Tuesday, May 04, 2010

Healthcare burden worsens inequality in Singapore....

Saw this para in the TOC article on the recent 1% CPF increase:

"Singaporeans withdrew a total of S$660 million from their Medisave accounts to pay for the direct medical expenses incurred in hospitals, clinics and other healthcare facilities last year.
This was an increase from the S$590 million withdrawn in 2008.
These figures do not include withdrawals for MediShield and ElderShield premium payments which were S$745 million in 2008 and S$875 million in 2009. 52 per cent of the withdrawals in 2009 were to pay for the members’ own direct medical expenses. The remaining withdrawals were to pay for family members: 17 per cent for spouses, 18 per cent for parents, 12 per cent for children, one per cent for grandparents and others”. (“
S’poreans withdrew total of S$660m from Medisave accounts in 2009“, CNA , Apr 26)



A years ago, I chatted with a taxi driver who was taking me to work during the rush hour. It was one of those days when I couldn't get up in time to take bus and had no choice but to take the taxi. The cab driver was very friendly and told me he worked close to 14 hours a day so that he could cover the morning and evening rush hour. It was tough but he had no choice as he was badly in need of money. According to him, his wife was bed ridden with diabetes. She lost both legs and her kidney had failed so she needed dialysis. Due to diabetes, his wife also lost her sight. His daughter was also suffering from diabetes. He also told me that his family situation was so pitiful, they once appeared on a documentary and were featured news paper article. He told me he had to borrow using credit cards and eventually sold his home to pay for the medical expenses. I didn't get all the details about his income (taxi drivers earn about $3-4K?) and what type of home he was staying in. However, the financial burden for medical treatment can be heavy (read this case about another family that had to sell their home[Link] ...another about a family whose savings are wiped out by medical expenses[Link]).


The PAP govt insists that Singaporeans shoulder as much of the burden for medical care as possible and they carried this idea to the extreme, making Singaporeans shoulder the highest % of medical expenses among citizens of developed countries:

Taking care of yourself and your family may sound like a sensible idea except that Singapore has the highest income gap in developed world. The cost of good medical care is driven the richer segments of society who will naturally demand the best private care. Because of the income gap, medical cost has been rising much faster than average income and for some in the the lower income bracket it is now unaffordable. The govt has allowed Singaporeans to use Medisave for treatment in Johor[Link] while Singapore is promoted as a world class medical hub for rich foreigners[Link]. About 400,000 adults are uninsured[Link] and face the risk of high medical costs. Without universality of medical coverage, the high burden of medical is passed other family members to keep govt's expenses down. The entire system worsens the inequality in our society by making medical care a heavy burden for those in our society less able to shoulder it.

This is an area where sensible things need to be done such as providing universal coverage. For those who are too poor or unemployed, the govt has to step in to help with the insurance premiums. In some countries, the insurance premiums for govt schemes are based on income to further narrow the inequalities buildup in the society. While PAP ideology prevents them from adopting such schemes, it is not clear how long Singaporeans, some of whom now have to seek treatment in Malaysia, will continue to accept the system and support the PAP. One good thing about being a developed country is that the citizens can stop worrying about something as basic as getting medical care....that is unless you're in Singapore where the burden of healthcare actually becomes heavier for ordinary citizens as the nation becomes more affluent.

34 comments:

Anonymous said...

In Australia there is no need to buy Health insurance as medical is FREE. Only those who are well off buy Insurance so that they can chose their own private specialists and go to private hospital. All citizens and PRs with health cards can go to bulks billing GPs and hospital for FREE. The Australian goverment funded this free medical by imposing a lump sum health tax. Some people may consider this as a forced insurance cover. However if your income is low or those on welfare, they don't have to pay this health tax.

Lucky Tan said...

anon 9:29,

Fixed it. Also yesterday the Australian PM annnounced measures to tax resource companies 40% of their profits to fund the well being of its citizens.

Anonymous said...

Now if your bill is not paid up in time, eg consultancy and medicine for even under $100/-. Theu use a private agency to send patient warning letters and to collect whatever money owed. If one goes to see social welefare officer in hospital you end up being humilated
by their interviews.

Anonymous said...

Basically people vote in the government they opine are the best people whom they can trust to look after their interest and welfare (for those who are shortsighted, please note welfare here doesnt means handouts. It means jobs, health and housing - basis needs). Nobody look forward to be sick and I think the government should seriously study the Australian model so that the sick and those with sick dependants are not overly stressed and burdened.

Anonymous said...

