Monday, February 28, 2011

Dr Susan Lim and the $22M medical bill...

I'm sure many of you have read about the Dr. Susan Lim case which is now before the SMC. She is trying to prevent the SMC from convening an investigation into her billing [Link]. I'm not here to discuss Dr. Lim's case or her morals but how the desire for Singapore to be a medical hub for the rich has raised the cost of healthcare for ordinary Singaporeans who are now made to shoulder the increasing financial burden of our govt's aspiration to maximise the profits made in this sector while keeping its own expediture on healthcare down by passing the increased costs to ordinary Singaporeans.

While Dr. Lim's case was brought up, the newspapers went around to interview doctors on what they think of it. Some say she should bill no more than $5000 a day others say it is okay for her to bill the $450k a day if the patient is willing to pay this amount for her services. There is no concensus on what amount she should bill a patient. Some suggested it should be based on patient's ability and willingness to pay. If this is true, Singaporeans with a median household income of $4-5K have to compete with the richest in the region. Healthcare is starting to get treated like housing -the good size bungalows for the rich and rental flats for the poor, you get what you pay for and the more you pay the higher the availability and quality. Pure capitalism.

Sometime back, I needed an minor operation on my back. I went to the GP who suggested that I pay a few thousand for day surgey at a private hospital called Eastshore. He told me the doctor there was very experienced, highly available and I can get my surgery the next day after an initial inspection. I asked him if there is any risk if it is done by a doctor with no experience. He told me the risk was minimal (nearly zero but doctors cannot say zero). I decided to have it done at the public hospital. The waiting time was months but I was not in need of any immediate treatment so I was opted to wait. To cut a long story short during my surgery I was put on LA (local anesthesia) - they killed the pain on my back but I was fully awake during the surgery. While they operated on my I could hear all the interesting small talk between a specialist and two surgeons who were "cutting" me. The surgeons sounded like rookies taking instructions from the specialist. I was quite okay with that given my condition was not complex and the surgery was a simple one. Half way through, the head of department came around to check on the surgery team. When he left, one of the surgeons said he was very nervous when his "boss" came to look at what he was doing. I told him, "hey doctor, you forget I'm still awake, now your patient also very nervous".

The surgery did go well and I have recovered fully. I was lucky to have a small problem and the public hospital took good care of it. However, my experience that highlights what is going in our public hospitals. Many highly experienced senior doctors, surgeons and specialists have been drawn out of our public hospitals into the private sector where they can earn much more money doing less work. That leaves those who remain in the public hospitals to handle a bigger loads - we enter a vicious cycle because those remain have to be retained with higher pay. The govt has shown no desire to fix this as they simply pass on the increased cost to Singaporeans (means testing, higher insurance premiums etc). They continue to advertise Singapore as a medical hub for the rich in the region[Linkj] and the expansion of capacity in private hospital will further strain our limited resources.

There is only one other developed country that allowed free markets to dominate healthcare - USA. We are going along the same trajectory and will reach a stage when it becomes very difficult to fix just like in the US. You cannot ask surgeons that make $15M a year to trottle down to $5M. We have already seen insurance premiums moving up - old schemes such as basic medishield becoming inadequate and more and more people with inadequate coverage. The medical care financial strain is moved up from low income now to middle income families. We continue to be told that "healthcare is affordable" and we are on the right track. This is not true. There are many other ways to run a healthcare system and many of my readers who are Singaporeans or ex-Singaporeans now living in Australia, New Zealand, Canada, France and UK attest the workability of other systems that give the sick the better care and lower financial burdens. The PAP likes to scare us by saying that such system can only lead to higher tax - ideologically the PAP likes to keep income taxes low but that comes at a price of burdening those in need. In the 2011 budget the PAP govt cut taxes for the middle income, in essence, giving money to all those in this bracket including those who don't need the money. But why do this? The govt hurt the sick people in the same income category by implementing means testing....why take from those who need it most to give to everyone? This philosophy can only exacerbate the effects of the already large income gap among the populace and thin out what ever remains of any safety net for those who need it most.

Friday, February 25, 2011

This election, your life, your future....

Chiam See Tong on his Facebook [ http://www.facebook.com/group.php?gid=141268129239308] said:

"I ask myself today, what is my dream?
I can humbly say, my dream, at 75 years of age, is to be able to fly the flag for the opposition in Singapore by Fighting a Good Fight, to win a GRC in the coming elections.

