SDP continues to try to sell its "National Healthcare Plan" on its website, now comparing it to auto insurance.
There are a couple of problems with this analogy: for one thing, when you get into a traffic accident, other people may be harmed; the insurance is not just to pay for your losses, but for other people affected by your actions - this is not always true of healthcare (except in the case of infectious diseases). Secondly, one may go through a lifetime of driving without getting into a single accident, but everyone requires healthcare.
Now I am not a fan of Mr Tan Kin Lian, but today I would like to borrow his wisdom, specifically in something he wrote about health insurance:
I want to be frank. Insurance may NOT be the answer. Here are my reason insurance works on the principle of risk pooling. Many people pay a small premium to buy insurance, so that a large payout can be given to the person who suffers the insured event. A good example is insurance covering death by accident. The expected claim rate is 1 in 2,000. If each person pays a premium of $50, the insurance pool can pay $100,000 to the single person who happens to die by accident. The actual premium payable will be more than $50 as the insurance company has to pay its expenses and wants to make a profit.
- This pooling does not apply to health insurance because each person wants to be insured for a lifetime and every one will eventually have to get a serious illness, either by cancer, organ failure (e.g. heart) or other critical conditions. It is likely that every person will make a claim on the health insurance policy – the question is whether it occurs earlier or later
- ...
- Insurance has the tendency to increase the cost of treatment. The insured person is likely to go for more expensive treatment, as it is covered by insurance...
- Every insured person wants the high medical bills will be paid by the insurance pool, i.e. by other people. Are they willing to pay for somebody else’s bill?
What this means in the context of a national health insurance scheme is this: collectively, the "premium" paid into the pool must be at least equal to the total payout; and since everyone is covered by a national insurance scheme, and "every one will eventually have to get a serious illness, either by cancer, organ failure (e.g. heart) or other critical conditions", and "every person will make a claim on the health insurance policy – the question is whether it occurs earlier or later", then it tells us that what is happening here is NOT a pooling of risk, but of some people being made to pay for the healthcare of other people.
Now you may argue that the premium or subscription to the health insurance is roughly equal despite one's income, but remember that the bulk of the payout is not funded by the subscription, but by other types of taxes. To carry on the analogy of the buffet from our earlier post, we have a situation where everyone is made to pay $5 for the buffet, but some people having to pay an additional surcharge of $45 to eat the same food as everyone else.
When I criticised SDP's plan in my earlier post, a reader challenged me to come up with a "better system".
Now I have little doubt that in the short term, before moral hazard and the silver tsunami bankrupt the system, SDP's proposed system is definitely "better" for the majority of Singaporeans: they get to pay less for consuming the same or even more healthcare, while the bulk of the tab is picked up by a small percentage of Singaporeans.
But "better" is not always fair, even when it is "better" for the majority of people.
83 comments:
The fairest is to just say buy it if you can afford it.
angrydoc says healthcare is a commodity. Like food, if you cannot afford it then too bad.
Hope for donations.
Perhaps the "fairest" way for healthcare is that too.
If you cannot afford it, then die. Unless you hope for some doctors to donate medicine and services for free.
Is this what angrydoc is dreaming for everynight when he sleeps? Don't have to pay any tax every year so can save up money to buy high COE car?
Dont bother to argue with angrydoc
Docs are elites and will always blame us for being sick.
That's why public hospitals are forced to pay them more for doing what they are supposed to do.
Listen to Salma and buy medical insurance if you can afford it.
I am not blaming you for being sick; you are blaming me for not wanting to pay for your healthcare consumption.
angrydoc, sometimes it is not a matter of "not wanting to pay" but rather being "unable to pay".
I mean that's how we deal with commodities right? If you can't afford it, then go without it.
For instance a car. Can't afford it? Then take public transport.
Gourmet food. Can't afford it? Then eat at the hawker centre.
Landed property. Can't afford it? Then buy condo.
Condo. Can't afford it? Then buy EC.
EC. Can't afford it? Then buy HDB flat.
HDB flat can't afford it? Then camp out at Changi Beach.
So what happens when someone cannot afford healthcare? (note that in your ideal system, there is no subsidy whatsoever for healthcare).
Answer :They are left to die.
I would like to see angrydoc say clearly that this is the reality he accepts and wishes for Singapore because it is the FAIREST.
Did you dislike SDP's plan because it takes away the notion of atas luxury healthcare where atas doctors look to get excessively high renumeration?
"I am not blaming you for being sick; you are blaming me for not wanting to pay for your healthcare consumption."
Don't worry angry doc, it may take another world war for Singapore to adopt anything like the NHS in the UK - http://www.nationalarchives.gov.uk/cabinetpapers/alevelstudies/origins-nhs.htm
The basic question at the heart of all this, is "Am I my brother's keeper?" Depending your answer, you will apportion blame and benefit and all debate will rage on until we all agree yes or no to the first question.
If the argument in this article is correct, I can only conclude that insurance companies are acting irrationally by offering health insurance as it can never be a profitable business.
SDP tries to show that it has the funding for its plan worked out. But I don't think it is the case.
There is no projection of the total medical expenditure in the next 5, 10, 15 yrs when the ageing population issue getting more and more serious.
Once we get into this national healthcare plan, we are getting into a bottomless money pit.
"The basic question at the heart of all this, is "Am I my brother's keeper?""
