Singapore's Version of Vaccine Coercion

A recent announcement from the Singapore's Ministry of Health should be of great concern to the rest of the world, particularly since politicians have long proven that they are incapable of independent thought, preferred to follow the lead of other governments, a situation that has presented itself repeatedly during the COVID-19 pandemic.

 

Here is the entire announcement:

 

 

The announcement notes that 85 percent of Singapore's residents have received their full primary soeired of two COVID-19 vaccines and 18 percent have received boosters.  As well, 94 percent of seniors in the 60 to 69 year age group and 90 percent of seniors aged 70 years and above have received their fill primary series with 82 percent of seniors aged 60 years and above receiving their booster shot.

 

Here is a quote on the local COVID-19 situation and Singapore's healthcare capacity:

 

"Daily case numbers have stabilised for around three weeks now. While cases have remained at more than 3,000 a day on average, close to 99% of cases continue to have mild or no symptoms and the vast majority are able to recover well at home. The proportion of patients who require oxygen supplementation has held steady at 0.8% of our total cases, and those who require ICU care at 0.3%, in the past 28 days. The number of cases in the ICU remains high but stable at around 140 cases, who occupy 70% of our current ICU bed capacity. We have been actively expanding the capacity of COVID-19 Treatment Facilities (CTFs) and Community Isolation Facilities (CIFs) over the past few weeks to take in COVID-19 patients who do not require acute care in hospitals. 

  

Despite the nation's high vaccination rate, new deaths continue to rise at a far higher rate than round 1 of the pandemic back in March to May 2020, a situation which is not unique to Singapore:

 

...but the case fatality rate remains fairly low:

 

Now, let's look at the key part of the announcement:

 

If the pandemic has achieved nothing else, it has proven that government coercion and fear-mongering can get anybody to do just about anything.

 

As a bit of background, here is how Singapore's health care system works:

 

"Singapore’s health care financing system is underpinned by the belief that all stakeholders share responsibility for attaining sustainable universal health coverage. Singapore has a multipayer health care financing framework, where a single treatment episode might be covered by multiple schemes and payers, often overlapping. The system, known as the 3Ms, comprises the following programs:

MediShield Life, a universal basic health care insurance, is mandatory for citizens and permanent residents and provides lifelong protection against large hospital bills and select costly outpatient treatments. It was launched in 2015 to replace MediShield, an opt-out catastrophic illness insurance scheme.  MediShield Life premiums are subsidized by the government on the basis of income. In addition, working-age persons pay higher premiums so that older residents can have lower premium increases. These features have helped to keep annual premiums affordable, ranging from SGD 98 (USD 72) for low-income Singaporeans under age 20 to SGD 1,530 (USD 1,117) for high-income residents over age 90.

MediSave, a national medical savings scheme, helps cover out-of-pocket payments. Personal and employer salary contributions (8%–10.5%, depending on age) to MediSave accounts are mandatory for all working citizens and permanent residents. These tax-exempt, interest-bearing (currently 4% to 5%) accounts can be used to pay for family members’ health care expenses.

MediFund is the government’s safety net for needy Singaporeans who cannot cover their out-of-pocket expenses, even with MediSave."

Ironically, we find this about Singapore's health care system:

 

"The Ministry of Health’s mission is to promote good health and reduce illness, ensure access to good and affordable health care, and pursue medical excellence. The Ministry of Health is responsible for regulating the public health system and the health care system overall."

 

So, basically, a person living in Singapore who had spent their entire life paying for their health care through the premiums paid for the MediShield Life program and find that because they chose not to have an experimental vaccine which is proving to be less than effective when it comes to transmission of the SARS-CoV-2 virus, they are cut off from the health care system unless they have the funds to pay for their own health care.

 

Next up for this special treatment for the unvaccinated - Canada, the United Kingdom, Australia and New Zealand.  You heard it here first.  Any excuse to cut health care spending will be perfectly acceptable to the power-drunk sociopaths running the governments of these nations.  And should you happen to think that it serves the unvaccinated right for their choice, what about people who choose to smoke or eat to excess and end up in hospital, the willing victims of their own unhealthy lifestyle?

The Health of the Global Healthcare System

Over the past year, governments around the world have justified their draconian, freedom-reducing measures to battle the COVID-19 pandemic using the mantra that "we must all do our share to protect our healthcare system".  With that in mind, let's look at one key indicator which shows just how well our elected leaders have protected the healthcare system.

