Singapore's most radical healthcare initiative to date kicked in at the beginning of this month. The nation's first universal and compulsory healthcare insurance scheme, MediShield Life marks a distinct shift in policy.
The conservative view is to hold down public healthcare spending and make individuals take primary responsibility for their medical costs, alongside some state support for the needy. A liberal stance is to make the state the chief provider of healthcare, at huge cost, which can turn the user into a free rider of the system.
What has emerged here is a maturing acknowledgement that society cannot in good conscience leave a good many without any basic insurance cover at all or push the burden of care onto only those paying taxes. Instead, everyone must chip in and take pride in doing so. All Singaporeans would in effect be saying to the world: This is the kind of people we are; we look after our own.
It is the essence of the national insurance scheme that must be told and retold as people come to grips with the nuts and bolts of MediShield Life. One might seek more benefits plus lower premiums and expect the State to make that unlikely equation work via all sorts of subsidies. But in looking after people's healthcare needs, the Government has to keep an unsentimental eye on costs. And the effort to socialise healthcare costs would be undermined if the scheme is regarded as a honeypot for practitioners and patients to dip into without a care for costs. It is the link between buffet-style consumption of medical services and the cost of premiums that should not be lost in translation as the scheme is explained to ordinary people.
The danger of runaway spending spawned by what might be the best of social intentions should be kept in sight. MediShield Life seeks to keep future generations of taxpayers unburdened by massive healthcare bills bequeathed by an ageing society. That is why MediShield Life's social ambitions must be tempered by a very Singaporean dose of pragmatism. Provisions against overuse or abuse are an intrinsic part of that pragmatism.
Given the universal scope of MediShield Life, which covers 3.9 million citizens and permanent residents, premiums are higher than for the old MediShield, which excluded about 340,000 people. Costs represent a constant pressure point that the authorities will have to manage with some care. Affordability will always be a key concern, especially for those with pre-existing conditions such as heart disease and cancer. What is equitable and how to manage costs over one's lifetime are issues that should be thoroughly aired. But discussions would not go anywhere if the scheme is fundamentally misunderstood. It will work only to the extent that its purpose is matched by a common sense of responsibility towards healthcare - one's own and that of others.