It goes beyond that. If you want to give, you are free to do so - the question is: do I have a right to force another man to give to my brother?
"I can only conclude that insurance companies are acting irrationally by offering health insurance as it can never be a profitable business."
That's where differential premiums, cherry-picking and exclusion clauses come in. In a "national system" where premiums are not loaded and everyone eventually claims, it will be unprofitable and require extra funding.
Even if I am my brother's keeper, there is still a limit, not a bottomless pit. I think most of us won't mind sharing some of our wealth to help the less fortunate. But I think we all have to accept the reality that ultimately, if we can't afford it, we just can't have it, unless we have the means to beg or borrow. So, we work for what we want and we prioritise accordingly. I certainly wouldn't want to see our society fall into the communist mentality where people no longer need to strive for what they want.
"Don't worry angry doc, it may take another world war for Singapore to adopt anything like the NHS in the UK."
In the meantime, the UK has just passed a bill to reform the NHS.
""The basic question at the heart of all this, is "Am I my brother's keeper?""
It goes beyond that. If you want to give, you are free to do so - the question is: do I have a right to force another man to give to my brother?"
It's called tax. It's already used for things like public safety (police and fire brigade) and education. Otherwise citizens have to hire bodyguards and private tutors or do without, like before there were police forces, fire brigades, and public schools.
Mowadays, you can hire your own cisco, install your own CCTV, but rich or poor, all can dial 999 and call police.
(BTW, the pit is not bottomless, and there are mechanisms like NICE to apportion spending.)
No, it IS as simple as that. It is a question of yes or no, and then working out the solutions with the amount of resources you are willing to commit.
Well then you and I have different ideas about why and how taxes should be levied.
Hey doc, why should I pay for you to get your MBBS?
Why?
AngryDoc said: "In the meantime, the UK has just passed a bill to reform the NHS."
Do you know exactly what this reform are? Reform to become a Singapore System?
Or are you making glib statement without knowing the substance just to be a contrarian?
For the record the NHS "reform" does not change from the buffet model to an ala carte on. So don't be too gleeful if your statement was meant to substantiate your believe.
"why should I pay for you to get your MBBS?"
You shouldn't.
"Do you know exactly what this reform are?"
No. But I know it means that the British (whether or not they support the exact form of the current reform) think that their present model is not sustainable. It means that they want to reduce cost and put more decision on spending into the hands of the clinicians.
AngryDoc said: "No. But I know it means that the British (whether or not they support the exact form of the current reform) think that their present model is not sustainable. It means that they want to reduce cost and put more decision on spending into the hands of the clinicians."
Hang on. Isn't all your mambo jumbo argument about buffet vs ala carte as opposed to cost reduction?
Neither does the the vast majority of the Brits want to move away from the buffet model -- even arch free marketeer Maggie Thatcher dare to advocate any radical change.
As for the "sustainability" argument, let's be clear, it was not the driving force for the reform. The so call reform, as you have eluded to is all about local vs central spending. The conservative likes local and labour likes central. So any reform tends to swing between these two. Never about sustainability but yes you may hear some commentator use words like "sustainability" but, possibly like you, use it as a cover to push for ala carte model for ideological rather than economic argument.
So if you wish to use the NHS reform to validate your buffet vs ala carte argument it certainly does not. Suggest you used other model to help you win your argument. Also the vast majority of Brits don't have any hung up about the "paying others" demon that you are so fond of raising.
It is also worth noting that the US (ala carte) spends about 15% GDP vs 8% GDP (buffet). If you compare coverage and range of treatment under NHS (virtually free for all), the US you get even less for the money you pay out of pocket. Even some continental Europe (mixed) system cost more than the UK. So you tell me which model is sustainable?
"Isn't all your mambo jumbo argument about buffet vs ala carte as opposed to cost reduction?"
No. It's about fairness.
"As for the "sustainability" argument, let's be clear, it was not the driving force for the reform... you may hear some commentator use words like "sustainability" but, possibly like you, use it as a cover to push for ala carte model for ideological rather than economic argument."
The assumption is that decentralisation cuts inefficiencies and costs - the Brits are not doing this out of an ideological love for decentralisation, but out of a desire to cut costs.
"Also the vast majority of Brits don't have any hung up about the "paying others" demon..."
Of course, because the way taxation is structured, the majority of people don't pay for other people's healthcare - a minority do.
We've already paid for your MBBS, whether we like it or not, part of our taxes paid goes to your education.
Did you become a doctor to strike it rich in luxurious private healthcare?
"We've already paid for your MBBS, whether we like it or not, part of our taxes paid goes to your education."
Sure. But that doesn't mean the system has to continue that way. We should change things which we think are unfair.
On one hand, you claim fairness, on another, your assessment of the greater good is lacking in morality and values.
You can win your argument and stand by your belief.
Your belief will never win your conscience over. If you still have a conscience, that is.
"... your assessment of the greater good is lacking in morality and values."
No, it just happens to be different from *your* morality and values.
"If you still have a conscience, that is."
My conscience does not extend to believing I have a right over other people's money. Does yours?
"Sure. But that doesn't mean the system has to continue that way. We should change things which we think are unfair."
What's unfair here? That we invest in cultivating healing hands to take care of the health of our nation?
It's never about fairness of the system when one sets his mind to be a doctor and when a country decides to invest in the medical profession. It's about giving.
