GE2011 Part 6
I read and heard James Gomez. But there are a lot of questions which I have regarding his healthcare plan, which is full of contradictions. I cannot claim to speak for MOH and Khaw Boon Wan, but I think I really want to put to the table some facts also for consideration.
Firstly, he proposed expanding the healthcare budget. In case he hasn't done his homework, the healthcare budget has been steadily but surely increasing over the past few years. Increasing our healthcare budget by three times would mean that we will be spending nearly 12% of our GDP on healthcare, just about a few percentage point lower than USA. USA, spending 18% of their GDP on healthcare, has since achieved the worst health outcome among all the OECD countries and deemed the least cost effective. There is a reason why Obama has been trying to reform the healthcare system there. But my first question, where is the 10 billion that he is asking for coming from? Reserve again? What are the KPIs that he hope to achieve?
This leads me to my second point. He wants to increase the number of healthcare personnels in the system. Exactly what MOH has been doing over the past few years. My question here, where is he going to get the warm bodies from? NUS has its own school of medicine which they collaborate with NUH, Duke-NUS collaborate with SGH and the upcoming medical school in NTU will collaborate with TTSH. Together, from what I know, at full capacity, Singapore's healthcare needs may not be met. So what are you going to do? Open a fourth medical school? Then collaborate with who? Who will be your academic medical centre? Medical professionals take a long time to train, I hope he realises that. How about nurses? We have two polytechnics providing nursing diplomas, NUS offers its own nursing degree and other institutions such as Parkway College and ITE offer their own nursing certification. But they too need time to be trained. Where is James Gomez going to find these people? From overseas? I hope they say that cos this will show and demonstrate that they admit it is impossible to meet their goals without tapping into the foreign pool.
Thirdly, I think James Gomez also forgot that Medishield can indeed be upgraded to cover the costs of hospitalisation. Together with a rider plan, you can even cover the deductible. I'm not sure if he knows that, but his plan on Medishield and a universal healthcare insurance shows a naivety. Insurance is risk pooling, not sure again if he knows that. So basically people come together and pool the risk together. In a universal healthcare insurance, where is James Gomez going to go to who is willing to bear the risk? Today in developed countries which depends on universal insurance, the fact of the matter is that the decreasing young populations begin to bear much of the risk as elderly begins to find it difficult to foot the premium. In Sweden, it is a different story as the population is willing to bear the consequence, but this is a result of historical understanding. Is James Gomez willing to bear the risk for our elderly population in this universal insurance if it really goes through? What are the terms he is looking at? Insurance to cover all medical expenses? Does he know that this will lead to moral hazard in healthcare? Proven and tested in other developed countries. When you have universal coverage, people will not hesitate to spend on unnecessary procedures due to cheap medical cost to them? Again, where is James Gomez going to find the money to cover for all these cost that the system has to bear?
Lastly, James Gomez's rhetoric about patients before profit seem senseless. He mentioned that desperation drove Singaporeans to go abroad to seek health treatment. I wonder if he has the numbers to prove that this is a prevailing case? Even so, is it necessarily true that they got driven abroad because of the profit making from the RHs? He told me he has an internal panel of doctors to help him come out with the plan, but I want to ask, how confident is he in ensuring that these doctors are credible? What are their credentials? And furthermore, the healthcare system is an integrated system, which involves not only doctors but also nurses and allied health professionals? So why only doctors? How come he doesn't get Lina Chiam (who was a nurse) to be in the panel? Even MOH nowadays won't just convene a committee of only doctors to look at policies.
My conclusion? James Gomez made the mistake of challenging Khaw Boon Wan on healthcare policies. He and his team have demonstrated stupidity and insufficiency in their proposal. It gets a grade of 'G', worse than a 'F'.
Firstly, he proposed expanding the healthcare budget. In case he hasn't done his homework, the healthcare budget has been steadily but surely increasing over the past few years. Increasing our healthcare budget by three times would mean that we will be spending nearly 12% of our GDP on healthcare, just about a few percentage point lower than USA. USA, spending 18% of their GDP on healthcare, has since achieved the worst health outcome among all the OECD countries and deemed the least cost effective. There is a reason why Obama has been trying to reform the healthcare system there. But my first question, where is the 10 billion that he is asking for coming from? Reserve again? What are the KPIs that he hope to achieve?
This leads me to my second point. He wants to increase the number of healthcare personnels in the system. Exactly what MOH has been doing over the past few years. My question here, where is he going to get the warm bodies from? NUS has its own school of medicine which they collaborate with NUH, Duke-NUS collaborate with SGH and the upcoming medical school in NTU will collaborate with TTSH. Together, from what I know, at full capacity, Singapore's healthcare needs may not be met. So what are you going to do? Open a fourth medical school? Then collaborate with who? Who will be your academic medical centre? Medical professionals take a long time to train, I hope he realises that. How about nurses? We have two polytechnics providing nursing diplomas, NUS offers its own nursing degree and other institutions such as Parkway College and ITE offer their own nursing certification. But they too need time to be trained. Where is James Gomez going to find these people? From overseas? I hope they say that cos this will show and demonstrate that they admit it is impossible to meet their goals without tapping into the foreign pool.
Thirdly, I think James Gomez also forgot that Medishield can indeed be upgraded to cover the costs of hospitalisation. Together with a rider plan, you can even cover the deductible. I'm not sure if he knows that, but his plan on Medishield and a universal healthcare insurance shows a naivety. Insurance is risk pooling, not sure again if he knows that. So basically people come together and pool the risk together. In a universal healthcare insurance, where is James Gomez going to go to who is willing to bear the risk? Today in developed countries which depends on universal insurance, the fact of the matter is that the decreasing young populations begin to bear much of the risk as elderly begins to find it difficult to foot the premium. In Sweden, it is a different story as the population is willing to bear the consequence, but this is a result of historical understanding. Is James Gomez willing to bear the risk for our elderly population in this universal insurance if it really goes through? What are the terms he is looking at? Insurance to cover all medical expenses? Does he know that this will lead to moral hazard in healthcare? Proven and tested in other developed countries. When you have universal coverage, people will not hesitate to spend on unnecessary procedures due to cheap medical cost to them? Again, where is James Gomez going to find the money to cover for all these cost that the system has to bear?
Lastly, James Gomez's rhetoric about patients before profit seem senseless. He mentioned that desperation drove Singaporeans to go abroad to seek health treatment. I wonder if he has the numbers to prove that this is a prevailing case? Even so, is it necessarily true that they got driven abroad because of the profit making from the RHs? He told me he has an internal panel of doctors to help him come out with the plan, but I want to ask, how confident is he in ensuring that these doctors are credible? What are their credentials? And furthermore, the healthcare system is an integrated system, which involves not only doctors but also nurses and allied health professionals? So why only doctors? How come he doesn't get Lina Chiam (who was a nurse) to be in the panel? Even MOH nowadays won't just convene a committee of only doctors to look at policies.
My conclusion? James Gomez made the mistake of challenging Khaw Boon Wan on healthcare policies. He and his team have demonstrated stupidity and insufficiency in their proposal. It gets a grade of 'G', worse than a 'F'.
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