little confused out there hearing some of the debate
that has, you know, gone back and forth today, that
they are entitled to health insurance. It is a right. And what I am afraid of is that the health insurers —I am
not picking on them, they are profit -makers. They
make profit. That is what they are in business to do.
But at the same time (I hear some chattering over
there) —

No. Speak to the Chair. You will be all
right. Just speak to the Chair.

1602 17 May 2019 Official Hansard Report

Bermuda House of Assembly Mr. Neville S. Tyrrell: At the same time, they have to
be conscious, because it is something that, co nsciou sly, th ey should do, Mr. Speaker.
Mr. Speaker, let me go towards the end and
just say that I believe that reform and streamlining of
the Health Bill is necessary. The Minister is doing the
right thing. And in the end, our families are definitely
going to benefi t. But I want to basically end by saying
that I am confused by the message that is coming
from the other side. At one time, I hear them saying
that they have some support for the Bill. Then there are others who got up and said they cannot support it.
So, o bviously, they have a—

[Inaudible interjection]

It says, “the conversations we
have been having with our Island’s health insurers are
just about how we make this social contract of shared
responsibility a fair proposition. How providers, pa yers, politicians, regulators, researchers and religious bodies can use their unique skill areas to put forth and
implement timely solutions in a proactive and non -
reactionary way.” Mr. Speaker, thank you.

Mr. Speaker, this has been
an interesting debate. Mr. Speaker, a lot of things that have been said and presented by the Minister of
Health make sense. She spoke about equity. She
spoke about efficiency. She spoke about streamlining
the process. She spoke about universal health care
for all. She spoke about lowering the costs. And she wants a better outcome. Mr. Speaker, who can argue
with those principles? Not many people can argue
with those principles.
Mr. Speaker, universal health insurance. As
my colleague, the Shadow Minister of Health, said, who is not getting covered now? Who is not getting
covered now? Because we have grants for the sen-iors, the youth and the indigent. All others ar e covered
through their health insurance. But, Mr. Speaker, as I said, in principle the issues that are being raised today
are normal issues that impact the health industry.
When I was sitting here, I wrote down how
many times Members have said, This is the first step. I
heard the Minister Wayne Furbert say this is the first
step. I heard the Whip say this is the first step. I heard
the Minister herself say it is the first step. But my
question, Mr. Speaker, is, The first step of what? Mr.
Speaker, what i s the vision? What is the vision? Mr.
Speaker, what type of health care is this Government
going to present?
Now, Mr. Speaker, we know that in Canada
they have Medicare, and their system is a gover nment -funded system. And they have universal health
care, and everybody knows that they can go to any
hospital facility and get free health care because it is paid out of the Consolidated Fund. Mr. Speaker, in the
UK, there is a two- tier system. There is National
Health Service, and then, if you want, you can supplement that and go to the Harley Street doctors, the private sector. Again, everybody is clear on the type
and model of health care that that country has. In the
US, you have similar. You have private insurance and
Medicaid, and again, everybody knows wh at they are
up against.
But I would have liked to have heard the Mi nister and her communications team say, Okay. We are doing a revamp of the health care system in Bermuda.
And this revamp, in the end, will look like this. Berm uda’s health care system wil l be a two- tier system. Or,
Bermuda’s health care will be a socialised health service system. But I have not had that clarity.
And I invite the Minister to basically speak to
that issue so that everybody would know what we are
doing. I know that they are making changes to the
legislation. We are talking about the premium. We are
shifting the premium from the carriers to the hospital. That is fine. But what does that lead up to? What is
the strategic plan for the delivery of the vision of
health care in this country? What is the vision of
health care in this country, going forward?
We have not heard it. And to me, we are just
moving around in circles and circles and circles. B ecause there is confusion as to where we are going,
what we are going to do, and what is the big picture
that the country has bought into. So, I invite the Mini ster to, when she gives her response, to basically give us an overview of her vision and say whether we will
have a two- tiered system whereby there will be public
health care and private health care. Or we are going to have all socialised medicine. Or we just have what
we have now. Or we are going to have all private
medicine. Just give this community clarity as to what
we will have, going forward, and the benchmarks and the timelines that will be in place so that we can deli ver on the vision and the overall long- term objectives
for the delivery of health care in this country that will


Bermuda House of Assembly improve the health outcomes of those who use our
health care system.

[Inaudible interjections and laughter ]

Are you trying to get rid of
me, Mr. Speaker? Mr. Speaker, the other issue that I would like
to speak to is the issue of . . . (Let’s see here. I have
her brief; sorry.) You know, I said everyone was to
reduce the health care cost and the middleman. But the question becomes, when we move the servicing of
the reinsurance fund to the hospital, I would like to
have heard the Minister speak more to the adjudic ation process. Who is going to review the claims and
services a nd service for value and ensure that the
money is well spent and that quality service is provi ded and that there is no excess usage?
Mr. Speaker, the other issue is that come
June 1 . . . June 1 is the date. And on the financing
side, my question is, you know, there will be $330 mi llion allotted as a grant to the hospital for the standard
health premium and the reinsurance premium. Well,
what happens, Mr. Speaker, to the liability that the
carriers have at June 1
st? Does the hospital assume
the liability, the outstanding liability for the standard
health care policies that are out there at June 1st?
Things have been quiet on that front, and just from an
operational point of view, I would like to know how we
will address the lost reserves that are outstanding at
June 1st. And the same applies to the unearned pr emium for June 1st. Will they get additional money as of
June 1st for the unearned premium that is in place that
straddles the old system and the new system?
Mr. Speaker, a lot has been said about prof its
and that the 20 per cent that has been allotted to the
insurance carriers will be used to cover their profits. I
did some research on this, Mr. Speaker, and I would like to share this with you. I got this from a reliable
source. And they spoke about ho w each dollar is br oken down in regard to premium dollars and costed
health care. If you allow me?

Eighty per cent of every do llar goes to claims cost. Claims costs include hospitals, inpatient care, sur gery, anaesthetists, hospital outp atient, lab and diagnostics, doctors’ visits, preventative
care, prescriptions and others. That is 80 per cent of
every premium dollar. Fifteen per cent of every prem ium dollar goes to administrative costs and reinsur-ance. This 15 per cent includes consumer service,
marketing, compliance . . . Compliance, compliance,
compliance.

Oh, Lord, that is a world unto
itself.
And claims processing and other administr ative costs. So, that is 95 per cent to administration,
compliance, marketing and claims costs. There is
5 per cent left, Mr. Speaker. And 5 per cent is attributed to risk charge and profit. So, what do I mean by
“risk charge and profit ”? There are risk -based capital
needs that these insurance companies have to have
for their solvency requirements and BMA requir ements. They also need to support investment in their
systems to get the work done. And then, they have to
provide a reasonable return on the invest ors’ inves tments in capital.
So, again, we talk about the 20 per cent as
though the 20 per cent is going to the shareholders.
But that is inaccurate. I think that we are just being
mischievous, Mr. Speaker, or we do not know what
we are talking about. I w ill let the public be the judge
of that, Mr. Speaker.
So, I would keep away from saying that 20 per
cent of every premium dollar goes to the profits of the
insurance companies, because that is not true and it
just shows our lack of knowledge, or the Gover nment’s lack of knowledge, of what is going on in the
industry.
And, Mr. Speaker, I will make it clear. I am not
working for an insurance company. I have no interest in insurance companies. But I have responsibility to
make sure that the facts are present ed to this House
in a reasonable manner and to make sure that the community is educated as to what is going on in this
country, Mr. Speaker.
Mr. Speaker, the other issue that I wanted to
speak to is the comprehensive coverage. I want the community to know that some of these smaller bus inesses will now ask to have the standard health pr emium coverage only. And what does that mean, Mr. Speaker? That means some of the coverage that they are currently getting they will not get. And I am talking
about after school coverage, dental coverage, and
some overseas medical treatment and care because
they are not in the hospital, Mr. Speaker.
And so, these Bermudians, these residents
will have to dig in their pockets because of the limited coverages that they have from the smaller busines ses, and the coverage being the standard health pr emium coverage, which will basically cause those who least can afford it to have more challenges from a f inancial point of view in securing health care in this
country. Because there are a number of services that
are excluded from the standard health benefits pr ogramme that people of this country need today.
The other issue that I would like to speak to is
the issue of the doctors. Mr. Speaker, as we all know,
we have an army of doctors and specialists out in
Bermuda who have private practices. Based on what I
am learning here, the Government will be encouraging
people to use the hospital facilities more because it
1604 17 May 2019 Official Hansard Report

Bermuda House of Assembly will be economically more efficient, because it gets rid
of the middleman and because it will be cost -effective.
For those who go to doctors, the question of co- pays,
you have to pay a co- pay to go to a doctor. And then if
you go to the hospital, there is no co- pay. And so,
there will be an incentive for most people to go to the
hospital.
But, as was said earlier, Mr. Speaker, the
hospital is having problems keeping up with the d emand in services now. Many people who go to the
hospital have waited hours and hours and hours out-side on a bed in emergency. Just last week Friday, a
colleague of mine said, Cole, you wouldn’t guess what
happened to me last night. My father -in-law fell down
at four o’clock in the morning, and I think he broke his
hip. So, my husband took him to the hospital. And at
five o’clock that evening, I said, Hey, Ann, how is your
father -in-law doing? He said he was still in the hospital
out in the waiting room in the emergency! They said,
well, they cannot take him in because they cannot find
a bed. That is over 13 hours out in the hallway.
So, with the additiona l demand for the hospital
based on this model that the Minister has been pr oposing, I have grave concerns that the hospital does
not have the infrastructure or the resources to service
this increased demand. And the consequence at
some point, we may have t o depend on these private
service providers if the hospital cannot get it done.
You might have to give them a nod to say, Listen.
Things are dire down here. And we’re going to need
your services just to supplement.
Mr. Speaker, in smaller jurisdictions li ke the
Caymans or the Bahamas or Barbados, they have
health centres around their islands. Cayman is the
same size as us. They have health centres.