Do you have a giving heart as a health professional? Or are you just in it for the money?
"My conscience does not extend to believing I have a right over other people's money. Does yours?"
My my, you must be so proud of your conscience doc.
I see now, you don't even believe in having a govt who portions and budgets based on taxes collected. I see. Well, to each his own. So long as your conscience agrees.
"It's never about fairness of the system when one sets his mind to be a doctor and when a country decides to invest in the medical profession. It's about giving."
Sure, feel free to be the kind of doctor you want to be; just don't expect me to conform to your idea of how I should practise.
Pooling is never the problem. It is in the specifics. So if someone travels more on buses, does that mean he benefits more from the 1.1b free money to the two bus companies? Is that fair?
Wah getting heated here!
Thank you angry doc for writing about this. Just as i was wondering if anyone would critique the SDP plan.
Let's not get personal here. Remember that doctor's are all humans too. We fall sick and are 'consumers' (gosh i hate that term) of healthcare as well. A 'buffet' plan actually benefits us as well. Ironically, healthcare benefits for healthcare staff in public service are quite pathetic.
The SDP's comments on the inefficacy of the 3M scheme is correct. And MOH is not stupid. They are already aware of the issue that it saddles future generations with healthcare debt. What they intend to do about it is anyone's guess though. Will be interesting to see how far off is the U-turn they must one day take and how they will go about it.
Angry doc's critique about the SDP plan is also not wrong. Wanna see how free healthcare pans out? Just look at the SAF. Report sick is free wad. Report sick at A&E is also free wad. So what is preventing the SAF healthcare cost from ballooning astronomically? The fact that MOs morph into monsters when seeing NSF report sicks. NSFs know that they will not get anything more than is absolutely necessary (and sometimes less than that) when they report sick. Running the SAF system with the ethos of 'public service' would be an epic fail.
So commentors who call for doctors to be backed more rigorously in their clinical decisions are right. In fact, even without the SDP plan, administrators and politicians need to realise that putting 'service' before clinical justification is what is driving up healthcare costs.
Unfortunately it's not as simple as not allowing patients to complain (though that is not a bad idea at all =P). Costing influences a doctor's prescribing habits as well. How do i choose between esomeprazole and omeprazole? An atypical anti-psychotic vs a typical one? To scan or not to scan? Every doctor also has an individual level of risk-aversion. A kiasee doctor will tell you a scan is always necessary. So the devil is in the details. We'll end up needed endless clinical practice guidelines to guide, nay, control prescription and treatment behavior in the setting of a free-for-all healthcare system.
To those who paint an all or none picture regarding healthcare funding now, you are not being fair to the system. It's not like the less well off don't receive help when they can't pay. No one is asking that you 'go and die' if you can't pay for healthcare. The gov has said as much, that no one will be refused treatment. Healthcare is still recognised as a basic right in the 3M system.
My beef is that the 3M system is not fair to my parent's generation, people who are supporting their elderly parents. 'Consumption' patterns will change with each generation, as living conditions and education do make a difference. Maybe our focus should be to shift our consciousness away from 'consuming healthcare' to preventing disease!
Who really wants to see a doctor anyway?
To the anon who is upset that he is paying for our MBBS:
Please please PLEASE ask the gov why our medical education costs soo much that they have to 'subsidize' us then bond us for 5 years.
If the MBBS really costs that much and it's not subsidized, few will be able to afford to become doctors. Then you will have no doctor to see when you fall sick.
If the MBBS costs less and we pay for it on our own, then there won't be a bond and you won't have junior doctors to overwork and abuse when you fall sick.
Before you say we're money grubbing SOBs, may i remind you doctors also need to eat, need to get married, need to buy house, need to raise kids, need to support their parents.
Anyway since when did this become about greedy doctors when we're discussing healthcare funding? Doctor's wages only make up a miniscule component of healthcare spending.
I think the SDP is just trying to gain political points with its naive idealistic presumptions. The reasons I think healthcare costs are going up is
1) doctors' pay is increasing by so much!
2) nurses pay increase but at much much slower rate than doctors
3) medicine costs are going up (controlled by US pharmaceutical companies)
4) GST on healthcare (you pay the govt 7% for being sick)
The above simply sucks.
Well, I do think that the current private shield plans are pretty good, except when you reach after 55 it becomes hefty. Think we could work on that. Medishield (CPF) decreasing premiums and let the private insurers (aviva, prudential, AIA) etc work out something better and be more competitive.
Healthcare cannot be totally free or else there will be abuse of the system. Living in most expensive wards and result in irresponsibility to most people. But yet we also need to balance to make it accessible to low income and retirees. And we also need to rely on some form of insurance because of risk pooling is the answer to driving down costs.
"I am not blaming you for being sick; you are blaming me for not wanting to pay for your healthcare consumption."
Hey doc, it's not like people likes to consume healthcare to begin with. Good lord, I can't believe you even used "consume". It's not a choice sometimes, many times.
"... it's not like people likes to consume healthcare to begin with."
Nevertheless, why should other people be forced to pay for them?
I don't like being hungry, cold, and exposed - do I force you to pay for my food, clothing and shelter?
Angrydoc, when you say "I don't like being hungry, cold, and exposed - do I force you to pay for my food, clothing and shelter?" you say it easily because you probably have never felt that way before.
