Monday, June 29, 2009

Lessons on Rising Healthcare Cost....

Recently Obama announced a overhaul of the American healthcare system that will cost taxpayers $1trillion over a period of 10 years. Although the amount is less that what it cost to fight the Iraq war it is strongly opposed by Republicans [Link]. Whether these changes will come is still uncertain as the politicians haggle over it. What is wrong with the American healthcare system?

1. It has lost its universality. A good healthcare system has to deliver healthcare services to everyone but in the US, 45 million Americans are uninsured.

2. Healthcare cost is the highest in the world and keeps rising.

3. It is extraordinarily complex.

The American system hold many negative lessons for us just as French system which is ranked No. 1 in the world has many positive lessons for us. A good healthcare system has to be simple, universal and among the top healthcare systems in the world govt play a big role in healthcare. Unlike many other industries where free market principles yield the best results, it is not the same for healthcare. Recently, due to the H1N1 spread we received some feedback on our system - a H1N1 patient expressed surprise that he got a $1000 bill for his short stay in hospital[Link]. The MOH explained that the bill is already 80% subsidised (the unsubsided bill is $5000!) as means testing is suspended for all H1N1 cases - everyone gets the full subsidy. A writer to ST forum wrote that he was quite angry that he had to pay $214 for an ambulance and H1N1 testing[Link]. "Why should being responsible cost $214?"....the writer asked. Singapore is now leading Asia in the number of new cases[Link]. Even in a pandemic situation, the PAP govt cannot shed its ideological constraints and insists that sick Singaporeans paying for testing. It would have been alright if Singaporeans all have jobs and are rich enough not to be deterred by the costly test but we have an unemployment rate of 4.9% and 30% of Singaporeans workers are in the low income category. It would have been more effective to waive the cost of testing to stop the spread of H1N1 but the PAP govt will not do it because of its ideology.... I'll talk more about this ideology later but lets see what happened to the American system to understand how a govt can steer a good healthcare system in the wrong direction and end up with a costly mess.

I will continue and finish this post later and relate the above and what is happening in Singapore and why we should watch our govt healthcare policies closely ....those of you with comments please feel free to post them.

I'm back....

If you watch the pinky video I posted on the American healthcare system, the root cause of rising healthcare there is due to the following:

1. Allowing healthcare to be driven by market forces.

2. Treating healthcare as a commodity.

3. Creating a system concerned with maximising profits over treating people.

The Americans created a complex system that involved many profit oriented private entities and the free market forces allocates healthcare based on who can pay for it. Before I get on to describe the state of healthcare in Singapore, lets take a look at some of the systems around the world :

"In the Japanese health care system, healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments. Since 1973, all elderly persons have been covered by government-sponsored insurance" [Link]

"The best thing about the Japanese medical system is that all citizens are covered. Anyone, anywhere, anytime — and it's cheap." [Link]

In Taiwan, they pay $20/month for insurance and if you're too poor or over 65 years old, the govt gives you money to live on and part of it goes towards this $20. [Link] This $20 (or higher for the higher income) is all they pay. It takes care of tests, hospitalisation and outpatient treatment.

In Taiwanese soap operas there is plenty of crying over life's numerous human tragedies but I challenge you to show me scene in a Taiwanese show where they cry because they they can't afford medical treatment.....it just does not happen because nobody walks out of a hospital there with a $10,000 bill.


One of the important lessons learned as seen on the above video from the healthcare systems of many countries is when private insurance is allowed to step into system the govt has to play it tough and disallow them from 'cherrypicking' who they want to cover and force them to accept everyone otherwise you end up with a pool of uninsured people and the system loses its universality.

Universal coverage so that not a single person is left out and full coverage so that little or no money comes out of pocket of individuals when they get sick - this is to makes sure that the poor won't avoid seeking treatment when they are sick - are common characteristics of some of the better healthcare systems in the world. In many of these systems the govt plays a central role as the single payer [Link] - this gives govt tremendous incentive to keep healthcare costs down by implementing the right policies and regulations.