[Inaudible interjections]

That is fine.
They have health centres, five or six, around
the country that can take some of the load of a hospital. But those health centres have to be sanctioned
and supported by the government. And that way, we can relieve some of the demands and tensions that
we currently see at the hospital. Because we ha ve
one major hospital. Even as we send more traffic
down to St. George’s . . . what is the name of St.
George’s facility?

So, Mr. Speaker, I would
suggest that the Government come up with a plan to demonstrate to the people of this country how they
are going to relieve some of the demands and the
challenges that we face in servicing the numbers that
currently exist in the hospital. I mean, currently, like I said, we are embarking upon a new plan that will place more demands on the hospital, and the hospital
cannot service what they have on a timely basi s. So
again, I would like for the Minister to just tell us what
plans they have in place to help the hospital manage
the additional demand that will be placed upon them.
The other issue that I had, and it was touched
upon earlier, is conflict of interest. Mr. Speaker, we
have doctors out here who own labs and pharmacies,
or, labs or pharmacies. I have a very good friend in
South Africa. I was there in February. And she has a
thriving practice. And so, I was telling her about that.
She said, Cole, that’s unheard of! In South Africa, we
would not be allowed to own a pharmacy or a lab if we
had a licence. Because that, in essence, encourages
malfeasance, overutilisation.

[Inaudible interjections]

And there is a potential, as
my collea gue has said. And so, I think we might need
to look at that because it causes . . . it is a fertile
ground for overusage.
But the interesting thing about this is that
somebody said to me, But what’s the doctors’ position
on this change ? Because it impacts them most. And,
Mr. Speaker, the interesting thing about these doctors around this country is that they do not say a word about any of these issues. They make all this noise
amongst themselves. But you never hear them come
out and say, This has [an] impac t on private practice.
You never know. And so, it is amazing. It is amazing.
Either they are too comfortable, or, This does not a pply to me. And so, it is interesting. And everyone
keeps [talking] about health care, and I can say wit hout a doubt that no doctor has lobbied me or even my
colleague, Ms. Gordon- Pamplin, about health care.
You get the insurance companies. You get the
service providers. But the doctors continuously remain quiet, and you do not know where they are at. But you
know they talk, because when you go to their office as a patient, they wring your ears off! But to come out
publicly to say something . . . it is very interesting. It is
very, very interesting, Mr. Speaker.
So, the conflict of interest with doctors owning
labs and pharmacies , I think that is [an] issue that we
need to look at.
The Minister indicated that basically she
wants to get rid of the two- tiered system whereby the
haves and the have- nots . . . I think right now, as I
said earlier, we are just reinforcing the two- tiered system. Because the working class, the middle class and
the elite, they have the resources to get supplemental coverage, comprehensive coverage. And they can
afford to have the best health care with bells and


Bermuda House of Assembly whistles, whereas , the small businesses cannot afford
to provide their employees with comprehensive coverage. There are one or two shops, businesses, that
will provide the standard health benefits, and there is
limited coverage there. And so, you have a large sec-tion of the community that has limited coverage with
the standard health benefit, and you have the working
class and the middle class and the executive class
having all the bells and whistles, and the blue collars,
and blue civil service . . . civil . . .

Blue ribbon service (thank
you) that they can have and enjoy. And what is the
end product? The end product is a two- tiered system,
just what we are trying to get away from. So, what is being proposed does not provide equity, as the Mini ster would like. And I would like to see equity. But it is
just not happening under this structure. And so, this is why it is important for the Minister to come out and
say, This is the model that is best for Bermuda. It has
been proven in other jurisdictions. We have taken the
best from Canada, the best from Cayman.
Cayman has an authority, a medical authority
that manages the hospital and health care system.
And they manage various clinics and centres around Cayman and the few hospitals. So, you are clear as to
what model is used. But, in Bermuda, we still have yet to define that with clarity, the model that we are going
to use.
So again, Mr. Speaker, I think we have to address the underlying causes of these health care challenges. And we have to manage the ageing popul ation, because our seniors are getting older and older.
The baby boomers are up there. And that is putting
additional pressure on the health care system. You
have the health care inflation, as was spoken about
earlier. And then, you have the ch allenges with the
infrastructure.
So, Mr. Speaker, I would like for the Minister
to pause. I am not saying stop completely. I am saying
just pause, take more advice. Speak to the stakehol ders. Examine other options. Come up with the model
and vision that she can share with the community and
[which] the community can buy into. Listen to the
stakeholders. And before we roll out our plan, make
sure that we have a plan in place to reinforce the i nfrastructure that will service the health care service in
this c ountry. And then, we have to also decide whet her we are going to be a for -profit hospital or a comm unity hospital or just a state- run hospital that will be
breaking even and that is it.
Again, Mr. Speaker, those are my limited co ntributions. And I will take my seat at this point. Thank you, Mr. Speaker.

Thank you, Honourable Member. Does any other Honourable Member wish to
speak?
I recognise the Honourable Member from
constituency 36. Honourable Member Scott, you have
the floor.

Hon. Mich ael J. Scott: Good afternoon, Mr. Speaker.
Mr. Speaker, of course, it is not always poss ible to respond to all of the Opposition OBA present ations in the House either by spin or, like the last
speaker who just took his seat, who is inviting the Mi nister to pronounce a grand vision, state the underlying
philosophy of health care in this country, whilst at the
same time and in the same breath, he is asking her to
pause and consult. So, the Minister of Health, the
Honourable Kim Wilson, is many things. But she is
just not an acrobat who can do all of these things.
[It is] b etter for us to pitch a policy that is addressing health care cost of living in our country. You
know, the Minister of Health, we were very busy in the Progressive Labour Party last night. T he Minister of
Health last night, while she w as in the East with her
town hall on health, in the West there was a town hall going on on the liveable wage discussion. And beyond
no doubt, the Premier announced even in his exce llent Ministerial Statement thi s morning, we are about
reform in this Island. And we are all concerned about
the cost of living. Health care cost is one of the grea test offenders of cost in our country.
So, I do not wish to try and respond to all of
the OBA spin that we have heard. But there are perhaps one or two spokespersons on the other side who deserve some attention. One of the Members of the
Opposition, in their early speeches this afternoon, has
laboured and been concerned about identifying where
the cost savings will be made. A nd he indicated, that
Honourable Member indicated that he did not see it in all of the speeches that he had heard up to the point
that he took to his feet.
Can I suggest that the answer to finding and
identifying where the cost savings will be made by thi s
Bill is in the simple formula that 0.0 per cent of regul ation, Mr. Speaker, 0.0 per cent of regulation of the
health care funding in this country is better than . . . I
beg your pardon —1.0 per cent regulation— of the
health care funding package of money i n this country
is better than 0.0 per cent, which obtains now. B ecause the money is in the hands of the private sector insurance companies. And they do zero regulation.
Rather, as was confessed to by the very Shadow Mi nister herself, when she expressed the ir concern that
this initiative is going to deplete and rob the insurance companies of their capital reserve. I mean, it was a
remarkable confession to make. And therefore, expose the insurance industry to risk. And by doing that,
by that confession, she w as actually confirming one of
the core arguments of the Minister of Health, which is
that heretofore, for the last many years, as the Mini ster for the Cabinet Office has pointed out, that has
1606 17 May 2019 Official Hansard Report

Bermuda House of Assembly been taking place since he was the chairman of one
of the commit tees at the hospital’s board many years
ago.
So, private sectors have been benefiting from
the use of taxpayer dollars. It is an old, old story of the
UBP/OBA. We have seen it most recently with the
America’s Cup, the transfer of public funds into the
private sector, wholesale, and used by them. And
what this Bill seeks to do is to stop that, to put a stop
to it. We are going to follow the money as the first step
in this health care reform. Follow the money. It is the policy that will give the most anxiety to the private sector health care insurance sector. It will cause them to
squeal with the greatest degree of squealing. But it is
not just causing the funding of health insurance in this company. That is not the end of this picture, as the
Health Minister has made very clear in her statement,
and that we have been hearing repeated by other Members taking to their feet, that this is just a step.
We begin with following the money and regulating it
better.
And it will propagate, Mr. Speaker. I dare say
it will propagate cost savings and efficiencies. It is
bound to. It is bound to. So, to the Honourable former
Leader of the OBA, that is where I invite you to look
when you look for where there may be cost savings
that you say that you have not heard in the debate to date.
On the page of the Minister’s brief, it would be
useful to turn directly to it, where she states —with
your permission, Mr. Speaker?

Go ahead.
Hon. Michael J. Scott: This is the starting point. “We
are starting with the way that we pay for the hospital.
We are giving our hospital a fair budget so that they
can deliver the care they need to the public. As a r eturn for that budget,” says the Minister, “we are also holding our hospital more accountable for how much
care they need to deliver and the quality and patient
care they provide.
“As a return for that budget, we are asking for
better reporting . . . .” That is one important outcome.
Better reporting will lead to better data understanding.
“[We will seek] better negotiation of better costs . . .,”
yet another opportunity to see an exchange for these
millions that are going to be in the MRF to be managed. And for those who say that you fear that the
management of all of these funds will be bleak or
weak, I dare say that with these kinds of approaches,
negotiating a better course, [with] “better reviews of utilisation” of these funds is a methodology. It is a
best-practice methodology for good management.
And it will throw up new models for identifying cost
savings.
And again, thi s is just but the initial step. It is
not the end of things; it is the beginning of things. It is not the end of things, I repeat, Mr. Speaker; it is the beginning of things. And finally, in return for this
budget being deployed, where it is to be deployed in
the MRF, the Minister will expect, and this Gover nment will expect “better partnerships with our comm unity doctors and nurses,” and may I add, without the
permission of the Minister, better partnerships with the
citizens of this country, the persons who most use the
health care system. I know that this kind of approach
is going to result in the propagation of new ideas for
cost savings in the health care industry.
The Member who just took his seat was as king from us this rather grand vision and said that there is no equity here. But there is great equity in this approach, I would like to suggest to him. His trope is that
this policy, this important policy is going to drive persons away, citizens away from the private sector and
drive more into the arms of Point Finger Road. I think that is a scary and unrealistic calculation and bears no
resemblance to the reality. We know that we will not
be adopting policies that are designed or, by accident,
to drive more business or more feet into the hospital
doors. There is quite enough utilisation at the hospital
right now.
And to the degree that the Government can
ensure with its partnering initiatives that we scope out opportunities to achieve what we have been trying to
achieve since 2009, with the Johns Hopkins Report,
which is less utilisation of the hospital, not more, no one can accuse the Government, the PLP, of pursuing
policies that are going to be driving more utilisation of
the hospital. Just the reverse is required. This affords
an opportunity for attempting to have less utilisation of the emergency room at the hospital. And these opportunities will come.
I am not quite sure what happened in the days
when there was not fee- for-service. But something
happened to ensure that there was this transfer of publi c taxpayer money into the private sector. Som ebody worked it out. And it started happening.