Some people say to me, “Why do you still want to fight the next election in a GRC? It’s time to retire. It’s getting too hard for you.”

But you know, this isn’t a hard job.


In fact, it is harder to bring up a family with little income.
It is harder competing for jobs with foreign talents.
It is harder to look after a disabled child, or an elderly parent
It is harder to afford hospital bills for your family.
These, are hard jobs that Singaporeans are facing. And it will get tougher.

If Singapore Parliament is dominated by just the PAP, there will be a monopoly of ideas, and your voices may not be heard. I have chosen to fight my next election battle in a GRC, so that hopefully at least 3 to 4 other opposition candidates will be returned to Parliament together with me"

When Singaporeans go the ballot box in the not too distant future, they will ask themselves a few very simple questions - did my life improve in the last 4 years or not? Is it harder to buy the things I need? How do I make my life better in the coming years? For the common people, the govt's job is not to build a magnifiicent city (that they cannot afford) or grow the economy as fast as possible (by importing labor) or build the most extravagent sovereign wealth fund in the world or be the world class hub for everything under the sun. For the common people, the govt's job is to make their lives better. When a govt does not do its job of taking care of the people and life become harder because of that, that govt does not deserve our support.

When medical cost increased, this govts response was simply to pass on the increased cost to the sick and their families by implementing means testing increasing the financial burden of Singaporeans during the most painful part of their life. When CPF was no longer sufficient for old age due in part to bad policies of the govt liberalising it for housing, children's education and medical care, the govt pushed the burden to us by forcing everyone to buy annuities stretching our already insufficient retirement funds further. Public transport fares are hiked often when companies running them claim that operating cost has increased. The burden is passed on to Singaporeans who later find out that the profits of these companies have increased...so did the pay of their CEOs. The govt's desire to turn this into a city of 6M caused our population density to rise to the highest in the world above New York and Hong Kong. We are packed like sardines in the buses and MRT and our housing cost has escalated much faster than our stagnant wages - dashing the dream of the ordinary Singaporeans to own a better home.

The answers to the questions Singaporeans will be asking at the ballot box are very clear. We need to bring this govt back to focus on the people, their quality of life and the promise of a better future.

Market and Economic Update.

I haven't posted for a while because I'm busy looking through various economic and market indicators. I'll be back to discuss the more important issues soon as the General Election is just around the corner.

For those who are interested, these are some of the things I've been looking at and some thoughts on the market.

The above is a chart showing the Dow Jones performance va our STI. You notice the 2 charts are closely correlated until sometime in Nov 2010. Following that there is a divergence resulting in the DOW Jones Industrial outperforming the STI by a whopping 18% over the short period. I have not seen something like this except during the Asian Crisis. The reason for this is money has been pouring into EM (emerging markets) for the last 2 years as investors saw the promise of higher growth (vs developed markets) generating higher returns. Towards the end of last year, a new thesis took hold of global investors - developed markets are now better investments vs EM because the developing countries now have inflation and will need to tightien by raising interest rates & other measures. Such tightening will slow these countries' growth - developed western countries are now preferred because they are now growing and there is little inflation. Based on this, funds have sold off their EM holdings aggressively in a herd like manner for the past 2 months causing this huge performance difference between the markets.

Fueled by QE2 and inflow of funds from EM, the DOW saw an unusual continuous rise (with very few "down days") from the end of last year.

If you examine the thesis closely, there are few things to consider. The Singapore economy is an open one and hence we are exposed to global inflation - commodities, oil, food etc. Tharman's strategy is allow the appreciation of the S$ to keep out imported inflation. So why do our inflation numbers look much worse than those of US. The main factor I believe is housing. In Singapore we had a housing boom (bubble?) as the western developed countries are having a housing bust. The effects of the housing bust keeps the component of home prices and rentals down in developed countries masking the effects of inflation in food and energy. What I'm saying is things are not so good in US vs Singapore to see such a big gap in market performance. Our economies are inextricably linked and we typically go into recessions and recovery together. Remember this "decoupling" theory was suggested at the onset of the last crisis suggesting that Singapore can avoid recession as US & Europe sank into one - it was quickly proved false although our MM Lee said he believed it was true.

Singapore also has been lumped together with India and China, countries that have to raise interest rates aggressively to prevent overheating.

