Originally posted by noahnoah:
SGH is popular for waiting
one
got appt or not no different
anway i scolded one dr there before
pay money ma
so got the right to scold...
Don't think it's the doctor's fault, more the fault of the SGH management and Ministry of Health.
Originally posted by Stevenson101:Yes i'm sure.
i certainly have not experienced the horrendous services you speak of.
aiya, only one or two cases who the childrens als never plan well, sometime you cannot just blame the hospital, people got to do some personnal responsibility themselves, see what is the options, where is the best treatment?? Bloody hell, i think most of them are thinking about father asset and that 3 room flat price.
Singapore health care system is based on the 3M system ie Medisave, Medisheld and Medifund.
For Medisave, workers have to put aside money in CPF and use the money to pay for in-hospital medical bills and some outpatient medical bills for chronic illnesses and day surgery and so on.
For Medishield, workers buy the insurance to pay for large in-hospital bills. It works on the principle of deductible and co-insurance.
When one really does not have the money to pay for one's medical bills, the government will use the money in the Medifund to pay for the medical bills. More than 99% of the really in need patients who apply for the Medifund get their bills paid.
Though Singapore has the very complete 3M system, it does not mean that its healthcare system is perfect. There are many B and A classes wards in hospitals that are heavily under-utilised and very frequently C class patients get to stay in B wards at C classes charges when C class wards are full. When one needs specialists treatment, one will need months (eg nine months to see a neurologist in SGH) before one gets to see a specialist in the government hospitals while one's conditions deteriorates in the meantime and so on.
Deepak, I'll try to answer your meandering rant as succinctly as possible, yes I registered to reply to you because your post shocked me with its contrast to the reality on the ground here:
I have lived in the US for about 15 years. I attended RGS and RJC and then an Ivy League University in the States, then a large public university for my masters. So I lived the first 23 years of my life among fairly elite crowds. I am a legal resident with all the rights of a citizen as my mother was born in the States. I am a Professor at a local college. I make about US$40 000 per year. I have also worked with underprivileged youth ( those you so kindly refer to as gangbangers) as a counsellor. My younger sister went to Harvard and then medical school. She is currently doing her residency at a large teaching hospital in the south. University hospitals are not free.
It is very difficult for a Singaporean to understand how America works without actually navigating the system. Your posts show that you assume the USA functions along some sort of consistent logic through all stratas of society. There is not such thing. There is instead a maze of competing government bureaucracies and private interests. American society is very fractured and very complex.
I will answer your questions 1 by 1.
1. No, Singapore doesn't give out food stamps. But I'm not trying to make a comparison. The info you quoted below does not play out the way it sounds in real life. I refer you to an article in today's New York Times http://www.nytimes.com/2009/07/12/opinion/12ehrenreich.html. The dynamics it describes are common knowledge outside of elite circles. This will answer some of your "questions" better than I can. In Singapore, you can safely assume that if the government says it will do something, it will do it. In the States, you can assume that the words are platitudes, and that efforts will be unevenly implemented and inadequate.
I myself have received the Earned Income Tax Credit when I was a student. I received about as much as it cost to file my income tax return. According to your info, the most you can receive is $320/month which would be 40% of your income, meaning with the tax credit your monthly take home is $1120. There is nowhere in the USA where this income is a livable sum for 1 person, much less a family. The cost of living is much much higher here. Furthermore, this Earned Income Tax Credit is distributed once a year as a tax rebate. Not a consistent monthly payment, causing many poor people to borrow from high interest credit companies which operate in poor neighborhoods for precisely this reason. It is an unregulated business. So yes, they give some small handouts but too small to make a real difference, I often wonder why they bother at all.
2. "Officials reported 46% of all gangs were Hispanic/Latino, 34% African American, 12% Causcasian, and 6% Asian. A third of all gangs were reported as having significant numbers of more than one ethnic group. "
http://www.uic.edu/orgs/kbc/Floors/Facts.html
Nice of you to quote a study done by the University I got my Masters from. Gangs are definitely a problem, and yes, they are idiots. But, there are 50 million uninsured Americans. There are not 50 million gangbangers.
There is NOTHING in the USA like Singapore's Medishield system, which at least provides basic catastrophic coverage. You've misunderstood the WHO rankings. They are not solely based on money spent. It is a factor. But #1 France spends quite a bit. In the WHO rankings of national health care systems, Singapore ranks 6th and the USA ranks 37th! 37th ! I know it's difficult to believe but it's true! http://www.photius.com/rankings/healthranks.html
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei
You can argue all day about how WHO came up with these rankings but there's no denying the US has a pretty lousy system. France spends about half what the US does and gets much much better results. Singapore could probably spend more. If I was designing the rankings Norway would rank above Singapore.
