Shadowy Health Plan

Blogger's impression of the James Gomez Wing of Chee Soon Juan Memorial Hospital

Since his fellow bloggers have touched on the topic of healthcare in politics, angry doc thinks he might as well join them... not that anyone can accuse Singapore MD of groupthink though...

Healthcare for those who need regardless of ability to pay it is an attractive concept, so much so that some doctors believe in it, and of course political parties promise it.

You can have a look at SDP's "Health Plan" here.

My visual gag aside, I find parts of the "Health Plan" worrisome...

I wonder, for example, how SDP plans to "encourage" "healthcare workers, general practitioners and senior consultants in private practice... to perform sessional work in public hospitals". You see, it is always easy for those who do not provide the funding or possess the skills to "volunteer" that of those who do. Somehow I am not "encouraged" by this part of the "Health Plan". Are my fellow healthcare workers?

SDP also proposes an insurance where "healthcare coverage is jointly managed by the Government and appointed national insurers". So the question here is of course: what's in it for the national insurer? Can they or can they not make a profit?

Well, the proposed insurance scheme "will not be a catastrophic policy with myriad exclusions like Medishield, it will be a truly comprehensive national health insurance policy that benefits from economies of scale and covers preventive healthcare rather than simply the expensive treatments at the end of life".

There are two problems with that.

First of all, if it is universal, and does not have a "myriad" of exclusion clauses and is "truly comprehensive", then most if not all Singaporeans will utilise it. For Singaporeans to benefit from it, they must be paying a premium that is less than what their claims amount to. That being the case, how can the insurers make a profit? It will be as though it were a lottery scheme where everyone wins more in prize money than they spend on the lottery ticket. When the insurance is "universal" and "comprehensive" and the insurer is not allowed to cherry-pick, then the only options for them are to make a loss or to charge a premium that ensures they don't make a loss, in which case the premium per capita will by definition have to be more than the pay-out per capita. There will be, at the end of the day, no free lunch.

Unless SDP decides to likewise "encourage" the insurers to... co-operate?

Secondly, the insurance does not cover (I may be reading it wrong, but the wording is vague here) "the expensive treatments at the end of life". Now this tells me that SDP actually realises and acknowledges the fact that the bulk of healthcare expenditure a person incurs actually occurs in the last year or the final months of his or her life. Add that to the fact that almost 100% of Singaporeans (yes, you never say always in medicine, especially since Mr Lee and Mr Chiam still seem to be out and about...) will eventually die regardless of how well they take care of their health, then you end up with either a) a healthcare insurance that covers you for what you can afford, but not what you cannot afford if SDP does not cover end-of-life treatment or abolishes the current 3M scheme, or b) a healthcare insurance that covers every Singaporean from cradle to grave, at either a premium too high to fund, or a loss too great to sustain.

And I haven't even touched on the issue of abuse yet.

So will it work?

SDP has given us the answer themselves when they write: If you do get struck by a serious illness, you will not have to sell your home if the SDP is in Parliament, we will make sure that all the money you have paid in GST, ERP and all the other taxes and levies go towards giving you the best medical care in the most appropriate manner.

It will work in the short and perhaps medium term (until the reserves run out) if the tax payers are willing to pay for it. It may not be a lot more than what you already pay now, but with "free" healthcare come moral hazard and abuse, and once the reserves run out, then whichever way they skew the income tax curve, someone's going to have to bear more of the burden. Are you that someone, or are you the person who thinks it's OK for that someone to bear more of the burden?