Misaligned incentives: Why Medical Tourism hurts us
I am quite against medical tourism, because I believe that the incentives that medical tourism creates are misaligned with giving our locals good, quality healthcare that is timely and affordable.
First, medical tourists are almost certainly going to pay top dollar--they have to, simply because we aren't going to subsidize them, and because if we don't keep the prices high, then our medical system will be inundated by a volume of medical tourists that our local system cannot handle.
Second, with the top dollar that medical tourists can pay, this will attract top talent--doctors, surgeons, specialists of all areas, and even nurses, technicians, and so on. Who can begrudge medical professionals better lives through better pay that they can command for their trade and professional skills? As the top surgeons and specialists in each area leave their field for private practice which would allow them to ply their trade and skills for a competitive price in the open market, the public sector will be left with a dearth of top talent.
Third, with the limited pay that the public health-care sector can afford to pay, who's going to be left staffing our public hospitals with our shortage of healthcare professionals? Quite obviously the lower-paid jobs will be left to foreigners who are willing to work for much lower salaries because they are remitting our strong currency home.
This naturally creates a two-class system, where you will get top-notch care and medical attention only if you can afford it. Otherwise, you will be relegated to the queues of the public health-care system. Of course, by saying this, I am also insinuating, perhaps inadvertently, that public health-care is inferior to private health-care. That is not my point, and by no means am I saying that our public health-care does not have well-qualified professionals. However, with the incentives created by medical tourism, and money pouring in from everywhere in the world, we are creating a system where the demand for our medical services in Singapore comes from around the world, while the supply to locals is restricted to whatever is here. We have our locals have to compete with international visitors for the limited supply of medical services we have available here, and this punishes the locals who are unaware of or unable to travel elsewhere (e.g. Malaysia, Thailand?) for cheaper medical care, and we have created a severe market failure due to this imbalance.
The consequence of market imbalances in healthcare is not just differences in utility. The subject of the matter here is actual human lives--how would you feel if your family were penalized, if a loved one had to suffer, because the top-quality care is not affordable? Because we want to add to our GDP numbers and become a playground for the rich?
This is social injustice in its ugliest form. We have to stop our excessive subscription to the free market and its principles, because there are some things that money can't buy, and we should stop hawking these things out for money.
What solutions are there? I'm not entirely sure either, but I don't think we should be stretching our medical system any further by allowing medical tourists to come here and distort our market for healthcare.
Immigration and the Growth Conundrum
There has been renewed talk of the need for foreigners, and how we cannot grow without foreigners because of our low total fertility rate. The media reports have phrased this "dilemma" as being a false dichotomy: either we accept foreign immigrants as a nation and people and have growth and prosperity, or we will go into a decline with no foreign immigrants. But, wait, since when was this a binary decision, to have either no foreigners nor immigrants, or foreign workers and immigrants but without any control on their numbers, types, or how they are allowed into our society and workforce?
Presenting the situation in such a stark dichotomy reeks of fear-mongering, and honestly, it puts me off a great deal, because I feel as though I'm being told that there are no other choices in between, when clearly there are. But let's put aside how repulsive I found the media portrayal of the report, and talk about this question of growth and immigration.
Sure, we're not replacing ourselves. But if we go by that argument, then why can't we just let in enough immigrants to keep our population steady? Our resident population has shot up from 3.2 million to 5 million in just 10 years. Surely that is not a sustainable, let alone comfortable, rate of population growth for a moderately advanced and already terribly crowded city? It did not help at all that infrastructure growth simply limped along, and even our policy-makers have admitted that the influx was much faster than they had expected. Sure, you guys were trying to catch the tides of growth, in 2007, and then again in 2009/2010--but didn't we use to be more selective in who we let in, as recently as 5 to 10 years ago? Whatever happened to that?
Second, let's address the question of growth. Sure, growth is good, because for overall personal incomes to rise, there must be a rise in the overall GDP, it's a question of simple mathematics. However, GDP growth is necessary but not sufficient for a rise in personal incomes, because it's not even just per capita GDP that matters, but how that money is distributed. Sure, you can redistribute incomes if the growth is uneven. But this is terribly bad on the self-esteem and mental/psychological well-being of these folks. You're basically telling them, sorry you're not good enough to play in the new world, and sorry it happened to be your home, but we'll make up for it financially.
