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An Activist Of Affordable Healthcare, My Reflections – Darren Mak

There is no better time to speak to an infectious diseases expert than in the middle of a pandemic, and so we spoke with Prof. Paul Tambyah, the first Singaporean president-elect of the International Society for Infectious Diseases. His passion and love for the topic was obvious, as he had so much to share and it was great to listen to his knowledge on the subject.  We spoke about the general global trend of dealing with the virus and thankfully Singapore is on the right path of adopting an endemic approach rather than a hard-line 0-cases approach. Though, we are moving in typical Singapore kiasu pace and easing into the endemic phase over an extended period of time and many people are getting impatient with the prospects of relative freedom after almost two years of being stuck in this limbo.

No more KTV cluster already please.

If we were speaking with just an infectious diseases expert, though, that would have been more or less it. Having been stuck in the endless COVID-19 news loop, we are all sick and tired of hearing about the disease and plan ABC and travel bubble XYZ. Good thing, then, that Prof. Tambyah is not just an infectious diseases expert. He is also the chairman of the Singapore Democratic Party.

Prof. Paul Tambyah, Wearer of Many Hats.

So, we spoke about two of his biggest passions – healthcare and politics. His clear political alignment and vision was also extremely eye opening for me as he had laser precision in the way he spoke about the healthcare system in Singapore. To him, Singapore’s healthcare financing system is way too convoluted and confusing with too many schemes and plans making it difficult for people to access the healthcare they need. This brought us to the topic of the iron triangle in healthcare, which basically refers to how healthcare systems generally can only excel in two of three areas – equity, efficiency, and excellence.

note to self: Academics don’t produce catchy graphics. Picture credits: Cambridge University Press

Some countries like the US sacrifice equity, so you get great quality healthcare that is delivered in a timely manner, but many people simply cannot afford it. Others like the UK sacrifice efficiency, so you have cheap and good healthcare but with wait times that might see you dead before you see the doctor. Singapore, according to Prof. Tambyah, started with a system similar to the UK’s, but has slowly been moving towards the US model, which is why we have had to come up with so many financial aid or insurance schemes to close the gap.

My memes are better. Take that, Cambridge.

I suppose it depends on whether you are talking about the private or public healthcare systems. Unfortunately, someone close to me was recently diagnosed with a terminal illness after going through the public route. Waiting for weeks and months for follow ups led to what was presumably a diagnosis that came too late, when treatment was more or less pointless. For some people, it doesn’t matter if the care is cheap and good – if it comes too late, it’s all for nothing anyway. On the other hand, I’ve also heard glowing reviews of how private hospitals operate extremely quickly, but the bills there might give you another reason to fall sick. The iron triangle can be quite a cruel reminder that no system can ever be perfect and governments basically have to pick the bullet they want to swallow.

Don’t worry, next paragraph already.

Beyond healthcare reforms, though, I was also curious about politics in general. It is not a secret that in Singapore, politics is broadly split into PAP, PAP-light, and PAP-zero. Maybe I am a cynic, but I always felt that opposition parties had a better chance if they would work together instead of being fractured into smaller parties. Why not join the biggest opposition party of them all, or even the biggest party of them all to get a better chance to push things through? To Prof. Tambyah, the matter was as simple as principle. His own politics as a Social Democrat does not align with PAP or WP, but SDP offers him the best platform to operate in a way that is best suited to his own views.

Spoilt for choice. Picture credits: LOOP Associates, New Nation

And of course, in a free and open society everyone is entitled to their own views. Some views, however, are just too ridiculous and elicit backlash from society. Mr. Brad Bowyer, now ex-PSP politician, knows this well when he compared differentiated restrictions for vaccinated and non-vaccinated people to the Holocaust. Many were offended by how entirely out of proportion this comparison was, given that vaccinations are good for public health. And that, like, genocide of 6 million people based on their religion is really not something you make light of.

Major oof.

Prof. Tambyah is quite the gentleman, however, as even though he too found the statement inappropriate, he had the generosity in him to understand that Mr. Bowyer had gone through some personal experiences of his own that shaped his views, coupled with his consumption of right-wing media from America. While I may not have such grace, I can appreciate Dr. Tambyah’s commitment to one of his own values that he prizes highly – freedom of expression. As a democratic and open society, and in an age where social media means we can no longer suppress unpopular views, the floodgates will open for more of such incidents. Democracy is messy, and I suppose as Singapore matures and faces the future, we too have to be prepared for more of such messiness. At the very least, have some popcorn at the ready.

Click on the links below to listen to the 3-part podcast on Plan B on Spotify.

Episode 1: The Social Democrat, Part 1

Episode 2: The Social Democrat, Part 2

Episode 3: The Social Democrat, Part 3

Darren Aadam Mak

Written by Darren Aadam Mak

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