This bitter fight is nearing its end as the US House of Representatives is scheduled to vote for it later today. The last effort to reform this system was undertaken 17 years ago by Hillary Clinton when she was the First Lady. Her reform effort was quickly killed off by lobbyists, big businesses spending on ads to misinform the public and political opponents with ideological differences[Link]. 17 years later, the US health care system deteriorated to a point that almost everyone agrees there is a need for reform. What they can't agree on is how and what to reform. The main problem is the lack of universality of the system - 30 million Americans have no insurance. If you take away all the misinformation (Obama-care is socialist, healthcare is being nationalised, it will bankrupt the country etc) and all details about increasing overall efficiency what this reform is about is simply the extending provision of healthcare coverage to everyone paid for by increasing the tax of those earning more than US$250,000 by roughly 3% and not extending some of the tax cuts by President Bush. According to the Congressional Budget Office which is politically neutral, the entire package will reduce budget deficit by $138B in the next 10 years[Link] so the belief that this bill will bankrupt the country is the result of misinformation - the Iraq War that cost more than $1 trillion and the Bush tax cuts pushed the US govt deep into debt did not see strong protests by this bunch who have turned into fiscal conservatives to oppose the healthcare bill. The genuine opposition is on the issue of whether richer Americans should pay slightly higher taxes to cover the poor. In countries like France, UK, they have chosen the other extreme making healthcare completely free. France has the number 1 healthcare system in the world. Some countries like Australia & Taiwan do something in between - everyone pays for insurance but the richer citizens pay more and the govt pays for the poor to make sure everyone is covered. Obama's health care reform steers America's system only slightly to the left but is strongly opposed by the Republicans - not a single one will support this bill for political and philosophical reasons. Increasing taxes to help the poor (and sick) is wrong....uncapitalistic? and everyone should be responsible for himself. However, at a time when income gap is the highest in the last 100 years and health care cost rising much faster than income not everyone is can be responsible for himself medically. There is only one other developed country that leans further to the right and put more financial burden (as a % of total expenditure) on the sick than USA....so far no Republican has dared to ask an American to go to Mexico to get cheaper health care.
Yesterday, the New Paper reported a cabby who saved $6K by going to Malaysia for an operation[ New Paper Link :here]:
- He saves $6,500 by doing op in JB
By Ng Wan Ching
March 20, 2010
A Singaporean cabby is one of the first Singaporeans to go to Malaysia for medical treatment, after the use of Medisave has been allowed for elective hospitalisation overseas from 1 Mar.
Mr Ali Ahmed has undergone a procedure called a laminectomy in Regency Specialist Hospital in Johor Baru with a Singaporean doctor.
His total bill will be $7,050, which includes surgery, meals and a five-day stay in a single deluxe room at the JB hospital, which is air-conditioned, with an en-suite bathroom, a telephone and a flat-screen TV.
He would have saved another $1,000 if he had opted for a Malaysian doctor. Accurate figures cannot be quoted because the cost depends on the Malaysian doctor.
For an equivalent stay and single room in a restructured hospital here, he would have had to pay $13,500.
For the operation in JB, Mr Ali can claim $5,150 from his Medisave. The rest he has to pay for himself as MediShield insurance cannot be claimed for treatment at overseas."
Mr. Ali is a cab driver. He is not poor enough to qualify for Medifund (you really have to have nothing to get some of this...absolute poverty!). The subsidy given out by the govt is does not even bring the cost of his operation at a Singapore govt hospital to the ball park of the cost of private for profit treatment in JB. Mr. Ali whom I guess is unimsured (like the other hundreds of thousands of Singaporeans) did the sensible thing of going to JB to save some money....
At a time when medical inflation outstrips rise in wages and when the benefits of our economic growth is distributed in the most unequal manner in our history causing our income gap to be the highest in developed countries, the PAP govt worsens all this by shifting more financial burden of medical treatment to sick Singaporeans and their families. This is seen from the reduction of healthcare subsidies over time. The goal of turning Singapore into a medical hub for the rich in the region means that an increase part of our health care system is turned into for profit private enterprises (Parkway, Healthway, etc) to cater to whoever is willing to pay the highest price and this drives costs up- Singapore has close to 1M medical tourists and Singaporeans like Mr. Ali have to go overseas to seek medical care. Singaporeans shoulder the most in terms of % health expediture than all other countries even more than Americans whose system is considered so broken they are in need of reform.Obama's argument is simple - at the end of the day you either believe everyone has a right to good medical care in his country or you don't. If you do, you make it happen even if it means higher taxes for some people in the country. At the end of the day, it is about getting one step closer to an ideal called equality. Obama and Americans have to make a painful choice because the country is feeling the fiscal strain of the crisis and years of irresponsibility by an earlier govt. Here in Singapore we have had more choices - that 2% GST increase which went towards corporate tax cuts would have gone a long way to help the sick if the govt wanted to. But it does not want to...it believes in raising burden for the sick so that it can keep cutting taxes for corporations and the rich (inheritance tax was eliminated last year) even as our income gap keeps rising and corporate profits as a % of GDP is at historic highs. The recent move to get Singaporeans to go to JB and the hospital bed crunch[Link] are the results of PAP's policies to keep govt expenditure down even as costs rise by increasing the burden of ordinary Singaporeans who get sick.