In keeping with its mandate to protect the interests of workers, the National Trades Union Congress (NTUC) has weighed in on the new compulsory MediShield Life insurance scheme, whose details are being worked out. The scope of the national scheme, which will cover everyone for life and is expected to start by the end of next year, naturally has raised public expectations.
In its recommendations to the scheme's review committee, the NTUC has focused, among other issues, on removing the higher deductibles which people over the age of 80 pay now, so that they will be on a par with everyone else. What motivated this suggestion was the sense of being discriminated against, felt by older people, because they already are paying the highest amount in premiums. NTUC members also want MediShield Life's coverage of chronic ailments to be expanded from cancer, kidney failure and organ transplant, to asthma and diabetes.
The desire to lower the scheme's cost is understandable, as is the call to expand its coverage. However, premiums lie at the financial heart of any health insurance scheme, whether individual or national. In the latter case, the key question is who should help carry the burden of higher premiums in order to support greater relief for older people and the expanded scope of the scheme. Younger workers might baulk at the prospect of carrying a disproportionate load for others' sake. By default, attention would turn to the state, but that would be just another way of passing the cost around because higher expenditure would have to be financed from taxes.
Universal coverage is a social imperative. The Government is right in treating access to health care as a moral and a social good, thus placing it more firmly outside the realm of market forces and personal ability to pay than used to be the case.
However, for any scheme to be viable in the long run, its costs must be watched carefully and managed constantly. There is also a need to avoid the moral hazard of over-consumption, and encourage a residual degree of self-responsibility for health.
Those who want MediShield Life to do more must ask themselves how these larger objectives can be met. Realism will help to make the scheme viable.
One suggestion by NTUC that is clearly defensible is that more companies should practise portable medical insurance. The modalities of how this could be achieved - higher tax rebates for companies that offer the benefit are one suggestion - are open to examination.
The fundamental principle, however, is a laudable one in a market where labour mobility requires that health-care provisions for workers are not compromised.