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探讨英,美,新的国家医疗服务体系

虽然现实世界还没有可以称得上是一个完美的医疗制度,但通过公开和诚实的审查最佳的实践(与最坏的失败),或许可以使我们做得更好,而不是通过笼统的发表如“当心西方的福利主义

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在《网络公民》医疗系列第四部,我们将新加坡的 3M 制度(保健储蓄、健保双全及保健基金)与其他发达国家作比较。虽然现实世界还没有可以称得上是一个完美的医疗制度,但通过公开和诚实的审查最佳的实践(与最坏的失败),或许可以使我们做得更好,而不是通过笼统的发表如“当心西方的福利主义”,。

在这篇文章中,我们的驻外记者考察了英国国家医疗服务体系 (NHS) 和美国奥巴马医改 (Obamacare) 。最好的国家医疗保健应随市场调整,还是国家资助制度更加可行?从我们的分析看来,答案并非十分明确。

By Ghui

医疗保健和不断上升的费用,在新加坡一直是争论的焦点。在新加坡人所提出的各种顾虑中,不断攀升的医疗费用占首席。

这并不是新加坡独有的情况。在美国被称为 Obamacare 的医疗改革的可行性与英国国家医疗服务体系(NHS)的可持续性,在各自的国家,每天都是头条新闻。大西洋两侧的怒火与激昂的辩论已被点燃。医疗保健涉及社会与个人,如此备受瞩目是有一定的道理。

美国、英国和新加坡的医疗保健制度有很大的不同。各种群体的需要也多样化。比较这些不同的制度将是徒劳之举。不过,我会尝试用各个制度的结果和目标对比它们的作用。

新加坡的制度(如果我们一概而论)是美国和英国的混合体。大致上,NHS可以说是由国家出资的。资金当然不是凭空而出。与新加坡相比,英国税金算是高的。英国纳税人得贡献一定比例的工资给国民保险制度 (National Insurance) 。对于所作出的贡献,任何纳税人都可以走进任何政府医院或诊所接受免费治疗(不包括每张大概15新元的处方)。该制度也承保那些供不起的国民保险供款的国民。

除非去私营医院或诊所,英国纳税人不必担心医疗费用。以一个在战后50年代所开发的制度,它是惊人和非常先进的。

然而,多年的管理不善,导致NHS捉襟见肘。它有庞大的债务,它的可持续性也是问题重重。 NHS 正在进行符合经济现实的改革。我相信 NHS 的可行性。然而它得根除工作重叠、不佳的记录保存与协调不力。

另一方面,美国是完全不同的。 在 Obamacare 成为法律之前,美国医疗保健可说是精英制度。很多的低收入美国人无法获得负担得起的基本医疗保健。美国的繁荣是建立在资本主义上。因此,它尝试将其医疗保健制度建立在自由市场上。毕竟,自由市场使美国成为世上最富有和最强大的国家之一,自由市场也应适用于医疗部门。

但是,正如保罗•克鲁格曼解释 (Paul Krugman) ,根据肯尼斯•阿罗 (Kenneth Arrow) 战后的开创性论文《不确定性和医疗保健的福利经济学》,医疗不能,如面包或电视,在市场上销售。首先,它是不确定性的——没有人知道何时会需要它,他们将需要什么,或者他们是否会需要它。其次,如果出差错,代价可能是一条手臂或腿(没有双关语意)。因此大多数人将无法咳出(再次说明,没有双关语意)一大笔现金。

荒谬的是我们得依靠保险来解决这个问题。我们不要忘记,保险公司基本上都是逐利企业,索赔被它们看作为“成本”。往往它们的利润与索赔有直接的关系。所以为什么当索赔困难重重时,我们还会惊讶?他们和我们索赔的目标并不一致。

总结——医疗保健不会在自由市场上正常运作,政府的干预是必要的。因此 Obamacare 能创建一个大众负担得起的保险市场。

毫无疑问,很多人会提到那些众多反对 Obamacare 的声音。然而,当你越挖越深,大多数抗议者的反对是出于缺乏了解,或是觉得 Obamacare 的应该走得更远。这完全是另外一回事,但重要的一点是,这些问题都被提出、讨论和解决。

美国和英国正在改变他们的制度。这些问题正在政府核心中辩论和讨论,以及被媒体审查。各自的公民则密切注视这些进展。

这样的辩论对于有权利关注的公民是健康的,重要的是一个国家希望把医疗保健实施好。这是新加坡将需要看齐的,如果我们希望看到在我们的医疗保健制度的成功。

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Ng Eng Hen: Dust clouds likely caused armoured vehicle collision during Exercise Wallaby

Dust clouds limiting visibility likely contributed to the collision between two Hunter vehicles during Exercise Wallaby, Defence Minister Ng Eng Hen explained in his parliamentary reply. 12 servicemen sustained mild injuries, but safety measures prevented more serious outcomes. A formal investigation is ongoing to ensure further safety improvements.

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SINGAPORE: Low visibility caused by dust clouds was identified as the likely cause of the collision between two Hunter armoured fighting vehicles (AFVs) during Exercise Wallaby last month, Defence Minister Ng Eng Hen said in a written parliamentary response on Tuesday (15 October).

The incident, which occurred in Queensland, Australia, on 24 September 2024, resulted in mild injuries to 12 servicemen.

Dr Ng’s statement was in response to a parliamentary question from Mr Dennis Tan, Workers’ Party Member of Parliament for Hougang SMC.

Mr Tan asked for details on the accident, specifically its cause and whether any lessons could be applied to enhance training and operational safety within the Singapore Armed Forces (SAF).

The collision took place during a night-time movement of Hunter AFVs at the Shoalwater Bay Training Area.