Going forward, I think there a few possibilities - the US markets falter and close the gap or US continues to perform or remain steady and investors start to be more discerning and some money start to flow back to developed Asian countries such Singapore and Hong Kong. Frankly, I don't really know especially in the short 2-3 months period but I don't believe the global economy is a healthy one in the longer term - just that it can look healthy for the short term when the US & European recovery pick up steam. Inflation is a real threat to the global economy and when it starts to show up in western developed countries, it can prove troublesome for economies and markets. Right now we are in a sweet spot for Europe and US. For those who missed the fine exits when the market euphoria took hold at the begiinning of this year, depending on how steadily the US & European economy recover, you may or may not have another nice (nicer?) exit in the coming months - I suggest you don't miss the next one....that is if there is a next one!

Saturday, February 19, 2011

Budget Goodies....2011

In 2006, the govt gave out up to $800 in cash as part of the "progress package". The money was deposited into Singaporeans bank account on 1 May 2006 and the election was held on 6 May 2006. The "progress package" cost the govt about $2.6B. It is hard not be happy to see cash in your bank account especially when you're poor and need money badly.

The budget goodies for 2006 is summarised below:

In 2006, the election budget took into account issues faced by Singaporeans. There was help for the poor, help for the elderly, rewards for NS men and so on. At that time, you would have thought that the govt was people or worker centered. But what happened in the next 4 years after the 2006 tells us that is not the case and we should not be taken in by budget goodies.

The 2011 budget removes the Radio & TV licensing fee which was something Singaporeans disliked and have demanded greater transparency for a few decades. If this has all along been a legitimate fee that was needed and fully expended for local productions that cannot be defrayed by the sale of advertisements, then what they needed to do was be transparent about it and show how the money has been used. Now that they have removed it doesn't it show that the fee was never needed in the first place. What happened to the hundreds of millions that was collected over the decades?

The 2011 budget like the 2006 overall does deliver some goodies - progress package, employer CPF contribution hike, HDB grants and so on[summary here]. The progress package will be paid before 1 May 2011 which means it is likely that we have the elections before May. Experience tells us that we will very quickly regret if we allow these goodies to sway our votes. The good intensions will quickly disappear and if they get a big mandate, they will take it that they can run the place the same way they did since the last elections. Just remember the torrent of fee hikes once the 2006 elections was won by the PAP - everything from GST to transport to minister's pay to kindergarden fees were raised in quick succession. We cannot let this happen again simply because we cannot allow the country to continue in the same direction as it has in the past 4 years. The quality of life of ordinary Singaporeans has deteriorated and we need some resolve as voters and citizens to set things right this time. Let not the euphoria of receiving a few hundred dollars take you away from long term considerations - the need to prevent our Singaporean identity from being destroyed by excessive immigration, the widening income gap, safety nets for the unemployed, poor, sick and old, and serious restructuring of our economy so that good quality jobs can be created for Singaporeans. If citizens repeat the mistake they made in 2006, the pain and problems will just expand and become harder to fix. The short-term quick results (for GDP growth) approach of the PAP has to end. We have to think about our future and our' children's future and choose the people who can help to reclaim it for us.

Thursday, February 17, 2011

Govt Performance in Numbers....

How did the PAP govt perform? Actually its not so hard to figure out. Lets leave aside all the untangible things like uncomfortable overcrowded buses and trains, the negative feelings generated by leaders who call us daft lazy lesser mortals, the higher stress level and insecurity caused by the large influx of foreigners. Lets just look at the cold hard numbers ....and what it means to ordinary Singaporeans.

Lets begin with the GDP. It grew by 14% last year. Median monthly income from work among resident households increased by 3.1 per cent last year to $5000. But after you adjust this figure for inflation the gain is only 0.3 per cent[Link]. Medical cost has escalated with class "C" wards costing 30% more than in 2006 (roughly 7% increase per year). Public housing rose 14.1%[Link] rising more than 60% within 4 years. Income gap has widened further[Link]. You probably figured the GDP can grow so much with improving the lot of ordinary Singaporeans because they did it by simply expanding the workforce by importing foreigners.