3. Medical procedures in the USA are often denied by insurance companies on the grounds of being " medically unnecessary". This happens even for things like heart bypasses, which are never really elective surgery. You don't choose to have a bypass. If you need one, you need one. Doctors in the USA then have to furnish proof, usually several times, get on the phone, argue with a bureaucrat etc, get a 2nd or 3rd opinion from another Doctor employed by that insurance company ( imagine the conflict of interest) etc etc etc and then hopefully the insurance company will pay. Chances are, the patient will be dead by then, which what the insurance company wants.
http://www.healthreformwatch.com/2009/05/14/health-insurance-administrative-costs-to-doctors-31-billion-per-year/
http://www.pnhp.org/single_payer_resources/administrative_costs_in_us_hospitals_are_more_than_double_canadas.php
Health Care Insurance companies profits have increased tremendously in the last decade. Forbes magazine reports that William W. McGuire, CEO of UnitedHealth Group) received compensation of $124.8 million in 2005. Managed Care Magazine also says that the average executive compensation (excluding unexercised stock options) for an executive of a ‘top 10 for profit health plan’ was $11.7 million and that was back in 2000.
http://blog.aflcio.org/2009/05/27/health-insurance-profits-soar-as-industry-mergers-create-near-monopoly/
http://blogs.webmd.com/mad-about-medicine/2007/08/ceo-compensation-who-said-healthcare-is.html
http://healthcare-economist.com/2006/02/14/united-health-ceo-earned-1248-million-in-2005/
Please watch this interview conducted by one of the most respected journalists in the US, He speaks with HIC whistle blower, this guy has also testified before Congress. Watch all 4 parts.
http://www.youtube.com/watch?v=0-M10jDkmm0
You can also watch SICKO, by Michael Moore. You can say he's a bleeding heart liberal whatever but the stories are real.
4. The US has the most advanced, best medical care in the world this is true. However, unless you are wealthy and well-insured you will never get to use that system.
5. In my city there are about 1 million uninsured. There is 1 hospital that will serve them, there are more than 10 for insured persons (4 million). The county hospitals ARE NOT FREE. They take insurance and bill you like any other hospital, it's only that if you really cannot pay ( and you have to prove this via a complicated system of means testing) then you will have your debt forgiven rather than sent to a bill collector. Get the idea that the US has a safety net out of your head. It is more like a band aid for a gun shot wound. " Regardless of ability to pay" doesn't mean free.
6. The income in the US IS NOT EVENLY DISTRIBUTED. Get the idea that Americans are well paid out of your head. There is precious little manufacturing left in the US. Most has been outsourced to places like China. Go on, try buying something stamped " made in USA". Every time I see that I do a double take.
$23 an hour is NOT ENOUGH, especially if you have kids. The cost of living is much much higher here. A medium cup of coffee in my city costs $2.00 ( at local kopi tiam, not starbucks), a movie ticket is $12. After federal, state,city, FICA taxes that's about $16/hour. Even at poverty level you have to pay taxes. The living wage in Chicago, one of the cheaper large cities is estimated between $13 and $16. The federal minimum wage is $5.15. It's a JOKE. Federal poverty level guidelines are a JOKE. Something like $10 000 per year per individual, $20 000 for a family of 4. There is no where in the US that a single person can live on $10k a year. ( Ok, some people do it by living in a rural area, growing their own food and cutting their own firewood, they're wierdos). Sociologists speak of poverty in terms of percentages, e.g. So and so is 250% above poverty level. When you hear this you probably think " oh, that person is ok", I don't blame you. When an American says that they really mean the person in question is still very poor. It's not till you get above 400% of the poverty line that you are ok. The semantics are completely different.
Here are the statistics for wealth distribution in the States.
http://sociology.ucsc.edu/whorulesamerica/power/wealth.html
As you can see the top 20% own 85% of the country. That means the bottom 80% have access to only 15% of the wealth!!!
Tuition at state schools is still quite reasonable if you go in state. Tuition at an Ivy League is about $40k per year. AT my teaching college it is $20k per year. Most students borrow to finance their education and then start adult life already in debt, even at state schools. Many American parents do not pay for their children's higher education. Outside of elite schools, students work at least part time to make ends meet.
9. So being under-insured is worthless, then why bother with being insured in the first place?
There are many reasons: It's hard to know how well you are insured. The language is so obtuse in the plans that it's impossible to understand without devoting weeks to reading all the fine print. You will think something is covered, but there will be some loophole you'll only find out about when you go to use the insurance and by then it's too late. Few people have the time. Also Americans are very badly educated to understand economics. It's not required or offered at most high schools, so they have very simplistic ideas about how their economy works, so they are easily exploited.
Also, people hope that something is better than nothing, so they accept whatever they can afford. Basically, if you are paying less that $400 for an individual policy per month it's probably worthless.
