Response to Medical Student in Oz

Hi JC,

thanks for writing in. Please find my responses below:

Those are some interesting insights to the Singaporean healthcare model.I'm a Singaporean studying medicine in Melbourne, Aus. I would like to point out that Singapore has relatively good healthcare compared to the rest of the Asian region and our prices are DEFINITELY affordable (be it pri. healthcare or that of a higher tier).

Affordability is subjective. Without intention of prejudice or malice but you appear to be speaking from a relatively well off point of view given your current ability to engage in medical studies abroad.

In Melbourne, the cost of an ambulance trip to hospital could be as high as AUD1k?

This is not surprising, if you have followed an earlier post on privatizing healthcare costs and healthcare insurance this could well be the case in some future version of Singapore's medical healthcare system.

The idea of a welfare state, ie. taxes going back to the 'needy people' could backfire in Singapore - look at Australia. Their taxes are exhorbitant thus price of living is improportional to the std of living (comparing to SG).

Hmm, I do not believe I have promoted the idea of a welfare state. As it stands in Singapore we are virtually a welfare state in the sense that roughly 50% of the population are supporting the other 50% when you take into account that nearly 40% of our population are hired by the civil service or its affliates then add in the self-employed like taxi drivers who are restricted in income to the local market.

Besides, with the introduction of GST, ERP, COE one should be constantly careful of claiming a 'low tax rate regime' in Singapore. Afterall, where does Temasek get its money to buyout USD $2 billion of Thailand's former Prime Minister's company in a private transaction that may have violated Thai monetary law?

But on the other hand, our standard of living may not be comparable to a high tax regime. This again is subjective.

Why would we want this? Singaporeans, especially in my medical school, are stereotypical hard workers and that should be the name we strive to uphold. Work hard and earn proportionally - a meritocracy. Is there a place for the mediocre attitude in singapore? not for long, i'd say.

My apologies if I offend you with this statement: Not everyone is born equal, some may not even have the chance to work hard the same way you do simply because of chance. I used to hold down 2 jobs bartending before I left for my degree in the US. Sometime in the early 90s I was taking home nearly $4k a month in return for working from 9am to 3am daily. My inability to focus on studies at a younger age was an initial setback in my life. My family's financial condition then did not permit me the luxury of even thinking about further education past secondary school.

There should never be a place anywhere for mediocrity. Chance, or some would say, by the grace of God, plays a large part. Perhaps we can afford to be more charitable to those who do not have the means and wherewithal to engage in conversations like this? Afterall, the universal adoption of the bell curve, particularly when it comes to things like IQ distribution, shows that in any given population set there will be those who are brighter and those who may need more help.

That being said, today I fear more mediocrity in thought then at work/study in Singapore. We should be a nation of critical thinkers if we are to proceed successfully into the 22nd century.

65% of Singaporean healthcare is privatised (pretty high) and that would increase the healthcare cost. The only thing the govt can do is to 1. increase the bond of med students that they subsidize, 2. make it more attractive to work in the govt sector.

It is arguable that 'privatized' healthcare in Singapore is dominantly shared by a very few selected shareholders. I do not know of any individual who has a share in SGH so wither the privatisation and its argument that profits need to be generated to sustain shareholder interest in light of capital accumulation tendencies?

As it stands, PSC and other scholarship granting bodies are dramatically cutting back on the numbers of scholarships given out. Due in no small part to scholarship predecessors who have decided to break bond in one form or another. Your recommendations above, in both points essentially go back to the moral equivalent of a welfare state with a slightly different model of tax distribution.

1. Increasing the bond of medical students. Assuming medical students are willing to be bonded for a longer period implies two things. First that a student of medicine will be willing to forego, for 'x' years, a chance at higher learning and therefore specialisation with an opportunity to make mega bucks - private moral contribution for zero future return.