First they rob you of your money by paying ridiculously low wages and not having any minimum wage. Then they rob you of your dignity by putting you through humiliating interviews conducted by lowlife morons. Finally you leave this world without money and without dignity while they sit on their toilet bowls and think happy thoughts about how rich they are when they see their CPF statement each month.

http://vonhayek.blogspot.com/ said...

PAP screw up such big time that universal healthcare Lucky desired is going to be pipe dream.

Very simple, if we want our citizen to have free healthcare, do not make it citizenship GLOBAL.

PAP FT policy means that even prostitute elsewhere are able to get citizenship, and where the hell we aboriginal gonna find fundings for all these PAP bullshit?

PAP is wicked and has no citizen welfare in heart. Serve our selfish parents right as they shed no tears when Lim Chin Siong..etc are unjustly persecuted; They old Singaporean deserve what they get when they voted PAP for material gain.

We younger one are the victim.

Anonymous said...

can you provide a link to the source for your graph? also, are the figures for singapore nett of the subsidies that the government claims to provide?

Alan Wong said...

Someone mentioned that in Malaysia, seeing the doctor in a public hospital costs only approx. 1 dollar inclusive of medicine, something that has remained unchanged for several decades.

It only goes to show that a supposedly 'clean' govt may not necessary have the best benefits for its citizens, sometimes.

Anonymous said...

I wouldn't mind taxes like GST or ERP, if I know they go directly to helping the poor or to help pay for our health insurance.

But in Singapore, our national motto is "you die, your own problem". The govt hoards the tax and would rather lose 100% of it overseas than to spend 10% of it to help the poor directly.

I am not sure why our govt is so obsessed with massive profits that MUST be channelled to overseas ventures and FOREIGN scholarships, instead of spending the money domestically to help grow local industries or local talents or to take care of our poor.

Singaporeans get their retribution for voting for PAP.

Anonymous said...

To: Vonhayek 4/5/10 15:25

I do not agree that it is only the old who voted for pap, I would say it is across all ages.

If you look at the persecution of JBJ, CSJ, etc it was quite recent and in fact the persecution continues to this day. And you can see plenty of young ones not only do they not condemn such persecution they actually sing the same tune as pap to condemn the victims.

Such is the state of the selfish brainwashed 66% across all ages.

Anonymous said...

Dear Lucky

I was at a public hospital recently and saw FT doctors doing on job training and seems like more than few are clueless.

So dun worry about healthcare burden!
Chances are those who cant afford private healthcare wont live long enough to run up a huge bill :-)
Instead the dependents\beneficiaries can look forward to a windfall!

You are indeed correct to praise Mini-star "Pious Buddhist" Khaw!

Anonymous said...

Say .. aren't you a BIG BIG fan of ObamaCare?

Since vast majorities of medical-linked bankruptcies in US are by folks who have crap insurance ... like the basic medishield ... its obvious every Singaporean (age 1 to 100) must be made to buy basic medishield (thats covers less than a playmate's bikini )

I think Singapore is missing the ambulance chasers ... maybe you should send your pal Mr Khaw a reminder.

Anonymous said...

Dear All:

let's be realistic and frank to ourselves. No matter how we plead and tell our pious leaders our difficulties and problems caused by their policies, me does not believe we could invoke their consciences.

The only way is to take preventive measures, keep oneself healthy by taking good care of one another. Do not indulge too much in GAMBLING, eating, drinking, smoking and other vices.

DO NOT BE TOO AGITATED BY THE POLICY MAKERS, TOO MUCH HATE ON THEM CAN CAUSE GREAT DAMAGES TO THE SENTIMENTS AND HEALTH. There is a Chinese Saying in Hokkien(Chinese Dialect) that if one dies because of anger, reason of death may not be known; meaning one dies without others knowing the cause of death. A life is wasted so to say.

Really there is no need to compare SIN with any other country; if our leaders are the best in the world, then thsy should also be best in taking care of their citizens. BUT WE ALL KNOW THEY HAVE FAILED TO DELIVER AND THERE IS NO SIGN THAT THEY COULD. ON THE CONTRARY, THEY ARE EXPLOITING US ALL THE TIME.

Take care and take the opportunity to find greener pastures or to rid the bullies.

patriot

Anonymous said...

I hate to disagree but...

yes, if what you've reported is true, then yes, healthcare burden appears to be getting bigger and the related inequalities etcetc. However, one solution that 'developed' countries have is to tax the people really highly.