The vehicles were returning to base when one rear-ended another. Dr Ng explained that the dust clouds generated by the AFVs’ movement significantly impaired visibility, might likely contributing to the accident.

The 12 affected servicemen sustained mild injuries and were promptly taken to the nearest medical facility.

None of the injuries required hospitalisation, and all 12 servicemen were able to rejoin their units for training the next day.

According to the minister, adherence to safety protocols—such as wearing seat belts and protective gear—played a crucial role in limiting the injuries to mild ones.

Following the incident, a safety pause was immediately implemented, with all drivers being reminded to maintain proper safety distances, especially when visibility was compromised.

Troops were also reminded to adhere strictly to safety protocols, including the proper use of safety equipment, Dr Ng added.

The safety lessons from the incident were shared not only with the affected units but also with other participating groups in the exercise, as well as units back in Singapore, through dedicated safety briefings.

Mr Tan also asked about the broader implications of the incident. In his response, Dr Ng said that a formal investigation had been launched in accordance with SAF’s safety incident protocol.

The investigation aims to assess the circumstances more thoroughly and identify any further measures that could be taken to enhance safety.

Dr Ng shared that recommendations arising from the investigation will be implemented where necessary.

Exercise Wallaby is SAF’s largest unilateral overseas exercise, and the 2024 edition began on 8 September, running until 3 November.

The exercise involves approximately 6,200 personnel, including 500 operationally ready national servicemen.

The exercise has been conducted at Shoalwater Bay Training Area in Queensland since 1990, and it is a key part of SAF’s overseas training program.

The Hunter AFV, one of the vehicles involved in the collision, is a state-of-the-art platform jointly developed by the Defence Science and Technology Agency, the Singapore Army, and ST Engineering.

It replaced the SAF’s aging fleet of Ultra M113 AFVs in 2019, which had been in service since the 1970s. The Hunter is equipped with advanced features, including a 30mm cannon, a 76mm smoke grenade launcher, and an automatic target detection and

tracking system designed to enhance operational effectiveness. It is also capable of traveling at increased speeds and covering longer distances, making it a versatile asset for the SAF.

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Government to “carefully consider” Lee Hsien Yang’s demolition application for 38 Oxley Road

The Singapore Government will “carefully consider” Mr Lee Hsien Yang (LHY)’s application to demolish the house at 38 Oxley Road. LHY announced his intent on Tuesday morning following the recent death of his sister, Dr Lee Wei Ling, reaffirming his commitment to honour his parents’ wish for the house’s demolition.

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The Singapore Government has indicated that it will “carefully consider” Mr Lee Hsien Yang’s (LHY) application to demolish the family home at 38 Oxley Road.

LHY, the youngest son of Singapore’s founding Prime Minister, the late Lee Kuan Yew (LKY), announced his intention to apply for the demolition in a Facebook post on 15 October 2024, following the death of his sister, Dr Lee Wei Ling, on 9 October.

The announcement marks a significant development in the ongoing saga over the fate of the historically significant property, which has been at the heart of a family dispute since LKY’s passing in 2015.

In his will, executed in December 2013, LKY expressed his desire for the house to be demolished “immediately after” Dr Lee moved out of the property. Dr Lee, a prominent neurologist, had been the last remaining resident of the house.

LHY reaffirmed his commitment to carrying out his father’s wishes, stating, “After my sister’s passing, I am the only living executor of my father’s estate. It is my duty to carry out his wishes to the fullest extent of the law.”

He added that he would seek to build a small private dwelling on the site, which would be “held within the family in perpetuity”.

LHY also referenced his brother, Senior Minister Lee Hsien Loong’s (LHL) remarks in Parliament in 2015, when he was Prime Minister, stating that upon Dr Lee’s passing, the decision to demolish the house would rest with the “Government of the day.”

In response to media queries regarding LHY’s announcement, a spokesperson for the Ministry of National Development (MND) acknowledged the intended application and emphasised that the Government would “carefully consider issues related to the property in due course”.

The spokesperson also highlighted that any decision would need to balance LKY’s wishes, public interest, and the historical value of the house.

The house at 38 Oxley Road, where key decisions about Singapore’s path to independence were made, has been a focal point of public and political discussion.

The future of the house became contentious in 2017 when LHY and Dr Lee publicly accused their elder brother, LHL, of trying to preserve the house against their father’s wishes for political reasons.

LHL denied the accusations, issuing a Ministerial Statement in Parliament, where he also raised concerns over the preparation of their father’s final will. He clarified that he had recused himself from all decisions regarding the property and affirmed that any government action would be impartial.

In 2018, a “secret” ministerial committee, which was formed in 2016 to study the future of 38 Oxley Road, proposed three options: preserving the property and designating it as a national monument, partially demolishing the house while retaining the historically significant basement dining room, or allowing complete demolition for redevelopment. LHL accepted the committee’s conclusions but stated that no immediate decision was necessary, as Dr Lee was still living in the house.

In a statement conveyed by LHY on behalf of Dr Lee after her passing, she reiterated her strong support for her father’s wish to demolish the house. “My father, Lee Kuan Yew, and my mother, Kwa Geok Choo, had an unwavering and deeply felt wish for their house at 38 Oxley Road to be demolished upon the last parent’s death,” the statement read.

She added, “He had also appealed directly to the people of Singapore. Please honour my father by honouring his wish for his home to be demolished.”

Despite selling the house to LHY at market value in 2015, LHL’s stance regarding the house’s preservation became a public issue, especially after the family disclosed that the Government had raised concerns about reinstating the demolition clause in the 2013 will. The ministerial committee had reviewed the matter, but a final decision was deferred until now.

The fate of 38 Oxley Road remains to be seen, but the Government’s decision will likely have lasting implications for the legacy of the Lee family and the conservation of Singapore’s historical landmarks.

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