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.
1. Medisave
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?
3. GPs
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.
34 comments:
Not too sure if Dr. Balakrishnan is still excellent after being away from clinical practice for so long.
But I agree with the points you've made.
Thanks for the thoughtful analysis. This point of view is quite a prevalent one especially among those who believe in the "moral hazard" argument - if you subsidize healthcare too much, people will abuse the system.
I have asked every government leader I have met (and the panel in parliament at the NMP interview!) the same question: "Do you really think that providing free treatment for children with leukemia is going to encourage children to go and get leukemia just so that they can enjoy the free treatment??"
I have never got a satisfactory answer to that somewhat rhetorical question. Usually there is some attempt to justify rationing on the basis of resources being limited. To that, I respond that treatment of leukemia and other childhood illnesses is surely one of the most cost effective measures - this is something that the good Mr Mistri knew when he donated the Mistri wing for near-free pediatric care for all Singaporean children in the old SGH (now Heart Center).
We all pay a price for citizenship. We are generally willing to pay a certain level of taxes for fancy high tech military toys or F16s. My gut feel is that many people would be willing to divert some of that to ensure that no child has to bankrupt his or her parents because of illness, no person who acquires an infection in hospital has to pay the astronomical sums charged for non-standard broad spectrum antibiotics etc. Of course the alternative to this is a functional national health insurance system proposed by some of the alternative parties similar to what works in France...Until we get there, simply removing the anomalies of the subsidy system seems to be a good first move.
I notice you did not comment on the forces driving young docs out of institutional practice. Or do you think we should pay our public sector doctors millions of dollars to make them stay on?? :-)
Paul Ananth
ps Vivian looked after my wife's godson and he loved him! He was so disappointed when he lost his ophthalmologist to politics!
I was almost surprised to find that this post was written by a local doctor. Almost.. because I then realized this was the same doctor who defended his colleague's $25 million bills to Brunei's royal family sometime ago in comments to a previous post. I wonder what happened during the course of your medical training and career such that hard coin is the only currency you seem to value? Would you kick a sick child out of your clinic because his/her parents could not pay your price? What would happen if all local doctors thought like you?
You blame the inability of many people to control their chronic diseases on lack of compliance. That may be true, but perhaps you should take this one step further. Why are these people non-compliant?Why are they - as you say - underutilizing the available services in the polyclinics? Are they stupid and unthinking? Is there something wrong with these services or the education they are given? Perhaps the polyclinic doctors or nurses are too busy to actually discuss their diseases with them? Perhaps there are so many foreign doctors in our polyclinics that it is hard to find one who can speak their dialects or that they are comfortable with? What do you know of the barriers that the people face such that you dismiss them so easily? Just because a few people are incorrigible, it does not mean that others cannot be educated about their health.
Perhaps polyclinics are providing the primary healthcare services at a price that the GP's are unable to compete with. Therefore many have had to turn to aesthetic medicine. It is lucrative for now but eventually the oversupply will drive down prices for all but a few, and force some out of the market. If you studied 5-6 years of medicine, trained in the public sector, went out to be a GP, and then went into aesthetics - well, you might do well financially but you might as well have started off as a beautician and/or opened a spa. Many doctors get away with unlicensed treatment, over-treatment and overcharging simply because the private sector is so poorly regulated. Be careful lest medicine becomes just another service, and doctors become just like that property agent or car salesman.
Come now, Prof...
To your question:"Do you really think that providing free treatment for children with leukemia is going to encourage children to go and get leukemia just so that they can enjoy the free treatment??"
I ask: Do you think that increasing spendning in primary care/polyclinics is going to prevent that child from getting leukaemia?
You (and SDP) are conflating the issues here. You give the example of people in financial difficulties after having a catastrophic illness, yet say that the solution is to improve primary care; this brings up a couple of issues.
Now if you think better primary care results in fewer catastrophic illnesses, then you must admit that personal responsibility in accessing and complying to healthcare is part of the equation. But if you say that people do not always have control over whether they get a catastrophic illness, then investment in primary care doesn't matter, does it?
The truth is the reality is a mix - a small percentage of people getting catastrophic illnesses they cannot prevent, and a large number of people having catastrophic illnesses from chronic diseases they can prevent or at least control.
We have the means to subsidise both groups fully (I think...), the question is whether it is fair, whether we should.
Providing free treatment for leukaemia will not encourage the kid to get leukaemia, but it certainly will not encourage the kid's parents to set aside money to pay for the kid's healthcare if he did get leukaemia. That is where the moral hazard lies - not with the kid, but with those who have a responsibility.
