I’m puzzled. How did you surmise that I do not treasure human lives? I trust that most people treasure human lives. So do I. And I hope you do.

Since I do not know you personally, I have no way of knowing how much humanity you have. So I abstain from accusing you of any lack of human decency.

Dear Donaldson, though we may disagree on certain occasions, I think we should keep our discussions cordial and argue on factual matters rather than wantonly ascribe negative traits to others. I hope we agree on this point.

In any case, evaluating a health system requires only a cool and logical mind, some inside knowledge and some experience in life. An indignant self-righteousness is not required.

The point I am making is that if you cannot treasure human lives, you are in no position to judge the adequacy of any healthcare system.

To I am foolish (#33),

NHS and the SAF Medical Corp are similar, but not entirely the same. Under SAF Medical Corps, every soldier entitled to all aspects of healthcare until they are either discharged or kicked out of the military. Under NHS, free healthcare is only limited to medical consulting, surgery and doctor-prescribed testing such as X-Ray and Smear Test. Medicine and Self-initiated tests such as full body checkup are not free. Selected medication for major illnesses are subsidised but not entirely free, while most categories of medical drugs are not subsidised at all.

http://nhsblogdoc.blogspot.com/

#27 Donaldson Tan: as a medic i have seen TOO MANY soldiers abusing free healthcare provided by the SAF. even i did that to a certain extent. and i know people who live in the UK that abuse the nhs (like getting free medicine and shipping them to asia to sell or to give relatives).

I don’t quite understand the point you’re making in #31. Perhaps you still do not understand the simple wisdom that skyrocketing medical costs and unrestrained demand for medical services do not go together. Anyone with simple logic and a little working experience will know that. If you still have much difficulty understanding that, I don’t think I can help you.

Why is the NHS running into trouble due to “Govt funding neglect”? Does the British Govt deliberately neglect it? Or does it recognise the structural problems inherent in such a socialist model of health delivery rationalised not on economic principles but ultimately on its own political philosophy?

Don’t get me wrong. The underlying concept of the NHS is noble and inspiring, but just like communism, its implementation will remain a major challenge.

I agree with you that there has been definite improvements in the NHS since the early days. But the inherent conflict between sky-rocketing costs and restriction in public funding remains and therefore it is not recommended for adoption in Singapore.

Please do not underestimate the capacity of Singaporeans to take advantage of anything that is free and unrestricted. It is ok if it’s just free old textbooks or free tissue paper at McDonald’s. When it is medical service, it can do serious damage to your Budget.

Webster’s book is about how a good system like the NHS that has consistently delivered is running into problems due to govt(-funding) neglect. If anything, his book is an argument for redirecting political leadership to NHS rather than abolishing the NHS.

Singapore’s current system has much to learn from the NHS.

We have an equivalent of the NHS in Singapore and it is known as the SAF Medical Corps. It only covers military personnel and we all experienced it when we were in NS. Do you see Singaporean soldiers abusing the healthcare system just because it is free? Do you know how impractical it is of Singaporeans to swarm hospitals / clinics just because it is free?

If you compare NHS in the 1980s to NHS in 1948, it has made progress no doubt. If you compare NHS in 2008 to NHS in 1997, it has made progress too. The experience of NHS differs by location and some NHS Trusts (hospital and polyclinic clusters) manage better than others. It is always improving despite the huge problem in containing healthcare cost and delivering good healthcare services.

However, there is no comparable basis if you compare NHS to private or subsidised healthcare because they work differently and serve different managerial goals. Using efficiency as a guage to determine which is better fails to take in account of the distribution effects of providing healthcare to different classes of people in society.

I’m actually quite shocked that you dismissed Mr Charles Webster’s book “National Health Service: A Political History (2002)” as a compilation of MY hearsay! I hope you can be more careful in what you say. Perhaps, if you have proof of your allegation, please inform Amazon to stop the sale of this book as you obviously think that it is a fraudulent piece of work!

The shortcomings of the NHS such as lengthy waiting lists for surgery since the 1980s are the inevitable result of its comprehensive coverage despite restricted resources. Also, there has been inefficiency in the system such that increased spending since 1997 had not resulted in any perceptible improvement.

One must not forget that the NHS was established in 1948 as part of the Labour Party’s socialist program after World War 2, borne out of political expediency rather than the result of rational or prudent decision-making. It is wholly publicly-funded, mostly free and universal.