[Inaudible interjections]

Hon. Michael J. Scott: And when the Honourable
former Leader of the OBA barracks us for not having
made or identified how cost savings are going to take
place and seeks in this House to punish this plan as
being inadequate, how he can do that without exami ning the status quo that currently obtains and making
an analysis of it and coming to the conclusion that
surely the transfer of public taxpayer monies gamely
into the private sector is a better model than clawing it
back and deploying it with government regulation and
control . . . it was the Honourable Member, Ms.
Furbert, who began to advise this House with her
speech that control is better. And I commend her for
pointing out and helping me to support my statements
here this afternoon, Mr. Speaker, that this is the raison
d’être for this Bill in its native and nascent stages of
reform and regulation of health care—control. B eBermuda House of Assembly cause so far it is just a cowboy situation of no control.
And we know that it is driving up health care costs.
I heard the Deputy Speaker speak to the generic cost issue, where Attorney General William
Tong, in Connecticut, has identified this remarkable scam of pri ce-fixing by health care providers —well,
generic drug providers in the United States. I commend Attorney General Tong for taking this matter on.
But even as we examine this story in the
health care platforms, insurance companies have a
poor record and a r ole to play even in that kind of si tuation. I do not say that this is happening here. But
when generic drugs are being moved from $80 to
$1,000, then that makes insurance companies raise
their premiums in the United States because they are having to meet t hese higher costs of persons visiting
surgeries or visiting drugstores and collecting drugs, and paying for health care, at these increased costs.
All it does is cause insurance companies to raise their
premiums. So, they are willing participants and co llaborators in these kinds of awful schemes in health
care.
And this is a mark. It is laying down a marker
that we have to be aware of and that we have to si gnal to insurance providers that they are being watched
even on this front.

[Inaudible interjection]
Hon. Michael J. Scott: Absolutely.
So, reform is the new norm, Mr. Speaker, in
case anyone is —
[Inaudible interjections and laughter ]

Hon. Michael J. Scott: In case anyone is wondering
about the speech, in case anyone is wondering about
the commitment of this Government as articulated in
the Cabinet Committee Social Issues Ministerial
Statement today. Just read it, and you will see that
this is the commitment of this Government, to bring
life in this country to more reasonable proportions —
education, health care, energy and certainly in our
crime and conflict, crime/gang conflict that is driven by
these kinds of pressures on our society. These are
where we intend to commit our resources, energy and time in the Government.
Mr. Speaker, the Honourable Member, Mr.
Moniz, called for and sought to use the report that spoke to this $84 as being necessary, based on act uarial analyses as resulting in, as the Minister of Health pointed out as unacceptable, a further $84 being add-ed on. Surely, Members of the Opposition have not
been asking us to really seriously contemplate choosing that option. But that is what seems to have been
the suggestion, that we are ignoring the pronounc ements in that report. So, the Minister of Health, with
her Cabinet colleagues, saw that result and has adjusted her tack, and certainly has rejected even con-templating taking up the actuarial ’s recommendations.
And I commend the Minister for it and the executive for doing this. It is a true expression of, we are in the
game of fighting f or the citizens of this country, parti cularly in the context of everything being so awfully expensive in this country so that people cannot really
function.
It is the primary reason and basis for health
depletion in our midst. The stressors of living in t his
country, at the cost of living, is driving us to emigrate
to England. It is causing us to have hypertension i ssues, cancer, and strokes . Statistics in the country are
some of the highest that we have ever seen in our
history. And so, we cannot afford not to do what we
are doing. We cannot afford not to respond to calls for
or tropes being thrown out that, Oh, this is going to
result in loss of jobs in the insurance industry, or, This
isn’t well -thought -out. And we have stood, as the
Shadow spokesman for health said, stood health care
on its head. And I have not had enough time to exam-ine this because it is a significant debate.
Well, you are right. You are darned tooting it
is a significant debate. It is an overdue debate, and it
is important that we ha ve it within the seven- day per iod after it was tabled in this House, particularly after
we have foreshadowed, both in Budget Statements
and in Throne Speech Statements and in the actual consultation of this Minister, going out to the world here in this cou ntry called Bermuda, and letting the
people of this country know and the industry know that
this is what is coming. It is more than enough time.
Life does not rotate around the specialised requir ements and needs of the Shadow spokesman for
Health having just a little more time to work up arguments against reform. That is the new norm.
So, the Member, Mr. Moniz, has described
this as being a case of, and tried to attack it as being
a part of, the PLP’s poor track record of not managing
health care in our country. And that was just typical of Mr. Moniz. It has no bearing on really grappling with
the issues of this policy as stated in this amendment
Bill. He omitted to indicate that there was a reason for
the steps that were taken in relation to the matter of
where he accuses us of reversing legislation in this
House.
Mr. Moniz is blind, and has been blind to the
fact that the explanation to which I have referred you,
Mr. Speaker, yourself and this House, that is contained in the brief of the Health Minister, that is where
the explanation is for how cost savings will be effected in this matter, the starting point. And the demands that will be placed on the institution that is responsible for
45 per cent, as the Minister has advised me, of our
health care costs, what is a better place to start?
That is a significant percentage metric of
health care costs in this country which requires and
demands that any good Minister, any reasonable Mi nister, begin to shine the spotlight on it. And the Honourable Minister has done well to start there and tell
1608 17 May 2019 Official Hansard Report

Bermuda House of Assembly the House and tell the people of this country that it will
lead to other outcomes, based on better reporting and
better negotiation of better costs and better reviews of
utilisation and better partnerships with the communi ty
doctors, nurses and the people of this country.
And so, Mr. Speaker, I commend the Go vernment for adding to the platform of reforms in this
country’s health care reform, this Bill. It will go a long way to meeting the cri de c œur that we hear from our
citizens, and have been hearing from our citizens over
the years that we are fighting for you. And I look for-ward to June 1
st and beginning on an important initi ative dealing with the reducing of the cost of living in
this country. The Minister has begun a good thing and
has shown that she and her colleagues within the executive are fighting for the citizens of this country.

Thank you, Member.
I now recognise the Honourable Member from
constituency 7. Honourable Member Richards, you
have th e floor.

Mr. Sylvan D. Richards, Jr.: Thank you, Mr. Speaker.
Mr. Speaker, the Honourable Member who
just took his seat, who also happens to be my cousin
. . . oftentimes we do not agree on things that we do
up in this place. But I have to comment on his last
statement, meaning that he is fighting for the people in this country. I must say, Mr. Speaker, that when I look
at the track record of this current Government since
they have been leading this country, we have gone
backwards in terms of the cost of living, the expenses
that Bermudians are paying to live on this Island. And
they are fighting for the average Bermudian? Do not
fight for me. Because when I walk the streets of this
country, all I am hearing is people moaning and complaining about how the cost of everything has gone
up. I am struggling to think of anything that has gone
down since the PLP took over the Government of this
country.
Sugar tax has done nothing but drive up the
cost of food. I am hearing it, and I know they are hearing it. They walk the streets of this country. I know
they are not hearing people saying, Thanks for making my grocery bill more expensive! Our land tax is
getting ready to go up. Wait until the people of this
country start getting those bills. Oh, your phones are
going to be ringing off the hook.
Bermuda is the most expensive jurisdiction in
the world, and once this Bill passes, and it will pass today, it is going to be even more expensive, more difficult for the average Bermudian to live in this country. Now, I have reviewed this Bill. I have listened to
the Government Members vouch for this Bill and how
it is going to be so awesome and so great, and how it
is the first step in bringing down the cost of health
care in this country. And I call things as I see them,
Mr. Speaker. And I just do not see, no way, no how, how shifting around the chairs on the deck of the T itanic is going to make things more affordable in terms
of health care. I just do not see it.
And I will declare my interest. I am an insurance underwriter. It is what I do for a living. And I have looked at this thing every which way that I can.