Read the NYT's resident economist's blog about the subject. He won the Nobel prize this year so you can't say he doesn't know anything.
http://krugman.blogs.nytimes.com/2008/06/10/underinsured/?scp=2&sq=underinsured%20&st=cse
10. Every single expatriate I know in the US from Canada, UK, Spain, Italy, Scandinavia, France, Japan, Taiwan, Singapore etc maintains insurance in their home country. Every single one without exception. We joke about how when you go home, first you see your Grandma, then your doctor, then your dentist. I pay into the Singapore system because frankly, it's great value for money compared to here. If I was living in the UK or Canada, I probably wouldn't. Also, I may want to move back some day, for not just for money, but also family, weather, there are many reasons.
If I am a quitter or an underacheiver because I decided to become a college professor ( a low paying job in the US) instead of a corporate tool. Well then I'm proud to be one. I don't feel the need to organize my entire being around money.
11. "The US Medicare and Medicaid is funded by the government and not by individual citizens, it's more like a benefit provided by the US government to her citizens."
Are you stupid? Medicare and Medicaid are paid with TAXES, they are not FREE!! We have FICA taken directly out of paychecks every month. You can't use Medicare till you are 65. Even then there are complicated parts. Medicare part A is free, but you have to buy Medicare part B, about $100 per month. Prescription drug coverage is not necessarily covered and many seniors pay 100s each month out of pocket. That said, most seniors use it and appreciate it, because the alternative is so much worse.
Look I don't know why there are 600 000 S'poreans not covered by Medishield. Obviously that should be fixed immediately. I am saying don't look to the US as a model to fix whatever problems there are in Singapore's health system, look to France, or Canada, look anywhere but here. It's a disaster here for most people.
Most Americans would love to have a chance to go to a Singapore polyclinic. What is that now? SIN$8? The average co-pay for a simple doctor's visit here ( with insurance) is $30. Most cannot afford any preventive care so serious diseases are not caught early and chronic conditions become emergencies. Most Americans would really appreciate Medishield because they have NOTHING comparable in terms of cost vs benefits. Most insurance plans won't pay anything till you have spent a certain amount out of pocket, usually thousands.
"If the US government wanted to institute Medisave/Medishield, all the US Senate has to do is come up with a bill, to make it compulsory for citizens to set aside a certain percentage of their income, for future medical expenses."
This is hilarious. The US is not a 1 party state like Singapore. You can't just write legislation and pass it overnight. There are 3 competing branches of government: the Senate, Congress and White House. Within that you have republicans and democrats. Whatever 1 group proposes the other group opposes. Nothing gets done easily. It's a constant stalemate. Right now there are 60 Democrat senators, that's barely enough to push through legislation without a filibuster ( a time wasting review procedure). And that's only if every single one tows the line, which they won't. Even if they get something done, the President can veto it if there's something he doesn't like and then it's back to square 1. Years go by. IT HAS BEEN MORE THAN 40 YEARS SINCE THEY PASSED ANY PROGRESSIVE HEALTH REFORM.
I know it's hard for Singaporeans to imagine having a government that is so useless. You can't think of the American government as a single entity. You must think of it as figure with 3 heads, none of whom can agree on anything, even the time of day. When I hear non-Americans say about the American government I just roll my eyes. There's nobody in charge here except Wall Street. But Americans are also to blame, they are very much against anyone forcing them to do anything, even if it's for their own good. They'll never go for forced savings, most people have to spend everthing they earn anyway. Currently the public mood is very much in favor of substantial reform and the Senate and Congress are debating several plans. We'll see in a few weeks if we get something actually reformative or we get something so watered down it preserves the status quo. In the 15 years I've been here I've seen the country go from so-so to terrible. Honestly, the average Singaporean enjoys a higher standard of living than the average American when you factor in things such as crime, maintenance of infrastructure, environment, consumer protection, employment benefits...
I hope you have a better picture now. You might want to consider toning down your considerable anger and condescension. It makes it sound like you have more attitude than substance.
Here's my local county hospital's statement about payment. This is one of the hospitals you think is free.
Financial & Insurance Information We accept all major health insurance plans and managed care programs, including: Medicare and Medicaid, Blue Cross, Aetna/US Healthcare, Keystone Health Plan East, etc. It is very important that you have your insurance identification cards with you when seeking services at John Stroger Hospital. This enables us to provide proper billing, verify insurance benefits and obtain pre-approval for HMO patients before receiving services. You will be asked to pay any copay or deductible not covered by your insurance. After your discharge, the hospital will send you a monthly statement to keep you informed of any insurance payments and the balance of your account. Please check your statement carefully. If you have any questions or concerns, please contact our Billing Office at (312) 864-4640. If you do not have insurance coverage, you must make satisfactory arrangements made for payment of any balance due. For your convenience, the hospital accepts cash, checks and money orders. We will be happy to answer any questions you may have concerning your hospital bill or financial arrangements. Please contact our Billing Office at (312) 864-4640 Monday through Friday, between 8:00 a.m. and 4:00 p.m.
John Stroger Hospital is committed to providing healthcare services to the people of Cook County regardless of their ability to pay.
bump