In Singapore, the govt implemented MediSave in 1984 and MediShield in 1990. The MediSave is just a compulsory savings scheme in which CPF contributors set aside 6-8% of their income for the purpose of paying their future medical bills and those of their family members. Hmmm...the govt wants to make sure people can pay up as hospital bills go up. However, as hospital bills became bigger it became clear that MediSave wasn't enough so the govt came up with Medishield which was supposed to be a "catastrophic illness insurance scheme". There are several problems with MediShield. The first being it is it is not universal in nature. When it was introduced, it did not cover newborns and children and this gap was only closed 18 years later in Dec 2007 [Link], however, newborns with congenital health issues are still not covered (correct me if I'm wrong). MediSheld does not cover those with pre-existing conditions. People who have suffered certain mental conditions are uninsurable[Link]. If you think MediShield protects you from high bills all the time, it is time you do some checking. MediShield together its co-payment and deductible also has limits for various treatments and an annual limit [Link]. I've posted in this blog a number of medical cases in which the bills exceeded $100K - these occur with a higher frequency that what most Singaporeans think. Take the case of Charmaine Lim. Many Singaporeans are now familiar with the extremely sad story of this 4 year old who was diagnosed with stage four neuroblastoma. She is halfway through her treatment in NUH and the bill was reported to have already reached $80K[Link]. Unfortunately, the standard chemotheraphy available in Singapore gives her a 20% chance of survival. She needs US$350K for an alternative treatment in the US that raises her odds of survival to 50% (please donate, I'll be ashamed as a Singaporean if we can't raise enough for this little girl).

Means testng was introduced in the beginning of this year while Singaporeans were still struggling with the economic crisis[Link]. Means testing will hit middle class families whose members get seriously ill the hardest because it causes their medical bills to rise by 75% especially when the patient has a congenital problem and is uninsurable. In the past, they can try to keep the bills down by staying in "C" class but with means testing their medical bills can escalate by 75%. It makes no sense that means testing is done when the patient is admitted does not take into account the final bill the person has to pay. What means testing effectively does is to reduce the govt expediture on health care and pass the cost to middle class Singaporeans.

Why is healthcare cost rising so much faster than Singaporeans' income? Why is it rising so much faster than inflation?

The PAP govt's ambition to make Singapore a medical hub for the rich people in this region and the middle east resulted in an influx of 400,000 medical tourists into Singapore[Link]. A growing proportion of our medical sector is privatised to serve these tourists for profit. What this has done is cause price of limited healthcare resources to rise. So the PAP on one hand is passing rising cost of health care to Singaporeans and on the other going after profits in medical tourism that is causing our healthcare costs to escalate. 400,000 medical tourist is a huge number relative to the population of Singapore and when private companies such Parkway and Raffles Medical pursue these medical tourist profits healthcare in Singapore start to become commoditize like in the US and costs will be driven by market forces (rich Indonesians, middle easterners, ,...) and the system will become concerned with maximising profits over treating the sick. What is worrying is not where we are today but the path we have taken and where we will be in the coming years as cost continue to rise faster than income and the govt passes the a larger portion of the cost on to Singaporeans. As private sector medical hub grow and expand due to medical tourism and increased wealth of a small segment of our society, it will draw on our limited capacity and healthcare costs will rise faster than the average wage of Singaporeans. What the govt is now doing is looking into allowing MediSave to be used for overseas hospitalisation[Link]. The claim is they are doing this to give Singaporeans more options but I think for many Singaporeans they will have no option but to seek treatment where the health care standard is lower because the health care costs will be driven up beyond their means here.

46 comments:

HanSolo said...

Yes, the Singapore government is too rigid and unable to cope well with unexpected events.

The sad thing is that they don't even intend to change. So it's up to the voting public to change them.

Anonymous said...

to keep the elites in the healthcare regime incorruptible and attract similar talents, we must bench mark their pay to the best in similar industry or a basket full of greater mortals.

so everyone below follows this model of "incorruptibility" and you wonder why healthcare costs creep up? LOL

Ghost said...

$5000 for a 9 day stay? That come to $555 per day! Any wonder why people say it's better to die than fall sick in Singapore?

Suria said...

Check out this Youtube. It is about hidden agenda of Obama Healthcare plan<Obama healthcare plan similar to Nazi's

Anonymous said...

i think to charge 214 for a negative test is extremely irresponsible.

guess, do you seriously expect an unemployed person in singapore to go for voluntary testing???

yamizi said...

anon @ 1:10pm,

even an employed person will probably think twice before going for the test

and why didn't the fee of the testing make public?

if not because of that ST-writer, i doubt we will know that the testing comes with a price tag (literally!)

Anonymous said...

you dont want to deal with the root cause of the problem...we say, FUK YEW

Anonymous said...

Just a few days of hospitalization with crap food, vitamin Cs and the bill come to $5,000?