[Inaudible interjection]

Mr. Sylvan D. Richards, Jr.: The Premier just asked,
Do I have an alternative? If he would have asked before this, if he would have consulted with us before
this, he may have gotten an alternative from us. That
is what I am so frustrated about. There are alternatives to what we are trying to achieve. There are alternatives. But those alternatives are not being explored,
because there is a rush to get this legislation passed
in this place.
I thought it was kind of funny when the Member from constituency 26, MP Tyrrell, was on his feet.
He said, The actuaries are advising us . We are getting
our advice from the actuaries. Well, I will share a little
secret with you, MP Tyrrell. When I am in my office
underwriting an account and I see an actuary come
through my door, I want to run the other way.
[Laughter]
Mr. Sylvan D. Richards, Jr.: I want to run in the other
way! You know why? Because ac tuaries are very
smart. Sometimes, they are too smart. Right? An ac-tuary comes into my office and says, Sylvan, the pr emium you are charging for this policy is too low. It
should be at least three times loss payback, and he is
spouting off all this stuff. Your premium is too low.
And you know what I tell the actuary? If I did
what you said to do, I would have no clients. The company would have no business.
You see, there is advice, and then there is
operating in the real world. And I am going to tell you what is going to happen in the real world when this Bill
is passed.
Everybody’s insurance premium is going to go
up. I want that in the Hansard. Insurance, health care
insurance premiums, the Bermuda Health Council figures show that because of a shift in Bermuda’s
population demographics over the next seven years,
there will be a dramatic impact on the cost of health
care in Bermuda, which is already at 11.53 per cent of
Bermuda’s GDP. For example, health care costs are
projected to grow to 20 per cent of GDP in the next 10 years. But those figures do not factor in what Go vernment is proposing to do today. So, we can fully
expect those percentages to go higher.
Now, we all know that here in Bermuda we
have a problem with the overall health of our popul ation. We rank number one on all of the charts that we
should not be number one on. Seventy -five per cent of
our people are overweight or obese. Physical inactiv iBermuda House of Assembly ty is leading to chronic diseases, heart disease, hypertension, increasing rates of cancer. And t hen, on the
flip side, you have improving medical technology,
coupled with an increase in defensive medicine, which
means that more and more people are living longer, which impacts health insurance costs.
So, there is a perfect storm going on in Bermuda w ith our health care crisis. You have got more
unhealthy people living longer, putting a strain on
health care.
So, I understand the Government’s motiv ations to try and do something about it. But I have looked at this legislation. And the Government can
say . . . the Minister has said, you know, So many
terms ––and the standard premium rate is going to
stay the same ––and you cannot blame us if your i nsurance premiums are going to go up. They know
they are going to go up. They were going to go up
before they did this, because insurance premiums do
not go down. They go up. So, the only thing that I can
see is that a bad situation has been made worse. A bad situation has been made worse.
So, we have had a very informative debate
today. But when I get to my feet in this place, I am
speaking to the people out there listening on the radio
and to the people who tomorrow will go on Bernews
and listen to the audiotapes of what we say up here.
And I speak plainly. Because a lot of people do not
understand this stuff. I nsurance is an intangible. It can
be complex. You are talking about ratios. It is not an
easy thing to grasp.
But what I do know is that in the upcoming
year, people are going to be crying about the cost of
their health insurance. And the Government talks
about Two Bermudas and the inequities and this, that
and the other. This legislation is going to make it
worse for people in this country who cannot afford
health insurance.
So, I am just putting down the marker. And
history . . . I hope I am wrong. I hope I am wrong. Ev erything that this Government has done, I am hoping
that I am wrong, but I have not been proved wrong
yet. I do not know what you are thinking of. But you are not helping the people of this country to survive in
this country. It is getting more expensive and more
difficult for too many people.
In my view, the Ministry of Health is expanding services while paying little attention to the ec onomics of this change. I will repeat that. The Ministry
of Health is expanding services while paying l ittle a ttention to the economics of this change! Everything
that we do in this place, the first thing in our mind
should be, Am I making it better or worse? Am I making it easier or harder for the average person to survive in this country? It is my view th at we are not ma king it easier for people to survive in Bermuda.
The end result of this change will be that
health insurance premiums will continue to rise at a
faster pace. Those customers who can afford the health care increases will buy top- up insuranc e.
Those who cannot afford to will not. And once again, this will widen a divide between those who can afford
health care, health insurance, and those who cannot.
And then, there is the effect on the cost of
doing business in Bermuda for employers. Now, s ome
Members mentioned that they do not really give much
thrift to the fact that next week there will be meetings
held by the international business companies that are
the main drivers of economic activity in this country.
And they will tell their employees , Your deductions are
going to go up because health insurance costs and
premiums are going up. It is going to catch a lot of
people by surprise, because a lot of people do not pay attention to what we do up in this place until it is too
late.
Those seeking to look to Bermuda to set up
operations here, this is not going to help them to make the decisions that we want them to make in terms of
coming here. Because we are a very expensive juri sdiction, and we keep getting more expensive. We
should be trying to find ways to lower the cost of doing
business in Bermuda.

We are.

Mr. Sylvan D. Richards, Jr.: You are not! You are in
denial. And that is not a river in Egypt.

[Laughter]
Mr. Sylvan D. Richards, Jr.: So, you do not listen to
me, but that is okay. You do not have to listen to me.
Because I am in the Opposition. And you have got the
majority up here. You can do whatever you like. But
when you walk the streets of this country, you will
hear from the people of Bermuda. You are hearing
from them now. If I am hearing from them, I know you
are hearing from them.
So, I wish you well. But so far, your rhetoric,
your words are not matching up with your actions. And
the people will hold you accountable.
Thank you, Mr. Speaker.

That is what we heard. And
I took that as a very positive step.
There have been a number of major initiatives
[on which] the Opposition, to their credit, has decided not to take an obstructionist stance, but, for the good
of the country, has joined us in advancing these very important sets of agendas that are unavoidable. B ecause I think the realisation is happening there, along
with many throughout the country, that the current
status quo is no longer tenable.
However . . . however, only minutes later, we
had the once and perhaps future leader, for the third
time, perhaps, take a view that was contrary to the
positive view that came from the Opposition Leader.
And it was all doom and gloom, and the sky is going
to fall. Mr. Speaker, I will say this here. I know this
much: This Bill is just the opening phase of a multi -
phased appr oach to substantively reducing the cost of
health care in Bermuda. So, stay tuned! Because r elief is on the way.
But, see, what the Opposition failed to do,
because they are too beholden to the current status quo, is make the sort of transformative changes that
were necessary, because those persons who have been drinking quite easily out of that trough are steadfastly opposed to making any changes that are going
to leave them to get a little less water and to provide
more for everybody else. But, you see, we are at a
point now in Bermuda that you cannot have your cake
and eat it, too. It just cannot be done anymore.

We know that the insurers
have had a fantastic ride. The Minister was not off
base in pointing out that their motive for opposition was solely profit -driven. A large part of those extraordinary profits that we see them bragging and boasting
about over the last few years can be directly traced to
that model that was perhaps set up here maybe 50
years ago that essentially is a fee- for-service model,
with insurers at the centre of that model.
The fee- for-service model or a variation of it is
what has brought us to this juncture, as it has in the
US. As you know, as the election is getting read y to
wind up again in the US, health care is front and centre. Firstly, in the recent congressional elections,
where the Democrats were able to take a significant
number of seats, health care was the seminal issue. And it will be so again in the presidenti al election. No
less for us! I mean, look at those figures that ever ybody has been talking about. The amount of money
that we spend on health care is extraordinary! Over
$700- odd million per year!
Mr. Speaker, we know that . . . and the reference, of cour se, the Minister, the Honourable Kim
Wilson, looked at me and I looked at her. And we heard references where a Member there, one of the
Shadow Ministers was evoking 1980’s Russia. Now,
she dropped Cuba in there. Everybody knows that Cuba’s health system has been touted by everybody
for generations as being very good in the delivery of
services there. Top- notch. But the Russia reference
was just extraordinary; it really was.
Of course, they conveniently forget that,
throughout Western Europe, Scandinavia, Ca nada,
France, they have very good health care systems that
offer some variation of what we call a single- payer
system. These are not socialist countries. These are not communist countries. They have certain features
within their public policy that one coul d view as being
socialistic, I guess you could say. But they have free
market economies because they recognise that health
care is not a privilege; it has to be a right in a modern
society, especially one as wealthy as most Western
countries are, and increasingly around the world who
are also adopting some variation of single- payer sy stems. This is the way forward for us in Bermuda. It
has to be.
Mr. Speaker, I went to my chiropractor just
recently. As a matter of fact, it was just this week. And
he had a document that, in support, I would like to
add, of the sugar tax. He is a professional who is in
support of it. And if I may, Mr. Speaker.

I am just going to . . . this
just illustrates where we are at here. It is on the wri tten page here. He says, “By any country’s standards, they are shock ing figures.” He is referring to the
amount of diabetes that Bermuda suffers from, the
Bermudians, I should say. “More than a third of Bermuda’s adults have diabetes, and around three-quarters of men and women are obese or overweight.
As a result, the costs are extraordinary. Last year
alone, spending on people with diabetes amounted to
$77.8 million, or 10 per cent of that $700- odd million
of Ber muda’s total health spending.”
Extraordinary. And it is only going to get
worse.
Gentlemen, we can differ on some of the pol icy prescriptions. But we all have to come down and be realistic here that it is not going to get better in and
of itself, that the status quo is not sustainable. We
know [about] this ageing population. We are going to have to make hard choices here. This Government is
determined to make those hard choices! We have to. I


Bermuda House of Assembly think we are going to reach a milestone by 2020,
which is going to see our aged population . . . if an ybody here can give me the correct figures, I think we
are going to be at 20 per cent by 2020 of our popul ation being either 66 or 65 and above. And with the
baby boomers, particularly my generation, hurtling
towards, you know, their mid- 60s and above, we are
facing a tsunami, demographically.