So it is all very simple. Wages have been relatively stagnant for ordinary Singaporeans while the cost of housing and medical care has risen sharply since the last elections. Ordinary Singaporeans saw their working hours rise to the longest in the developed world based on the ILO report [Link]. We have the 3rd lowest fertility rate in the world if you count territories (Hong Kong and Macau at the bottom) and lowest in the world if you count countries Quality of life of ordinary Singaporeans has been deteriorating. This deterioration started about a decade ago but most Singaporeans woke up to it only in the past few years.

Some of you may say a large part of it is due to globalisation. I don't share this view. The PAP could have done a lot better if it had effective policies in place to tackle these issues. At the end of the day it probably won't matter. When people's lives don't get better, they will demand change. 4 years ago, they were hoping for change from a new PM who looked like he all set to "remake Singapore". Today many have run out of patience and ready to vent their frustration.

I was in Penang in 2007 and 1999. When I was there in 2007, everything more or less looked the same as 1999 and that is why some Singaporeans like to go there - things don't change much. The island looked the same but I sense a change of mood in the people. When I took the taxi from the airport, I chatted with the driver and he sounded unhappy ... he told me the KL govt didn't take care of the people of Penang and wanted to shift the airport to Buttersworth (which was not be true?). He felt insecure although he had been doing what he was doing for the past 10 years. I ate at a restaurant the next day - was at the same restaurant on the previous trip there. I noticed the waiter and manager were the same people - a chinese feller working with an Indian chap. I chatted with the Indian manager I remembered from 8 years ago. After chatting for a while, he started talking about how the Indians & Chinese are sidelined in Malaysia. I was telling myself then that this "pro-bumi" thing had been going on for the last 40 years ...this guy was born into the system shouldm't he be used to it? ...Over the next few days, I spoke to a few more Penangites and they were unhappy with the govt but their actual issues were all different i.e. the unhappiness was not very coherent in terms of actual issues. The thing they had in common was this feeling that the govt didn't care about them....they were not hopeful the govt would solve their specific problems. I carried with me this suspicion that something had gone wrong in Penang when I left the island. In March 2008, when the Malaysians had their general elections, I wanted to write about my trip experience and that there might be a swing in the votes. However, when I ran through the news reports at that time, the overpowering belief at that time was that an opposition win was simply not possible although they were expected to do better so I thought my suspicions were unfounded. The huge win by the Penang opposition was completely unexpected by pundits.

If you have been talking to people, the ordinary folks in Singapore - taxi drivers, hawkers ...the man on the street, you get a sense that certain thresholds have been crossed and there is feeling that patience has expired. Many have waited hoping that their problems will be solved or get some help solving them but you sense that the people already realised that they are not this govt's priority. This is a govt that would give out thousands of scholarships to foreigners but does not ensure its own citizens get quality pre-school. This is a govt that advertises Singapore as a medical hub to attract and treat foreign patients [Link]but tell its own citizens to go to Malaysia for medical treatment and nursing homes if they want to more affordable care. 4 years ago, people still had some hope that this govt will turn around and put the people 1st in all its decision making. ...today there is little doubt that this govt will not and cannot change. That is the hard truth that common people have discovered in the past 4 years. ..and their quality of life has deteriorated and will keep deteriorating until they do something about it.

Tuesday, February 15, 2011

The one really unavoidable hard truth....

Picture taken from ALVINOLOGY[Link]. It is a little morbid but if you use the Google auto-search suggestion for "When will", the 1st one on the list is when will the great man leave us, Google's autosearch suggestion is based on the frequency of search phrases. Apparently, the one about MM Lee is the most frequently asked question by Singaporeans. I do not wish our MM ill although I disagree with many of his ideas.

If you want the cold scientific answer to this question, it can be found in an actuarial life table[Link]. The quick way to work out the probabilies is to look at collumn 3. Column 3 shows the number of people still living starting with 100,000. When you're at age 87, 24000 people will be left. When you get to age 92, only 10,000 remain i.e. more than half the men who make it to 87 will not get to 92. When a man age 87, you have roughly a 13% chance of going the next year and that rises with every year.

MM Lee has worked very hard all his life. Whether you agree with him or not, his impact on our lives has been great. Although he once said he will rise from the grave [lLink] if something goes wrong with Singapore, it is time we start learning to live life without him around simply because he cannot be around forever....and this is the one cold hard truth that cannot be avoided.

Sunday, February 13, 2011

Papers put the spin on sick going to Malaysia....

