Interesting and balanced analysis by Amir Hussain in ‘Today’ on whether the PAP is truly transforming. Guess it all boils down to the balance- How to be popular enough to remain in power.
I am not sure that the PAP has not misunderstood the people though. My sensing is that people do NOT want ‘welfare’ the way the PAP polemically defines it; perhap the crux of the matter is the degree of state support. At least in healthcare, people I speak to strongly support the notion of co-payments and mitigating abuse and over-consumption. What they don’t want however is living with the ‘fear of being unable to pay for healthcare’ and ‘medical bankruptcy’ whether for themselves or for their fellow Singaporeans.
Even in the much maligned European ‘welfare’ model, co-payments are almost de rigor in healthcare, but not primarily to spread the costs of providing healthcare. Instead the policy intent is to combat moral hazard. Therefore the co-payments are designed to impose some ‘pain’ for patients but not to the extent that patients fear for their healthcare or worry about bankruptcy.
How then can Singapore balance the conflicting objectives of ‘individual responsibility for healthcare’ AND ‘reassurance that no Singaporean will be denied medically necessary care because of financial reasons’? MP Inderjit Singh has called for “a cohesive, united nation where people feel taken care of at home and are confident of their future”. How to square this with Mr Rajaratnam’s “We want to teach the people that the government is not a rich uncle. You get what you pay for. We want to disabuse people of the notion that in a good society the rich must pay for the poor. We want to reduce welfare to the minimum, restrict it only to those who are handicapped or old”?
I’d argue that healthcare is different from other forms of ‘welfare’ for at least 3 reasons-
1. Singaporeans cannot save enough even if they wanted to, to pay for a major, prolonged illness- risk pooling organized by the state becomes necessary
2. Public hospital services in Singapore are very generously funded but bills can run into the tens or even hundreds of thousands of dollars and so unbridled application of the ‘co-payment principle’ can saddle citizens with hefty bills despite subsidies. This sword of Damocles does not contribute to reassurance and “a choesive, united nation where people feel taken care of”.- Should a cap on co-payments borne by individuals be considered? How should this be worked out? Based on income? Based on assets?
3. The government subsidizes hospital services much more by dollar allocation compared to primary care (GP and polyclinic) and preventive health. What this means is that unhealthy Singaporeans afflicted by expensive diseases such as kidney failure from poorly controlled diabetes or stroke from poorly controlled high blood pressure costs the government and taxpayers substantial monies anyway. Should our financing model skew towards more upstream services and focus on keeping the population heathy? The trendy lingo is ‘compression of morbidity’ and what this means is striving to keep those with any chronic condition healthy and functioning for as long as possible, both because it is good for the individuals intrinsically and because it saves the government money.
It’s timely the PAP as ruling party and government are re-examining some of the fundamentals. At least in healthcare, closer examination will probably reveal the PAP and the people are not that far apart…