 

The Organization for Economic Cooperation and Development or OECD represents the world's more advanced economies and are generally considered to be the high-income nations of the world, comprising 42.8 percent of global GDP in 2017 and 80 percent of world trade.  Here is a list of the member nations:

 

Key OECD partner nations are as follows:

 

 

Now, let's look at data from the OECD which shows one indicator of the health of national health care systems among OECD members.  According to the OECD's definition, the number of hospital beds (per 1,000 inhabitants) "...provides a measure of the resources available for delivering services to inpatients in hospitals in terms of number of beds that are maintained, staffed and immediately available for use...."  The OECD includes curative or acute care beds, rehabilitative care beds, long-term care beds and other beds in hospitals in its measure of hospital beds.

 

Here is a graphic from the OECD showing the number of hospital beds per 1000 inhabitants for all 37 member states with some key states highlighted:

 

Here is a list of the data in order from most hospital beds to least hospital beds per 1000 inhabitants:

 

1.) Japan - 12.98

 

2.) Korea - 12.43

 

3.) Germany - 8.00

 

4.) Austria - 7.27

 

5.) Hungary -  7.01

 

6.) Czech Republic - 6.62

 

7.) Poland - 6.54

 

8.) Lithuania - 6.43

 

9.) France - 5.91

 

10.) Slovak Republic - 5.7

 

11.) Belgium - 5.58

 

12.) Latvia - 5.49

 

13.) Switzerland - 4.63

 

14.) Estonia - 4.57

15.) Slovenia - 4.43

 

16.) Luxembourg - 4.26

 

17.) Greece - 4.2

 

18.) Australia - 3.84

 

19.) Finland - 3.61

 

20.) Norway - 3.53

 

21.) Portugal - 3.45

 

22.) Netherlands - 3.17

 

23.) Italy - 3.14

 

24.) Israel - 2.98

 

25.) Ireland - 2.97

 

26.) Spain - 2.97

 

27.) United States - 2.87

 

28.) Turkey - 2.85

 

29.) Iceland - 2.83

 

30.) Denmark - 2.60

 

31.) New Zealand - 2.57

 

32.) Canada 2.52

 

33.) United Kingdom - 2.46

 

34.) Sweden - 2.14

 

35.) Chile - 2.06

 

36.) Columbia - 1.71

 

37.) Mexico - 0.98

  

It is interesting to see that four nations which had among the most strict lockdowns, the United States, New Zealand, Canada and the United Kingdom have among the lowest number of hospital beds per 1000 inhabitants, a factor which plays into the governments' "protect the healthcare system at all costs" mantra.

If we add in all nations in the OECD's database to the graph, here is what we find:

 

 

Note that Russia, a nation not particularly considered "advanced" by many of the world's political leadership, has the fourth highest number of hospital beds at 7.1 per 1000 inhabitants (2018 data).  China, at 4.0 hospital beds per 1000 inhabitants, also has more hospital beds per 1000 inhabitants than the four most severe lockdown nations that I noted above.

  

While I realize that the number of hospital beds isn't the only measure of the health of a healthcare system, it is this metric that governments are using as their excuse to lockdown entire healthy societies during the COVID-19 pandemic under the guise of protecting "the system".  Instead of shouldering the burden of blame, citizens of the nations with extremely low levels of hospital beds should be holding their elected governments responsible for allowing the healthcare systems which they control to degrade to the point where hospital services are threatened by a virus that is turning out to be only slightly worse than a normal seasonal illness when measured using the infection fatality ratio.

The Health of the Global Healthcare System

Thanks to Our World in Data we have access to some of the more interesting global data which allows us to directly compare key components of healthcare data.  This is particularly pertinent during the current pandemic; the nations with the best and most robust healthcare systems are the ones that have been able to provide the best medical services for their citizens.

 

Let's look at two key components of healthcare that provide us with an idea of the robustness of the healthcare systems around the world:

 

1.) Medical doctors per 1000 people (latest World Bank data for 2016 unless otherwise noted):

 

 

Here is the data for several nations :

 

Australia - 3.5 per 1000 (2015)

 

Canada - 2.54 per 1000 (2015)

 

China - 1.81 per 1000 (2015)

 

Germany - 4.19 per 1000 (2015)

 

India - 0.76 per 1000 

 

Japan - 2.37 per 1000 (2014)

 

Russia - 3.98 per 1000 (2015)

 

Sweden - 4.19 per 1000 (2014)

 

United Kingdom - 2.83 per 1000  

 

United States - 2.57 per 1000 (2014)

 

2.) Medical doctors per 1000 people vs. GDP per capita (latest World Bank data for 2016 unless otherwise noted):  