If your healthcare system is not universal and becomes so expensive that citizens have to go to developing country for treatment, it is a tragedy not an achievement. However, if you read today's New Paper, it seems to be saying the MOH has helped Singaporeans to save money by allowing them to use their Medisave for hospitalisation in Malaysia. All of us have to thank Minister Khaw for this flexibility of being able to save money by travelling to Malaysia when we get sick.
The article doesn't ask about adequency of govt support for poorer Singaporeans when the cost of private care in Malaysia is less than half (according to New Paper) that of subsidised care in Singapore. It doesn't ask why these people have to go to Malaysia to save money when Minister Khaw can get his heart fixed for $8....so poor people pay more and rich millionaires like Khaw get cheap healthcare - there is certainly a moral issue here. The New Paper article is filled with smiling patients who are happy to save money going to Malaysia for treatment but I believe the story in many real cases sound more like tragedies. Take Singapore singer Yue Lei case as an example[Link]. He had to sell his home and go to Mahkota Hospital for cancer treatment because healthcare in Singapore is too expensive. Singapore often boast of having one of the highest standard of medical care in the world but when the govt wants to keep its expenditure on subsidies down by sending poorer sick Singaporeans to Malaysia, it says the standard of care in a developing country is just as good as Singapore's. Being able to get poor Singaporeans to go to developing countries for medicak care takes the pressure off the govt to do more to contain costs and ensure universality in our system. We shouldn't have allowed this ...it is a tragic development for poor Singaporeans who get sick and don't get adequate help.

Saturday, February 12, 2011

Mubarak Resigns...

I was reading the BBC report on his resignation and found this:

"Mr Mubarak ruled for 30 years, suppressing dissent and protest, and jailing opponents. US President Barack Obama said that Egypt must now move to civilian and democratic rule "
- BBC Report[Link]

The current bout of overthrowing dictators around the world reminds me of how democracy was brought to S. Korea and Indonesia during the Asian crisis. Dictators and strongmen hang on to power by suppressing opponents and tweaking the election system so that those who oppose them cannot get elected. Unhappiness festers but the country carry on with the system so long as the economy is okay. Then some kind of serious economic problems emerge and galvanise the people to move into the streets. In Egypt it was explained that the high fertility has resulted in a large population of young who cannot accept the authoritarian govt and the Internet + social media help to fuel the current unrest.



But do you know what was the trigger given these people hate Mubarak so much they can't wait to get him out? Some people have called this the Bernanke Revolution. In Egypt, household spend 60% or more on food. When Bernanke implemented his QE2 in Aug 2010, food prices went through the roof



Source : Link

When people suffer economic pain under authoritarian govt, they quickly point to the govt which controls a vast amount of the nation's resources. Especially so in countries with big income gaps where wealth is unequally divided - very often correlated how closely linked people or businesses are to the govt. In Egypt's case, the rising food prices caused much of the economic pain among the people. They are not going to be bothered with who or what actually caused the rise in food prices. They hate Mubarak so he must go....they blame his 3-decade rule for widespread poverty. In a democracy, with freedom of press and information, governments have to make continuous adjustments and be sensitive to the people's demand. When a crisis occur, it can result in a change of govt but seldom a big change in the political system.

History shows that systems that depend on repression often see a build-up of dissatisfaction with govt that result in abrupt sometimes violent changes. When you need to use some segment of society to repress another, you have to reward people for loyalty so they are willing to carry out the injustice for you. There is the dirty work of spying, detaining opponents without trial or on trump up charges or thinking up policies that serve your interests. After a few decades, you find that intelligent people with principles don't want to have anything to do with you and you need to pay people more and more to get people to join you. You end up recruiting from a narrower and narrower base to as you go along because you can trust only those who benefitted the most from your repressive rule and ultimately these are people linked to your govt who have shown loyalty to you and your system rather than pure competence in serving the needs of the people. The common man whose lot has not improved will find it harder and harder to accept that you need to give out so much benefits just to hold up a system from which they derive little benefit. At some point, they will just say enough is enough...and you or your system will have to go.

Thursday, February 10, 2011

Expected List of New PAP Candidates for coming elections...

Except for 2, most of the new candidates are from GLCs or banks.

