Dr. Paul Tambyah, Chairman of the Singapore Democratic Party (SDP) and infectious diseases specialist, doesn't mince words:
His stark warning, made during a candid interview, cuts to the heart of a growing fear for many Singaporeans – the terrifying prospect of medical expenses derailing retirement plans, draining family savings, or even leading to bankruptcy.
The interview transcript reveals a healthcare system at a crossroads. While lauding Singapore's medical talent and infrastructure, Dr. Tambyah pinpoints financing complexity and profit motives as core problems. "The problem is in the financing and the complexity of its financing," he states, tracing issues back to the 1980s shift towards privatisation influenced by Reagan and Thatcher economics, coupled with a deep-seated fear of "welfare queens" – a myth, he emphasises, that never existed.
The consequences aren't abstract. Dr. Tambyah highlights a shocking reality: "The number four reason why people go bankrupt in Singapore... is medical expenses." He paints a grim picture of the system's failures:
Debt Collectors for Public Hospitals: "The public hospitals do use debt collectors... They'll call you up and just every day ask you when are you gonna pay."
The Insurance Trap: Cherry-picking by for-profit insurers leaves many vulnerable, especially those with pre-existing conditions. He recounts a case: "Somebody I know... had a benign ovarian condition... the insurance company said, we'll exclude your whole pelvis." Negotiation only narrowed it to excluding the "female genital tract."
Fragmented Care: Navigating care for elderly parents or complex conditions becomes a nightmare. He references a book, When Mama Fell, which details the exhausting journey through multiple agencies just to secure basic aids like a wheelchair.
Dr. Tambyah argues that the increasing involvement of venture capitalists and hedge funds in owning medical practices prioritises shareholder returns over patient care. He points to facility charges and implant costs as major, unchecked drivers of inflation, contrasting this with Mount Elizabeth Hospital – Singapore's only major not-for-profit hospital – which reinvests profits into staff training and cutting-edge technology like the Da Vinci surgical robot.
"The president of the Singapore Medical Society actually broke down the pricing... all these for-profit hospitals are getting net margins of 10% and up... which is crazy," Dr. Tambyah states, questioning the efficiency of a system where distribution and operational costs for private insurers can consume 20% of premiums – costs largely avoided by the compulsory MediShield Life.
The SDP's solution, developed over years of study (Dr. Tambyah notes they were "probably the only one that spent a lot of effort on this policy thing" during election periods), is a robust single-payer national health insurance system:
Universal Coverage: A mandatory national insurance scheme ("MediShield Life Plus") covering everyone, eliminating cherry-picking and ensuring coverage for pre-existing conditions.
Cost Control Through Scale & Price Setting: Leveraging Singapore's market size (e.g., like flu vaccine tenders) to negotiate drug prices (citing the successful Cancer Drug List which forced significant price drops) and set procedure fees. "The classic example is like the flu vaccine... Companies have to get that government tender because if they don't... they lose the sale of a million vials... So they cut the price."
Reinsurance for Rare Diseases: Pooling risk nationally or internationally to cover astronomically priced treatments for rare conditions (e.g., a $3 million neurological drug).
Integrated Primary Care: Empowering GPs as the first point of contact with a $10 co-payment, reducing unnecessary specialist visits and hospital admissions. "80% of the primary healthcare in Singapore is provided by GPs."
Maintaining Private Options: Allowing individuals to purchase supplementary private insurance for amenities beyond the basic national coverage, similar to Australia's model.
Would this burden taxpayers? Dr. Tambyah argues it could be revenue neutral or even save money by eliminating inefficiencies and profiteering. He notes government healthcare spending ballooned from $9 billion to $23 billion recently. With a national insurance pool replacing complex subsidies and leveraging compulsory contributions (including from healthy young people currently avoiding insurance), combined with modest co-payments ($10 outpatient, $100 inpatient), the overall cost trajectory could be reversed.
Concerns about waiting times or quality? He contrasts the UK's tax-funded system with Taiwan's successful, tech-savvy insurance-based model emphasising primary care integration and efficiency. He also stresses that attracting talent requires fair compensation within the public/not-for-profit framework, not stratospheric private profits: "You have to have a certain amount of pay, but once you reach the stratospheric level... it's about work-life balance and contributing."
For working professionals saving for retirement, parents worried about children's health costs or aging parents' care, and anyone fearing a major illness could wipe them out financially, Dr. Tambyah's message is urgent. The current system's complexity and profit-driven elements are fueling unsustainable cost growth and leaving too many vulnerable. The SDP's single-payer vision offers a potential pathway to:
True financial security against medical bankruptcy.
Simplified access to necessary care.
Controlled, predictable costs for individuals and the nation.
Preservation of quality through investment in talent and technology within a more equitable structure.
As Dr. Tambyah’s grandmother wisely said, "Without your health, you can't do anything." Ensuring Singapore's healthcare system protects both health and financial well-being might require a fundamental shift. The conversation started on "Chills with TFC" demands serious consideration from every Singaporean whose future depends on it.
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