Yes the harsh realities of the world today is such that we have to fend for ourselves. However the conscience part of "giving" is what many are trying to say.
I think the litmus test is this.
If for whatever reason, the government does indeed abolish all taxes and tells the people that they have to fend for themselves in all aspects of life, how many will pull together and give enough to the needy?
How many?
The number you get will tell what kind of society you have.
That's all it is.
And that makes it OK to force people to give?
crazydoc, in angry doc's case, it is a case of doctors eyeing exorbitant luxurious healthcare demand. Medical tourism yea?
Any good Singapore taxpayer has the right to get personal here. He took up a precious place in our med school remember?
Aiya, angry doc, you don't like to give, don't give lo. It's a waste of a med school placing but oh well, that's life.
Similarly, don't impose your standards of morality and values on others.
I don't think angry doc is arguing for a completely self-funded healthcare system. He's just pointing out that free healthcare *is* and bottomless pit, and that the SDP has not considered the financials carefully enough.
Very easy to villify doctors as a whole when you don't know our struggles as well. You know we're getting a raise, but do you know how much junior doctors are being paid? If you don't treat your junior staff well, do you think they will want to continue to work for you?
Believe me, we want a system that is accessible and fair too, but the devil is in the details. Doctor's are also taxpayers, also employees, also consumers of healthcare, also human.
Please don't make this about doctors.
People who don't want to give aren't imposing - they just want to be left alone with what's theirs.
People who want to take are imposing.
No it is never ok to force anyone to do anything against their will. Heck even God gave man free will!
But it is also NOT OK to force people NOT to give.
My point is that angrydoc is assuming that given a choice, EVERYONE will not want to give.
What happens if given a choice almost everyone wants to give?
Here's another thing angrydoc.
You actually DO HAVE A CHOICE NOT TO GIVE.
You CAN CHOOSE NOT TO PAY ANY TAXES. Nobody is forcing you to file your taxes or pay your taxes.
It is your choice. Of course the system is such that you have to choose between paying taxes (which you do not like) and being caught and charged in court (which you probably do not like either). But it is still a choice open to you.
Often people say there is "no choice". But we always have a choice. It is MERELY THE PRICE OF MAKING THOSE CHOICES WHICH WE DO NOT WANT TO PAY.
The next time angrydoc says what gives us the right to force him to give, we should just tell him, then choose not to give.
@angry doc
do you think it's ok to force people NOT to rob?!
Likely the answer is YES, it is OK to force people not to rob.
And reason behind is morality and to maintain a functional society. The same apply here. It is OK to force people to give as we assume that to care for the needy is a basic human rights and it is part of out morality. And with this, we are also creating a functional society.
Although i do agree that we should help the poor/needy, i do not agree to help lazy and irresponsible people. So in my opinion, the suggestion from SDP is not feasible, not sustainable.
Ah. Come and see the violence inherent in the system.
Yes, it is true that I don't show my disapproval of the system by not paying taxes and risking jail, but I don't think that renders me unfit to argue that we should change it.
And by your argument, when someone says that he has no choice but to consume healthcare, may I also argue that:"But we always have a choice. It is MERELY THE PRICE OF MAKING THOSE CHOICES WHICH WE DO NOT WANT TO PAY."?
"do you think it's ok to force people NOT to rob?!"
Robbing is considered wrong for the same reason I think forcing people to give is wrong: it violates a person's right to his possessions. Robbing cannot be a "right" because it violates a more fundamental right.
We've discussed this issue extensively in an earlier post, so I don't want to rehash here.
In my personal opinion, taxes and subsidies is about return in investment at the end of the day.
The government subsidizes locals for their education up to their first degree in local unis. When they graduate they would become average and above average income earners and pay tax. I would dare say a vast majority of MBBS graduates working in Singapore are now the top 11% tax contributors.
The government subsidizes locals for healthcare so that they would not hesitate to seek medical treatment, get well, get back to work and contribute to the society. You may argue there are some which clearly are no "return in investment". With such a low % of our GDP budgeted for healthcare, I would say that the overall returns would definitely outweigh the costs involved.
@angry doc,
do you think it is OK to force people not to rob?
And likely your answer is YES, it is OK to force people not to rob. Cause our perception of morality tells us that this is not right.(yes it's just OUR perception. The definition of morality diffs from generation to generation). On top of that, this enforcement create a functional society too.
So now reapply to your statement.
And that makes it OK to force people to give?
And yes, it is OK to force people to give. As some of us believe that providing healthcare to poor/needy is part of our morality, and the way to go to create a functional society.
Personally, i do hope to help the poor/needy, BUT i certainly hope not to help the lazy and irresponsible. In short i don't think SDP sugggestion is sustainable or responsible.
Angrydoc, why don't challenge the SDP Panel of doctors to a public debate? We would like to see what kind of doctor you are. Maybe you don't like the strict audit that the SDP is proposing? Surely you know that doctors are the worst perpetrators of buffet by over-treating and over-investigating for gains. Is that why you think doctors must be allowed to charge what patient wants (or what doctors think they should want)? Don't be a coward, defend your stand with an open debate with the SDP.
" Don't be a coward, defend your stand with an open debate with the SDP."
No thanks, I'd like to remain a coward. Feel free to ignore my arguments of you think my anonymity invalidates them.
So the same can be apply again. By setting the price of medication at a high price, you are "robbing" a individual of their rights to receive care. So it cannot be right as it violates a more fundamental right.
