I am glad to read that, in response to the calls from several Singaporeans, including Tan Kin Lian and myself, the government is now considering covering under MediShield, the national health insurance scheme, children with congenital illnesses.
In a letter to the Straits Times (21 Sept 2009), the Ministry of Health (MOH) said that:
…for those with congenital illnesses, we are sympathetic to their plight. We would like to get them insured but precisely because they are in the minority, the premiums will be high for such a risk group. One way to lower the premium significantly is for the majority of Singaporeans without congenital illnesses to cross-subsidise them through higher premiums across the board. This is done in some countries and we are studying their experience. But such an approach will require the support of Singaporeans.
While I am glad to hear of this long overdue move by the government, I disagree with its proposed approach, which is (1) to make the parents of the insured children pay much higher premiums; and (2) to increase the premiums of all Singaporeans to cross subsidize them.
Let me state from the outset that I personally have no objections to paying higher premiums if it is the only way to provide insurance coverage for children with congenital illnesses, especially those from low income families.
But I don’t think that is the only way.
From what I know about how this government operates, they want MediShield to be a self-funding scheme — and preferably profit-making. The government’s rationale, I would assume, is that MediShield needs to be sustainable for future generations of Singaporeans and they cannot have it depend on constant government injections of funds to prop it up.
As I’ve said before, this is not the way a state-run health insurance scheme should work.
There is a distinct difference between a national health insurance scheme and private insurance schemes. Private insurance exists for the purpose of enriching the shareholders of the insurance companies, and minimizing the payouts.
MediShield should be run on social principles, to ensure that no child, no adult, no elderly person is left behind because of their inability to pay. It should be run on a cost recovery basis — but only as far as possible. For certain categories of people like sick babies, the elderly and the poor, we cannot expect them to bear the same burden as the wealthy. It should definitely not be run for profit, as it appears to be now.
My proposal is for the government to cover the higher premiums for these babies with congenital illnesses. Since such babies are in a minority, as even MOH has admitted, the cost cannot possibly be prohibitively high, especially in contrast to the $5.6 billion that CPF Board (which administers MediShield) gained from its investments of Singaporeans’ retirement savings last year.
Raising a child is difficult enough. I cannot imagine the financial and emotional burden that parents with sick children have to bear. If we aspire to be a compassionate country, the government should lead by example and help relieve the financial burden of these parents.