One wonders whether such a system is feasible and viable in Singapore. If it covers everybody for everything and is totally free, (knowing how Singaporeans are like) what do you think will happen? Is it sustainable? Now you tell me.

We agree to disagree. Just because your hearsay has been compiled into a book, it doesn’t make it a better argument that universal healthcare is a bad idea.

Just like any healthcare system, the NHS faces financial and manpower constraint in delivering care to its consumers. When funds are centrally allocated, it is only natural to expect that NHS would have a limited portfolio of treatments for specific illness in order for NHS to maximise its cost-effectiveness.

The trade-off between free healthcare and private healthcare would fall in the areas of quality of service, access to the latest or expensive treatments. When people choose free healthcare, they also make a concession to accept lower quality of service. When people choose private healthcare, they demand the best. Nobody gets the best of both world. Even in the private healthcare system, the consumer is limited by his budget and there are cases where people would be left behind if healthcare is entirely privatised.

The political beliefs which underlie the NHS have remained intact even through the course of Thatcherism and an increasingly centre(-right) New Labour. No doubt you and Webster are right in pointing out that this will hinder rollbacks where they appear to be necessary. I’m certainly not arguing that the NHS is the gold standard (by my own anecdotal evidence!). But perhaps there is also some comfort to be had in that there is a firm belief in the need for taxpayers money to go towards a service which is necessarily provided to all?

It is good to hear that you had a recent positive experience with the NHS. You also had good feedback from hearsay.

However, it is imprudent to rely on anecdotal or hearsay evidence.

My opinion is based on evidence from a doctor friend of mine who had worked under the NHS before. My impression was reinforced after reading the book “National Health Service: A Political History (2002)” by Charles Webster.

Mr Webster is the doyen of British medical historians and is acquainted with more than 50 years of health policy-making. Generally, his gloomy verdict is that the NHS is a system whereby no one is ever completely in charge and vested interests had exerted undue influence on it.

This is hardly surprising if you realise that the NHS is caught between the conflict between the ever increasing costs as a result of advances in medical knowledge, medicines and technology on the one hand; and the financial restrictions inevitable in a centrally funded service with changing management dogmas and political beliefs on the other.

Furthermore, such incidents are hardly the norm. When I was injured during a hike in the Lake districts and had to be rushed to the hospital, I was attended to after a 30mins wait at the hospital, the doctors and nurses were friendly. The cost (which only included medication) came up to a mere 20 pounds (S$50+). If I were to go through the same process in Singapore I think I would have had to pay at least S$150.

This is only my personal experience to be sure, but I’ve heard wonderful things about the NHS from others, Brits and foreigners alike. It might not be so efficient, but given wjat it’s been tasked to do, it’s doing a wonderful job.

Of course, the Singapore govt and its mouthpiece Shitty Tiimes have made Singaporeans to think that NHS is crap, welfare states are dying, and only the Singapore way is the best and its govt most glorious.

Between the current Sg healthcare and the UK one, I’d take the UK one anytime.

#20, the NHS isn’t the utopia of healthcare, but it is greatly valued by Britons. Free healthcare has come to be regarded as a basic necessity, and while there are plenty of problems to be had, I think it’s also worth noting that Britons are not afraid to voice their displeasure on a service that they as taxpayers fund. It may not be perfect, but it is also open to scrutiny — by users AND by the Conservative opposition.

Please do not be seduced by the free and universal nature of the NHS. It may not be worth emulating.

Like any managed healthcare scheme, it is inefficient, it has a long list of exclusions and is subject to abuse by health-care providers.

It has been reported to discriminate against non-whites, the poor, the disabled, the obese, and the smokers. Appointments and surgeries can take ages to materialise.

It is not the Gold Standard to be envied.

For starters, sg should LEARN from TW and now Japan who use cash / vouchers to BOOST their economy.

TW has proven it works.

Japan , i suspect , has taken the hint.

There has been calls to sporeans to spend and spend to pay and pay for the businessmen their goods and services. that has not worked as well as I expected.

Put money into hands of sporeans, and voila! presto! see what would happen.
Its worth a try. Afterall, sg is so rich right? look at the reserves. So strong wor. ;)

injoy!

I strongly support your idea to
compare Apple with Apple.

Often, people get fooled into comparing a peanut with an Apple (figure of speech).

but when there is ‘debit’ they say long term.
when credit they say its me.

its almost kindergarten thinking.

I thought we already have , albeit for the millions-dollars club members sitting in Ivory Towers collecting money every second while shaking leg.