And by your argument, when someone says that he has no choice but to consume healthcare, may I also argue that:"But we always have a choice. It is MERELY THE PRICE OF MAKING THOSE CHOICES WHICH WE DO NOT WANT TO PAY."?
Yes that is true.
As I have said, the litmus test is when you open it to a "free for all" to society. What will most choose to do?
Like in China, when a young toddler is run over by a van, and then a truck and then a bicycle, and people just walk past and "choose" not to see and not to help. I suppose you feel nothing wrong with that as it is the right of these people to choose what they want and do not want to do.
It would be interesting to see what kind of world Singapore would be if there were no taxes and everyone had full freedom to choose what they wanted to do and not have to abide by any laws or rules that forced them against their will.
You can't have it both ways angrydoc.
The murderers and rapists will also say they have a right to choose what they do. Arsonists, robbers, looters. Why force them against their will not to take what they like?
"It would be interesting to see what kind of world Singapore would be if there were no taxes and everyone had full freedom to choose what they wanted to do and not have to abide by any laws or rules that forced them against their will.
You can't have it both ways angrydoc."
But I am not advocating no taxation at all and no laws to protect us. You can have taxes, laws and law enforcement, but no subsidised healthcare - it's not all or nothing.
"By setting the price of medication at a high price, you are "robbing" a individual of their rights to receive care."
The "right to receive care" presumes that someone is obliged to provide that care, so it cannot be a right.
Interestingly, the more angrydoc polarizes, the higher the risk he runs of being looked up.
Be careful of the media these days. It is hard to stay anonymous. Some doctors found out the hard way.
It would be interesting if the media caught on to the story of a Singapore doctor who wants to pay zero taxes and feels that if the poor cannot afford medical care they deserve their plight and should fend for themselves.
"But I am not advocating no taxation at all and no laws to protect us. You can have taxes, laws and law enforcement, but no subsidised healthcare - it's not all or nothing."
Yes. However you do realize that the very arguments you would put forth for keeping the former actually are the same arguments for not subscribing to your latter proposal.
It's a case of selective condoning.
The "right to receive care" presumes that someone is obliged to provide that care, so it cannot be a right.
??
The "right to receive protection" presumes that someone is obliged to provide that protection, so it cannot be a right?! so to expect a country with police ensuring a functional state is not a right?!
I think your argument with the rest seems to drain you out. I will post later
Angrydoc said "But I am not advocating no taxation at all and no laws to protect us. You can have taxes, laws and law enforcement, but no subsidised healthcare - it's not all or nothing."
I would like to ask angrydoc what are his reasons for having taxes, laws and law enforcement?
I believe government should exist to protect our right to life, liberty and possessions. To function, a government needs revenue, and it obtains revenue via taxation. Therefore taxation is a form of transaction where the taxpayer pays for mutual protection, benefits, and purchases. I believe taxes should not be levied disproportionately. I believe people shouldn't be taxed for expenditures that do not benefit them directly if it is practicable to do so.
"I believe people shouldn't be taxed for expenditures that do not benefit them directly if it is practicable to do so."
The problem with that statement is that many of the expenditures are on things that do not SEEM to benefit people directly at THAT POINT IN TIME.
(Sorry for the caps but I don't know how to bold in the comments box)
Another question I'd like to ask is whether angrydoc feels there is any place for government run healthcare and why?
I think the government's role in healthcare should be limited to regulation, to protect patients from malpractice and fraud.
Why should I be forced to pay taxes to protect people from their own stupidity?
"Why should I be forced to pay taxes to protect people from their own stupidity?"
Well, feel free to start a blog and argue for getting the government out of regulating healthcare then.
OK, I was being snarky.
But if there's a practicable way of charging people per use and making the offenders pay for the cost, then that may be an idea too. But the authority will still have to be vested in a government structure.
What this means in the context of a national health insurance scheme is this: collectively, the "premium" paid into the pool must be at least equal to the total payout; and since everyone is covered by a national insurance scheme, and "every one will eventually have to get a serious illness, either by cancer, organ failure (e.g. heart) or other critical conditions", and "every person will make a claim on the health insurance policy – the question is whether it occurs earlier or later", then it tells us that what is happening here is NOT a pooling of risk, but of some people being made to pay for the healthcare of other people.
Might I ask this:
If everyone pays the premium, and everyone will eventually make a claim, and that claim will be a serious one for everyone - then is it not that everyone will pay for each other, and not that some will pay for another?
In simple terms, everyone puts money in, everyone takes money out. When they take that money out it will be at the same scale (for a serious illness), therefore, as you have rightly assumed, it is necessary that everyone puts money in that matches the scale of the money coming out - everyone pays a premium at the same scale as the serious illness they will eventually receive.
And hence, to say that some will be forced to pay for all is unsupported by your own premises.
Indulge me.
Why must the authority "HAVE" to be vested in a government structure? And I have to pay for that too? How does it benefit me directly when I do not consume any healthcare at all?
That is the problem with our society isn't it? That it's always about the money.
That the fate of the minority is somehow always in the hands of the majority. The poor has to suffer or even die because the rich don't think it's any of their business.
Healthcare is a public good, much like defence. Some people have more at stake in this country, so should they pay more for defence?
Push your arguments and hide your greed and self-interest behind your so-called 'fairness'.