[Inaudible interjection]

That has got to be part of
the mix, too, raising the retirement age. And this Gov-ernment is dealing with that.
So, Mr. Speaker, I applaud what the Gover nment is doing. There is going to be some short -term
dislocation. There is going to be some short -term pain
for some. But I want people to understand that there is
going to be long- term sustainable gain for Bermuda.
And you know, I have been involved in a f ew
of the town halls that we had on the living wage. And I
am not going into any specifics around that, Mr.
Speaker. But I will say this here. As I mentioned earl ier, Bermudians are understanding that the status quo
is not working for us. And what is grati fying, Bermudians are also more open to dealing with the complexity
around these issues. They know there are no easy fixes. Bermudians know that.
So, Mr. Speaker, we see what we have done
with the hospital there is long overdue. The block
grant for the hospital has to have occurred. It should
have happened some years ago. But again, Bermuda,
if you are listening out there, that is only phase one. And, believe me, you will get the contours of the
phase two plan very soon. Because this part is just —
this is j ust one aspect of it. We are going to move t owards having a single- payer [system] or some vari ation thereof, maybe one, maybe two pools. When the Minister is ready, when we have all of the numbers
together, when we have the whole framework established, tha t will be made public and there will be debates around that.
But that is the way we have to go. And by d oing so, it will be no different than what many of our peers, in terms of countries large and small, have
done. And you will also note that it is what they are increasingly looking to adopt in the US, as well. B ecause they know that they have reached a dead end
with that system. And they know that it has not helped
health outcomes. And we, tracking or actually adopting many of the American prescriptions for health care
coming out of that World War II era, went the same direction. Look where it has got us.
The other thing is we went in the same direction in terms of adoption of what I call that Western, but particularly American, diet. Look where it has got us. So, it is not just a fix in terms of how we pay for
health care. It is also about the whole wellness pac kage and diet. It has got to be all a part of it. I reme m-ber my godmother, Hyacinth Jones, God bless her,
from out in Spanish Point, the back of West Pembroke
School out there. And I remember one of the last conversations I had over to the house we were visiting.
And everybody started reminiscing about Bermudians and how Bermudians were such a handsome people.
And they then talked about, Why? Because they were
not eating a lot of processed food. You know, a higher
percentage of fresh fish and vegetables. Everybody
had a garden, you know. And some of the better -off
families would have had maybe a goat tethered in the
yard, right?
But they also walked and, in particular, rode
what we used to call in the vernacular, pushbikes,
back in the 1920s and 1930s and 1940s and 1950s.
They were all slim and handsome people. That is the
way Bermudians used to look. But you look now, and, ah, man, I tell you.

[Laughter]

But anyway, I mean, let us
create a better model that is going to serve Bermuda
and its people, a healthier Bermuda. It can bring about
such significant benefits, not only for the individual,
but for our economy. Let us not lose sight of this. This
also brings about economic benefits for our country by having a healthier population. By decreasing the debt load [we have] incurred by having a sort of fee- forservice winner -take- all, wild, wild West system around
health care, w hich is going to lead us to bankruptcy.
And I know we all want to avoid that.
And if it means that everyone has to sacrifice
and that those who have been doing well with this cur-rent system have to sacrifice a little more than others,
then so be it. But w e are no longer going to put the
burden for the downside of this system firmly on the backs of low income and the working poor in Berm uda. Thank you, Mr. Deputy Speaker.

[Hon. Derrick V. Burgess, Sr. , Deputy Speaker, in the
Chair]

Thank you, Mr. Deputy Speaker.
My interests are declared under the parli amentary website.
I believe in investing in Bermudian companies
and Bermudians. And that includes investing in certain
of the health insurance companies on this Island.
There is a quote often attributed to Winston
Churchill, which is that “Democracy is the [single]
worst form of government, except for all the others.”
And that is an apt quote today, Mr. Deputy Speaker. It
is an apt quote in the context of our health care con-versation because Bermuda’s health care system is
1612 17 May 2019 Official Hansard Report

Bermuda House of Assembly the single worst health care system in the whole
world, except for all the others.
Generally, our health care system works. It
has significant problems, and they need to be fixed.
But it works. It is costly. But it works. There is overut ilisation, but it works. Our population is ageing and
generally unhealthy. But the health care provision that
they gain and that we gain on this Island works, generally. The provision of urgent and emergency care is
there. If you are Bermudian and you need urgent
emergency care you are going to get air -vac’d out of
here to Lahey or wherever it is, this happens. This
happens today. And it happens whether you have a
job or you do not. It happens whether you are white or
you are black, whether you are rich or you are poor. That is the health care system that we have today,
and it is the health care system about which we Bermudians should be proud.
Is it perfect? No, it is not perfect. It is costly.
There is overutilisation. And we as a people are gen-erally unhealthy and getting older.
Mr. Deputy Speaker, moving to the legislation
itself, I have attended numerous discussions w ith
people in the health care industry about this Bill. I
have read the Bill. I have discussed the Bill at length
with my parliamentary colleagues. And we must say
on this side of the aisle, despite our vigorous efforts, we are none the wiser. It is hard t o see. It has been
touted as a reform Bill. It is hard to see what it intends to reform. I mean, if these are the Commissiong r eforms for our health care system, where are they taking us, and what do they mean? Because those questions need to be answered, and they have not been.
Now, we all know that this Bill will pass b ecause the Government has the votes. But it is the
Government that will be held accountable to explain to
Bermudians what these changes mean. And I hope
they can do so.
What I think they mean, Mr. Deputy Speaker,
is that money is being moved from one pocket to another, from the private sector insurance pocket, where
we have health care claims that are managed to try to
keep costs down, to a government pocket, where we
may have managed cla ims to try to keep costs down
or we may not. What has not happened is any identif ication of cost savings by borrowing from Peter to pay
Paul. And, as we understand it, and no doubt we can
be corrected with facts and figures, but at the m oment, this first s tep in this journey does not show any
cost savings at all.
And so, to link it to the Throne Speech promise by the current Government that they were here
and elected to reduce the cost of living, it is a disconnect. This is not going to reduce the cost of living, and
no one has said how it will reduce the cost of living.
Indeed, I would suggest that it is far more likely that this change will increase the cost of living for Berm udians. Now, why do I say that? If you obtain health
care from a Bermudian heal th care provider, know
this: Your premiums will go up. And I will repeat that. If
you obtain your health insurance from a Bermudian
health care provider —Colonial, BF&M, Argus —your
health insurance premiums will go up as part of this
journey. Maybe not with the first step, but as part of
this journey, the cost of health care for the vast major ity of Bermudians is going to get more expensive. So, we should at least be honest about that. Your prem iums will go up.
Why? Why? The only answer at the moment
is the desire expressed by the Premier in the motion
to adjourn last week that his goal, which we take to be
a collective PLP goal, is to dismantle the system, tear
it down. Burn down the house. Because things need
to be changed. The Commissiong reforms are need-ed. We need to have a new landscape.
The problem with burning the house down is
that if you want to be a radical bomb- thrower and you
want to light things on fire, be careful who gets burnt. Because the evil pantomime villains in this picture, the
health insurance companies, the bad guys, they are
Bermudian companies. They are owned by Bermudi-an shareholders. They are public companies. They
have a diversity of Bermudian shareholders. Not every
shareholder at BF&M and Argus looks like me.
And more importantly, what do they do? They
employ Bermudians. They have some of the highest percentage employment rates on the Island compared
to other sectors of Bermudians. These are Bermudians, Mr. Deputy Speaker, who will lose their jobs when this money is shifted awa y and into the gover nment sector. There will be job losses. Premiums will go up, and there will be job losses.
So, if you are going to start a fire, take a m oment to stop and think about who is going to get burnt.
But let us say this Government is succes sful
in burning the building down. Well, what next? We still need the building. Someone is going to have to build it
again. Who is that going to be? Well, we heard last
week, We need more competitors in this space. Great!
Where are they coming from? Overseas. So, we are
going to get some foreigners to come in and build the
buildings, the Bermudian buildings, that we just burned down with job losses. So, that is a solution.
And maybe that is not what will happen. Ma ybe we will not have foreigners come in and build new businesses to the loss of Bermudians and Bermudian
employees. Maybe the Government will take over the
whole system.
Now, I ask, Mr. Deputy Speaker, is that a
good idea? Look around at any country in the world
and identify a circumstance where the government is
better at running things than the private sector. They
are pretty hard to find. This Government is not in the
business of providing health insurance for all Berm udians, nor should it be, because it will not be very
good at it. And the fac t that it is not good at it is why


Bermuda House of Assembly we are struggling currently to deal with the circa 6,000
high-risk Bermudians who do need better health i nsurance and provision of care. And the Government
has not been very good at that thus far, and that is
why we face some of the problems we are facing with
escalating costs. That, and obviously, utilisation and
an ageing environment and an unhealthy environment.
But we are told that this is just the starting
point. This Bill is just the first step on the journey, was
a quote from earlier. Well, Mr. Deputy Speaker, watch
out, Bermuda, because this road is likely to lead to job
losses.
Let us look beyond this Bill. Let us look at the
next steps. Because we have been told that there are
next steps, that this is the first step in a journey. Well,
how is this all going to work? We know now that King Edward is going to get a lump- sum grant. Well, how
are they going to manage this change? How are they
going to cope when the lump sum grant runs short?
We have heard, parenthetic ally, that dialysis treatment
now is going to be capped. Okay. So, how does that
work come July or August, where someone needs
dialysis treatment? Money is not there. Today we
heard that we had an emergency $65 million medical
fund. Okay. But still, maybe it is not July. Maybe it is
September. Dialysis treatment is still needed, but the
money is not there. How is it going to work?
You can look to other jurisdictions that have
(quote/unquote) “socialised medicine.” And what you
tend to see there are two thi ngs. One, you see delays
in the provision of services. You see waiting lists. The
words “ waiting list ” were on the front page of the UK
papers any time they talked about hospitals, the delay
in getting service. Something, I would point out, that
under the current system is not a problem. If you are a
very sick Bermudian, you see the doctor you want to
see. You get the emergency treatment you need. You
get good health care.
So, here we are, Mr. Deputy Speaker. There
is going to be a block grant. Maybe it is not July. Ma ybe it is September. So, what happens when the money runs out? Will there be a reduction in services? Will there be waiting lists? Will we go a step further? Will
we go on to the next step, where Bermudians who
want to be able to decide their own health care choi ces are told, No. It’s not your decision anymore. This is
a government health care system. We’re going to tell
you which doctor you go to. And that is how it works in
the UK. You go to the doctor who is in your post code.
You do not say , Oh, I’d like to go see Dr. Jackson,
because she’s a great doctor and I’d like to go see
her. Oh, no, no, no, no. You will go see the one two
streets away from you, because that is how it works.
So, they start choosing your doctors for you.
And the second point, and it is a point that my
honourable friend, Sylvan Richards, already raised—you will start to have a two- tiered system. There will
be more of Two Bermudas in the health care system. Because those who can will go off and buy private
high-end premi um health insurance to make sure that
if things start to go badly at the hospital or wherever,
they are still covered. So, that is the problem that will
be faced.
And so, respectfully, if this is the start of a
journey, we must be very careful about where this
journey will take us. We do not want the clunking fist of the state telling people how they must manage their
health care. This is a matter for personal choice for all
Bermudians. And this is a first step down the treac herous path. And we will wait. We will see what ha ppens. And the Bill will pass because the Government
has the votes. But my prediction is that costs will not
go down, and premiums will go up. And Bermudians
will be less better served by their health care system
in five years’ time than they are today, notwithstanding
the problems that exist in our system. Thank you, Mr.
Deputy Speaker.

