On Rising Healthcare Costs - And Why I'm Not Buying Opposition (or PAP) Promises

As a medical doctor, I read with concern claims by the opposition that rising health costs are the fault of "government mismanagement". Even more worrying were promises by the opposition to provide cheaper medical care (with one politician reminiscing of low healthcare costs in the 70s and 80s), with plans such a welfare scheme put forward by some parties, as if this were an end-all solution.

The reality is that healthcare is getting exponentially more expensive, by processes beyond the control of any government. The “cheap and easy” gains in health outcomes, such as vaccinations and sanitation, have been already been achieved. With demographic shifts reflecting those of first world countries, Singapore would soon be facing increasingly complex healthcare issues that require new, and often expensive, solutions. These would include an ageing population, with people living longer and developing more illnesses associated with old age (such as dementia, cancer and arthritis). Recent economic analyses from the US have demonstrated that any cost-saving from addressing preventable illnesses will be offset by these unavoidable “diseases of old age”.

Rapid advances in technology also mean that medical care today is a far cry from medical care from yesteryear (especially from the "good old 70s"). We have a larger number of more powerful drugs to treat conditions, many of which are being detected with more sophisticated tests. Technology has revolutionized medical practice, such as fibre-optic imaging in keyhole surgery. However, all of these advancements involve significant R&D costs, into the millions of dollars, which are then transferred to the end-users. By positioning ourselves as a medical hub, Singaporeans effectively now have access to these latest developments. However, if we want to continue to enjoy the latest pharmaceuticals or the most advanced imaging and surgical techniques, we will need to face the burgeoning costs associated with them.

What this means, is that healthcare is becoming more expensive at a rate never seen before, bringing the issue of healthcare costs to the forefront in many political debates around the world (the most recent, and perhaps significant, are the healthcare reforms in the USA). The best minds from around the world have sought a solution, but no easy answer has yet been found. Ultimately, the costs have to be borne by someone – in Australia and the UK, the governments have borne the costs through a welfare system. However, this is translated to significantly higher taxes for the people (close to 50% for some categories!) Even then, these governments are frantically searching for a way to curb the ballooning healthcare expenditure that is pushing the countries deeper into debt (as a friend of mine says – health care expenditure is basically a black hole). On the other hand, the USA has attempted to use a free market approach in an attempt to drive healthcare costs down via competition. Unfortunately, this has backfired for a number of reasons, leading to even basic healthcare being out of reach of a significant proportion of the population.

We should thus take any blanket promise of lower healthcare costs with a grain of salt, being aware that there is no simple answer to this complex issue. As the election draws close and more promises are being made, we should be wary of such utopian offers, realizing that there is no magic bullet to ease the pain of rising medical costs.

My 2 Cents, on probably the only topic I'm familiar with.

Sing Chee

Book review: Unscientific America by Mooney and Kirshenbaum

In this book, Mooney and Kirshenbaum (I'll just refer to Mooney from now on) address the key issue of scientific illiteracy - the decline of scientific awareness and engagement with the public, and the dangerous implications it has for the future. He splits his chapters up into key topics - describing the current situation, how we got here, the issues behind the decline in various disciplines (eg: science in culture, science in movies, science in schools), hot topic issues such as the new atheism, and what can be done about it all.

I really want to like much more than I did, for good reason - it's centred on an issue that I'm (somewhat) interested in: scientific illiteracy. Mooney shares the same desire as I do - that people become more aware of the wonderful progress being made in scientific fields, that science conciously becomes a integral part of society, and that more people take consider pursuing science as a career path for the sheer love of it. In my case, my career direction (As a doctor) was most impacted when I was barely 10, by a "Book of Science" (that I still have) which contained some of the most marvellous pictures of the human body (dissected down to the level of vessels). I think my parents must have thought I was crazy to have placed "B.Science/Arts (combined)" right after "MBBS" on my university course preference list (I do have a crazier medical colleague who put B.Education as his second choice). So for sharing this passion, and communicating it in a easy and readable manner, Mooney scores some points.

But why doesn't this book score higher? Well, Mooney loves the scientific process no doubt, but underlying his entire book is a very questionable stance on what "science" is, and it's relation to the rest of society. Take for example, Mooney's discussion on the nature of science - which he describes as the description of an objective reality, compared to the humanities, which make a fool of reality. (He tries to be fair to the humanities, but he still comes across as poo-pooing them. Eg: His chapter on science and entertainment starts with a mockery of the idea that movies don't need to follow the natural order) He more or less completely dismisses post-modern philosophy in a few sentences, without showing evidence of engagement with some of the serious epistemology challenges it throws to scientific research. Even Stephen Hawking, in his new book The Grand Design, makes an admission that traditional "realism" is no longer a tenable position, not in light of post-modern philosphy, but in the context of new knowledge of the quantum world.

In addition, he repeated uses the word "science", like it were some holy grail - he says "we must fund science/protect science/encourage science", but never really deals the whole question of "what is science" - is it a concept, a philosphy, a defineable entity? He writes in such a way that one could be mistaken for thinking that science is a god to be worshipped, and that anyone who doesn't recognise that is a moron.

It is this "holier -than-thou" attitude, masked by what seems like a false sense of humility (he repeatedly says "Scientists are somewhat at fault to, for not doing enough to make sure things are done the proper way"), that marrs the entire book. For example, he complains that in politics, decisions are made not on careful analysis, but rather on ideology and political belief (well, surprise surprise, but ideology and political belief does form the entire framework on how we perform our analysis).

There is ultimately no clear outline on what exactly accounts for "Scientific literacy" is, and what differentiates it from scientific illiteracy. For example, he mocks things such as the Reagan "star wars" project as examples of stupidity, but then heaps praise upon projects that were once "Dreams" but have become reality (eg: space flight).

Scientific America is a book that for all intents and purposes addresses a key issue, not just in America but all over the world, even in Singapore (despite our world record science and math scores, how many of our students can actually apply critical scientific thinking to problems?). But ultimately, it comes across as too much of a kopitiam whinge, than a well thoughtout engagement with the key issues at hand (although there some points that shine through).