Our health care system

Stanley Jeremiah is mostly correct. Good reminder. Just because most of us didn't need to call upon the system in a catastrophe we forget.

Below his response to the WSJ op-Ed article.

LETTERS NOVEMBER 3, 2009, 5:40 P.M. ET
Singapore Has Health-care Hurdles Too

William McGurn's column "What Singapore Can Teach the White House" (op-ed, Oct. 21) paints an inaccurate picture of Singapore's health-care system and the costs it incurs.

Singapore does not have "universal coverage," as Mr. McGurn asserts. Even the government has admitted that in a country of about three million citizens, tens if not hundreds of thousands of Singaporeans do not have any basic medical insurance coverage, which is provided through government agencies. Many of the uninsured are women and children.

In Singapore, as in the United States, there are people who are uninsured and uninsurable. Even the government's basic health-insurance program, Medishield, refuses to provide cover for those with pre-existing and congenital medical conditions. Parents of a child with a congenital condition have to carry the entire medical cost burden themselves.

It is true that medical costs in Singapore are generally lower than the U.S., but the average Singaporean does not enjoy the same per capita income or standard of living as the average American. Medical costs are significantly higher than in neighboring countries. The minister of health recently admitted in Parliament that many Singaporeans regularly cross the causeway into Malaysia to buy prescription drugs because they are much cheaper there.

The quality of Singapore's medical care is high, but as in the U.S., cost is a pressing issue. To some extent, the situation has been cushioned by the collective responsibility of Asian families, where the larger family chips in to pick up the medical cost of a parent or sibling. Yet these social structures are slowly breaking down. Singapore has an aging population and the baby boomers are the most exposed. Having paid for their parents' medical costs, they have no one to pick up to the tab for them. To avoid picking up the cost for those who cannot pay, the government includes siblings and children—including those living overseas—in their means-testing assessment. Employers provide some level of health-care insurance but these programs are often not portable.

Singapore spends roughly 4% of its annual GDP on health care—one of the lowest outlays in the developed world. The average Singaporean cannot afford to use the upscale Raffles Hospital to which Mr. McGurn refers in his article. They have to wait in line at government-managed hospitals. The 2009 budget allocated 3.7 billion Singapore dollars ($2.6 billion) to health care; by contrast, S$11.5 billion was allocated to defense.

Singapore's medical-savings accounts, known as "Medisave," are not fully controlled by their owners. Withdrawals are subject to a complex set of rules which the Ministry of Health changes from time to time—a process that often baffles the average Singaporean.

In many ways, Singapore is heading in the same direction as the U.S. when it comes to health care. While a high quality of care is available, it is not always accessible or affordable. People unfortunate enough to be born with or develop significant medical conditions can find the cost financially crippling to themselves and to their families.

Stanley Jeremiah

Singapore