It is likely that all of them will serve as part-time MPs given their current high paying jobs which they will probably keep. I believe Singaporeans' problems now require full time attention not part-timers. We need more MPs closer to the ground not more of the same corporate high-flyers who will seek to maintain the status quo. I guess the people who really care about changing the system to benefit Singaporeans will emerge from parties other than the PAP.

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ONG YE KUNG Assistant Secretary-General, NTUC

TAY LIM HENG Deputy CEO, Keppel Integrated Engineering

OON JIN TEIK Outgoing CEO, Singapore Sports Council and Incoming Group Executive Vice President, Hyflux


TAN SU SHAN Managing Director and Head of Private Banking, DBS

DR JANIL PUTHUCHEARY Medical Director, Faculty Development, Duke-NUS Graduate Medical School & Senior Consultant, Children's Intensive Care, KK Women's and Children's Hospital (KKH)

DR TAN WU MENG Department of Medical Oncology, National Cancer Centre

LAM PIN WOON Ex-CEO, Health Promotion Board

TAY PING HUI Actor, Mediacorp

FOO MEE HAR Global Head, Premium Banking, Standard Chartered Bank

MARY YEO Vice President, Supply Chain Operations, South District, UPS

ABDUL RAZAKJR Consultant Cardiologist and Clinical Director of Cardiac Electrophysiology and Pacing, National University Heart Centre

DESMOND CHOO Deputy Director, Youth Development Unit, NTUC

VIKRAM NAIR Associate, Norton Rose Asia

GAN THIAM POH Senior Vice President, Institutional Banking, DBS

Sunday, February 06, 2011

High Cost of Medical Care in Singapore....

Leong Sze Hian recently wrote a letter to the Straits Times forum asking about the large jump in the size of class "C" hospital bills [Link]. In my blog, I've highlight numerous cases of families (that are not rich) shouldering enormous healthcare burden due to either cracks or inadequecies in the system. In the past 4 years, class "C" bills have nearly doubled and this escalating cost hit the sick and their family really hard. The latest case being that of Olympic hero Tan Howe Liang's wife who had breast cancer [see article below]- fortunately an anonymous donor came the family's rescue.

The MOH's reply to Leong Sze Hian generated by its PR (Corporate Communications) dept dismisses his concerns without addressing the real issue.
-----------
Class C wards are highly affordable
[Affordable? In the same sense that HDB flats are affordable?]

MR LEONG Sze Hian seemed to disbelieve that C-class patients would know to ask for non- subsidised drugs and implants ('Puzzled by spike in unsubsidised items for C-class patients'; last Wednesday).
[Mr. Leong wrote that he found it hard to believe the MOH explanation that the bill increase is caused by patients asking for unsubsidized medicine and implants]

There was a time when C-class patients were largely lowly educated and ignorant of treatment options. This has changed over the years.

Many subsidised patients are now well-read and often come with Internet printouts about alternative treatment options. We welcome this development as better informed patients can participate more actively in their treatment, especially where lifestyle changes can make a critical difference to their health outcome.
[This reply is really hard to believe. MOH is saying that doctors in class C ward do not offer patients the best treatment options and patients look it up themselves on the Internet? Even if what MOH said is true, why is so much of the better treatment unsubsidised? ]

With more than 42 per cent of all admissions to restructured hospitals opting for Class C wards, many are clearly not from low-income families.
[When I was hospitalised about a year ago, I also asked for class C because I was unsure what was wrong with myself and terrified of falling through the many cracks and getting hit by a enormous bill. Although class C does not ensure it will not happen, class B, B1 & A will be far worse. It is cause by fear of this system more than anything else and more people are now aware of the problems of our healthcare system. When I was in C ward, I was surrounded by people who appear to be from low-income families. No I did not look up the Internet to ask for unsubsidised treatment, I received very little subsidy anyway since I was means tested. Part of the reasons for the bill increase could be due to subsidy reduction due to means testing as the cost of healthcare escalatesm ]

To keep health-care costs low, our policy is to prescribe standard drugs and cost-effective implants for our subsidised patients. However, where the patients have expressed a strong preference for such non-standard items despite knowing that they will have to pay for them, we will meet their requests. [Trying to blame the sick for their healthcare financial burden is more than just a little inhumane. Why would patients ask for treatment and doctors willing to carry it out if it does not improve the quality of lives and odds of survival of these patients? Classifying treatment as standard and non-standard to exclude them from govt subsidy then blaming patients for high cost is an uncompassionate way to treat the sick.]