This is typical of how PAP is using the excuse of 'subsidy' to transfer OUR tax dollars into their "privatised" healthcare businesses, namely NHG and SingHealth. One can only imagine how much money they would amass every year and the laughter of their CEOs on the way to the bank.

Alan Wong said...

"Any wonder why people say it's better to die than fall sick in Singapore?". It's a fact.

If you try to fix your next appointment to see a specialist at any of our govt restructured hospitals, you probably get a appointment booked in approx. 3~4 weeks time, whether it is for a minor check-up or x-ray. If there is a long queue for major operations, be prepared to wait for 1~2 months. If you try requesting for an earlier booking, they will inform you that no earlier date is available as all earlier appointments are fully booked.

What they did not probably tell you is that earlier bookings are indeed available within a week if you tell them that you are willing to pay as a private patient. That will explain why some foreign patients prefer to be admitted to our govt hospitals because they charge slightly cheaper compared to private hospitals.

This only goes to show that our public hospitals are now being run as commercial enterprises in direct competition with private hospitals.

If one does not have the money, then one must be prepared to wait longer to be treated at our govt hospitals. That's because our specialists prefer to attend to private patients, I suppose, for their higher remuneration.

LuckySingaporean said...

Alan,

I once needed to see a specialist and called up the hospital. They told me if I wanted to see the specialist "immediately", I have to register as a "private patient". Otherwise, I'll see him in 3-4 weeks. I wasn't sure what being a "private patient" means so I went for the later appointment.

When I saw the specialist, he told me that there was no point seeing him so late when the symtoms have disappeared. For the 3 minutes meeting with the specialist, I paid $70....and that was supposed to be subsidize!!!!!!

Anonymous said...

We all know that the money belong to the tax payers. When a responsible person takes the trouble to under go H1N1 test, the tax payers are protected from the potential spread. As a tax payer myself, I say it is fine to use my tax money for such screening. We should not make such responsible person pay for the test.

Anonymous said...

Some time ago, I read that Singapore Health model is similar to the US model. Found this link and the research statistics is very alarming (link : http://www.nchc.org/facts/cost.shtml)

Excerpts:

1."In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.9 Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem."
2."A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings."
3."About 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs."
4."A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses"
5."Retiring elderly couples will need $250,000 in savings just to pay for the most basic medical coverage. Many experts believe that this figure is conservative and that $300,000 may be a more realistic number."
5."According to a recent report, the United States has $480 billion in excess spending each year in comparison to Western European nations that have universal health insurance coverage. The costs are mainly associated with excess administrative costs and poorer quality of care"
6."The United States spends six times more per capita on the administration of the health care system than its peer Western European nations."
7."Policymakers and government officials agree that health care costs must be controlled....What we do know is if the rate of escalation in health care spending and health insurance premiums continues at current trends, the cost of inaction will severely affect employer’s bottom lines and consumer’s pocketbooks."

Having read the article, I find many areas quite uncomforting. We, too, are an aging nation. Our government is also one who advocates free market forces to solve issues. But isn't free market forces some sort of 'inaction'? Western European nations fare better. Most of these countries do have some sort of subsidised health system. Anybody can verify?

Anonymous said...

I believe that the reason why free markets are bad for health care is the same that they are bad for Lehman mini-bonds.

Free markets are great when everyone has perfect information. When access to information is very difficult/ expensive (what do most of us know about cancer?), free markets are not optimal and open up thoes without information to exploitation by thoes with.

Anonymous said...

Lucky

The americans have some of the best hospitals in the world. And usa is big.

so comparing singapore with USA is like oranges vs apples.

You worry about cost ... eh ... wrong. worry about the quality of our public hospitals. is good for the common flu and issuing MCs. and thats pretty much it. Forget pandemics. even the Indian FTs would rather send their loved ones back to India for treatment than goto a public hospital. So either become rich or pray very hard to whichever god u believe in.

Anonymous said...

Anon@5:37pm

Exactly...when I saw the movie "Sicko" I had a feeling that our health ministry is moving towards the US model...try to push the cost to insurer & patients...government just sit back and tighten the policy to ease itself off the system...

First is limit Medishield coverage and then push it to private insurers...end result is less cost to government but higher premium for patients with slightly better coverage..

Second, mean testing is introduce so that 'correct' resource is channel to 'correct' group of ppl..
I see it as a way to control the amount of subsidies the government is giving..they can anytime change the income grouping and more will get lesser subsides..