I realise the s peaker has only
[just] wandered into the Chamber, but you were here, Mr. Deputy Speaker. And right at the beginning I declared my interest.

[Inaudible interjections ]

Hon. Jamahl S. Simmons: Mr. Deputy Speaker, in
this Chamber, we are all honourable men. I will take the Honourable Member at his word. The Hansard will
speak for itself.

Yes.
Hon. Jamahl S. Simmons: But, Mr. Deputy Speaker,
I think that the theme of the previous speaker’s
speech was that, if I cannot convince you, I will scare you. If I c annot sway you with facts, I will frighten you.
Mr. Deputy Speaker, I will say this. And I will quote my
colleague, my neighbour in Parliament, and my
Sandys PLP representative neighbour, Mr. Michael
Scott. Greed, not government, will lead to an increase
in health care if it comes. Greed, not government, will
lead to an increase in health care costs, if it comes.
Mr. Deputy Speaker, I have listened to the
One Bermuda Alliance defend the status quo. I have
listened, with apologies to my good friend, the Ho nourable Member from constituency 21, the One Bermuda Alliance tap dance on behalf of seemingly certain interests. And, Mr. Deputy Speaker, I think that
we recognise that, when it comes to the One Bermuda
Alliance, the degrees and the education, the exper ience that we possess will never be enough. We recognise and understand that the degrees and expertise
and experience and knowledge within the government
and the civil service that helped to advise us to shape
the policy we developed will never be good enough.
So, I am less concerned about their attempts
to frighten rather than convince, but more concerned
about the people whom they profess to care about.
Because, Mr. Deputy Speaker, you will not hear me
talk about Mr. and Mrs. Bermuda, because I like to be
specific. I talk about Bermudians, Bermudians. And
so, Mr. Deputy Speaker, when people talk about the
cost of health care, when people talk about the cost of
health care, I have lived it first -hand.
Mr. Deputy Speaker, from 2012 when I was
made redundant to the day I was elected, I did not
have health insurance. I did not have health insurance, Mr. Deputy Speaker, because I could not afford
it. I did not have health insurance to be put on my
wife’s insurance because it would have taken her take- home pay s o low it would have made no sense
for her to go to work. So, for two years, I hoped and
prayed that nothing happened. All right? And there are
many Bermudians in that position. There are many
Bermudians in that position. And, Mr. Deputy Speaker, those who profess to care about Mr. and Mrs. Bermuda were among the people who mocked people
like me when they did not have insurance, when they
could not find work, when they took work that some
viewed was beneath them.
So, one thing I can say about this Progressi ve
Labour Party, and the Opposition may never accept this, our hearts are with the people who, at the end of the month, their dollar does not go far enough. Our
hearts are with the people who cannot afford health
insurance or whose health insurance bills are wiping
out their salaries every month. And so, Mr. Deputy
Speaker, the status quo will not do. We had a choice, Mr. Deputy Speaker, and when we came to the Cabinet table, I cannot disclose the Cabinet discussions.
But we were told we are going to put a higher bill on
our people, Bermudians. And as a collective and as a
party, we said no. We must find another way.
So, we had a choice. Raise the costs on our
people. Do not raise the cost and hope for the best and pray that it worked out. Or find a new pat h. And
one thing, Mr. Deputy Speaker, I can say about this
party is the status quo will not do. We believe in bla zing new trails. And, Mr. Deputy Speaker, when I think about some of the remarks I have heard, and some of the remarks I have heard over the ye ars, I am r eminded (and with your indulgence, Mr. Deputy Speaker), I am reminded of a quote from a book, Dante’s
Inferno [sic]. Before Lucifer was thrown into the pit, he
said to God, Better to reign in hell, than serve in
heaven .
Now, Mr. Deputy Speaker , the devil could not
and no longer envisioned heaven, because heaven
was denied him permanently. So, a devil will put an
air-conditioner in, trying to make hell a little cooler.
The devil will try and make a backyard barbecue a
little bit more festive, because they are not getting to
heaven. We have to envision not to make hell, which
[is what it] has been for many of our people for the
past several hundred years on this side of the world, better, slightly better, a little bit less painful. We must
work st ep by step towards creating, as best we can, a
more heavenly life for our people on this Island.
And, Mr. Deputy Speaker, when we stand up
here and we bring things for that, we recognise that we speak not for corporate interests. We speak not
from fear that our friends will make less money this year at the end of their bottom line. We speak for the
people who wonder how they are going to pay their
bills. Not Mr. and Mrs. Bermuda, but Bermudians, Mr.
Deputy Speaker, and unafraid to say it —unafraid to
say it .
So, when I stand to my feet in this Chamber, I
do not speak for any insurance company, although we
must ensure that we have an environment that is
prosperous for business. But I do not speak for them. I
do not speak for them. They do not own me. I do not
take a dollar from them. Lord knows they have taken
enough dollars from me.
But, Mr. Deputy Speaker, when we, as we
seek to go forward on the first step of this journey, I
am excited because I was not put here to make the
backyard barbecue more festive, nor hell a little bit
cooler. I was put here to transform and tear down the status quo. And when I stand alongside of my co lleagues, we know the status quo will not do. It will not
do for our seniors. It will not do for our children. It will


Bermuda House of Assembly not do for an y generations. The clock has run out. The
day is over. The time has come to move forward in a
way that benefits all, not just the few.
And so, Mr. Deputy Speaker, I commend the
Health Minister because she could have taken the
tack and said, You know what? Let’s burn Bermudians
one more time. You know? Let’s listen to the bean counters and burn Bermudians one more time. And
we said no. We have to find a new path. And so, when
you hear companies that declare millions and millions
of dollars of profits, and t hen saying, Guess what? We
need more. When you hear companies outside of that
industry declare profits and say, You know what? We
need more. And people are out on the street. Mr.
Deputy Speaker, that is not the Bermuda we are
fighting for.
Our Bermuda is about making sure that that
little guy, who works hard, works hard, has a few do llars to scratch together at the end of the month. That if
he gets hurt, he does not have to worry about whether
he is going to pay for medical bills. That is what we are here for, not tap- dancing for insurers and for
shareholders. No, sir. No, sir.
So, while I appreciate the support that was
given by the Leader of the Opposition, and I recognise
the agenda of the man who would be king, the former
Premier, but we have a job to do. We have a job to do. And it is no clearer the division between these two
parties than on the issue of Bermudians and ensuring
that we level the playing field. This is the first step on
a journey. We have laid out our rationale and our reasons for taking the first step on this journey.
And, Mr. Deputy Speaker, I look forward to
the conclusion of this journey because we will once again prove that those who fight for the status quo,
that not only is their day over, but they were wrong.
Thank you, Mr. D eputy Speaker.

Thank you, Mr. Deputy
Speaker.
I have been listening to this debate. And for all
of the speakers, I still have yet to hear exactly what
this means for the person who is employed and i nsured. And I find that this legislation and the changes
that are about to take place around the payment of the
insurance premiums to be quite confusing. And we
have gone through this process in a very short period
of time. So, I would like to just take a few minutes and see whether I can understand this for the person who
is actually the one who is employed and is going to be
paying this premium.
So, if a person is working in the private sector
and they are paying their premiums to date, the insur-ance company is paying a couple of hundred dollars
out of your insurance payment to go to the Bermuda Hospital for the Standard Hospital Benefits. And the
insurance companies, because they are right now r eceiving, if you go to the hospital for services, they, the
insurance company, will receive a bill from the hospital, and then the insurance company will pay the hos-pital. And the insurance company is keeping a rec ord
of all of this activity.
So, if you are healthy and you do not use the
hospital facilities, then there is an opportunity for your
premium to be reduced, because you are healthy and
you are doing a good job, no claims. You are being rewarded.
In the new framework, more than $300, a [full]
$335 is now going to go into a fund, which will pay for any hospital visits that you, the employee, the worker,
are going to have, any services that you need at the
hospital. So, it has gone from about $100 that you used to put into this fund, now it is going to be about
$335 that you are going to pay into this fund for any
hospital treatments that you may need.
And the insurance company is no longer going to know what services you may or may not have at
the hospital. So, it is going to be virtually impossible
for the insurance company now to reward the people
who are healthy with a lower premium, because they
have no record of the services that may or may not
have been provided at the hospital. And so, they just do not know.
So, in summary, you ( being the worker ) are
going to pay $335 out of your insurance premium to
the hospital, and it goes. Whether you use the hospital
or not, it is gone; it is being spent there, and that is it.
The remainder of that standard hea lth prem ium, or Standard Health Benefit premium that you pay toward the hospital, there is this little bit, there is about
$25 that is left over. And there are certain services
that you can get that are not provided at the hospital.
And that $25 goes into a pot to help pay for those services that are not provided at the hospital.
And if you can imagine, let us say, I do not
know, I just had a running accident. I needed some
services that are covered by the Standard Health
Benefit. And I am not sure that the $25, the pot that I
am putting that $25 into, is actually going to be overall
covering the costs of whatever services that I might need outside of that hospital $335 that you have to put
in whether you use the hospital or not. So, there is this
risk that the insurance companies may say, Well, you
know what? That $25 that you’re contributing toward
any of the services outside of the hospital that still fall
within the Standard Health Benefit, which is basically
services that are provided to insured people in Be rmuda, [for] those services you may now have to pay a
little bit more. So, your premium may be adjusted upward in order to cover those costs.
Now, in addition to all of this money that you
are paying toward the hospital and any of the other
standard health benefits outside of the hospital, these
things I do not have a list, but dieticians, it may i n1616 17 May 2019 Official Hansard Report

