Sunday, October 02, 2011

Healthcare : An Enlightened Move...

I will tell you a better policy idea than the $2 health screening announced for the poor today later on in the posting.

There is one area that there is little doubt that govt should play a big role and that is healthcare. All we have to do is look at the mess in the largely privatised healthcare system in USA. The cost of healthcare there is growing at 22% every year and if you do quick calculation, it won't take long for healthcare cost in America to reach a point that it devours half the GDP - every other person would have to be a doctor to treat the other person! Of course that is just a hypothetical mathematical possibility, before it reaches that point the US govt will have to do something or most people will have to live without healthcare - these people will keep throwing out incumbent politicians until something is done even if it means re-nationalising the healthcare system. Having an expensive healthcare system is a big drag on the US economy and its competitiveness healthcare insurance as one of the major business cost.

I'll use this $2 screening to illustrate why a healthcare system that keeps most healthcare resources under the govt rather than the private sector will lead to a system that has lower overall cost for a nation and society.

Most of us go for health screening after we get past age 35. I would recommend you go every year even if you're younger. The basic checks that consists of blood pressure, cholesterol, sugar level, uric acid levels etc costs between $30-$45 at a private clinic. For many working Singaporeans the cost is not really an issue - in fact in many companies there is reverse welfare, the higher your position and your pay, the more checkups and medical care you will be entitled to. For the low income workers, their package usually don't cover annual medical checkups. These workers along with the unemployed, retirees and the poor will skip health screening because they have little money - it is just human behavior that is impractical to change. We cannot expect charities to fill the gap because of the large number of people and charities have to priorities their resources. Only the govt can take care of these people - so they have to decide whether to do or not. Suppose they chose not to do it and a poor person with high blood pressure goes untreated until he gets a stroke and has to be rushed to the hospital. At this point, the govt choose do the inhumane thing of not treating the person because he has no money - we will have to rule this out because this is simply unacceptable. The person gets surgery costing maybe $30K-$50K but because he is poor can never pay for it even if it is heavily subsidised. The person might suffer from permanent disabilities and has to be care for the rest of his life. Instead of spending $30 to screen the person, the govt ends up paying more than $30K of tax payers' money.

By spending small amounts in perventive care on the poorest members of our society, the govt can lower the overall cost to society. It is a very practical pragmatic thing to do but why did it take the PAP take so long to do this? We can go back in time to understand why by recalling the incident that resulted Lim Hng Kiang acquiring the nickname Hairdo Lim. During a parliament debate on whether the Medisave should be allowed for use for breast cancer screening, Lim Hng Kiang argued that the $50 for the screening can be easily be borne by women by saving on one hairdo. Ideologically, the PAP wants people to take as much responsiblity for their own health as possible so that govt can keep its expenses down by making people shoulder as much healthcare burden as possible. But Lim Hng Kiang's expectation of human behavior does not result in the best policy outcomes. Singaporeans are no different from the people anywhere else in the world when it comes to preventive care. People will skip it because will always make the mistake of viewing it as an unnecessary expense.At the end of the day, it will end up costing tax payers and society more money when the person fails to get early treatment.

If you look at the top healthcare systems in the world, most of them are single-payer systems with the govt playing a central role. France has the number one healthcare system in the world and treatment is paid for by the state at a overall cost far lower than the US where a large part of the system is in private hands - insurance companies, private hospitals etc. The problem is some govts are not so good at running such a system and ended up high costs, long queues and rationed care - even so, most are still considered better than  what they have the US for the average person.

In the past few years, the PAP govt has allowed the private healthcare sector to expand hoping to turn Singapore into a medical hub for the rich. So much of our healthcare resources are now in private hands, the govt has to seek help from the private sector to reduce the load in its public  hospitals (Read : Govt turning to private sector for healthcare). The aspiration to be a medical hub and growth of private sector that draws doctors and nurses from public healthcare has resulted in a cost spiral that has reduced the affordability of healthcare in Singapore.

There is a lot more to be done to take healthcare costs off the minds of average Singaporeans. Universal single payer systems like those in France, Australia & Finland are ideologically hard to accept for the PAP govt and some segment of the population to accept because it leads to higher taxes although it may have lower overall costs and ensure great equality among Singaporeans.