Third, only subside selective medicine, some life saving medicines ae not subsides (eg, cancer drugs)

Furthermore, if hospitals decide to charge $5K for whatever service you receive, who can justify the $5K is a 'correct' amount...Yes, you can say :" Oh we a XX% cheaper than private, therefore, it's subside...but the fact the actual cost might be only $2K not the $5K being charged...

So, who's the policeman??

Anonymous said...

Our gahmen can lose billions of our tax payers' money via temaSICK without battling an eyelid but yet cannot pay $214 for the H1N1 tests ????? Oh, I forgot they have to keep some reserves for their 8 months bonuses this year end !!!

Anonymous said...

what a sick govt!!

don't they realise how many people would rather risk h1n1 just to save the $214??

esp the elderly who are not working or depending on low wage sons/daughters.
thats how great the spirit of self-sacrifice in the older people who built singapore. and the govt is taking advantage of that.

this current govt is totally sick and without a sense of proportion.
can lose billions without regret and take obscene pay but ask the people to take care of themselves.

WL said...

Lucky

You made valid and sensible points and would request you to submit these to the MOH for their response. Write a letter and post this on your blog. Thanks.

LuckySingaporean said...

WL,

I like many Singaporeans write to the MOH giving regular feedback. I think my letters just end up in a big database with the other few thousands of letters.

The PAP thinks it knows best what to do...when they do it, you are expected to take it that it is the best for you.

Anonymous said...

I believe we have crossed the point and are now in the stage of 'privatising profits, socialising the rich'.

recruit ong

Anonymous said...

If I as a taxpaying citizen who is subjected to means testing, it reeks of double taxation. If I had worked hard all my life to give myself and my family a middle class (not my definition) standard, paid my dues/taxes to society, why am I discriminated to pay more for healthcare. It shd apply equally to all citizens. It is akin to saying that U grads shd not borrow books from public libraries.

Anonymous said...

Just imagine if you are intelligent enough to become a doctor, would you leave somebody who is sick and cannot pay the bills to die? But then again, there are so many people who are sick and cannot pay the bills, you, alone, can only do so much and as time passes, you become numb and accept things as it is? Or fellow doctors will tell you not to pretend to be noble and that actually you study to be doctor is to become well-to-do in this society?

What this government thinks, well, you have to pay enough for people to become doctors, if not there will be monkeys......

In economics, we learnt that some things are public goods which cannot be justified in terms of monetary sense. Guess Singapore has lost its soul on these.....

Why do you want to be doctor? Why do you want to serve the country? Is it really about $$$? Ricardo Semler once said that when one accumulates a certain amount wealth, that additional amount meant little any more.....Life is more than just $$$. Granted the renumeration must be there to attract people, but how much is enough or how much is fair?

Anonymous said...

Whilst we pursue the status of world class medical hub, I hope that the locals are not left out. Yes, there is a subsidy scheme, but the extra long waiting time is a problem.

Anonymous said...

I just wish all these people taking millions from the people and hiding behind their so called "ideology" of not giving out welfare will contract some illness which cannot be treated with all their money. I wish their family members realise and suffer for their actions. I wish they understand what is the meaning of suffering the emotional pain the poor, jobless, underpaid and old people are going through. Please god, don't let these hypocrates get away.

Rialce said...

Taiwan is another extreme. It is because of elections that the politicians come out with the National Health Insurance. However, it was poorly planned and it resulted that the doctors there getting little pay. However, it would do the society good if spore and taiwan's system could merged because the price for spore health care is ridiculous!

Anonymous said...

I dun see why doctors should have good pay. They just memorize books. I think anyone with reasonable iq can be a doctor. At least stuff like engineering is a skill.

I am an engineer. =)

Anonymous said...

There are many more people graduating as engineers than as doctors every year from the universities. And locally only NUS produces doctors. All these are due to policy.

Naturally of course being a doctor is more prestigious (and higher pay) than as engineer lah, at least in Singapore.

Anonymous said...

The rich will have options.
The poor can only die in the pathetic class C wards.

But since Khaw is a pious Buddhist, he must be doing the poor a favor.

Anonymous said...

"Just imagine if you are intelligent enough to become a doctor, would you leave somebody who is sick and cannot pay the bills to die? But then again, there are so many people who are sick and cannot pay the bills, you, alone, can only do so much and as time passes, you become numb and accept things as it is? Or fellow doctors will tell you not to pretend to be noble and that actually you study to be doctor is to become well-to-do in this society?

