Thursday, January 14, 2010

1 calamity away from poverty

I had been thinking about writing this entry since the beginning of the year, but kept putting it off because I felt it was possibly my bias outlook. Finally I got around to this after reading Lucky Singaporean's blog entry on Sickness in Wealth and Poverty.


Singapore does not have universal healthcare. Its ruling political party PAP has given many reasons and excuses for not providing it. In fact, it installed "Means Testing" since the last general election. The rationale given was to prevent the rich from abusing the "public (a.k.a. restructured)" healthcare system by making use of its subsidised wards.

In such an environment, one reads about a respectable 52 year old neuroscientist doctor who needs to raise funds for his own leukemia treatment. Despite his background as a well-known charity fundraiser and years of working as a doctor, Dr William Tan cannot afford medical treatment from the very public healthcare system that he works for.

There are also others who fall through the cracks. For example, the repeated admissions of a 2+ years old patient. This child had operations as an infant due to mal-rotation. Last June, he was admitted and operated twice for ?intussusception. 6 months later in December, he was admitted and operated again for abdomen pain and ?adhesion. By then, the insurance company declared his case as congenital and refused further payment. A week later, the child was re-admitted for abdominal pain and ?obstruction. This time his parents opted to prolong the NBM (Nil By Mouth) observation period as they could not afford another operation. They were a professional couple, born-and-bred Singapore citizens, yet the father told me that going to a public hospital would cost almost the same. Thus they decided to return to my hospital despite their limited budget. Thankfully, after 1 week of nursing care the problem resolved itself and the child was discharged.

Perhaps my nursing kakis are right that Singapore takes care of its destitute poor. [Or does it, really?] However, as the above examples show, the average person is only one calamity away from poverty.

As my friend LC (who was born in Hong Kong, grew up in Hong Kong and Ireland, and worked in Ireland, UK and Singapore) puts it so succinctly in his email to me, coincidently on April's Fools Day in 2009...
"I am afraid, i do agreed with you on Singapore and it is a wonderful place if you don't have to be here forever and you're rich.
However, if you are a nobody, you're at a huge disadvantage compared to other nobody in other countries..."
"Why should it be so?" is my question as a "nobody" Singapore citizen. It seems that the answer, for me, lies in migrating to where Universal Healthcare is available.


  1. well, universal healthcare has its own problem...and of course there are absolute pros abt it but the cons are equally as bad as well...

    what singapore needs is not a universal healthcare system...l believe if public healthcare in singapore is not interested in making $$$$ in the 1st place to pay their CEOs and stakeholders (ie like public housing, transport and education etc), then singapore can be a slightly better place for people to tolerate.

  2. dear winking doll,

    it's hard for singapore to deviate from the way they manage their policy from now...for example, would u ensure that all foreigners be getting the same pay as locals (such as nurses)?? would u mind those earning 100k/year to having the same concessions as the ordinary joes in healthcare??

    as an economists (i would like call myself one but far from it), it's a dream to have a system like singapore's. every one pays, hospitals always makes money and thus needs alittle bail-outs from the governments. but of course in achieving economic efficiency, equity is being trade for...thus it is a hard policy to get rid of..and worst, harder for mind-set to change!

    For me, stero-typing is hard to rid off..something that had tag onto me while working in am empathy healthcare system back does take time....u will come to understand when you are in canada...

    hope it goes well for u....don't worry..the frustration will be behind you soon...

  3. Hi Bone Collector,

    Actually I think it is in the benefit of the Singapore citizen workers that the foreigners get the same pay and labour rights as citizens. By same pay, I mean in take-home cash terms, with Workfare/whatever-policy modified to cover CPF related cost differential for low-mid level workers. By same labour rights, I mean protection (e.g. safety rules, housing policies). That will drive up the costs of the currently cheap foreign labours and put the Singapore citizen workers on a level playing field. The main problem is Singapore government has become addicted to massive import of cheap labour to increase its GDP, disregarding the social, productivity and other side effects. There is little political will (because PAP is unlikely to lose an election and MPs' bonuses are tied to GDP) for change or even adjustments to create a better world for all workers here, be they foreigners or locals.

    Personally I don't care if those earning $100K/year wants to stay in a C-class ward as long as they paid their taxes and enough of it goes into the healthcare system. A sick person, rich or poor, is entitled to healthcare if one were to label one's own country as 1st world. The gist of the problem in Singapore is too little of our tax money -- less than 3% of budget, way below other 1st world countries -- goes into the public/restructured healthcare system. That leaves a mountain of healthcare costs to be covered. Thus Health Minister Khaw introduced "Means Testing". The mainstream media spins it as a fairer system. IMHO, it is really just a way to contain the government's liability, given the ageing population, by pushing the burden to the patients and their families. The public/restructured hospitals are profit-making entities now.

    In that respect, I am thankful that my hospital is still very much guided by its founders' value of compassion and respect for life. Ward in-charge are given leeway in handling special cases. I heard of a case of a long-term ICU patient (more than 2 years, and still there) whose 6 or 7 figure bill is yet to be paid. It's only one case, but as the saying goes, "one is better than none" (just like the song "The Change").

    A common comment from our (local Singapore citizens) repeat patients is that our private hospital's costs is competitive to the paying class in the public hospital, yet it retains its caring culture. Ironic isn't it, when one considers that public/restructured hospital is supposedly streamlined for the cost-conscious? Of course, I'm not saying that my hospital is perfect. There are lots of room for improvement (especially with respect to staff development), which may increase the costs. Nevertheless, it shows that there are alternatives approaches in operating a hospital.

  4. Hi winking doll,

    u are spot on your views about guess that majority of the people do not think that giving foreigners equal pay and rights is just about protecting them either! As you can see, narrow minded thinking are created from policies that enhances average jobs stero-typing in the 1st place. it's a vicious cycle many cannot get rid of...

    i suspect importing cheaper labour was the only way to keep singapore's the only way to maintain their GDP and to keep singaporean working for the rest of their lives to pay off their mortages and cars..and later in life, medical bills...

    as a minister, to keep their job and continue to earn their mega salaries, khaw can only develop this kind of stragtegies to achieve technical and resource efficiency within matter what religion you are from (khaw is a buddhist i think and the preception is that buddhist are kind and compassionate people), you still have to keep milking the system dry...who wants to have a ministry always in the red, giving handouts and subsidy to people??

    Like my wise friend in sydney tells me: it's all a conspiracy!!