I have a suggestion that builds upon the $2 health check up proposed for the poor and elderly - extend the scheme for everyone above the age of 40. Here's why:
  •  Such checks unlike other treatment cannot be abused or overconsumed so that overcomes a common objection to providing free or subsidied care.
  • Some might object because people who can afford it like Wee Chaw Yaw might turn up for one of these checkups. But it is fair because he pays much more taxes. Chances are the ultra-rich won't bother they will just go for their private hospital $1000 checkups. Many in the higher income category will skip it because their corporations provide something better than basic screening.
  • Economies of scale when the govt set up clinics that specialise in these checkups so there is overall cost savings (individuals + govt expenditure)
  • There incentive created will lead to almost 100% screening for common illnesses and overall cost savings and better outcomes -less undetected illnesses = fewer emergency cases.
  • Making checkups so highly subsidised for everyone may be hard for the PAP to accept but this idea is reasonable and middle-path compared to govts that provide everything free of charge.
If you take away ideological thinking that Singaporeans must always shoulder as much healthcare burden as they can afford, there is a one objection is that the expediture might shift from individuals to govt although there is a good chance there will be savings from early detection. 

"Individual resident taxpayers will enjoy a personal income tax rebate of 20% for Year of Assessment 2011 (YA2011), capped at $2,000. The PIT rebates will cost the Government $580 million.
Taxpayers do not have to apply for the rebate. The Inland Revenue Authority of Singapore(IRAS) will take into account the rebate when computing the tax bill for YA2011. The amount of rebate will be shown in their income tax bill."
Instead of always thinking about cutting taxes especially one-off cuts before elections, there could be  ways to put some of this money to better use. $580M can provide check ups for Singaporeans for those over 40 for maybe the next 10 years to achieve better outcomes. There are numerous ways to find money for this probably we don't even need to forego those middleclass tax rebates - the govt probably has enough annual surplus to do this - the issue is not money. The only real problem is ideology - Hairdo Lim ideology....that gets in the way pragmatic beneficial approaches to healthcare. Shifting expenditure slightly from individuals to govt for a govt that already shoulders the smallest % healthcare burden among developed countries to achieve overall better results and cost savings cannot be wrong. Many positive changes in Singapore requires the Singapore govt to compromise and shift. Many at the other end of the political spectrum are asking for single payer universal healthcare system to erase some of the inequality in our society - this is a big change that will require far more debate. However, the overall benefits of the govt playing a bigger role in preventive care is quite clear and pragmatic for the angle of cost and efficiency. Still I'm a little happy that the PAP has decided to provide $2 for the poor and elderly - they are slightly more enlightened today than they were yesterday.


Anonymous said...

"Shifting expenditure slightly from individuals to govt for a govt that already shoulders the smallest % healthcare burden among developed countries to achieve better results cannot be wrong."
Lucky Tan

But if it cannot be wrong, then why the PAP govt didn't do more about it?

Is it because they know something that is not right (for the country) which Lucky Tan doesn't know? After all, Lucky Tan is not the health minister.

And for govt and in politics, sometimes things or the real reasons are not easy to explain or convenient to tell the public.

Of course bloggers and their commentators don't have this problem. They can say what they want.

Veritas said...

The problem is some govts are not so good at running such a system and ended up high costs, long queues and rationed care - even so, most are still considered better than what they have the US for the average person.

The privatize healthcare is more expensive than the relatively inefficiency of public sector for reasons many economist would like to ignore.

A privatize hospital charges includes the rents extracts by the banks, share holders, insurance company, colluding with big pharma, , greedy high pay CEO + management + doctors, predating on the patients.

A public hospital are built without the need to raise cash through banks, and bulk medicine purchase can reduce price rigging by big pharma.

Our government knew exactly that, but greed has force them to injured the people favoring the rich.

Everywhere in the world, doctors are always part of elite class in out of government.

We should toss out all economics professor in our schools. In fact, I am already very convince of flaws in many aspect of capitalism.

Anonymous said...

Truth be told, but it is inconvenient to tell.

Anonymous said...

This is a fantastic move by the Gov.

It could be a begining of much more things to come. There is light.

Should have done this long ago, but somehow seems to have slipped through the debate over expenses.

I dont think the wealthy will abuse the system, if we firmly believe that it is a system meant for all citizens, regardless of income or wealth. They will probably go for a private visit and dont mind paying $xxxx. In fact, they may get it as a free add-on with the insurance that they buy.

As for corporations, yes, the upper crust will get better deals.
Different blood sample but same machine used for analysis.

Great move by the Gov.. hope they do more like this.

Anonymous said...

"But if it cannot be wrong, then why the PAP govt didn't do more about it?"

Because the PAP govt is not made up of the bestest and brightest. There is a lot that PAP and their so-called top brains are ignorant of. Hard truth.

Lye Khuen Way said...