We have eyes to see and make our own value judgment.
"Why must the authority "HAVE" to be vested in a government structure?"
Because we collectively invest our authority to physically enforce laws and contracts in a government, renouncing our right to do so individually.
"In simple terms, everyone puts money in, everyone takes money out. When they take that money out it will be at the same scale (for a serious illness), therefore, as you have rightly assumed, it is necessary that everyone puts money in that matches the scale of the money coming out - everyone pays a premium at the same scale as the serious illness they will eventually receive.
And hence, to say that some will be forced to pay for all is unsupported by your own premises."
Because under the SDP scheme, people do NOT all put in the same amount of money into the pool. The "premium" is roughly equal between the middle and high income earners, but the "premium" only covers 10% of the payout. 90% of the payout comes from other taxes, which is levied unequally.
"That the fate of the minority is somehow always in the hands of the majority."
Yes. That's why the majority can vote for a minority to bear more of the tax burden under a scheme like SDP's.
"Some people have more at stake in this country, so should they pay more for defence?"
If you can quantify that and propose a way to implement it, you are free to propose something.
Am I right to say that you (angry doc) do not view healthcare in the same light as law and order?
For some, we think they are equal. i.e We have basic right to protection from criminals AND basic healthcare.
So when we are talking about basic rights, those who can pay more (tax) will have to do so. After all, they are taking more from a society made stable by the granting of these basic rights. e.g A big boss will have healthy workers.
Just like we do not expect personal bodyguards, I would not expect the tax for healthcare to cover cosmetic surgeries nor A class wards.
"Am I right to say that you (angry doc) do not view healthcare in the same light as law and order?"
Yes.
"For some, we think they are equal. i.e We have basic right to protection from criminals AND basic healthcare."
I see them as different. We have a right to protection from criminals in the "natural state" - i.e. we can hurt people who try to hurt us or take revenge, but we surrender that right to the state. We cannot "take the law into our own hands" but in return the state protects us. The same is not true of healthcare.
"So when we are talking about basic rights, those who can pay more (tax) will have to do so. After all, they are taking more from a society made stable by the granting of these basic rights. e.g A big boss will have healthy workers. "
If a boss wants healthy workers, he can pay for their healthcare. Why should I pay for his benefit?
angry doc these good people you are arguing with don't seem to really grasp the crux of your arguments.
If I may humbly try to summarize; what angry doc is arguing about is not whether we are morally obliged to help our fellow man in need - we each have our own morals and values and the extent to which we feel we should help our fellow man will inevitably differ from person to person.
What angry doc is arguing for is what he thinks should be the role of a government (at least with regards to taxation and spending policy) - A country is nothing more than a group of people that happened to be staying in or around the same geographical location. We each have our own goods and services to sell. Some may be skilled in medicine, others in law, cooking, military skills, making clothes, making cars, etc. In the past, people bartered with the goods and services they have/can provide with those that they wanted. It is essentially the same today, just that we use a common medium, money.
However, there are some goods and services individuals will find it very hard to afford. these include military protection, police and security, and infrastructure that would improve quality of life in general - roads, street lamps, communication satellites, airports, etc. This was why governments (initially in the form of kingdoms) were formed. People paid taxes for someone to collectively buy and provide for these services.
What I gather angry doc is trying to say is that taxation should remain at that - collective payment for things that need to be collectively shared, that one cannot afford on his own. And because everyone presumably uses these collective goods/services equally, taxes should be equal as far as possible.
In relation to this point, to the Anon who is upset about being taxed to pay for doctors' MBBS; the government subsidizes and thus pays for a service that is collectively difficult for an individual to afford - the training and service of a junior doctor. Doctors PAY BACK their subsidy, by being held in bondage to public service for the first 6 years of their professional life at a salary that is significantly lower than what they otherwise can demand in other countries. The per hour pay of a junior doctor (even after the recent pay raise) is comparable to the hourly rate my family pays for this pleasant auntie to clean our house.
When asked if he knew what he knew about the NHS reform.
AngryDoc said: "No. But I know it means that the British (whether or not they support the exact form of the current reform) think that their present model is not sustainable. It means that they want to reduce cost and put more decision on spending into the hands of the clinicians."
AngryDoc then said: "The assumption is that decentralisation cuts inefficiencies and costs - the Brits are not doing this out of an ideological love for decentralisation, but out of a desire to cut costs."
AngryDoc also said: "Of course, because the way taxation is structured, the majority of people don't pay for other people's healthcare - a minority do"
Er first you said no you don't know what the reform is about then you suddenly somehow know a lot about how the Brits think. Contriidicting yourself aren't you?
First of all as I have said the so call "reform" is like a cycle. Labour wins reform funding get centralised. Conservatives wins funds get decentralised. But in both cases overall Heath Care spending as a portion of GDP remains the same. (a) what is your evidence to say the "Brits" are not doing it out of ideological reason? When you said the Brits do you mean all have collectively the same thought? (b) So how come spending don't drop when localised? (c) centralised or localised the argument has never been about getting people to co pay!
Also only 8% of Brits are unemployed seemed odd for you to say that the minority pay and the majority don't. Also the low paid pay national insurgence the same rate as the rich. So how is it the you can say the majority of Brits don't pay? Anyway the "rich" extra contribution to the taxation based represents less than 1% of the entire so clearly by your logic the NHS would have collapse by now. Even the unemployed pay VAT.
