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Hell Care Health Care

This is the unedited post of the article which was published byPublicHouse -http://publichouse.sg/categories/topstory/item/246-the-price-of-life-what-value.

Hell care Health care


Well, it certainly feels that way at times. Just recently a bunch of us got into a discussion on healthcare again. Someone in the group shared his personal story. When his father was admitted into a local hospital several years ago, Class C ward-mind you, he was made to sign an undertaking to pay the bill before the staff would proceed with treatment. 5 months of coma later, his dad passed away. His bill – $500 000.


This story really got me upset. I do not claim to be an expert on healthcare policies, government budget or hospital administrative policies. I am just an ordinary citizen with healthcare concerns for myself. So do not throw me questions on funding – that is the problem for our superbly well-paid ministers to solve. I am also not going into a discussion on the merits of health insurances and medishield. The discussion will get too involved otherwise.


Even as I write this, I hear the many conversations I have had with taxi drivers and the aunties peddling simple ware at the market. “Di zhi dao, ooi si, buay sai pua pi.” Translated from hokkien, what they are saying is, inSingaporeit is ok to die, just don’t get sick.


Someone else mentioned that a cancer patient had to pay close to $600 for a pill – that’s right – $600 for ONE pill. Hospital bill so far, $13000. My reply – if I were the patient, I would stop all treatment. That night, I kept wondering if something similar were to happen to me, at what point would I stop treatment? What is the economic value of my remaining life?


Yes, this world is so economically driven, so financially based that even life itself must have a price tag. The question is, who determines the price tag?


Out of curiosity, I decided to check out the Hippocratic Oath. In particular, I checked out the often used version, rewritten in 1964 by Dr Louis Lasagna (forgive the irreverence – but he sounds almost edible!) One line stood out for me and I quote:


“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”


How interesting. The medical profession needs to be concerned about how the sickness of the patient affects the financial burden of his family. This seems quite the opposite to what is happening in actuality. Not only does it seem as if an impersonal system is uncaring of the “economic instability” of the family, it seems to want to ensure that the family is responsible for every last coin that the treatment may cost, never mind if it costs more than the family home.


I grant you there are those who care, that there is help available – if you know how to look. I know doctors who bring foreign patients into their own homes while they are recuperating from their medical conditions. These would not be able to pay for local accommodation otherwise and once home, would not be able to afford to make trips back toSingaporefor follow-up appointments. I have seen doctors waving their consultation fees when they realize the financial difficulties their patients are in. However, these are the exceptions, not the rule. And as a society, we do not expect the medical staff to be made out of pocket either.


After all, we are a meritocratic society, and how good we are is measured by the salary we can command, the amount we can earn. At a recent interview for placement in our prestigious local university, one student who had applied for either law or medicine, I cannot rightly remember which, said this in answer to the question, “Why do you want to be a lawyer/doctor?

“I heard you can earn a lot of money!” It was a cheekily honest answer – and guess what, his honesty paid off – he got a place.


I remember how when Ng Eng Hen was introduced, his earnings as a doctor was brandished about as proof of how we had snatched a trophy from the private sector. Currently, doctors, especially specialists are leaving government hospitals in droves. They want to be paid more, for less stress. Let me state emphatically that I do not blame them.


What I do blame is how we have allowed ourselves to get to this stage. It begins with a paper chase, and it continues with a paper chase. First it is the degree, then it is the money. What values have we transmitted to our children?


During the discussion, someone mentioned the cost of drugs.  Malaysian pharmacies sell drugs at way lower prices thanSingapore. Someone else said that this is because of the low cost of registration of drugs. There is a downside though. Often times, imitation drugs make their way to the counter. These drugs are either ineffective or may pose a danger to the patient. Be that as it may, counterfeit drugs do not make their way to the counter because of lower registration costs. They get there as a result of corruption. There is no reason why we cannot lower the cost here inSingaporeand still maintain a stringent standard of registration. The truth is pharmaceuticals spend a lot of money testing drugs and coming up with new courses of treatment. They want to earn back the money they had spent and then some. As a people, as a government, we cannot control their business policy. However, we can control how much we profit from their successful research. Are we too profit driven?


Which brings me to the question I asked earlier -who determines the price tag of my life? In the case of my friend who inherited the $500 000 dollar medical bill, the hospital put the decision squarely on his shoulders by making him sign the undertaking. The value of his father’s life to him was priceless – how else could it be?


What if the undertaking was reversed? Instead of making the next of kin sign such an undertaking, bearing in mind the emotional upheavals, the struggles in the conscience on how much filial piety is worth, the lack of medical knowledge that makes such decisions a stab in the dark, why not get the hospital or the government administration to give us a signed policy statement instead? Let them put in black and white to what extent they are willing to treat patients – at which point of debt would they feel compelled to stop treatment. Let them be the one to put a price tag on lives – for they can do so in an impartial, considered and educated manner. The next of kin can still try to maintain treatment by servicing the debt to acceptable levels – if he can find the means to. When he cannot, then let the professionals pull the plug. Stop putting the guilt on the relatives – make the expert decision and take the responsibilities that come with it.


I know I sound cynical and upset. I am cynical and upset. I have one last proposal to make. To me it is absurd to expect the common folk to pay hundreds of thousands of dollars in medical bills. I propose that there is a cap set on the cash portion of medical bills. This can be gradated according the financial standing and affordability of the individual patients. Beyond this amount, I feel a specially set up fund must foot the bill.


I will conclude by quoting the last two lines of the Hippocratic Oath. My prayer is that as a nation, we can help the medical professionals keep their professions honourable and noble.


I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.














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