 

Here is the data for several nations noting that GDP per capita is measured in constant international dollars meaning that it is adjusted for price differences between countries and adjusted for inflation to allow comparisons between nations:

 

Australia - 3.5 per 1000 (2015) per capita GDP $44,493

 

Canada - 2.54 per 1000 (2015) per capita GDP $43,238

 

China - 1.81 per 1000 (2015) per capita GDP $14,401

 

Germany - 4.19 per 1000 (2015) per capita GDP $44,432

 

India - 0.76 per 1000 per capita GDP $6,096

 

Japan - 2.37 per 1000 (2014) per capita GDP $38,283

 

Russia - 3.98 per 1000 (2015) per capita GDP $24,417

 

Sweden - 4.19 per 1000 (2014) per capita GDP $46,568

 

United Kingdom - 2.83 per 1000 per capita GDP $39,309

 

United States - 2.57 per 1000 (2014) per capita GDP $53,399

 

One would think that the world's most affluent nations would have more doctors per 1000 citizens, however, such is not always the case.  As you can see, Russia's per capita GDP is less than half of the United States yet it has significantly more medical doctors per 1000 of its citizens.  Australia and Canada have roughly the same per capita GDP, however, Australia has 1 additional medical doctor per 1000 people than Canada, a significant difference.

 

3.) Hospital beds per 1000 people (latest OECD and WHO data 2018 unless otherwise noted):

 

Here is the data for several nations:

 

Australia - 3.845 per 1000 (2016) 

 

Canada - 2.5 per 1000   

 

China - 4.34 per 1000 (2017)

 

Germany - 8.0 per 1000 (2017)

 

India - 0.53 per 1000 (2017)

 

Japan - 13.05 per 1000 (2017)

 

Russia - 8.05 per 1000 (2017)

 

Sweden - 2.22 per 1000 (2017)

 

United Kingdom - 2.54 per 1000 (2017)

 

United States - 2.77 per 1000 (2016)

 

4.) Hospital beds per 1000 people vs. GDP per capita (latest World Bank data for 2016 unless otherwise noted): 

 

Here is the data for several nations:

Australia - 3.845 per 1000 (2016) per capita GDP $44,493

 

Canada - 2.5 per 1000 per capita GDP $43,238

 

China - 4.34 per 1000 (2017) per capita GDP $14,401

 

Germany - 8.0 per 1000 (2017) per capita GDP $44,432

 

India - 0.53 per 1000 (2017) per capita GDP $6,096

 

Japan - 13.05 per 1000 (2017) per capita GDP $38,283

 

Russia - 8.05 per 1000 (2017) per capita GDP $24,417

 

Sweden - 2.22 per 1000 (2017) per capita GDP $46,568

 

United Kingdom - 2.54 per 1000 (2017) per capita GDP $39,309

 

United States - 2.77 per 1000 (2016) per capita GDP $53,399

 

Once again, you can see that in this sampling of nations there is not a close relationship between the number of hospital beds and per capita GDP.  In fact, Russia which has the third lowest per capita GDP on the above sampling of nations has the second highest number of hospital beds per 1000 people by a relatively wide margin.

 

While a high ratio of doctors and hospital beds to population does not always result in better healthcare, it does mean that, in general, citizens of nations with a low ratio of both cannot expect to receive the quality of care that those who live in better served nations have become accustomed to receiving.

 

COVID-19 - Out-of-Pocket Expenses for Hospitalizations

Thanks to an analysis by the Peterson Center on Health Care at the Kaiser Family Foundation, Americans can get a sense of the potential costs of coronavirus treatment for people with employer health insurance coverage.  While private insurers have agreed to waive copayments and deductibles for COVID-19 tests, America's Health Insurance Plans (AHIP) has made it clear that out-of-pocket costs for hospitalizations would not be waived, meaning that people who have plans with high copayment costs could find themselves with high expenses.  Here's what AHIP has to say:

Now, let's look at the analysis by the Peterson Center.  The analysis opens by noting that the total average cost of treatment (combination of employer plan and employee's out-of-pocket expenses) for pneumonia with major complications and accompanying co-morbidities was $20,292 in 2018 with a range from $11,533 to $24,178 (25th and 75th percentiles).  Here is a graphic showing the total average cost of treatment depending on the level of complexity:

In the case of China, the average length of hospital stay for a patient diagnosed with coronavirus was 11 to 12 days with around 2.3 percent of Chinese COVID-19 hospitalized patients receiving mechanical ventilation support.  In the case of the United States, when ventilator support is required for pneumonia, the average length of hospital stay increases substantially as follows:

1.) Pneumonia with or without major complications or comorbidities - 3.1 days

2.) Respiratory system diagnosis with ventilator support for less than 96 hours - 5.8 days

3.) Respiratory system diagnosis with ventilator support for more than 96 hours - 22.6 days

Obviously, the total cost of treatment rises substantially when mechanical ventilation is required.  Here are the average costs of hospital stays where ventilation is needed (2018 data):

1.) Pneumonia with or without major complications or comorbidities - $12,692

2.) Respiratory system diagnosis with ventilator support for less than 96 hours - $34,223

3.) Respiratory system diagnosis with ventilator support for more than 96 hours - $88,114

Out-of pocket expenses can be significant for patients with employer coverage.  Here is a graphic showing average out-of pocket spending for inpatient admission for pneumonia among enrolees in large employer plans by degree of complexity (2018 data):

The analysis notes that there are three reasons why out-of-pocket expenditures could be higher during this outbreak:

1.) many patients will have higher deductibles, particularly those with private coverage through small businesses and in the individual market.  The Peterson analysis is based on claims from large, more often generous private plans.

2.) The COVID-19 pandemic is occurring early in the calendar year meaning that many people have not yet accrued much health spending to fulfill their deductible.

3.) The Peterson analysis does not include balance billing where an out-of-network provided sends an additional bill directly to the patient for an amount not covered by the health plan.

Let's put these numbers into perspective.  According to Magnify Money (data from the Federal Reserve and Federal Deposit Insurance Corp.), a median American household has $12,330 in total savings in bank accounts and retirement savings accounts.  At the bottom end, 29 percent of households have less than $1,000 in savings.  The analysis by Peterson suggests that hospitalization as a result of a COVID-19 infection could result in severe financial difficulty for a very significant portion of American households, particularly since many of these households likely find themselves without their regular income thanks to the shuttering of the United States economy.  It is no wonder that a survey by the Kaiser Family Foundation found that 36 percent of Americans were worried about being able to afford testing or treatment related to the COVID-19 pandemic.

Where are American Taxpayer's Spending Their Health Care Dollars?

Those of my readers that live in the United States are well aware of the high cost of health care in America.  One of the high costs of health care is not one that consumers of American health services generally give consideration to; the high cost of administering health services in the United States.  A recently released study by David U. Himmelstein MD, Terry Campbell and Steffi Woohandler MD breaks down the major components of health care administration in the United States and their costs on a per capita basis and then compares these costs to Canada and its universal health care/single-payer system.

Here is a bar graph comparing the health care administration costs in 2017 for five of its major components with the United States in blue and Canada in orange:

As you can easily see, the per capita costs for administering America's health care system are far higher than Canada's.  In fact health care administration costs in the United States account for 34.2 percent of national health care expenditures (or $812 billion in 2017) compared to only 17 percent for Canada.  This means that more than one-third of all spending on health care in the United States is consumed by administrative costs and not on treating patients.  Not only are American health care administration costs high, but America's per capita health care administration costs have risen by 3.2 percentage points since 1999 with 2.4 percent of that increase being accounted for by the growth in private insurer's overhead costs thanks to its expanded responsibility for the administration of both Medicare and Medicaid plans.

Back in 2014, Dr. Himmelstein also compared administrative costs for hospitals in eight advanced nations; the United States, Canada, France, Germany, the Netherlands, England, Scotland and Wales. He found the following:

Not only did the United States have, by a wide margin, the highest per capita total hospital expenditures among the eight nations, hospital administration costs as a percentage of total hospital costs were also the highest at 25.32 percent compared to only 12.42 percent for Canada and 19.79 percent for the Netherlands, the second-highest nation in the group.  To put this into concrete numbers, United States hospital administration costs rose from $97.816 billion in 2000 to $215.369 billion in 2011.  As I noted above, this means that a significant portion of hospital costs in the United States are not going to improve patient care, rather, they are going to feed the administrative "monster" that is consuming hundreds of billions of health care dollars every year.  In addition, American hospital administrative costs increased significantly over the decade from 2000 to 2011 from 1.0 percent of GDP to 1.4 percent of GDP.

  Let's close with this quote from Dr. Himmelstein:

“We can afford universal coverage with a single payer plan, not just universal coverage but first dollar coverage for everybody in our country if we adopted a single-payer Medicare for all approach.  If you’re going to cover everybody without getting those savings you’re going to have to spend more or you’re going to have to have big co-payments and deductibles that deter people from getting the care that they actually need.”