In the UK the max income tax at the moment is 40% and they're hoping to bring it up to 50%. VAT/GST is 17.5% and they're talking about raising it. Yes, we therefore have 'free medical' but it's not as free as you'd think because unless you are pregnant, under 18 or what other criteria they put on you, everyone in England (not Scotland - but that's a different story) has to pay £7.20 (SGD16-18?) per prescription. Yes, it doesn't sound like much but it really isn't free. On top of that, of course, we have to pay monthly National Insurance which rather inadequately funds the 'free' National Health Service.

Like your first poster, there's private insurance options here and there are people who have that, otherwise, you wait for some time to see the specialist oncologists/cardiologists etcetc.

In a way it doesn't discriminate poor/rich - everyone has to wait for the kidney/operation/new hip, which I suppose goes a way in sorting out your inequality argument. But honestly, to sort out some of the issues you keep raising here and in other posts, a significantly higher tax has to happen and until that happens, the 'poor' will not and cannot be catered for.

Anonymous said...

the poor's plight has been milked to the tits by leftist since the time when women realized their meat could be sold for a piece of flint.

the way i see it, gahmen's position has always been for its citizens to be self reliant. on the brighter side to this approach, no freebies in health related care means everyone is forced to stay healthy - both financially and physically.

only those who fall under exceptional circumstances can seek special assistance.

but for the majority, we have to live smart which maybe the best solution for all.

Anonymous said...

The Singapore General Hospital has a Service Partner called Pinnacle Credit Services Pte. Ltd. The telephone no: is 65976390. If you don't pay your bill in time GH sends you a red letter with this company name on it and telling you to deal with them. Wonder if they will break the victims arm!! Also my guess what they are getting paid to do the job.

Anonymous said...

There are many irresponsible abusers out there. When money not enough, they make use of their children, their spouse,their parents, their employers and the goverment. How do you deal with such people? Show more compassion or return the abuse with tough love?

Sometimes, we need to get the ah long san to shaft the baseball bat up their arseholes before we sit them down to talk some sense into their thick skull!!!

Anonymous said...

If u have irresponsible abusers, deal with them.


You don't punish everyone for a few's doing.

Like every business will have customers who default, you don't whack all your customers.


I think we were all brainwashed to think without a heart and soul like LKY.

PAP government is all about taking the easiest way out and reaping the most benefits for themselves.

I live in Australia. While I belong to a higher tax bracket than when in Singapore, Kevin Rudd returns 200 dollars to me every fortnight for having a family.

I have come to realise that the true meaning of being a citizen of any country is that it must care for me too. Citizenry is about caring both ways.

Anonymous said...

Re Anonymous 5/5/10 06:52


////////////////////////
There are many irresponsible abusers out there.
////////////////////////

The government is iresponsible not the people in Singapore.

How many woman in Singapore got pregnant out of wedlock like the west? and.....etc

I think the most irresponsible people is Ho Ching, and LKY in GIC.

Roy said...

To Anon 23.13

Ref High Taxes. As far as I am concerned. If a part of my income is taken from me by the gov and I have no access to it and the rules that dictate when they can be used are changed without my consultation, they(the money taken from me) are effectively no longer mine and the property of the government. In my opinion, the CPF contributions to Special Account and Medisave are taxes, and I am being generous by not including Ordinary Account CPF contributions.

You can call a cow a tiger but it doesn't change the fact that the "tiger" moos.

So regarding the very high taxes, are you sure we do not already have it? We have our regular income tax and out 13-17% non-OA CPF.

Finally I would like to add. CPF contributions has a "max-out" amount. Thus, it "taxes" if you buy my argument that it is a tax high income earners proportionately less. Are there any regime in the world that taxes the rich less in such obvious manner?

Anonymous said...

The best solution is to emigrate to Canada or Oz or NZ. You get FREE
healthcare and education for your kids. And, the best part is that
you can get 100% of your CPF money.

Anonymous said...

I, a Senior Citizen, would like to leave my humble comment here about MediShield premiums, esp. for the older age groups. Take a good look at the huge amount a Senior Citizen as to pay entering a higher age group. When I am too old to work. I wonder how many years can my MediSave last just paying my MediShield premiums alone. At present I have about 30K in my MediSave Account. I have so far refrained from withdrawing from my MediSave. Also, like a good S'porean, I pay MediSave regularly to pay for my health matters. The longevity hazard likely meaningless to me. I had op at 55 and the surgeon said life span is usually 20 years in cases like mine. I factor in risk factors like stress due to uncertain income, job marginalization due to being mature worker, etc., probably cuts off life span as well.

Anonymous said...

don't just pray for good health but work hard to stay out of costly medical bills.

Anonymous said...