Bermuda House of Assembly clude some physio, things like that, sort of these services that go, sort of complement things that you may
need outside of the hospital. So, [these things are in]
that pot.
Then, we pay a whole bunch of other money
for major medical. So, if we work in the private sector
at the banks, the insurance companies, we do get m ajor medical. And that is when the doctor may say, You know what? There is not any servi ce at the hospital
that can help you with this particular illness. We’re
going to have to fly you overseas. Or maybe you go to
your general practitioner, and he says, Oh. This needs
a specialist. So, you are going to go and see a specialist. All of those extra special services are also a
part of this premium that you pay. And that is what it is, and those premiums adjust according to how
healthy we are or how sick we are.
So, all in all, I guess what I am saying is that if
we are working in the private sec tor, yes, you will still
get your coverage, be able to fly overseas, go and see
a specialist, and the insurance company will pay for that. But I guess the most important part is that we are
paying this large amount of money into a fund that is
going to go to the hospital, and basically it is going to
get paid whether we use the hospital or not.
Now, one might say, Okay, well, that’s wo nderful because there are people who use the hospital in emergency circumstances, and, you know, as a responsible citizen, I make my contribution. Well,
those that are seniors, those that are indigent and do
not have any money to pay for any hospital or medical
care, and then children, they all receive medical care
at the hospital free of charge anyway. So I am going
to leave it to the listening audience to figure out where
that extra money is going to be spent. I do not know
whether it is going to be spent to care for people who
are underinsured or whether it is going to pay to help
with the services that are provided at the h ospital, but
that money will all go into a pot and it is going to the hospital , and no one is really going to know other than
probably the H ospital s Board and the Bermuda Health
Council where and how that money is going to be spent.
So, the other side of this coin is that if we
were to decide as workers who are paying this large
amount of money that, All right, well, since I am paying all this money toward the hospital then maybe I
am going to use the hospital services a little bit more.
So, if I get hurt rather than waiting and having to go to
my private doctor and he is going to charge a co- pay,
I might as well just go to the hospital and get those services. Well, the risk there is that the hospital, as we
know, struggles with the amount of people that g o into
the hospital now and it is often overcrowded. And we
have heard stories today of people having to wait in
hallways in the emergency room or sit and wait for services for, you know, 20 hours before anyone can
see them. So, there is this risk that if we were to say
because we are spending all of this money and it is all going toward the hospital, then we might as well go to
the hospital.
And if that happens, then we are getting to
this point where the hospital just does not have the
capacity . . . they just do not have the space, they do
not have the medical staff to care for all of us who are
going there. So, it puts us as the workers who are
paying these premiums and paying this lump sum into
this fund that is going directly to the hospital in kind of
an awkward situation, because it makes it very difficult
for us to get value for money.
I am now going to sort of shift a little bit
around that value for money. The insur ance companies, when they had a little more oversight of the services that were provided at the hospital, and we were
not paying as much money (we were paying about
$100 toward the hospital , whereas now we are paying
over $300 a month for the hospital ), the insurance
companies, if we were healthy or if our . . . if, you
know, part of w hat that extra expense or the extra
money that was left from the premiums that we all
paid, the insurance companies, I believe, have done a very good job with education. So, they have intr oduced many different programmes around healthy
eating, healthy lifestyles . There are some private
companies that have very complex and sophisticated
health monitoring, computerised programmes and
websites where people can monitor and track their healthy lifestyles and be rewarded for that. So, whet her it is an extra rewar d that you get in the form of gift
cards , or whatever it is, oftentimes you will get a r eduction in your premium when the annual calculations are made. It is going to be very difficult for the health
insurance companies to really gauge and have the
extra r esources to provide that kind of service.
So, as difficult as this entire process and this
change is to understand, the bottom line is that we as
the workers who are paying the premiums into this
Mutual Re- insurance Fund, the MRF, really are not
going to necessarily know what benefits we are going
to get from it or what the actual use of our funds is
going to be going toward. And I do not know in the
government system where you have GEHI, so if you
are working as a civil servant, I am not sure whether
GEHI is also contributing to this Mutual Re- insurance
Fund or not . And that is a question that I would like
answered by the Minister if that is possible tonight ,
because I guess that would put the civil service in a similar situation as the private sector, or maybe not. I
am not sure. You may not have to pay as much mon-ey toward the Bermuda Hospital s Board as the private
sector.
So, I guess one of my other concerns is that
the insurance companies , not receiving any of the d ata, [will not] know who is having s ervices down at the
hospital, what services they are getting or how much
those services are costing. It concerns me because I do not see that anyone is having any real oversight, or
anyone is sort of policing the services that are going


Bermuda House of Assembly to be provided out of the money that we are paying
through our premiums. Now, I understand that the
Bermuda Health Council will receive the data on the
use and the services at the hospital , and I am not sure
whether that data will be made available to the public
or not so th at we have some idea of whether the ho spital is being overutilised or whether the hospital is
finding cost savings and efficiencies . And, of course, if
the data is not released at least to the insurance companies, then there is no one who can really calcul ate
and see whether we are being healthy enough and
whether it is possible for our premiums to be adjusted
downward if we are in good health.
So, I do not know who is going to administer
that and I do not even know what is going to happen
to some of the staff who in the past have been the ones at the hospital who have been processing the
services and sending the claims to the insurance
companies for payment. So, it may be , not only the
insurance side, but as well as the hospital, where staff
could be impacted, because if there is not that exchange of, sort of, invoices and payments, then there
may not be need for some of the staff that have been
providing those services in the past.
I guess my only other issue or fear is that if
we do find that there are a number of people who are
deciding to go into the hospital and the hospital is b eing used at, you know, 100 per cent or more and full
to capacity, whether ultimately the hospital is going to
have to cut their services —whether they are going to
have to lo ok to see what [rationing] they can [institute]
because they are unable to provide all of the services because maybe they do not have the staff or maybe there is just not enough equipment to serve ever ybody. And so that, from a country -wide perspective,
could be a real miss.
And it is unfortunate because a lot of what I
am saying is . . . you know, I am asking a lot of questions. I am feeling a little uncertain because no one has had that conversation in the public domain. Ev erybody has been so concerned about who is going to
get the big pot of money , and no one is really telling
the working population what exactly is going to ha ppen and how their money is being used. So, I do not
believe there has been much or any real conversation
publicly amongst people who are insured about these
changes. Some people . . . I do not . . . some people
may even get offended by that , because if we are li ving healthy lifestyles, if we are certainly noticing our health premiums because they are the largest deduction from our s alaries , if we are not feeling as though
we are getting value for service all around, then there
is going to be greater concern and, in particular, as
[has] been mentioned by colleagues here in the
Chamber this afternoon, international business
whether the y are here and existing now or whether
they are thinking about coming to Bermuda, they are
going to look at the costs of living here and if our i nsurance package does not look attractive, then many potential and prospect ive companies that may want to
come to Bermuda may start to look at other jurisdi ctions because it is not in their best interest to have unattractive and costly health payments for their staff,
especially if they are trying very hard to keep a healthy and young population of employees who wi ll
feel as though there is a large amount of their pay that
is going to go toward a service that they are not going
to be using.
Finally, the small businesses, charities . . . I
spend an awful amount of time looking at the expenses at Summer haven. Clearl y, our health insurance is
the largest payment that we have . And I know that
there are many small businesses out there who also struggle with health insurance for their staff members.
I guess the fear is that the expense of it in general,
because with this amount of money going into the
hospital , eventually we are all going to have to pay a
little bit more for those services outside the hospital.
And that is going to make it more difficult to keep up
with our health insurance premiums . And if we have
not paid for our health insurance premiums, then we
are not going to be able to use the hospital services
either without a costly bill.
So, in that situation where it is a small bus iness and the charities, I just . . . I just cannot imagine
what the cost of that is going to be, and the impact on
small businesses in Bermuda, the impact on charities
and how that is going to be handled by the employer.
It certainly is a stress now and I do not see it getting
any better.
I am going to end by . . . and I have no need
to defend an insurance company. I have no interest to
declare. But it seems to me that an awful lot is being
placed on, you know, sort of let us get this large pot of money away from the insurance companies and, you
know, possibly we will be able to spli t this pie up and
weaken the structure a little bit. But, I guess, we cannot lose sight of the fact that we do live in a capitalist environment , and everybody who has a business is
doing their best to make a profit .
Insurance companies make their money in
lots of different ways . And, you know, I happened to
go on a random local insurance company site and they have every kind of insurance you can imagine. They have got travel insurance, home insurance, boat
insurance, they have car insurance, they have pensions, they have all kinds of products that are out
there, and the health products are toward the bottom
of the pile. So, I am saying all of this to say that insurance companies are making their money in lots of di fferent ways . And if we are doing this simply to break
the back of an insurance company , or insurance companies in general, or to knock it down a size, I think we are really hard pressed and may be surprised that
these are astute business people and they are going to continue to make money.
So, yo u know, I just would hate to see the
Bermuda Government cut off its nose to spite its face
1618 17 May 2019 Official Hansard Report

Bermuda House of Assembly and we find ourselves in a situation where we are gi ving an awful lot of money to the hospital and we have
not really thought through how this is going to work,
how the money is going to be spent and where we
can find cost efficiencies. I just do not know how much
has been really thought through. I have not seen any
plan. I have not seen any semblance of proof or di scussion around how this is actually going to manifes t
itself and bring about a positive change for Bermuda. So, with that, I take my seat and it is with concern. I really, really hope that the Government plans
this out well , because it is the people who are working
really, really hard in this country who are trying to find
the funds to stay afloat will end up being hurt in the
end.
Thank you.

