The debate

Dear A,

I truly believe that Singapore has a good government in place which can listen to the public. Compared with many places in the world, the model especially in healthcare, is sustainable and will not bankrupt the nation in the long run. I know you think differently.

B

Dear B,

I disagree with you that we’ve a sustainable model. This country used to have far-sighted leaders who thought out of the box and came up with innovative solutions. Many people mistakenly associate the current leadership with the first generation leaders (and BTW LKY is only one of them and I wouldn’t even give him much credit), but too bad subsequent leaders including incumbents have squandered all the achievements away.

Since you bring up healthcare, yes I agree the medical standard and services are pretty much world class. But the crux of the problem lies in financing. I suppose you know that healthcare only makes up 3% of governmental budget, less than defense (which I don’t get for the life of me). I’m not sure if you’re aware that there’s now a discussion on a nationalized healthcare plan and revamping of eldercare to make it more comprehensive. The truth is the government hasn’t been spending much on healthcare because they pass the buck to the people. (That’s why the healthcare system here will not ever bankrupt the nation. With many years of budget surpluses, the country is rich but one too many persons are living from hand to mouth, up to their necks in debt.) Has there been any independent study done on the healthcare cost borne by the average households here? There’re a number of people out there, particularly the old folks, who are not seeking medical check ups and treatments because they are afraid of burdening their families. You mentioned before that there’re various safety nets available. Well, these nets have large holes and the bureaucrats make the average Joe pay for measly aid with their dignity. And not to mention, Medishield (the national hospitalization insurance) doesn’t cover pre-existing conditions, congenital illnesses and mental illnesses. I don’t want to ramble but I can tell you that this place looks better than it is, because there’s no independent media and a lot of the bad stuff is swept under the carpet.

A

Dear A

I have to disagree with you on your sensationalization of the healthcare situation in Singapore. If a country can spend 3% on healthcare and achieve this outcome, I will say why not. Especially when compared to the many countries where healthcare is much inferior.

You may think that I am a rich doctor stuck in an ivory tower. But I see subsidized patients and used to do many subsidized cases. Nothing causes me more pain than poor patient not being able to afford appropriate care. Trust me that what you described is pure sensationalization.

B

Dear B,

First of all, I want to apologize for quoting the wrong number for healthcare spending as a percentage of GDP. It turns out to be 1.5%, and not 3%. You might be tempted to think, “wow! This is even more fantastic! The government has found a way to turn stone to gold.” So are Singaporeans such a healthy and fit bunch that they hardly spend on healthcare? Or are they actually the patsy whom the government has passed the cost to? I received an article link this morning published in the Straits Times yesterday, Are We Ready For The Future. This is an interview with the former Chief Economist of the Government Investment Corporation of Singapore, Mr Lam-Keong Yeoh. He was shocked that Singaporeans have to bear 55% of the healthcare cost out of their own pocket (and the rest from self-financed insurance or state), far higher than the average of 25% in other advanced Asian economies such as Taiwan and Hong Kong, and definitely higher than the WHO recommendation of 33% or below. In addition, the situation in Singapore is even worse because the bulk of medical insurance is financed out of own pocket and using Medisave (self financed pension fund) and not state funding. Being a former senior government economist, Mr Yeoh realizes there are a whole lot of serious problems plaguing the country that require addressing soon.

I don’t know why you said I’m sensationalizing the healthcare cost problem since you didn’t provide any supporting evidence to the contrary. Singaporeans face rising healthcare cost due to many factors: limited supply of doctors, high drug cost, under investment in healthcare facilities such as hospital beds, and medical tourism, etc. (You even mentioned in your reply that you had seen many subsidized cases.) And on top of healthcare cost, the people are made to bear with higher inflation as a result of rising housing and transport prices due to mass influx of foreigners. Coupled with stagnating wages, this makes for miserable living conditions for Singaporeans and possibly cause insufficient retirement funds. It’s no wonder birth rate is so low. To make it worse, the government cited low TFR as a reason to continue import foreign workers, so the vicious cycle carries on, potentially paving a road to economic hell.

You have asked a number of times what is the alternative. Well, Professor Tommy Koh (chairman of the Centre for International Law and Rector, at the National University of Singapore) has made some sensible suggestions that we can learn from the nordic countries in this article, What Singapore Can Learn From Europe. Mr Yeoh said in his interview that there is room to raise the income tax, and Prof Koh mentioned the Gini coefficient number, that measures income gap, is too high in Singapore. Both points are interrelated. The rich are paying less than what they should contribute to the economy, whereas the poor and middle-class are paying more and more as a percentage of income as taxation moves regressively towards higher GST, not to mention other implicit taxes. Hence, many people are squeezed by high and rising cost of living and yet are made to pay for the bulk of their basic needs with their stagnating wages. Yes, the government coffers are full, as a result the country will not go bankrupt but how is this sustainable in the long run for the country?

Personally I feel that if structural changes are not made to the economy, the best days of this country are over. There is a parable that can best describe yours and the government’s mindset: in the depth of winter, the emperor dressed in a thick fur coat asked his advisor, “hey, the weather is not really that cold. Why are the people complaining?” The advisor answered him, “Your highness, you’re dressed in a fur coat. The people can only afford a thin jacket.”

A

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