As always, Lucky has demonstrated more grey matter than most Ministers- both current & recent past. Of course, there must have been many reasons why the Govt did not do more for Singaporeans, but I bet, all these reasons Cannot and Must not he disclosed for national security sake ! Healthcare is only one of the pressing issues but like the others like housing/ transportation/education/ FT-/ minimum wage debates, we lesser mortals can only offer our opinions & suggestions..... & pray.

Anonymous said...

"Still I'm a little happy that the PAP has decided to provide $2 for the poor and elderly - they are slightly more enlightened today than they were yesterday."

Is it good or is it politics to them?

Where to go for such test?

SIMPLE said...

Cheap checking is good but not enough. The result of this initiative is surely that many will discover that they have some sort of illness which will require treatment. For those who can't afford it, then what in the absence of a a national healthcare system?

Anonymous said...

SIMPLE 2/10/11 19:18

Treatment and followup, that's where the high cost will be.

For instance for just simple dressing alone at Polyclinic for a month will cost a few hundred dollars.

And even for followup without treatment(only checks and tests) will also cost a lot, and more than the medicine, even for subsidised patients.

This is really a problem for those who can't afford it, unless the fees are waived.

Anonymous said...


Sick and cannot pay?
Go JB lah!!!

Why u ask so difficult question?
Brainchild of Holy Cow u know!
Endorsed by Lucky cannot be wrong!

Vote Cow! vote PAP!

Anonymous said...

Wish that Lucky had held back this posting.
But, if the Sin Government follows up with treatment as cheap as a $8(Eight) heart bypass for the Ex-Health Minister Khaw Boon Wan, for those found with health problems after the $2(Two) screening, then me will be as happy as Lucky Tan. Even at $80(Eighty) for a heart bypass, ten times more than what Minister Khaw paid, it is still very affordable. HOWEVER, if the treatment that follows are at the current rates charge by the polyclinics and hospitals, forget about going for the screenings even if they are free.

We know Telephone Companies give away free or cost free phones and computers. And we know why they are so generous; the fees for their services rake in multi million profits per annum. So, beware! Do not be too eager or greedy for the offer.

Unless, the people are assured that treatments will be given nor matter how costly they(treatments) are, the $2(Two) screening could cost many thousand times more.


Anonymous said...

They have done their numbers. Have you?

Very acceptable said...

"...he gets a stroke and has to be rushed to the hospital. At this point, the govt [can] choose [to] do the inhumane thing of not treating the person because he has no money - we will have to rule this out because this is simply unacceptable."

Nonsense! Lucky thinks too highly of the PAP. What is unacceptable to Lucky and the rest of the world, is acceptable to PAP. It IS acceptable - to PAP - to do nothing, and the govt has been adopting such an acceptable position for a long long time: No treatment, no medication, no CT scan for stroke victim for 4 days until already brain-dead (but CT scan within 2 hours for LKY's wife, and every one, according to Old Fart!) The only "treatment" this guy received in 4 days were blood tests to check the compatibility of his kidney to a (rich FT?) receipient!)

So who say it is unacceptable to do nothing to a stroke victim who got rushed to hospital? Of course it is acceptable! 60% of Singaporeans find it acceptable!

very acceptable said...

The first comment:
"And for govt and in politics, sometimes things or the real reasons are not easy to explain or convenient to tell the public."

The real reason that is inconvenient to tell the public:


The PAP govt prefers poor (and by its inference, stupid) Singaporeans to die off quickly than to waste resources!

It is for this reason that:
(1) CPF money cannot be used for one own's cancer treatment eg chemotherapy, immunosuppression drugs etc. The govt is not going to eat up your CPF money. But it prefers your CPF money to be passed on to your (healthy, young, productive) children than for it to be used on your treatment because you are sickly, old, and unproductive!

and so on...

Everything is founded on the principal of E U G E N I C S

very acceptable said...

The first comment:
"But if it cannot be wrong, then why the PAP govt didn't do more about it?"

Because the PAP govt doesn't want to prolong the life of poor, stupid, unproductive slaves that can be replaced easily by foreigners!

To repeat:
Your own CPF money. Why can't you use it for expensive treatment that will cure you of cancer? Or reduce HIV virus in your body to a negligible undetectable level? Why? Is it because the govt is out to get your CPF money? NO! This money, after your death, does not go to the govt! Your children are able to get your CPF money in cash!!! So what's the reason? Clearly, it is because the govt prefers you - the old, sick and unproductive slave - to die, and prefer your money to go to your son - who is young and can be a productive slave for many years to come!

And so it is the same thing here when it comes to spending money on poor people's healthcare! The govt doesn't want to do it because it prefers such poor (and by its sick definition, stupid) slaves to die off!