Also, how many people can you do that for? For small numbers, say, 3 to 5 % of the population, that might still be feasible. But when you have large swathes of the population reading about GDP numbers shooting through the roof, but not seeing their own lot improving, that doesn't sound right anymore. And it's worse that our leaders don't want to create a crutch mentality and a sense of entitlement, then how do you level that inequality? The fact is that you cannot level the inequality without creating such an addiction to welfare (or transfer payments, or payments without work), so why not try to avoid the inequality to begin with?
Finally, this country is ours, because we will die to defend it. Stop telling me that our forefathers were once immigrants too. Sure, they were. But the past 2 generations, and soon to come a 3rd, have gone through or are going through national service. So we're slogging our 2 years, and then some more, away to help defend a piece of land that we're freely giving out passes to? And not to mention the risks in national service--not everyone has completed national service alive, mind you, as much as we try to keep it safe. Thanks a lot, but that just doesn't add up.
Growth and economics are hard-nosed, rational decisions. But too bad, citizenship is naturally an emotional issue. There is nothing, but the emotional attachment, to this small piece of land we call our home, for which we will die to defend the country. Please do not take that last thing away. We are not stupid, and we know that foreigners are needed to do some things where we fall short on manpower, but we still need to preserve our home, and make it a worthwhile place to live in, where our home is not cheapened.
Practising what you preach
I've had plenty of opportunities in the last couple of months to both think about, and experience first-hand, the importance of software engineering, which goes far, far beyond computer science and the Math behind it.
First, there was the academic perspective, of whether having good engineering practices in place would help yield quality code and quality software that's not vulnerable to attacks, but all that was still pretty abstract.
Next, I had to make some not-very-minor modifications to intern code which I had made the mistake of not looking at closely while they were still interning, so I ended up writing even more ugly patches to code that was already too patched up to begin with.
Finally, I had the chance to actually write some code declaratively, in ocaml, with nice libraries to help me along, so I was really focusing on the exact high-level task without having to worry about writing graph libraries or decompilation libraries. It was painful to begin, because I had been working on this imperatively rather than in Java, and also because of the bad experiences with ML back in my freshman year haha. But it became quite a refreshing exercise soon, and I found it quite liberating to be able to just think in the abstract about what exactly it was that I wanted to do, without worrying about how to do it. Ocaml is really quite beautiful. (I wouldn't say the same thing about Lisp, simply because I'm used to typing rules haha.)
Discipline in practising software engineering is really important, because it really helps you focus on what are the high-level things you want to accomplish, yet the overheads can be really high, and you wouldn't really be worrying about whether your models and specifications look right when you start to realize that your specifications are wrong as you begin to implement them, and much less when you have a deadline to meet and everything's not working.
But it's really nice if you can actually find the will to stay disciplined--then writing code becomes a thing of beauty.
Now if only my code would run and the libraries were well-documented haha. Back to reality.
Interlude
And we interrupt the usual (albeit sporadic haha) programming to bring you:
PicnicSunday Vintage! A new online shop by my fiancee, which I helped set up as well, selling one-of-a-kind, unique, and very very interesting vintage women's wear! And do check out the store blog, Picnic Sunday Vintage blog, as well!
And back to our usual programming, soon enough. Presidential election campaigning is in full swing, and here comes another chance for an orderly public expression of our sentiment. There really should be more of such opportunities.
False dichotomies
The fiery post-election rhetoric hasn't died down, with the former MM warning that if we go towards a two-party system, we will have a weak government that is unable to govern effectively.
This is plainly a false dichotomy on three levels--a stronger opposition doesn't equate a two-party system (as long as the opposition doesn't capture > 1/3 of the seats), and even then, the presence of an opposition does not equal a weak government, and lastly, having a single, strong party in power does not imply automatically that it is a good government.
It would be foolish to assume that the electorate is stupid. If things were all going as smoothly and as well for the majority of the people, I do not believe that we will have 40% of our citizens asking for alternative representation. This 40% reflects actual hardship on the ground that cannot be dismissed, and that if left alone, and not effectively addressed quickly enough, will create a permanent underclass that cannot be brought back to the rising tide that is lifting the rest of the boats.
This is the turning point, I believe. Whether we make it or not and manage to build good lives and a good home for our generation, hinges on the current generation of leadership. I hope, for everyone's sake, that the folks up there are able to see things objectively.