We can subsidise only those with diseases they cannot control fully, and hold those who do not control their preventable diseases correspondingly less, but the system does not have the moral courage to enforce this, which is why we allow people to abuse cheap drugs, investigations, and treatment they can afford or may not really need, but deny expensive ones to people who need them and cannot afford them. I don't think the solution to this is to subsidise more at the expense of the tax-payers.
Also, while it is always easy to compare the defence budget to healthcare and say we should spend more on one and less on the other, I think the more responsible thing to do here is to look at wastes in both sectors and ask how we can reduce waste and channel that savings to other sections or sectors, but that is beyond the scope of the present discussion and perhaps something SDP can look into if it wants to make itself look more convincing.
Finally, I would just like to say that it is indeed a privilege to watch Dr Vivian in consultation with a child - the man is just incredible...
Few times I agree with angrydr
1. I work in a corporatized civil service organisation and as you know, civil servants cannot enter politics unless they are unemployed.
How do you explain the other doctors in PAP? Only MOH and MOHH doctors are employees of the government and you can join but you need to resign to be an eligible candidate
2. I see people who have to sell their homes and move into rental flats to pay for their medical bills. Do you think this is right?
This is not right but with higher subsidy, where is the money coming from?
3.Medishield cherry pick to reduce premiums paid by Singaporeans. Singaporeans need to choose whether they want to pay higher premiums or not.
4. Medifund the endowment fund is limited to those who have already sold their homes and exhausted their children’s Medisave. Every year it is not fully utilised as it is so restrictive.
Endowment fund can only spend the investment income so it is designed to be restrictive
5. A Patient of mine has an infection that has caused him a stroke. He needs medication that costs more than $250 a day. There is no subsidy for this medication.
In a ideal world where we have unlimited budget. we can subsidise all the drugs but we need to be selective on which drugs to subsidise.
In the White Paper by PM Lee, the govt will provide affordable basic care
6. economic plan is raising the healthcare budget significantly up to three times.
MOH has announced building 2 hospitals, 3 community hospitals and 2 polyclinics. With more medical doctors being trained, the healthcare expenditure will increase in future
7. focus on primary healthcare by bringing care to the people using nurse practitioners and allied health professionals in void deck health centers.
Nurse practitioners are cost effective to utilize for chronic care.
Can use the business model (facilitated network) proposed by Clayton to better manage chronic care
8. reduce the crunch on healthcare workers in public hospitals by allowing GPs and specialists to work in the public hospitals
Will they want to work in hospitals? Will healthcare costs rise if we hire them at market rates?
We are already hiring locums in polyclinics and ed so what is the issue here?
Dear All,
I believe no one likes to fall ill. No one wants to be sick.
Therefore, tell me who is there to abuse system?
I for one, do not mind subsidizing others for other people's healthcare through my taxes. Better subsidizing healthcare for others than to increase the already sky high ministerial salaries. By the SDP, would be donating 50% of their allowance to set up a fund for the needy if they are elected as MPs.
We have been for years looking after ourselves, as individuals, for our own families, for our assets. I do not want my children to do that. I want them to look beyond, to share and care as a community member.
This is the good fight. Bringing back humanity into our society and intangible riches into our being. When we take care of others, we are in return nourishing our own lives.
Do you know about companies who provide welfare for their workers? I do. It has been documented in Harvard Business Reviews. Bringing in childcare into their office space, allowing workers to knock off earlier? In return, the workers gave their best to the companies, these companies have the lowest attrition rates and highest levels of productivity and innovation. When we care for others, naturally, we are caring for our families, for our nation and ourselves.
"tell me who is there to abuse system?"
You are ignorant, msyong. Just because you do not witness it in your day to day life does not mean it doesn't exist.
"I do not want my children to do that. I want them to look beyond, to share and care as a community member."
By all means bring them up that way. What I don't understand is why you insist that other people must be forced to do the same thing through taxation.
The ironic thing is I used to vote SDP, back when it was about civil liberties, human rights, preventing government abuses...
Now, in a bid to win votes and power, SDP is willing to go the socialist way and trample over people's right to their own possessions...
It boils down to a simple philosophy.
Do you share? Or do you just take care of yourself?
The guy who takes care of himself will say why is it he has to take care of others?
The guy who shares will say everyone should share. But the people who share usually tend to be the ones with less because they have shared it with others.
You can justify all you want why you won't share and how people abuse and brought whatever it is on themselves but at the end of the day the basic fundamental is there.
As far as I know the true great men and women are the ones who cared about their fellow man and shared what they had.