Last time when the wife of you-know-who was hospitalized in London, the govt flew a team of medical officers on a converted 747 to bring her back to Singapore. Did she pay for this special medical service out of her MediSave? Just curious to know!

Anonymous said...

Dear Roy
This is anon 23:13.

The income tax in the UK starts at a minimum of 22% and goes up to 40% and like I said, the gov (whoever they are, by tomorrow!) hopes to move up to 50%. Going by your definition, this amt of tax is taken away from me by the gov and I have no access to it, and the rules that dictate when they can be used are changed without my consultation - therefore the property of the gov.

On top of that we have National Insurance - going by the calculations we pay between 10-20% of our pay. This national insurance does not necessarily come back to me - if it does, it comes when I am 1. on maternity (as part of maternity pay - at the moment statutory pay is something like £123/week), 2. retired (as part of my pension (£120/week)), or 3. looking for a job (and even then it's all calculated based on how much you have in your piggy bank in the first place). Ie, if I happen to need cancer treatment now, I still stand in line to wait for my treatment, together with the person who's never worked in their lives, and together with the person who has lots of money in their bank (and presumably has no private insurance).

With your CPF and variations of that, it would appear that yes, although there's a minimum amount that you need to save up to for retirement etc, the rest of the money you can use for some payment of medical treatment etc - no?

Just my opinion, but the idea is that at least the CPF which you take to be a tax (which I agree it is), is at least something that you and your family can benefit from depending on how much you/your family's put in to it. Of course, it does not benefit the poor or less well to do as much, because if you start with a salary of 2K a month, the CPF contributions will be much less, compared to a salary of 5K a month.

In the UK situation, I cannot say for example that I have contributed 10K in National Insurance, and therefore can I have 8K back of cancer treatment!

I wouldn't know much about whether your CPF taxes the rich more or whatever - that wasn't my argument. What I was pointing out was that ONE of the reasons why the other countries seem to be able to treat all their residents with some form of healthcare (other than America) is because there's universal healthcare that's available through taxes.

So, if you are poor, never worked in your life, you can have 6 kids, a 4 bedroom house, get cancer and be treated because the social system allows it - the same way, if you're working/middle class, always worked, have 2 kids, live in a 3 bedroom house, get cancer - you can also be treated (oh and the pregnancies would have been free too).

In Singapore, it's pretty self-sufficient - you rely on yourself (or your family)... over here, it's not self-sufficient - you rely on the gov. And when the gov fails, you vote in a new one, and hope for the best. In Singapore, every kid has a savings acct (I know I did - I remember my standard chartered mickey mouse bank). Over here, they are trying to do that, but to little success. My son has a savings acct - but only coz I had one!

In Singapore you pay for university fees. Over here, they've introduced university fees to the chagrin of the people and they are still campaigning to stop university fees.

It's a different social system and I think it's pretty difficult to compare like for like.

Anonymous said...

Anon 23:13 and Roy

I think its very difficult to compare UK and SG just basing it on taxes... The society, culture and methodology of running the country is entirely different...

Take for example, NHS provides free medical consultation while SG doesnt. However, the Doctors in Singapore generally are better than those in UK (according to my medical friend who is doing PHD in the UK)... He once told me, 'Survive the operation but die because of rats and cockroaches...'

So pros and cons... More free stuff, the tax rate goes up higher... Add on to the salary raise on top of their ridiculous amount, the Ma Bok Tan HDB et cetera... Tell you, leave ur car-park got ERP Gantry liaoz...

Anonymous said...

Just a thought - in the UK we've had lots of 'scandals' with the MPs expenses (basically MPs using public funds to pay for things like treating dry rot in their house, a bird bath in their garden - all to the tune of thousands and thousands of pounds). I wonder whether there'll be anyone brave enough in the Singapore media to look into this...! :)

Anonymous said...

Wondering if the tax payers paid for Minister's of Health medical bills as part of his "corporate healthcare benefit", when he had the elective heart bypass surgery... surely all top class service, 1st class wards.. or did he have to dip into his Medisave?

Our ministers are highly paid and they and their family are entitled to top class medical treatment, how can they ever feel the pinch of escalating health costs? How can they ever understand the pain of not being able to afford healthcare when it is needed or be saddled with mountains of medical bills?

Anonymous said...

you can always smell a pap mole, by the fart he gives.

who cares about "in the uk, the maximum income tax bracket is 40%." who? who? who?

let me tell you, it is the rich like pap elites. they don't want to pay income tax of 40% so that their ill-gotten money can be used to fund the medical care of the citizens.

vote out pap. vote for max income tax of 40%!!!! (yeah, baby, bring it on and up to 50% pls)

Anonymous said...