They assess that they can afford these non-subsidised drugs and implants as they are covered by both Medisave and MediShield, subject to certain limits.
[So those who cannot afford it don't get the better treatment?]

The reality is that Class C wards are highly affordable. Where is the evidence?

The average Class C hospital bill is about $1,600, equivalent to less than one week of the average household income. Eight out of 10 Class C hospital bills are fully covered by Medisave withdrawal limits. With MediShield, the vast majority of Class C patients do not have to pay anything out of pocket.
[I've pointed to the flaw of using average bills, 80 percentile bills as an indication of affordability. A typical hospital see numerous small cases of people warded for observation, minor surgeries etc. If you've stayed in hospital, you will know that severe cases such as ICU, major surgery etc form a small number of cases and for many people, it is a "once in a lifetime" illness. What is important is the size of these large bills - the top 5% or top 1% - how much they rise over time. Because it just take one case in a family to severely burden them. Looking at average bills then concluding that it is affordable is incorrect. Look at the previous case I posted in which standard Medishield which was designed for catastrophic illness is now inadequate because of the payment limits are too low given how much medical bills have escalated for serious cases.]

Mr Leong cited a $90,000 Class C bill. Such bills are rare and are usually the result of very long stays in the intensive care unit. The rational way to protect against such a catastrophic event is insurance. MediShield offers such coverage at very affordable prices.
[Enhance MediShield not MediShield may be sufficient for serious cases. Because of pre-conditions developed between the time MediShield was launched and Enhanced Medishield is introduced, many cannot upgrade because insurance companies won't accept them. Others can't do it because of much higher cost due to age...many have not done so because the MOH keep misinforming them that MediShield is sufficient when it is not. Otherwise, why was it necessary to introduce Enhanced MediShield? In this letter, MOH again misinforms by saying MediShield is sufficient. Even for MediShield, almost one in 5 (or 6) don't have it...so how many have sufficient Enhance MediShield coverage?]

Where patients have no or insufficient insurance coverage, we still have Medifund as a last resort.
[There is big gap between Medifund and your ability to get it. If you look at the strict criteria for Medifund, you would have to lose most of your assets due to illness before you can touch it.]

Our 3Ms (Medisave, Medi- Shield, Medifund) approach to financing health care is the correct answer to rising expectations for high-quality health care.
[Rising expectations? Oh come on. It is rising cost for the same expectations. Sometimes this type of PR people tactics is just to frustrate you with words. She again blames rising cost on rising expectations. What is really rising is the cost ...the same treatment cost far more today than it did 4 years ago]

Patients can do their part by staying within 3Ms and accepting their doctors' prescription of lower-cost alternatives. Most Singaporeans do.
[If most Singaporeans do, then how did it cause the near doubling of class C hospital bills. She shoots herself in the foot because she said many are asking for non-standard treatment earlier]

Karen Tan (Ms)
Director, Corporate Communications [We should make Minister Khaw answer for his policies. We should not accept this type of disingenous reply to genuine concerns of Mr Leong].
Ministry of Health

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Help for Olympian Tan Howe Liang
By Patwant Singh Posted: 05 February 2011 2033 hrs

SINGAPORE: An anonymous donor has donated an undisclosed sum of money to Singapore's first Olympic medallist Tan Howe Liang.

In a MediaCorp exclusive last December, it was reported that Mr Tan's wife had undergone surgery for breast cancer and the subsequent treatment had set the family back by almost S$100,000.

Now an anonymous donor has come forward to present the former weightlifter with an undisclosed sum of money.

The contribution was facilitated by the Singapore National Olympic Council, which said the amount given was sufficient to meet Mr Tan's needs.

Other parties had earlier expressed interest in wanting to help the Olympic hero.

NTUC FairPrice is looking into an ambassador role for the 77-year-old to promote healthy living and active ageing. An announcement on this could be made soon, said the company's chairman Ng Ser Miang.

Mr Tan became Singapore's first Olympic medallist when he won a silver in weightlifting at the 1960 Rome Games. He currently works for the Singapore Sports Council as a gym supervisor.

The Olympians Singapore, an exclusive group of former and current athletes, also recently said they are planning to raise funds for the former athlete.

- CNA/ir

Tuesday, February 01, 2011

Lessons from Egyptian crisis...