Again if you want to make your argument worthy suggest you use facts that you know about. Or maybe you just like arguing with imagined facts. In which case good luck.
I was asked: "Do you know exactly what this reform are?"
and I replied 'No' because I don't know every single clause in the bill - the operative word here being *exactly*.
From what I've read, the motive of NHS reform is cost-reduction, the NHS is operating at a loss (although you may argue that it *should*), the British government is in deficit, and the British have a progressive tax regimen. Everybody pays, but the rich pay more.
slave,
I'm sorry but I accidentally deleted your other comment. I think you understand my position and I appreciate you taking the time to write.
Once again, sorry.
AngryDoc says: "From what I've read, the motive of NHS reform is cost-reduction, the NHS is operating at a loss (although you may argue that it *should*), the British government is in deficit, and the British have a progressive tax regimen. Everybody pays, but the rich pay more."
Again not sure what you mean by NHS operating at a loss. The NHS is not a profit oriented organisation to speak of in the first place.
As for the British government being in deficit, that is due to a wide variety of reason. Not just health care budget. For example, the recent crash resulted in the UK government bailing out the banks to a tune that is about as big if not as big as the spending on NHS. Coupled with the fact that the Brits went to war not once but 7 times from Maggie Thatcher.
Yes, the rich do pay more (marinally) but if you look at the polls the majority of the Brits consider this FAIR. Neither are the rich saying that they should pay more.
Your argument is that it is not fair for the rich to subsidise the poor which is a totally different argument anyway. As I have indicated to you that is not what driving "reform" as you put it.
What I think of the NHS is irrelevant really as it is you that have bought up the NHS to bolster your argument. All I am pointing out to you is that unless you get the full facts, the basis of your thesis don't quite hold up.
Again unless you want to avoid being seen as a raving ranting person, suggest you look for a better analogy.
Let me be very clear here.
Is there currently a viable case for spending less on defence and more on healthcare? YES.
Should we unconditionally commit ourselves, now and into the foreseeable future, to providing top-quality healthcare to every citizen without realistic proposals as to how we are going to sustainably fund these commitments? NO.
And that is exactly what the current Government has done. Doubled the health budget while still maintaining complete control over the reins of current and future spending.
Which gives them the flexibility to spend more anytime the situation demands it... or checks and balances force them to.
Big difference.
@CrazyDoc
Anyway since when did this become about greedy doctors when we're discussing healthcare funding?
See for yourself. That's the way these cyberspace liberals work these days. They will twist and turn anything into this narrative. These are the "values" they are promoting.
Class warfare.
If you disagree with their interpretation of morality, you must be rich, greedy, and no conscience. You took up a precious space in Medical School which should have gone to someone of better character.
Mindless stuff which is destroying the Singaporean blogosphere, and will destroy Singaporean society if it ever makes it into the mainstream.
(its ok, i wrote so much that i decided to save it. haha)
.. Why angry doc subscribes to this idealogy is because he views one's right to his/her own property as the most basic right. In other words, what you legally own (yourself and your body and the things you can do, as well as your legal possessions such as your cash, house, car, etc.) is yours and yours alone, and no one should be able to force you to do something that you don't want to do with it.
This is indeed a very basic right, and the basis behind why we have laws against theft, burglary, rape and murder (because in doing these things, we are forcibly taking away something which rightfully belongs to someone else, which he/she was not willing to give).
This is not an argument about morality perse. IF the government does indeed change the tax structure to something similar to what angry doc wishes for, it does not mean that he will necessarily revel in all the extra things and expensive houses/cars he can buy with his extra cash (which he maintains is rightfully his). He MAY spend it on a lavish lifestyle, but he also may CHOOSE to donate most of it to a charity of his choice, helping the needy that he wants to help. The key point here is not what is done with the money, but that everyone should be able to choose where his money ends up being spent on.
Perhaps to put things into perspective, for those here who are considered 'poor' or in the low-middle to low socioeconomic group - if all you had (your 2RM or 3RM HDB, your savings however little, all your worldly possessions, were all SUDDENLY transported to the middle of rural India or Africa, you would suddenly find yourself in the top 1% in terms of wealth! Will you then agree to share your rice, your clothes and whatever extra space you have in your house with the thousands to millions with no food, no shelter and no clothes? Do they not have a right to those 'basic' things? Being the minority, the poor will then elect a government authority that will legislate a law that requires you to share your possessions with those around you. Will you be happy then? Who dare says that they will be?
To the Anon who criticized our society and argued that without tax laws, everyone would just watch their fellow man die - if you suddenly found yourself in India or Africa surrounded by dying children, how much would you be willing to give of what you own, or will you just watch the people around you die? By extension, MOST of us here in Singapore (at least those of us commenting here presumably with broadband access to the Internet) - aren't we just ignoring the plight of those in the world who are dying of hunger and poor hygiene?
Going by the arguments (of morality and our obligation to help fellow humans), even if angry doc is forced to pay his taxes, shouldn't the money collected go to helping these truly poor instead of you?
The root problem is not angry doc's morality (or the lack of it - this is subjective anyway). It is the nature of all men - we are ALL inherently selfish and will naturally put ourselves and our close family before anyone else. As we all demand more and more and more from the government, do remember that it comes from someone, and Person A being poor (as opposed to Person B being rich) does not make it moral for A to forcibly take what is not his from B.
