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.
"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."