A Citizen by birth.... said...

I voted other than PAP.

This step that they have taken is an improvement.
They can do much more, and I am not going to be swayed to believe that they have changed.

I demand more. Yet, I will not venture into what the situation is now and that there are specific cases that indicate their "wrongness"

If they continue to improve and begin the process of change, I will be very happy. Yet, it does not mean my vote will go to them in the future.

My key indicators will measure the amount of care, concern for citizens. Meeting this means they are doing the right thing, the right values and I support these values.

But it will not change my view about them. Because, like them, it is expected of a Government.

They know their weaknesses and they know what they need to do as a Government. It is a goal that is very different from a goal of a politcal party.

As a party, I will never ever vote for them again.Regardless of what they do now in Government.

Alan Wan said...

Frankly it really defeats the purpose of having Medisave when at the same time it impose so many restrictions that one can hardly tap it to pay for most of our medical needs.

Prevention is better than cure and yet our PAP govt is so paranoid about people not being able to pay for their big medical bills that they make policies without the ability of thinking out of the box.

This is what I called our PAP leaders seem to have big heads but small brains.

1st they came for... said...

Its called policies:

Look at mediacorp's Channel News Asia

Everytime, for sports news, they kiam kanna, do not screen video clip of games, sports that they are reporting about. Only still pictures.

You and I have to imagine what the goal, the golf ball's track was like.

Come on man!.. even the chinese tv stations, thai tv screen the goal shots!

Its very likely "policy" of not wanting to pay rights for screening these short but meaningful clips.

As for movie/music reports, sure, they will play the clips.. but that is because its promotional material!... free! ( with restrictions of course )

So.. remove these damned "policy" makers.. the so called "brains" who have very bias, very out of sync with reality.
Equally accountable are the "new" brains.. who just shut up and go along...


1st they came for the marxists
I did'nt speak up

Then they came for the oppositions
and I did'nt speak up

Next they came for me..
and there was no one else to speak up for me.

Anonymous said...

This is a great move by the newly minted minister of health. My family and I thank him from the very bottom of our hearts. In this one act, he has done 10 years work when compared to the last 10 years of damage done by the last minister, who is now going to do another 10 years of damage to the public housing system. God help all of us.

Anonymous said...

Compare to the european mps, our mps are the most well paid and have the least level of stress. they should contribute 90% of their pay for the poor, weak and elderly of the society.

Anonymous said...

"At this point, the govt choose do the inhumane thing of not treating the person because he has no money - we will have to rule this out because this is simply unacceptable."

You forget that there was a Health Minister who regretted having to save a baby because the bill ended up in the hundred of thousands (?)...

Anonymous said...

Every morning, I wake up and wait out for a BTO that is far off in the future and I ask myself: does the government care about the people? I know my answer. What about you?

Anonymous said...

Wish Patriot did not post the comment. Then we would be able to see if the health ministry operates like the telcos.

Anonymous said...

What happens after the health screening? Supposed an old man who collects cardboards for a living went for the screening and found to have illnesses that require long term medication . How is he going to pay for the medication?

It's like I want to be a kind person to the poor. I gave the poor man a bag of flour so he could bake bread to eat. But the poor man has no oven, no utensils nor cooking oil for baking. (And I pretend not to know).

SG Girl

Anonymous said...

"How is he going to pay for the medication?" SG girl

See the MP. Maybe they will be kind enough to waive all the charges. I think this will be handled on a case by case basis. Of course they won't publicise such things lah.

And maybe that's why PAP can get at least 60% votes every election, including votes from the poor.

Anonymous said...

We have a problem with the system. Too much obedience to blind autthority is dangerous. Singaporeans accept bad policies and the impact of these bad policies will hit them and they can't do much to change it but to tolerate the pain and difficulty.

Anonymous said...

When some one believes, then he is right and another would be wrong.

Egalitarian, humanistic concern with practical realism would be the best belief we can cultivate and eschew.

Political policies are products of belief systems.

Can enlightenment ever come to our land when vested interest and selfish greed predominate.

Anonymous said...

To all Singaporeans overseas, please notify all friends of a missing Singaporean Duke-Nus medical student in Greece.

If he remain missing, the PAP will be worried for next 2016 election by the news that the native Singaporean population excluding new citizens/PRs in Duke-Nus medical school has decreased by 50%, and they must import more AT and abnn doctors (hopefully with real doctor qualifications).

Anonymous said...

Good start to have a affordable test for all.

Better to make it more affordable treatment for those who has medical problem detected.

Or else more stress to those who found out their problem from the screening.