UPDATE: I was quite baffled when I read that Mubarak actually won the 2005 presidential elections. Given his unpopularity now, it is quite surprising that he won 80% of the 2005 election votes. Here is how he did it[extracted from Wikipedia]:

Under the election law, parties proposed candidates for the election, which were reviewed by the Presidential Election Commission. Of the 30 proposed candidates, only 10 were allowed to participate in the presidential election by the Presidential Election Commission. One prominent candidate not allowed to run was Talaat Sadat, the nephew of former President Anwar Sadat, who appealed his disqualification unsuccessfully.
,,,,,,
According to a late August report by the Cairo Institute for Human Rights Studies,[4] media coverage was biased in favour of Hosni Mubarak
.....
there appeared to be official harassment of the leading opposition candidate Nour, who was stripped of his parliamentary immunity and arrested on January 2005, on what many observers regarded as trumped-up charges.
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There were also accusations of vote rigging. Harassing and arresting political opponents to send them to jail, control of the media, and using various means to exclude strong candidates from running gave Hosni Mubarak 80% of the vote and a false sense of confidence. His support base was actually crumbling fast and he didn't even know.

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After 30 years in power, Mubarak is not without supporters. Here is a report on a small pro-Mubarak rally : Link.

Here is a shouting match between Mubarak supporters and an anti-Mubarak crowd. The remarks below sums up why people still support Mubarak:

"Really," screamed a woman in a burgundy abaya and black hijab. "God damn you all, you stupid people. We'll all starve in less than a week if Mubarak goes. He is stable; we will be at each other's throats if he leaves." [Link]


Why Mubarak is opposed is summed up is the following paragraph:

"The government's self-declared crowning legacy has been its economic achievements: rising GDP and a surging private sector led by a construction boom and vibrant, seemingly recession-proof banks.

But many say the fruits of growth in this formerly socialist economy have been funneled almost entirely to a politically connected elite, leaving average Egyptians surrounded by unattainable symbols of wealth such as luxury housing and high-priced electronics as they struggle to find jobs, pay daily bills and find affordable housing
." - Full Article :here.

and this one:

The widening chasm between rich and poor in Cairo has been one of the conspicuous aspects of city life over the last decade — and especially the last five years. Though there were always extremes of wealth and poverty here, until recently the rich lived more or less among the poor — in grander apartments or more spacious apartments but mixed together in the same city.
- CNBC Protests in Egypt Expose Rift Between Rich and Poor [Link]

Reading this report, I gathered that Egypt's income gap has to be horrendous given than many observers feel that it is one of the main causes of the protests in Egypt.

Checking the Wikipedia on Income Gap[Link]:

Singapore RP 10%=17.7, RP 20%=9.7, Gini=42.5 (year 2008)
Egypt RP 10%=8, RP 20% = 5.1, Gini =34.4 (year 2000)

RP 10% is the ratio of the average income of the richest 10% is to the poorest 10%.

Although the data for Egypt is older, it shows that our recent figures for income inequality is far higher than Egypt's in 2000. The problem with Egypt is the median income level is much lower and those who are poor probably difficulty fill stomachs, the high unemployment levels drove many to desperation and recent rise in food prices was the last straw for the Egyptians[Read The Hidden Roots of Dispair].

Egypt may not be better off after Mubarak goes - there is a real fear the country may fall into the hands of more radical elements and destabilise the whole middle east but people whose hopes for the future are dashed and stomachs are empty have little to risk and will opt to reshuffle the deck through regime change.

Lets not forget Egypt 6 months ago was peaceful on the surface with little signs that protest of this scale would erupt. It is believed that the toppling of the dictator in Tunesia ignited the protests and only recently the deep unhappiness with Mubarak became clear and visible. Mubarak's first reaction was to shut down the Internet and mobile networks because modern communications is probably how people in Egypt come to the know to understand the real situation in the country.

Unless Mubarak opts to hang on to power by violent means, he has to go because the majority of people wants him out. He hung on to power for decades by controlling the media, repressing opponents and conducting unfair elections with rules heavily stacked against opponents. These methods commonly used by dictators can only repress the unhappiness among the people for so long. Although Mubarak did not try displace his own people economically by importing foreigners in large numbers, his propaganda machine is probably not as efficient as those in some other country and with a population size of 82 million, Mubarak has a far more difficult task keeping the country under control.