I want to know what alternative you have. I have laid out the
implications of a two-tiered healthcare, one for the poor with very
basic but cheap healthcare and one for those who can afford the
first-world standard of medicine that people like fymk
expect..
I still do not know if you and Singaporeans in general are prepared
for a lower standard of healthcare without the patented drugs,
without the high-tech medicine, as I have laid out. It makes no
difference to those with minor coughs and cold, which resolve
without treatment anyway...but it may mean that the poor person
unfortunate enough to contract a bacterial infection that is
resistant to all the common, generic antibiotics will die. It means
that the woman with early breast cancer has to live with a 60%
chance of cure instead of 80% and so on...
Are we prepared for that? For those who want healthcare to be
cheaper than it is now, do they have the moral courage to accept
the implications of a cheaper, 'more basic' healthcare?
Is Singapore's model the best - with Singaporeans being made to
pay for their needed medical attention, especially at your stated
"secondary and tertiary levels" ?
Do you have an alternative? Are you and Singaporeans prepared to
pay higher taxes to fund a system like the NHS in the UK or a
co-payment scheme like in Finland with taxes that are many times
what we pay?
And I understand that almost 40% of Singaporeans do not pay taxes
after deductions (housewives, low income etc). The tax burden will
fall on the middle class that is already hard pressed. Is that
fair? With an aging population and a shrinking workforce, how are
you going to fund a welfare system without massive
immigration?
In a report prepared by the National Center for Policy Analysis
- "Medical Savings Accounts: The Singapore Experience" - it was
stated that Singapore only spend
"..... about 3.1 percent of gross domestic product. Even with these
low expenditures, the income of Singapore doctors is about the same
in relation to average wages as
physician income in the United States ..."
And what are those figures? Look at this website which has
listed the salaries of US doctors from various sources:
http://hypertextbook.com/facts/2004/TiffanyYam.shtml
The latest figures from "Physicians and Surgeons. Medical Group
Management Association, Physician Compensation and Production
Report, 2003" gives a figure between USD$150,267 - $306,964 per
year. The lowest is that of the GP at about 150k a year and that is
considerably more than what many GPs in Singapore are
earning.
The reason is that if you look at average wages, you do not see the
big picture because the high salaries commanded by a minority
(mainly surgeons, O&G doctors) obscure the true income of the
majority. It is a basic error in statistics...Particularly in
Singapore, where there is a huge discrepancy in salaries between
different specialties and between doctors in the private versus
government sector, you cannot talk about average wages...the median
or mode will give you a better picture...
"Because mandatory Medisave deposits are a percent of wages,
deposits are smaller for lower-wage workers, and the least affluent
may not be able to pay much out of pocket. Thus the combination of
out-of-pocket, Medisave and Medishield payments may not cover all
of their medical expenses.
Everyone knows that but what is the alternative? Welfare states
that fund a comprehensive system based on taxes are finding it
difficult to cope all over the world. With an aging population in
Singapore, we will face a similar problem with such a scheme. Would
tax payers in Singapore be prepared to pay more for those who do
not? There are people like fymk who feel that there must be more
individual responsibility as well. Surely smokers should pay more
for the consequences of their habits..
If the Government can hand out BILLION Dollars in refunds from
surplus tax collections - would it not have been more effective for
the Billion Dollars to be placed in a NATIONAL HEALTH "SINKING
FUND" so that those who need it most will stand to benefit from it,
rather then placing the entire family in desparate situation to
source for funding at the last minute.
Do we have billions in surplus tax collections every year? What
about the years when we go into deficit? Tell the patient with
cancer to wait for a good year before he gets treated?
Relying on surpluses to fund a healthcare system is no better than
the chronic gambler hoping for a 4-D strike to put food on the
table.
It is important to mention here two widely prevalent "myths"
(particularly among the policy makers): one is that greater access
to better medical care and containing cost of care do not go
together. To put it differently, if you are to have the finest
medical care system, be prepared for high costs.
The second myth (some would call it "public expectation" recognized
by many scholars, is that high technology is essential for improved
health and longevity.
If you have read my earlier posts carefully, you will note that
studies have shown that although there is a general trend globally
that with greater health expenditure, life expectancy increases,
the correlation is not perfect. In this respect, Singapore has done
better than Sweden and the US. The US spend more money on
healthcare with the least improvement in life expectancy.
So I agree with your first myth but is life expectancy is only
relevant measure? Does it matter if one stays in hospital for a
shorter period and with less pain following a keyhole surgery
compared to a long incision? An improvement in survival of 3 months
may not be cost effective for the thousands you pay. But is it
worth it? Why don't you ask the patient?
Not being a medical doctor yourself I don't expect you to
understand how advances in technology has transformed healthcare.
But you are still avoiding the question. If we restrict non-patent
drugs (drugs lose their patent protection after 20 years) to
patients in public hospital, we can lower healthcare costs
tremendously. If we combine that with outsourcing lab tests to
non-accredited labs overseas, employ cheap foreign doctors who do
not hold similar internationally recognized qualifications of our
doctors, we can lower healthcare costs in public hospitals even
more.
Is that what you want? Do Singaporeans want that? It is easy to
criticize but are you prepared to accept the implications?