MEDISHIELD LIFE
Should those with high-risk habits benefit?
Published on Sep 07, 2013
SENIOR health correspondent Salma Khalik suggests calling upon wealthier Singaporeans to subsidise the proposed MediShield Life premiums payable by their less well-off compatriots ("Healthy opportunity for generosity"; Thursday).
MediShield Life is premised upon the notion that people who suffer medical misfortunes - including the elderly, the frail and those with pre-existing conditions - have not brought these upon themselves. An inclusive and compassionate society should collectively bear the costs of treatment without, as much as possible, regard to the sufferer's ability to pay.
While this is true for the vast majority who need medical attention, there is a significant minority who bring medical misfortunes upon themselves through intentional lifestyle choices. Smoking, consuming excessive alcohol, substance abuse and high-risk sexual activities are some such lifestyle choices.
Should the rest of society subsidise medical expenses resulting from such choices, even if low-income Singaporeans with limited means are involved?
While most Singaporeans can support or at least accept the principle of universal coverage behind MediShield Life, one must not allow a well-intentioned plan to unintentionally delink deliberate lifestyle choices from their medical consequences, regardless of whether such choices are made by the wealthy or the poor.
Cheng Shoong Tat
MediShield Life shouldn't create more inequality
Published on Sep 10, 2013
MR CHENG Shoong Tat made a fair point that MediShield Life should not "unintentionally delink deliberate lifestyle choices from their medical consequences" ("Should those with high-risk habits benefit?"; last Saturday).
He raised an important question on whether the rest of society should subsidise patients suffering the consequences of their own habits.
Lung cancer as a result of smoking, infections due to promiscuous sexual behaviour and many other medical conditions are indeed costly consequences of lifestyle choices.
However, we should be clear that the role of MediShield Life - and, for that matter, any health-care policy - is not to judge a patient's lifestyle choices or effect "double punishment" on him.
It is unfortunate enough that a person is suffering from such medical conditions, and it is not for society to decide that he also should not be entitled to the same level of subsidy.
Furthermore, it is impossible to decide the extent to which a medical condition is the direct result of a lifestyle choice. Where do we draw the line on personal responsibility?
If a patient with a history of substance abuse should be denied a subsidy, could we also refuse to subsidise the bills of someone injured in a high-risk sport?
Could an unhealthy diet and little exercise also be deemed poor lifestyle choices that exclude someone from subsidies?
If we choose not to subsidise certain groups of patients based on their lifestyle choices and regardless of their income, there will undeniably be a greater burden on those with lower incomes.
Socio-economic gradients exist for diseases and disabilities. It is well-established that stressful economic and social situations predispose people to chronic diseases.
For example, smoking is more common among shift workers than managers, and those with higher incomes typically make healthier dietary choices.
We will all make poor lifestyle choices at one point or another in our lives - whether out of ignorance, difficult circumstances or sheer stubbornness.
MediShield Life is a means by which we can look after others in our society; it is meant to be a leveller, and we should not use it to create more inequality in our society.
Rhea Tan Yan Ying (Miss)
Let's not tag others over 'high-risk' behaviours
Published on Sep 10, 2013
MR CHENG Shoong Tat said "MediShield Life is premised upon the notion that people who suffer medical misfortunes... have not brought these upon themselves" ("Should those with high-risk habits benefit?"; last Saturday).
Such a condition for eligibility would be unenforceable and not inclusive. Other than suicide, there is really no benchmark for so called "high-risk" behaviours.
Much has been said about the ills of smoking and alcohol consumption, but is there conclusive proof that having such habits will shorten one's life? Is there proof that those who do not have such habits will not suffer from cancer, heart disease and so on?
Just how much alcohol or fast food should one consume, or how many sticks of cigarettes should one smoke, before there is proof of a direct causal link to ill health? And if there is a benchmark, how can it be proved that a person has exceeded this threshold of indulgence?
If there is indeed proof that smoking, alcohol and fast food cause premature death, then these should be banned.
And what exactly constitutes "high-risk" behaviour? Will it include taking up vocations like pilot, policeman and fireman? For that matter, do jay-walking and going for aesthetic surgery count as "high-risk" behaviours?
Except for suicide, it would be futile to even try to exclude people based on their lifestyle choices.
Unfortunately, human beings are not rational all the time. Let's live and let live and not unnecessarily "tag" our fellow human beings.
Colin Loh
