Multi-pronged approach needed to make good healthcare affordable and available
The national healthcare plan recently proposed by the Singapore Democratic Party (SDP)has alerted me to the urgent need to make good healthcare both affordable and availableto all Singaporeans. But since this issue is in fact a global one, it is inevitable that wemust adopt a global perspective in tackling this pressing need.The healthcare plan proposed by SDP is not a revolutionary idea, but is acommonsensical idea based on the philosophy that the government must take good careof its citizens by co-funding and co-paying for essential services which include healthcare, subject to the parameters of long-term fiscalsustainability and prevention of moral hazard.Our government has been a good saver in terms of accumulating foreign exchange reserves and other financial assets. However it has
not been a good manager of these reserves, as evidenced by many disastrous investments made over the years. Most regrettably, thegovernment has not used its financial muscle to take sufficient care of the citizens.The area of healthcare is one of the most pressing areas, because healthcare costs all over the world, not just in Singapore, areescalating, very often much faster than the prevailing overall inflation rate. This means that unless incomes grow fast enough, goodhealthcare will become increasingly unaffordable. The worst affected will be the low income, and those unable to work due to per-existingdisability or other medical conditions.According to research published by the SDP, the PAP government currently pays for just slightly over 30% of all healthcare expenditureincurred. The SDP proposes that the government pays for at least 70% of all healthcare expenditure incurred, using funds that can bemade available by reducing defence spending, increasing the corporate (but not personal income) tax rate, and introducing a luxury tax.The SDP also proposes removing the complex 3M system (Medisave, Medishield, Medifund) system currently in place, and introducing asingle-payer system via a National Health Investment Fund (NHIF), which will attract contributions from both the people and the
government, with the government contributing the most.Under this system, the people will pay less into the NHIF than what they currently contribute to their Medisave accounts, and those whoare living below the poverty line or who are unemployed due to circumstances beyond their control will enjoy free healthcare. The annualhealthcare expenditure of each person will also be capped at $2,000, to ensure affordability of healthcare for all.
At the same time, there is also a need to properly regulate the medical and pharmaceutical industry, so that both healthcare providers aswell as drug-makers do not abuse the system, and keep their charges reasonable. This is a global issue, and keeping the medical andpharmaceutical industries liberal and open will subject us to global economic forces that may impact our ability to keep healthcareaffordable for all Singaporeans.Healthcare therefore is a fundamental issue whose long term solution must include dealing with fundamental challenges. The Europeanwelfare system has failed because it was not equipped to handle abuse, could not balance supply with demand, and was not designed totackle the fundamental challenges facing the medical and pharmaceutical industries. We must avoid these pitfalls if we are to succeed.From the ground up, the government must foster a vibrant medical and pharmaceutical industry in Singapore that attracts genuine
competition. Healthcare capacity must be greatly expanded so as to cope with both the increasing as well as the rapidly aging population.This will itself consume much government resources, but it is absolutely necessary if healthcare is to be available and affordable for allSingaporeans in the long run.In fact, the government can go even further. Since healthcare is in fact a global issue, there should be a regional inter-governmentalinitiative to tackle the issue of providing sustainable and affordable healthcare at the regional level. This initiative, for example, couldbegin at the ASEAN level, with the Singapore government spearheading the initiative because the cost of healthcare in Singapore is oneof the most expensive in the region.Next, the government must greatly increase the focus on healthy lifestyles and preventative medicine so that people will remain healthyfor as long as possible.Finally, the government must recognize that healthcare is not a commodity or a luxury item, but is in fact an essential service. As such,there must be a sound regulatory environment to prevent abuse and over-charging, and maintain standards and ethics. As an essential
service, the government must play not a reactive, but a proactive role, in pushing for increased professionalism, productivity, whilstkeeping prices affordable.A multi-pronged approach is needed to tackle the challenge of making good healthcare affordable and available to all Singaporeans inthe long run. We must adopt a regional and global mindset with regards to healthcare, and be prepared to spearhead initiatives to tacklethis challenge at a regional level.