What this government thinks, well, you have to pay enough for people to become doctors, if not there will be monkeys......

In economics, we learnt that some things are public goods which cannot be justified in terms of monetary sense. Guess Singapore has lost its soul on these.....

Why do you want to be doctor? Why do you want to serve the country? Is it really about $$$? Ricardo Semler once said that when one accumulates a certain amount wealth, that additional amount meant little any more.....Life is more than just $$$. Granted the renumeration must be there to attract people, but how much is enough or how much is fair?"

this is what it meant....the WAGES of SIN is death - not that kind of garbage many have been taught in those kind of places.

WL said...

It is frustating that the Government refuse to listen to sensible suggestions. Worse they do not bother to explain why the suggestions are not applicable.

The current model for health care will result in profits for the health care providers, and for the insurance companies. I am not an expert in this matter, but looking at the high costs of health care and the increasing increase in putting more savings in medisave is worrying. Sometime is wrong somewhere. And unless a careful relook is undertaken, the situation will only worsen with an aging population.

Anonymous said...

a nation needs the "talented"( or should i say hyped importance) as much as the humble laborer. both cannot function or even exist without the other playing their respective role in society.

and yet, the wicked perpetuated a system that grants greater rights and provision to the "talented" than the lesser mortal.

when the lesser mortals get paid less than what they deserve, they inevitably succumbed to "death" by LAW. the LAW of the land.

Anonymous said...

Here in Australia where I have been for the last 1.5 years, it is a public-private healthcare system. 1.% of your pay goes towards paying for the public healthcare system called Medicare. It covers all public hospital treatments, and provides a fixed schedule fee that it will reimburse GPs and specialists for treatments and consultations. If the doctors want to bill beyond the schedule fee, then the patient will pick up the difference. That way you can shop around and if you can't or do not want to wait in the public system, you have the option of paying the difference and go to a different doctor.

To ease the public healthcare system, there is a disincentive in place to encourage private health insurance. If your income (or family income) is above a threshold and you do not have private insurance, you need to pay an additional 1% of your pay towards Medicare. Also, for each year above 30 that you are out of private health insurance coverage, you pay an additional loading over and above the normal premium for the next 10 years, before the premium goes back to normal. The government also provides a 30% rebate on private health insurance premium as an incentive.

You always have the option to pay a bit extra when you can afford, as private insurance will pay for private hospital treatments instead of having to wait in the public system. If you lose your job, you can go back to the public system. There is also a family Medicare safety net that is income dependent. If your out-of-pocket cost for the year exceeds that threshold, Medicate will pick up all the balance. That way nobody goes bankrupt because of medical bills.

The public-private system works to keep public healthcare spending manageable, yet provide universal coverage for those who cannot afford. The schedule fee also automatically weeds out doctors who charge a fortune since the reimbursement is capped, and the consumer can choose if they want to still select that doctor and pay the difference. Even private health insurance has a universal premium regardless of age or medical history, only difference is 1 year of waiting time for pre-existing conditions, quite unlike Singapore where pre-existing conditions are not covered.

Since my vote never resulted in any difference, I elected to vote with my feet. I am more than glad to dump the Singapore passport when I qualify for Australian citizenship by the end of the year. For those who are able, think about your options. The more you wait and tarry, the lesser your options will be.

LuckySingaporean said...

anon 7:39,

The Singapore system leaves many people uninsured and exposed to the risk of high medical costs. When medical debts are incurred they are handled by debt collectors hired by the hospital.

The lack of universal coverage, the escalating costs together with means testing exposes Singaporeans to financial risk when they get sick.

When the Taiwanese developed their system they looked at those around the adopted the best features.

The Singapore system is pretty much the product of PAP ideology. The belief that people will take better care of their health if made to pay for their illness. They believe that if affordable care is always accessible, it will be badly abused. Hence the long waiting time for specialist as subsidized patient. The $75 upfront charges at the A&E which deter poorer sick people from seeking emergency treatment. All that combined with the PAP's unquenchable thirst to seek profits in health care as a medical hub works against the interests of ordinary Singaporeans.

Anonymous said...

Dear All:

Blogger utopia8787 has blogged(linked to Sg Daily 30 june 2009) about a foreign based Singaporean not charged any fee for H1N1 Screening.

I think the Singapore Authority owes all Singaporeans an explanation, if Zaiton Rosie, the Said Foreign based Singaporean, was indeed given a free screening, as claimed.

