Free market in health care not the cure

SINGAPORE - There were many comments made in response to my letter ("Shouldn't top doctors charge top dollar?"; last Thursday).

I had merely pointed out the difficult questions surrounding a fee guideline for doctors. I have never favoured a free-market system in medicine because in matters of sickness or threat of death, the patient can hardly be considered a truly free and independent buyer.

The reliance on market forces to control demand for medical services will cause disadvantaged groups such as the elderly, disabled people and the poor to be deprived of health care.

As far back as 1982, I wrote to say that "if society wants good, caring and ethical doctors, medical care must not become a product for sale. To regard medical care as a saleable commodity is to invite escalation of the cost of health care and the promotion of illness rather than health" ("A good doctor does not advertise"; June 22, 1982).

As long as we look on health care as an industry, we will have problems controlling the cost because the demand is insatiable and the market very imperfect. Moreover, once health care becomes a commodity, it must be mined, bought and sold.

Cold market policies will fill society with hungry and greedy people trying to plunder what they can. In the end, we will have people tearing away at society without thought of protecting it. In the mid-1990s, the Government noted that after many years of growth and prosperity, the values of Singapore had changed.

It was afraid that highly educated workers were becoming scarce and their incomes were rising sharply in many countries. If we kept executive incomes low, Singapore would lose talent. Thus the need to pay top money for top talent.

Together with the aim of turning Singapore into a medical hub and medicine into an industry, we have a prescription for the commercialisation of medical care.

Thus, it is no surprise to see our society becoming selfish, greedy and materialistic. Wealth becomes a way to gain respect, even in the medical profession.

To me, only a national health-care plan, and not a free market or fee guideline, can make health care universal, affordable and sustainable for Singaporeans.

Wong Wee Nam (Dr)


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