The greatest of them all said to share EVERYTHING! Maybe that is too godly for us mere mortals.
But we are not asking people to share EVERYTHING. Just to share some.
Perhaps unsurprisingly, in Singapore sharing is out of the question. You reap what you sow and you live with that.
Conclusion? Singapore is too insecure. Singaporeans are too insecure. Too vulnerable. Too scared to share. Because who knows what will happen tomorrow when everything is gone BECAUSE YOU MADE A WRONG DECISION.
How to live like that?
In my opinion
The key issues for me:
would be heavily subsidisied healthcare for all kids inclusive of all catastrophic illnesses.
Payment thru coinsurance to reduce moral hazard.
For all the other issues raised, well angry doc gives a considered reply which is both logical. Although it may be better to give premium rebates for those who go for regular checkups annually
"But we are not asking people to share EVERYTHING. Just to share some."
Sure.
Share what you have all you want.
Ask others to share if you want.
I have nothing against your right to share and your right to ask others to share.
What I have an issue with is when you force people to "share", or campaign to force people to "share" via taxation and state-subsidy. I have a problem when you try to violate my right to not share.
You call those who share all they have great - what should we call those who force others to "share"?
I call them tyrants.
Polyclinics offering some form of basic or primary medical care is a joke. I brought my mum and noticed the number of foreign doctors. When it was my mum's turn, and whilst in the consultation room, these doctors, both local and foreign were having discussion of where to lunch. That is fine. But being more focused on that. Did i leave the room any wiser in terms of medical knowledge prior to my entry. NO. Glanced through my mum's blood test and hospital referral to poly and just prescribed the medicine. A doctor just for that. In fact the pharmacist had to call the doc to clarify some medication. A pharmacist can do that. In fact, that's what i had been doing all before, buying the medicine from JB over the counter. I went to the poly after getting her PR. Mind you, i pay taxes [a fair amount] and it is probably becoz of that that her PR application was approved this time. We have lost our social responsibility whilst enjoying the cushy lifestyle that the meritocracy system has facilitated. We forget our responsibility to those who for reasons can't afford. Is this the first world we live in where we calculate everything to the minute dollar. In fact solutions suggested may not be in sync with the grandoise plans we are accustomed to as they are too simple. Please look to India for the similarity of the solutions and yet the solutions in India are recognised.
I deal with chronic diseases in a restructured hospital. I agree with Angrydoc that our model of basic health care is accessible and subsidized care, for the quality of care patients are receiving is value for money (yes yes.. waiting time is usually long waiting, consultation areas crowded, consultation time short..).
I also agree with Prof (a great mentor and inspiration for many generation of students) that there is room for improvement but I find great issues with some of the arguments put forth by the SDP.
1. Set-up health care facilities at HDB void decks
- Singapore is a small country, transportation is well developed. Accessibility (in terms of distance) is not an issue at all ! Furthermore, GPs are around every corner of the HDB block. This part of the shadow health care plan just sounded silly and poorly thought through.
2. Maldistribution of manpower (my focus will be on tertiary hospitals)
- Hospital work is unattractive. That's the nature of the Job (night calls, weekend rounds, attending to VVIP or pseudo VIPs, research output etc etc etc....).
- I do not think that any amount of rebranding or cosmetic surgery can make the nature of the work more attractive.
- Do you think any sensible GP would want come back and do MO work ?? and what is renumeration expected for doing this level of work ? ?
I think the problem of healthcare needs to be handled at a more fundamental level. Patients need to take greater responsibility, the government however needs to provide a conducive environment to encourage such behavior.
A quick and rather ruthless way to address this maldistribution of manpower (since you cannot make government service more attractive) is to make the alternative unattractive. I leave it up to one's imagination.
"I think the problem of healthcare needs to be handled at a more fundamental level. Patients need to take greater responsibility, the government however needs to provide a conducive environment to encourage such behavior."
Let's face it: subsidised healthcare, like welfare, erodes personal responsibility. You yourself have seen how affordable and accessible healthcare has made your patients make little effort in looking after their own health.
Ironically, the government is providing a conducive environment to encourage such behavior. :)
I think we are all forgetting something.
HDB imposes a income ceiling of $8k per month for applicants for their flats.
Who do you want the said child and his/her family to stay then after they sell the condo as you mentioned to pay for the parents medical bill ?
They could buy a resale HDB in which case they have maybe 300k left over given the current prices. Then what ? Spend it all over the next few years ? Cos nobody can survive on $500 a month?
If truly u are a doctor as u claim to be then your income
would be right smack in the middle of this 8-10 k sandwich.