Angrydoc: No thanks, I'd like to remain a coward. Feel free to ignore my arguments of you think my anonymity invalidates them.
It not only invalidates them. Together with your distaste for poor patients, it reduces your moral standing considerably. No wonder you can respond almost immediately to all the comments. You must be very free unlike other doctors. No wonder you are angry, doc.
I don't understand what the big fuss is all about.
angrydoc is angry that he has to pay taxes. But he is ok with his taxes going to pay for everything else EXCEPT healthcare.
How much of the government's budget is allocated to healthcare anyway? It's less than 5%? For every $1 that's....$0.05? And we are bickering about that $0.05?
Fine, no more tax collected for healthcare. Everyone save that $0.05 per dollar.
"Together with your distaste for poor patients, it reduces your moral standing considerably."
I don't have a distaste for poor patients; I reserve that for people who think they have a right to force me to help them, and feeling moral while they are at it.
"See for yourself. That's the way these cyberspace liberals work these days. They will twist and turn anything into this narrative. These are the "values" they are promoting."
Thank you, Melbourne.
I say no one should be forced to help, and they say that I don't want to help or that I say that the poor shouldn't be helped...
I write about healthcare spending, and they fault me for not speaking against other expenditures...
a bit OT, but... if paying taxes (or paying even more taxes as per sdp's plan) is such a great and glorious thing to do, why does EVERYONE complain when paying taxes? why do people even evade taxes?
does anyone here actually LIKE paying taxes, as opposed to just being resigned to having to pay them?
Perhaps they are full of humility and would rather all that greatness and glory be borne by... er, I mean conferred onto more deserving personages other than themselves?
I dunno - I'm just a selfish guy who doesn't like being forced to help other people, so I don't think I deserve that great and glorious experience...
Hello AngryDoc,
I can't believe you actually bother to take the time responding to some of these people.
Going on about Margaret Thatcher, for instance. That was near 30 years ago! I always knew she was a strong leader, charismatic and all that, but jeez. The Iron Lady must have made an unforgettable impression.
Firstly. The main problem with the SDP "plan" is that it's an economic black hole.
It is not insurance. Insurance is sustainable because premiums differ between individuals, and there are excess amounts and exclusions. With Singaporean's rapidly aging demographic profile, this is not.
The co-payment and deductions from CPF are just fluff... 80% of funding comes from progressive taxation.
What happens if someone cannot pay their $500? Government pays. If someone cannot afford their CPF contribution? Government pays. If the 12 billion is not enough for the year? Government pays.
You see the pattern here. Such a policy, where the tail explicitly wags the dog, is a joke.
Besides the whole issue of moral hazard, which some doctors here have already touched on, it makes a mockery of the whole Budget process, where you supposedly decide how much you are going to spend for the year and stick to it.
Let's not even discuss the poison pill of mandating that all wards have only 2 or 3 beds.
Secondly. People need to understand is that, like it or not, there are limits to funding, whether explicit or implicit. That is reality... thanks to this wonderful invention of democracy we have called... checks and balances.
Tax too many people too much, and they get upset. Tax the rich too much, and they leave.
So even if you have a universal healthcare system, it doesn't mean you can break the bank. But in a universal healthcare system, you can't turn anyone away - which means quality of care inevitably drops.
Take your pick - you can end up a basketcase like the UK, or with a two-tier system like Australia where the system is so overloaded anyone who can afford to do so avoids it.
Finally... Who gives a crap about the Brits? If Singaporeans wanted a universal healthcare system they would have gotten one long ago. Singaporeans get to have their say every 5 years, and so far they have said, 'NO'.
This issue is not even on the mainstream national agenda, as much as certain people in cyberspace would prefer it that way.
I think they can continue pissing into the wind. The recent doubling of the health budget should improve the situation and assuage any public anger somewhat.
"Tax the rich too much, and they leave."
That is forever the reason to not 'touch' the rich. If only there is a universal tax rate for the rich, so that there are no longer any tax havens.
Other than that, your post reads like a strawman. Take everything to extreme, and argue against the extreme case. How hard is that?
There are indeed limits to funding, and that is why I talk about BASIC healthcare. Yet, instead of C-class wards, you talk about how to make C-class wards become B-class (2 or 3 beds). 0.o
The issue is not the tax, but what the govt is offering in exchange for the tax. The Scandinavian countries seem to be doing a reasonably good job... and I don't see all their 'rich' running away.
@angrydoc:
I used the rich and healthy workers only as an example. Precisely because of the 'fear' that Melbourne brought up. I wanted to counter that fear.
In truth, all of us will benefit. If everyone was healthier (see doctor when needed, instead of trying to outlast the virus), we are least likely to be infected (by sick pple).
However, that is still beside the point where I think BASIC healthcare = law and order. Why is protecting your body against a knife a basic right, but against a virus it is not?
@Melbourne
While I do not agree with some of the comments either, to me, I think you are just as extremist in your views and your comments are laced with loads of arrogance and the fastest way to stop others from posting any further comments. And I do agree with Lobo76. Anyone who disagrees with your views and Angrydoc's are not worth your consideration. If divergent views are not acceptable in this blog, then I would say, the blog entries should not be left open for comments. Or the blog moderators could just sieve out divergent views and not post them. These are fine too, its their perogative if they choose to go that way.
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