Dear anon 5/5/10 17:46,

You said - "The income tax in the UK starts at a minimum of 22% and goes up to 40% and like I said, the gov (whoever they are, by tomorrow!) hopes to move up to 50%."

I have lived in the UK for few yrs and my relative is still there. Singapore has been my home for the past 5 yrs.

what you said about the 50% tax is ingenius. FYI, that tax is for those earning AT LEAST 250,000 pounds a year. How many british citizens earn that much? the answer is less than 2%.

Is it so wrong to tax the SUPER RICH? I have seen a garage full of rows after rows of expensive cars just idle. I have experienced being poor and rich. I met a man who took a 1 year holiday just drinking away in a club in singapore during the 2009 recession. the recession didnt affect him and his family at all.

I think selfish and greed knows no bounds. We can either help the poor or we can come up with a million excuses/reasons why we don't.

Look at all the developed nations -Japan, Taiwan, Canada, German and Sweden. They all help the poor with healthcare. Some of these countries dont even have reserves like Singapore.

Successful countries that lacked natural resources -
1. Switzerland
2. UK
3. Israel
4. Taiwan
5. Japan
6. Monaco

The problem with singapore is that the rich are the lawmakers and they dont want to be taxed. As simple as that.

Fortunately singaporeans are slowly starting to smell the foul play.

Anyway, my guess is that singaporeans are saved by the grace of God. 87 old man going to kick the bucket soon. internal fighting in the party is happening right now.

History proves me right!
1. alexander the great.
2. king darius of persia

both these kingdoms crumbled almost overnight after they died.

Cheers
Economist with a heart :)

TokyoSingaporean said...

One of the reasons I decided to return to Singapore is the knowledge that LKY is gonna kick the bucket soon and that his son is a pussy-whipped man, who can't put her wife's billion dollar horrific investment loss to account. In fact, the PM reinstated his wife as the chairman of Temsek Holding again.

The Prime Minister of Singapore clearly lacks objectivity. He finances a all-in-the-family corruption.

The PAP downfall is approaching soon. The problem is that they know of past histories as well. And the recent opening of the floodgates to foreigners is key to sustain a vote for their selfish machinery.

Alex Tan said...

in other countries, people buy insurance so that they can afford staying in private hospitals and get premium health services. they can jolly well do so because they have universal healthcare that even a homeless can be given basic healthcare without worries for money.

in Singapore, people buy insurance so that they can afford a bed in the public hospitals. if you are poor, you either take the suicide route or burden your family members with hefty "subsidized" medical bills.

after studying the existing Medicare and MediShield systems, the most hardest hit will always be the average middle-income and low-income households. even with Medishield, one still has to fork out up to $10 000 for a critical illness treatment like cancer after subsidies from Singapore Cancer Society and a few thousand more for outpatient treatment.

does average families even have $10 000 in cash reserves?

Anonymous said...

there is completely NOTHING WRONG with taxing the highest earners at 50%... I would vote for that too. and FYI, it's not £250K... it's £150K (http://news.bbc.co.uk/1/hi/business/8604215.stm). And FYI2, I know of Singaporean bankers/professionals in London who are looking very keenly to move out of the UK for that sole reason. (As are other British and other different nationality professionals who are looking to leave the UK because of that increase in tax).

If in Singapore the govt won't tax the highest bracket of earners, then well... that's something the govt/people have to sort out.

perhaps you are right - the person who pointed out the selfishness of the situation in Singapore...and perhaps it's time that changed. Here, we have a universal healthcare system that caters for all (rich and poor, young and old, disabled and abled) - and like someone else (or was it you?) pointed out, we buy private insurance so that we get our private rooms and faster-tracked appt with the specialist. In that sense, it favours the rich too. The rest of the world 'slums' it and waits its turn (hence why healthcare is always an issue with the elections).

In Singapore people buy insurance for various other reasons - I remember the days when the moment you leave university, you'll be hounded by seniors who became insurance agents - and most people end up with 2 or more insurance policies!! Over here, you have the complete opposite where people will not even save money for a rainy day because the govt will sort us out (hence why huge debts, deficits...etc) and where people see the word 'bank overdraft' and automatically assume that the money that the bank allows you to 'overdraw' = money you can spend. overreliance on the govt and 'others' to bail them out, perhaps.

Anonymous said...

Is'nt it a governments responsibilty to provide accessible health care for its citizens in a first world country. The US is no example to follow , and they have been looking at Europes systems .