$214 is not a small amount to many Singaporeans, including me.

If any parliamentarian or senior civil servant is reading this site, please be responsible to provide an explanation.

Yourstruly: patriot
patriot

Anonymous said...

"The Singapore system is pretty much the product of PAP ideology. The belief that people will take better care of their health if made to pay for their illness. They believe that if affordable care is always accessible, it will be badly abused."


i don't understand why we need to pay top dollars to pap ministers. their solution is always the same and can easily be done by even a rebot.

want a certain behaviour-> give money
don't want a certain behavior-> fine
w/o any regards to human feelings.


that is all! can anyone mention a policy that is not like that?

Anonymous said...

To Anonymous at 12:13 AM

I totally agree with you.

Also why are we paying top dollars to our pap ministers when they keep telling us that there's nothing they can do but wait for US to recover first from recession, then Singapore will recover ?

A moron can say the same thing and cost much less !!

Anonymous said...

All the pap policies time and time again show they only care for themselves and their cronies, rewarding themselves with obscene pay and perks !
For the rest of the population, pap's policy is "you die your business" !! Worse still, pap asks you to go to JB and die !

Anonymous said...

Means-testing is rubbish... I was knew this therapy patient...An old lady... All her children are very rich retirees...she stays in a very exclusive condo with just her maid... Thanks to means testing, she only had to pay 25% of the therapy cost, the rest was covered by taxpayers' money...(I saw her a therapy at least twice a week)...you calculate the cost...

Then to find out they charged for H1Ni testing...total slep to the face...

Anonymous said...

Actually the policy makers, i.e. PAP ministars and MPs, wouldn't care about the reality of healthcare costs for a typical Singaporean. They are covered by pension and free A1 class healthcare for superscalar civil servants and their family.

Just look at LKY. Who paid for the exclusive treatments for his wife? Is such treatment available to your typical Singaporean? Would the typical Singaporean have "priority" wait-times like his wife? Or is our real wait-times more like NHS which LKY mocked, and circumvented by jetting Mrs Lee back to Singapore in a converted SIA jet?

Add to that, heard that whenever LKY is hospitalised, he demands that the air-con is maintained at 23 degC at ALL TIMES (imagine the extra manpower to ensure that), all the local daily newspapers in English, Chinese, and Malay (when typical private patients get only 1 copy of a newspaper), his entourage of body guards also get special treatment (free food etc). In addition, only senior staff are allowed to enter the room to serve him, even for low-level tasks (imagine the wasted manpower and associated costs). With this extra special treatment, FOC to policy-makers like him, is it any wonder that the elite is disconnected from the reality of a typical Singaporean's life?

It is not just limited to LKY, self-declared founder of modern Singapore. Ask SHT, who foots the bill for his hospitalisation and skin grafts?

Taxpayers are made to pay for the free medical care for the policy makers and their families, while the rest have to cover one's own ass when it comes to medical bills. The only other people who get free medical care are those under the pre-independence British civil servant contract, but they are often limited to poor class treatment, i.e. C or B2.

Anonymous said...

That there is double standard is something we all know. The question is whether they have forgotten their duty and responsibilities to the country. Looking at the ways things are being run, many are having doubts.

Anonymous said...

i agree that the administration of national healthcare shld not be done in a capitalistic, free-market model.

i fear that sg is at the turning point, crossing which we'll get a messy ineffective healthcare system like the us.

Anonymous said...

The ruling elites together with the family members, relatives and cronies have morphed into a class of their own. They control everything with their complex network. I believe they are so entrenched into every aspect of running the country that an opposition which comes to power will face too resistance to show its capability. From the civil service to the judiaciary everything is controled. All the huge corporatised entities are controled by them. The fact remains that they need not win a election to run singapore. We might as well do away with election and start a system similar to China or better still appoint a monarchy. We have surrendered all the power and we will never gain it back without a reform.

sgcynic said...

Only in Singapore will a minister regret allowing a child medical treatment which eventually cost the healthcare system a few hundred thousand dollars, while another "high-flyer" can lose a few tens of billions of taxpayers' money "investing" in Western banks without any regret. Uniquely Singapore!

Anonymous said...

If it is so expensive..
A poor person who can't afford to go to the doctor when he suspect he have H1N1.
So he self-medicate and still go to work because he can't afford to lose his job.
I think this is why H1N1 is spreading like wild fire..

Its ME said...

enjoy blogging here with you too.it's sickcare versus healthcare here.

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