Suppose it is your parent who had this illness.
What would you do ? The system would expect you to work on saving lives which slowly bankrupting you. Then when you are finally penniless they step in.
By then would your patients still want to see you ? A bankrupt doctor slovenly dressed cos you cannot afford new clothing ?
I am not saying this in support of SDP's plan for healthcare or PAP's for the matter.
I also don't think we should open the system for abuse - and I do see quite a few examples of that. However it seems in my humble opinion your earlier statement about condo stayers do not bear much thought. But I stand ready to be corrected.
Yes we should stop abuse. May I suggest that this can start elsewhere. Obviously inappropriate complaints such as the one my Indian colleague received for not being able to speak Chinese should not be entertained. Who knows how many work hours and dollars are wasted each year on such fraudulent complaints ?
Perhaps enough for a condo ?
"... $250 a day or $7500 a month for medications for three to six months..."
I don't think that's going to bankrupt our patient and his family of 6 children.
"... I then realized this was the same doctor who defended his colleague's $25 million bills to Brunei's royal family sometime ago in comments to a previous post."
Funny how people have a problem with Dr Lim earning $25 million for her work, but have no problems with how the patient's family came to have $25 million to begin with... I guess being a patient just automatically makes on the victim, and being a doctor automatically makes one a villain preying on other people's illness?
angrydoc, who is forcing you to share?
Well here's the truth. You can actually choose not to pay any taxes whatsoever. That is a valid choice. Of course there is a price to pay that has been laid out in the law.
I guess your fantasy is to be able to have no taxes to pay whatsoever. I think there are some countries that do that.
Do you pay tax in Singapore? Well, then you are "sharing" already. And by your reasoning it is the tyrants who force you to pay tax.
I think it is too far fetched to be discussing whether Singapore can be a country where no one has to pay any tax at all (ie no sharing at all. Free to choose to pay tax or share but by default no need to)
A more realistic discussion would be how the government chooses to spend the money they collect from taxes. At the moment we know where most of the money goes to. And it ain't healthcare.
As I mentioned in the comments section of another post, I think taxation is necessary.
But make no mistake: taxation is by force, even if they do thank you for nation building when they send you their demand...
When you tax someone and use that money to "share" in paying for other people's healthcare, you are in fact forcing the tax payer to share.
The issue here, as you have identified, is not whether we can abolish taxation altogether, but on whether the tax burden is fair, and on whether the manner in which the revenue is redistributed is just.
I don't think progressive taxation is fair. I don't think the way we are subsidising healthcare is just. Looking at SDP's proposals, it seems like they want me to "share" even more of my money with other people. I'm pretty sure I don't like that.
yes, angry doc, i hear you and share the same concerns. that is why half an hour ago, i voted for the lesser evil. socialistic policies cut no ice with me!
Healthcare discussions (like many areas of life) are often colored by ideology and not actual logic, hence at the end, one can only respect the others' rights to their views.
To angry doc and his medical colleagues:
1. How the patient earned his/her $25 million is irrelevant, Dr Susan Lim had displayed distasteful greed and/or excessive arrogance in her billing. In the same way, people are unhappy with the PAP ministers for their excessive pay and perceived arrogance. There is a similar issue of lack of checks and balances in the medical community, especially in the private sector.
2. You keep harping about personal responsibility and moral hazard. Some of that is true but it can be taken to excessive lengths. The only way to stop moral hazard is to remove healthcare subsidies and to have all costs come out of one's own pocket. Buying insurance does not remove the moral hazard, because what you pay for that insurance is still much less than the true cost of healthcare. After getting that all-comprehensive insurance, there is nothing to stop the patient from asking for more healthcare than he/she needs. Sure, premiums will go up but so what? Also, look at US (or some third world country) where healthcare is largely a personal responsibility - is there any evidence that the chronic diseases are better managed or that the system is not abused? You as doctors see cases where patients abuse the system and no doubt this turns you off. I will wager, however, that these comprise the minority, and no healthcare system in the world breaks down as a result of too many of these freeriders.
3. How about the responsibility of doctors? They cause complications that result in longer stays and more deaths - and this becomes just a statistic (there's always a small chance things go wrong). Patients bleed to death or die from infections after operations in hospitals that doctors don't attend to fast enough and all the doctors get are slaps on their wrists (3-month suspensions are just that, after all). Doctors fail to wash their hands and transmit bugs to patients but are they ever taken to task for that? There has to be campaigns just to make doctors wash their hands! Doctors overprescribe medications and perform unnecessary procedures (especially in the private sector or 'A' class wards) at times (this is probably just about as rare as patients who abuse the system but who knows) but where is the accountability? Those doctors who prescribed subutex and ruined so many lives - did a single one go to jail?