2. Increase the pay/perks pacakage for those who serve in the public sector. By definition the public sector runs on public funds. To increase the pay/perks package implies an increase in either the cost to the patients who happen to utilise the service OR an increase in general taxes to maintain healthcare costs. Which then is a fairer model?


Also, the supply/demand of specialists in singapore is a consideration. With the highly limited places given to medical graduates to specialize, pri healthcare costs peanuts and secondary healthcare costs a bomb.

My first question is then why are there so limited places given to specialisation? If we as a society truly believe in free market capitalism then this practice of limiting places essentially places an externality, in the form of a 'monopoly,' on the healthcare market model. On the other hand, if I were in your shoes and wanted to become a specialists, I would fight against the creation of a large pool of specialists as that would lower my returns on investment vis a vis my studies and aim in life. So the question that has to be begged would be: Are medical specialists specializing for the sake of money / fame or knowledge in light of the Hippocratic Oath?

As Singapore progresses and Singaporeans become more aware of better medical treatments secondary healthcare will play a larger and larger role in the burgeoning of healthcare costs in Singapore. Very soon the model will be imbalanced by a requirement for the expensive secondary healtcare cost that you cite earlier. When this imbalance occurs is when money needs to be found, one way or another, to keep the system going. The other alternative is that the rich will remain 'well' and the poor are allowed to die. Which brings us back a full circle on state welfarism when it comes to medical healthcare costs.

Recent incidents in the last fews years, as reported in the local papers, show that there is no guarantee of a long life even if you keep fit. Young, very fit, males and females are dropping dead around us. Some in school while playing basketball, some in NS just after finishing a 5km run, some while doing taichi. I do not think these unfortunate souls were mediocre in any way related to their own health. It is the luck of the draw when Fate decides it is your time. As a medical student you should be aware of SIDS (sudden infant death syndrome). Even expert medical science is unable to appropriate a more scientific and accurate term for SIDS hence demonstrating the capriciousness of human life.

I personally feel that having a health insurance scheme using govt funds deals injustice to taxpayers. Be it the darwinism in me, or the fact that I detest dole thiefs, I support the pay-for-your-health idea in SG; opposing the medical ethics pillar of 'access and distributive justice'

Singaporeans are, by and large, brought up with enough principles to detest dole theft. Myself included. But given the arguments raised above it is inevitable that if healthcare costs are to be more effectively managed it should be state run (the idea here is not on taxpayer's funds primarily but more a focus on 'non-profit') to enable mass participation.

An example: (Touch wood) If anyone had a family member who was terminally ill but refused to give up on life, and there is no public healthcare insurance, the financial impact will ultimately by born by that entire family (assuming that family is close knit and will help each other out). This is as you suggest no?

This draining of funds in a family structure means that others will have less of that fund to spend on other things. For instance, an overseas education for a bright deserving member of that family. (Given that scholarships are now on the wane.)

So that bright young thing is condemned to mediocrity through no fault of his/hers? Yes, one may argue that that is not a fine example of mediocrity but it will surely be the way society will judge an individual. At least our society will.

I do not profess to have all the answers to many questions in life that bank on morality. I do know that morality is a creature that changes with the times. I also do know that certain moral practices are prevalent at this point in time in our general society and they are taken as norms to which we should all aspire.

At the end of the day as an aspiring politician the most vexing question for me in terms of equitability is of this nature: should 1 be saved at the expense of 50? 100? 200? 1000? or conversely should 1000 be saved at the expense of 1?

Should despots be removed at any costs so that the people can be free? Do people even know what it is to be free or be able to appreciate it? Or are we Singaporeans, as an NTU student I took on a diving trip recently so aptly described as : A dog which growls and moans because it sits on its tail, causing it pain, but apparently insufficient pain to justify a movement to a position of more comfort.

I wish you the best in your endeavours in Australia. And I hope you will come back to Singapore, one way or another, to contribute to society with the skills that you have gained.

Thank you for taking an interest in my blog and thank you for your contribution.