Thank you, Mr. Deputy
Speaker.
Mr. Deputy Speaker, I have listened today i ntently . And if ever there was a philosophical difference
that separated the Progressive Labour Party from the
philosophy of the One Bermuda Alliance, it is certainly
manifesting i tself today. I have listened with particular
interest to the amount of times that “ Mr. and Mrs.
Bermuda” has been used in sentences . And I would
venture to say from my historical knowledge that
some political advice has been given to say , Listen, it
is imp ortant that you refer to Mr. and Mrs. Bermuda as
often as possible to give the appearance that you
could very well be interested holistically in what mat-ters to them. But, Mr. Acting Speaker, Mr. Deputy
Speaker, I am minded when I make that comment of a
very poignant quote from Star Trek “the needs of the
many outweigh the needs of the few.”

Yes, sir. I am aware.
Thank you.
“The needs of the many outweigh the needs
of the few.” And nowhere has this been practi ced
more than the economic construct of Bermuda.
The Honourable Member from Sandys, Mr.
Jamahl Simmons, spoke in what I would term he who
feels it, knows it . Well, I would have t o agree with him,
having lived four and a half years without health i nsurance myself . And I have said it on this floor of the
House, there is no better assurance than blessed assurance because—

[Laughter]

—between 2012 and
2017, Mr. Deputy Speaker, I prayed, Dear God, keep
me healthy enough.
And, Mr. Deputy Speaker, when people are
going through that it is people like you, Mr. Deputy
Speaker, who would show a little compassion when
somebody tells you, Y ou know, that boy is up there
teaching barefooted because he cannot put on his
shoes , but he has still got to work . In Bermuda? The
land of plenty? The land where the same person would go away and promote this country as one of the top richest countries in the world and a person li ke
you, Mr. Deputy Speaker, would make a call and say ,
Listen, I will pay just to have that person go and get themselves checked out . I am not making it up. I am
saying thank you, Mr. Deputy Speaker, because that is a true story —in this country of milk and honey!

[Inaudible interjections]

The reality is that in this
country persons use cap italism as the reason and
profits and the maintenance of that to gloss over the
fact that there are many countries who temper capita lism with significant social policies that benefit their
countries. I just happen to know through my trade
some of the wealt hiest people who have walked this
earth. Some of them have actually lived in this cou ntry. Some have been my friends.
And I remember this, Mr. [Deputy] Speaker . I
remember one of my dear friends, an oil man out of
the Canadian region, who had a home in Bermuda not too far from where I plied my trade in Tucker’s Town.
And I remember, Mr. Deputy Speaker, that person
bought one of the largest houses in that region, conveniently sold [his house] and moved to Mexico.
When it came nearer to the time when they had to
retire, they ventured back closer to the Canadian bor-der to the point that when they needed health care,
they were not in Bermuda, they were not in Mexico,
they were not in America—they were back in Canada.
Why? Because the structure provided for them to receive the coverage that their country had invested in.
And when you look at quality of li fe in countries that are doing both a capitalistic model and
providing for the people, those countries are unashamed at providing that. But in this House, Mr. [ Deputy] Speaker, you have had Members who have had
substantial economic interests —

[Inaudible interjections]

—and you have a political
party, an Opposition party , who speaks for that substantial interest, whether they want to admit it or not.
Whether they want to masquerade as being for Mr.
and Mrs. Smith, they really are the party for big bus iness in this country . And when the Progressive L abour Party, through the Health Minister, starts ventur-ing into a sphere that makes that r eality uncomfort able, you are going to hear the howls, you are going to
hear the fearmongering, you are going to say watch
out for that. You are going to say the sky is falling, long before—

The Health Minister . . . I
have been listening. She has been doing other things
that need to change the dynamic in Bermuda. When
speaking to— not only speaking to, putting into place —initiatives that will encourage a generation of
Bermudians to change their habits when it comes to a healthier lifestyle. Fortunately, they did not get through
to the Whip so we can get some nice salad tonight,
we have a little fried . . .

But that is just an aside,
Mr. Deputy Speaker .
It is going to take a ways to turn around the
country that caters for the few in great abundance.
And I hear people talking about diversity. Diversity is
practiced least in the boardrooms of this country and
the sharing of the economic wealth of this country,
and when this country went thr ough its worst economic downturn since the war times —and quite possibly
during the 1990s, early 1990s recession. Our people had to flee and we did not see the empathy that I hear
about Mr. and Mrs. Bermuda from those same folks. I
have to say that. We did not see it.
So, whilst persons hear those talking points,
while they try to pour cold water on the initiatives of the Progressive Labour Party, in particular in this i nstance as it relates to trying to turn things around,
make Bermuda more fair and equitable, bringing
about a transformation. What does a transformation mean? A transformation means moving from one set
of circumstances that benefit the few to make it poss ible for greater sharing of the economics of this country. That is what it really means.
So, in order to do that, you have to go w here
persons have not prepared to go before in this cou ntry, b ecause all before the scar emongering was
enough to chase people away from addressing what needed to be ad dressed in this cou ntry. And, so within
my 20 m inutes . . . Oh, Mr. Speaker —

[Hon. Dennis P. Lister, Jr., Speaker, in the Chair]

Within my 20 minutes, let
me say this: Two Bermudas is real; not a fantasy. The economic disparity that exists in this country is real.
The plight that impacts people who cannot afford
health care in this country, who are making the choice between health care and other bills is real. The fact that the Government is taking steps to address this is
real also, and do not be fooled. Do not be fooled.
Thank you, Mr. Speaker .

But, somebody else spoke
and they . . . I am going to take a different tack today,
Mr. Speaker . I am going to ask some questions.
Mr. Speaker, a good politician listens to their
voters. And over the last few weeks, people have
been posting on social media, Oh, my insurance is
going up. Oh, I just got a letter from BF&M. ( Anybody
know about BF&M?) Oh, I just got a letter from this other insurance company , my insurance is going up.
So, I a m saying, Wow, why are the insurance
companies like going up so much?
And then it says, Oh, because the Gover nment is putting in this policy .
So, I am like, okay . . . I do not really understand it. I work at BELCO, so I do not know all about this insura nce thing. So, I sent a text to the Honour able Minister, I said, Minister, I need a couple hours of
your time for you to break this down for me. And, the
gracious Minister said, Come to my office. And for two
hours, I sat in her room, got some coffee, no s ugar in
it—

[Laughter]

Well, I will not say an ything.
She went chart by chart explaining metic ulously what we have been going through as a country,
where we are now, where we need to be, and how we
need to get there. So, again, you know, she kept on
saying to me, and I quote, “Chris, your eyes look
glazed. Are you understanding?”
I said, “Wheel that back. Explain this graph for
me again.” And she carefully explained it.
And, so I said, “Okay, I am starting to get it. I
am starting to get it.”
Mr. Speaker, I am going to take liberty and
read from my pay cheque, which I get every week —

[Inaudible interjections]

I am not going to tell you
everything.
[Laughter] Mr. Christopher Famous: Let me go to the medical
part—$230.28. That is every week. So, if I round that
off, that is $1,000 per month, $12,000 per year. I have
been there for 26 years, so I am kind of figuring I am
paying out a lot of money to insurance companies. I
have probably only been sick in the hospital, accum ulatively, maybe two weeks. So, of the hundreds of
thousands that I have paid out, I have got very little
back. Ver y little.

[Laughter]

So, I ask myself, Self,
should I keep going down this road, or is there an a lternative?
And self said to me, Hey, you probably got
another 10 years around here, 10 years times
$12,000 a year —that is another $120,000 that you
ain’t never going to see.
So, I said, Self, my wife has a business . . . as
a matter of fact, quite a number of people in my family
have businesses. So, I asked them, Hey, give or take, what are you paying out in insurance?
And they said different figures.
I said, How often do your employees get sick?
They said, Very rarely, very rarely. Maybe the
day after Cup Match if they are for, say, Somerset. But, very rarely.
So, I am calculating what I am paying out. I
am calculating what they are paying out. And it is in
the millions of dollars going to certain insurance com-panies. I am saying, Okay. I am saying to myself (because I think a lot), Self, I wonder if during the regular
AGMs, if any of those shareholders say to themselves: ‘Hey, sel f, we are collecting millions of dollars,
why don’t we just not take so much; why don’t we
make it easier for the working- class people?’

[Inaudible interjection]

No, I would not even say
that.
So, I am wondering if anyone who is a shar eholder within my hearing range is saying to themselves, Maybe, just maybe, we should not have raised
those rates every year. Maybe.
So, I listened to the OBA and— okay, I heard
the OBA, and I listened and I saw that, you know,
there are some valid points being made here and
there. Some valid questions are being asked. But the
only thing I did not hear from the OBA was, Hey, you
guys have Plan A; we have Plan B. I sat here and I
listened. I said, they are asking, So, what is the way to
contain costs? But they are not coming up with any
[suggestions]. I am telling women . . . Mr. Speaker, a
couple years ago they tried to tell women to only have
mammograms once every two years. That was not acceptable. Anyway, let us move on, Mr. Speaker . Let
us move on.


Bermuda House of Assembly So, I am saying to myself . . . I am not going
to get up here and argue and say, Well, these guys
are just representing the rich people. I really want to
hear from them, or anybody, what is the alternative to what we are offering here. Because my friend here, to
my left, the Honourable Member Kim Swan, for years I
heard him say, Hey Famous, bye, I hope I do not get
into an accident by here. I do not have insurance.
I was like saying, W ell, how can we help those
that do not have insurance?
So, again, bac k to what the Minister explained
to me. She explained, Now, your wife has a business.
This other person has a small business. In the long
run, a pool will be created where different businesses
can amalgamate (for lack of a better term) what they
are paying out in their insurance premiums. That
would help to mitigate the rise of insurance rates . That
would possibly help those who find themselves in si tuations where they have no insurance. That is what
we call . . . in Canada, what is it called?
An Hon. Mem ber: Compassion.