4. In most societies and certainly in Singapore, being a doctor is a privilege (no one denies that most of you are overworked too). You are respected as a profession, are well-paid (after specialist training, or as an average GP, probably already in the top 20% of the salary bracket in Singapore), and are protected when things go wrong (especially in Singapore compared to the US). Patients and society appreciate you for saving lives and restoring health. Do treasure that and hope that it lasts.
Anon 15:40, and anyone who keeps harping on the susan lim issue - if you were susan lim, how much would you charge your bruneian royal family patient?
That's the problem isn't it, jun?
They don't have Susan Lim's skills, they didn't do what Susan Lim did, yet they all presume to tell her how much she can ask for in a willing-seller, willing-buyer situation.
And let's not forget that around 20% of that $25 million goes into taxes that go towards helping patients? How can anyone be against that?!
wow angrydoc replied me! :)
for the record, in case anyone is curious, if i were susan lim, i'd charge exactly the same amount she did. maybe even more if the market could bear it. :P
oops read too fast and missed the bit about 3-5 months limiting the bill to $45k
I stand corrected :)
Fellow anonymous :
Thank you for your respect and appreciation of doctors :)
that number is dropping unfortunately.
Tomorrow, we'll have a new govt. Regardless the results we have to stick together to work it out.
hi angrydoc, well at least we agree that the issue is not about abolishing taxation.
But it seems to me your point is that there should be absolutely NO SUBSIDY whatsoever for anyone in healthcare.
Am I right to say that?
Wow. So you feel that the revenue from taxes in Singapore would be better spent on anything but healthcare?
You know, a professor once told me that the bigwigs in MOH think the same way. Healthcare expenditure to the government is an expense. That's all it is. It is not an investment like defence, education, trade, foreign affairs.
So the less expense the better.
Looks like you are advocating ZERO expense from the tax coffers!
Just a question though. Do you seriously believe that if there was only private medical care and the government washed their hands off running subsidized healthcare, that common folk would be able to afford treatments? What happens then if you cannot afford it?
Too bad? It's all your own fault for falling sick? Serves you right?
While I believe you are not talking about that extreme, my question to you is how much "sharing" is too much?
Singapore shares about 1% of GDP. Too much? Too little?
"But it seems to me your point is that there should be absolutely NO SUBSIDY whatsoever for anyone in healthcare."
Hopefully we can get there eventually. Hopefully we have a country where people all earn enough money to not require subsidy, and those we do will get help they need from civic organisations and charities. We need to get away from this mentality that it is our right to force people to help through taxation. We need to decide that it should be an individual responsibility to decide to help, and not our right to make others do.
I think we can achieve that - NKF and Renci were doing well getting people to help until, well, it all came crashing down. But they have shown us that Singaporeans will and can afford to help those who are in need; they can and will be generous with what they have, not what others have.
I am glad that Singaporeans seem to tell us with their votes that they do not agree with SDP's "Health Plan" for Singapore. I think I will allow myself to celebrate a little today.
Have a good weekend too, my readers.
There is no end to the possible scenarios but I think the point is this; we have moved to a first world country, we pay our ministers way above the the world but the health spending is way at the bottom. The government could spend a little less paying themselves and a little more in healthcare.
I think we need to move away from looking at how little we spend on healthcare, or how many percentage points of our GDP or budget we spend on healthcare, and look at the results we have.
Not true. We need to look at results, we also need to look at how much we spend. Spending more will generally mean better results and less hardship on the people. Where do the curves intersect? It is also about whether we have a heart for the less fortunate. Comparing with other countries will give us an idea what the optimum is.
I can respect that, but I think the problem with our expenditure is not with how much we spend, but how we spend it. I think we need to reduce waste and be more targetted with our subsidy.
I think we all recognize that channeling money into the right pockets is a lot harder than increasing expenditure overall.
The former requires that the powers that be recognize where money needs to Go (always difficult when the minister is not a doctor, and the ground is too timid to provide any real feedback) and then actually Act on it. Increasing overall expenditure has the happy effect of increasing money well-spent, as well as money wasted. Perhaps there is a role for doing both - increasing expenditure, then performing rigorous audit and feedback sessions to ensure that results do improve, and waste is minimized.
Arguing amongst ourselves for one over the other unfortunately usually translates into wasted breath. (unless, of course, angrydoc happens to be involved in policy making.)
Post a Comment