Well, as I promised, here is my rebuttal to Prof Tambyah's speech at the SDP rally.
The first few paragraphs are populist rants and jibes which I have come to expect for rally speeches, so let's get straight to the meat.
Prof Tambyah asks how many Singaporeans "can afford to pay $250 a day or $7500 a month for medications for three to six months on top of the needs of their own families". Well, $7500 over six months translate to $45,000. Now if you lived in a private condo, and needed $45,000 to fund something in your life, what would you do? Do you expect other Singaporeans to help you pay for your need?
What if someone who lived in a private condo who needed $45,000 took some money from you without your consent to fund his need? Do you think that is fair? Wouldn't you ask him to explore other options of raising that money before he took it from you? Cut back on some discretionary expenditure? Sell some assets? Borrow from friends and families? Or even downgrade to a less costly home, perhaps? Charity? Why should "get someone else to pay" be the "solution" of choice?
Now ask yourself why things should be different when it came to healthcare?
It is easy to say "ask the government to fund", "ask the medical social worker to help", but we need to recognise that at the end of the day, that money come from all tax payers. By demanding that others pay for our healthcare, we are making our own health other people's burden.
2. Primary Care Proposals
It is perhaps impossible to get precise statistics on this (so feel free to ignore this section if you disagree with my basic premise), but our outcomes in the management of chronic diseases at the primary care level does not fail at the level of access or provision, but at patient compliance. Our polyclinics are already staffed with nurse managers, nurse practitioners, dieticians, physiotherapists, podiatrists, psychologists... all charging nominal sums for their advice and treatment. But ask your friend who works in a polyclinic what the take-up rate for these services is like.
Patients can afford these services which will help them understand and manage their health better, but they choose not to. Their health is not a priority to them when their diseases are still in the primary stage and they choose to invest their resources elsewhere; but when complications set in as a result of their decisions, it suddenly becomes everyone's problem?
It is often said that GPs go into aesthesics to make ends meet - I prefer to think that they do so because aesthetics is more lucrative. And that aesthetics is lucrative tells us two things: 1. Singaporeans are not too poor to afford healthcare that they want, and 2. Singaporeans choose to spend on aesthetics.
Can the government make GPs stop doing aesthetics by lowering HDB rents? Well, ask yourself this: if you are running a tea stall selling tea at $2 a cup and people are willing to pay for it, will you lower your price to $1 just because your landlord lowered your rent?
The reason why GPs can do aesthetics is simple: people can afford aesthetics, and they are willing to afford it. If patients are willing to show that they are willing to afford good primary care, then GPs will return to providing good primary care.
My take on the speech overall?
It is true that healthcare can be expensive - if your health is valuable, then why shouldn't healthcare be expensive?
But is primary healthcare really out of reach to the average or low-income Singaporean? No. I reiterate my point that the key barrier to good control of chronic diseases at the primary care level is compliance and not access or cost.
Look at what Singaporeans spend on instead of investing into primary care, or setting aside for catastrophic illnesses: cigarettes, alcohol, hairdo (yes, I actually wrote that word), iPhones (what, you think iPhone users don't get diabetes?), that year-end trip to Perth - show me a polyclinic doctor who hasn't had a patient who can afford to go on a year-end holiday in Australia ask him or her for subsidised travel medication.
Cases like that related by Prof Tambyah are not unique, but it is disingenious to conclude from that one anecdote that Singaporeans are dying at a massive scale for want of healthcare, and that our healthcare system is heartless or has failed. Prof Tambyah wants you to think about the patient with a stroke and his son who lives in a private condo, I ask you to think of all the Singaporeans who by paying tax have a little less of the money they have earned themselves to spend as they wish to, to invest in their own health and their own future. If they wish to help, they can always donate to a charity - but to say that they must help? Is that fair?
What I do agree with Prof Tambyah though is this: Dr Vivian Balakrishna is an excellent ophthalmologist. I too think Singapore will be better if he returned to clinical practice.