Thursday, June 12, 2014

Politicising healthcare leads us down a slippery slope



Much anxiety over the topic of health stems from us grappling with the unknown. On a personal level, we do not know if, when or how we will get sick. Families are unsure of who will need support and who will take on the role of caregiver. As a society, we do not know what will happen in the next five to 10 years in terms of disease, new treatments and costs.

Given the uncertainties, it is only right and proper that we seek out the facts, ensure the fundamental sustainability of our healthcare system and take a far-sighted, clear-headed approach.

As a starting point, one of the questions to ask is: Does Singapore have a good healthcare system? A good public healthcare service should be accessible, affordable, safe, comprehensive, provide high-quality care that is cost-effective and invest significantly in disease-prevention strategies.

Many nations think Singapore has such a system. Healthcare professionals and policymakers visit us regularly, hoping to learn from us. We often hear of the latest and greatest new technology or technique being implemented in our public institutions.

But the key factor in answering the question of whether our system is good is the health of Singaporeans. We are living longer and more healthily, and have a better quality of life. Looking at the facts, we come to the conclusion that we are living in a healthy nation, with one of the best healthcare systems on the planet.

We can always do better and do more but, in general, we are doing pretty well. The next question is: How should our system evolve?


I do not know what the ideal future of our healthcare landscape should look like. There are many complex pieces of the puzzle; there are counter-intuitive scientific findings, competing ideas and vested interests. We will need the ability to make rational choices that may not be immediately popular and to balance the risks and benefits.

One of the key challenges in the practice of medicine is to persuade a patient to take some medicine to prevent a problem in the future. This means asking him to take a substance with sometimes unpleasant side effects to prevent a problem that he has not yet suffered. It is not easy to accept these trade-offs.

How do we persuade the patient to do the right thing? You can explain, reason and discuss but, at the end of the day, it comes down to trust. There has to be a leap of trust in taking a recommendation from a physician. There are risks and, therefore, there needs to be trust.

In medicine, we are often asked to provide a second opinion. When I consult for a second opinion, there will usually be many points of agreement with the primary team. Out of 10 decisions, I might agree with nine and have a different perspective on the 10th. What you do with that difference is critical.

One can, in a negative way, focus one’s energy on the single point of disagreement and imply that one’s opinion is outright better than that of the others. This approach would be self-serving, confrontational and serves only the interest of the person giving the second opinion.

The other approach would be to acknowledge that you agree on most of the plan and highlight the benefit of having an opportunity to discuss and agree on a way forward. This approach builds trust by being honest and open. And this is ultimately what we must strive for in politics, as in healthcare.

It is not enough to say you are supportive of good policies and good governance in general. What you say and how you say it are both important, as is what you choose to say nothing about.

When you fail to acknowledge the good, when you avoid discussion of consequences and trade-offs, when you spend a whole speech attacking one point you disagree with and fail to support all the others you should agree with, when you incite division in the name of diversity, these are not the markers of good politics, no matter how much debate and diversity of opinion they may reflect.

One of the things I stress to my students is that one has to be intellectually honest in choosing between two proposed solutions. You must compare the risks of your proposed solution with those of your opponent’s, and the benefits of your proposed solution against those of your opponent’s. One has to take the holistic approach and understand the whole situation.


The politicisation of healthcare can be easily recognised by the presence of the opposite, where the benefits of one’s proposal are compared with the risks of the opponent’s.

What else would the increasing politicisation of healthcare look like?

It would start with sound-bite politics, such as making jokes about corridor beds, when these are not reflective of the health outcomes. It would look like anecdotes are being used to create fear and anxiety, with carefully selected stories about unusual situations to persuade people that everything is bad and needs to be changed. It can be recognised by politicians taking potshots at easy targets, not discussing outcomes or consequences.

When healthcare is politicised, it would look like the hard work of our healthcare workers of every profession is being ignored. It would look like pretending that healthcare workers are heartless automatons, rather than deeply caring human beings who are doing their best to care for the public.

Above all, it would look like the excellent health and healthcare outcomes that we as a nation have achieved, and will continue to achieve, are being ignored.

The facts are out there, together with a whole host of hysterical, irresponsible and inaccurate claims about a catastrophically dysfunctional system. We need to keep calm and look at the reality, not the hyperbole.

Looking around at the world, it is clear that the more politicians play with healthcare, the worse the health of the nation, because short-term popular political interests overthrow the long-term outcomes and the deep issues. Will we do the right thing or go down the route laid out for us by many other advanced economies, where the key issues in healthcare are increasingly polarised and politicised?

It is not that we do not have to improve things. We do. We need to invest in the expansion of services and, more importantly, in manpower. On the ground, it is exactly what we are doing. We need to develop an ecosystem that integrates research into education and practice. That is what we are doing. We need to improve on-the-job training with a view to maintaining safety and at the same time improving the effectiveness of training. That is what I see happening around me.

This is why I support the Government’s policies. Not because I am compliant, but because the policies are achieving the outcomes we need. To agree with someone else’s policies is not compliant politics. Debate and a diversity of opinion are not in themselves sufficient to help us navigate difficult choices in future. If the policy is good and achieves its outcomes for a better life for citizens, then attacking it does not generate better politics.

I plead for the sense, good wisdom and experience of the healthcare professionals to prevail in serving the long-term good of the nation and to continue doing the right thing. I hope we can avoid using the politicisation of our excellent public healthcare system as an electoral tool.


Janil Puthucheary is a doctor and Member of Parliament for Pasir Ris-Punggol GRC.

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