It is obvious from this study that, until administrative costs are controlled, American consumers of health care will continue to suffer from a health care system that is by no means world-leading....except when it comes to paying high administrative costs.  Unfortunately, Washington seems incapable of understanding the problem or coming up with a concrete solution to the problem.  But, then again, when you see this from the anti-Medicare For All lobby (aka the benign-sounding Partnership for America's Health Care Future), why should we be surprised:

The Economic Impact of Medicare for All

With relatively little fanfare given its importance to American taxpayers and their families, Rep. Pramila Jayapal (D-Wash.) introduced H.R. 1384 to Congress in late February 201.  The goal of the bill is to establish an improved Medicare for All national health insurance program.  While there is no summary of the text of the bill on the Congressional website yet, here are some quotes from Rep. Jayapal's website about the issue:

"Today’s healthcare system fails to provide quality, affordable healthcare as a right to all people living in the United States. Nearly 30 million Americans are uninsured and at least 40 million more cannot afford the costs of their co-pays and deductibles.

The quality of our healthcare is much worse than other industrialized countries—the life expectancy in the U.S. is lower than other nations, while our infant mortality rate is much higher. Yet the U.S. spends more money per capita on healthcare than any other industrialized nation. We waste hundreds of billions of dollars every year on unnecessary administrative costs, while healthcare industry executives measure success in profits, instead of patient care.

The current healthcare system in the United States is ineffective, inefficient and outrageously expensive. It is time to remove the profit motive in healthcare, to resolve the inefficiencies and to guarantee quality healthcare to every person living in the United States.

The Medicare for All Act of 2019 improves and expands the overwhelmingly successful and popular Medicare program, so that every person living in the United States has guaranteed access to healthcare with comprehensive benefits.

“Today in America, 30 million people are uninsured. 40 million are underinsured. We have the most expensive healthcare system in the world and yet our outcomes are the worst of all industrialized countries. I and the more than 100 co-sponsors of this bill refuse to allow this to continue.  It’s time to put people’s health over profit. Our bill will cover everyone. Not just those who are fortunate enough to have employer-sponsored insurance. Not just children. Not just seniors. Not just those who are healthy. Everyone. Because healthcare is a human right. We will need every single person in the country to help us, to stand with us, to organize and to fight for this,” said Rep. Jayapal. “Because the industry lobby is going to pour hundreds of millions of dollars into killing this bill, saying it costs too much, scaring you into thinking you’re giving up something, pitting the healthy against the sick and the young against the old. It’s time to ensure that healthcare is a right and not a privilege, guaranteed to every single person in our country.  It is time for Medicare for All.”

  

Here is a two page summary of the Medicare for All Act of 2019 thanks to Common Dreams:

  

One of the first question people have is how much this will cost taxpayers.  Fortunately, the Political Economy Research Institution (or PERI) at the University of Massachusetts Amherst have completed a detailed analysis of the economic impact of a Medicare for All system.  In this study, the authors note that 9 percent of Americans are uninsured (up to 13.7 percent in the last quarter of 2018) and 26 percent are underinsured.  While the demand for health care services will increase once these people access a Medicare for All system, the overall demand for health care services in the United States will only rise by 12 percent.  That said, the authors note that there is a significant cost savings potential under a Medicare for All system with the following savings:

1.) Administration - 9 percent savings

2.) Pharmaceutical - 5.9 percent savings

3.) Uniformity of Medicare rates - 2.8 percent savings.

4.) Waste and Fraud - 1.5 percent savings

All in all, the authors estimate that overall U.S. health care costs could fall by roughly 19.2 percent relative to the existing system.  With current Health Consumption Expenditures (other than public health programs) reaching 3.24 trillion in 2017, with a 12 percent overall demand increase and a 19.2 percent cost saving, total Health Consumption Expenditures would fall to $2.93 trillion, a saving of $310 million.  It is also interesting to note that United States Health Consumption Expenditures in 2017 were equal to 17.2 percent of GDP (up from 6.2 percent of GDP back in 1970), far higher than the eight other large industrial economies which range between 8.9 percent of GDP for Italy and 11.3 percent of GDP for Germany.  Under the analysis by PERI, U.S. Health Consumption Expenditures will fall to 15.8 percent of GDP under a Medicare for All system. 

Medicare for All will be funded in two ways:

1.) The same public health care revenue sources that prettily provide 60 percent of health care financing including funding for Medicare and Medicaid - this will provide $1.88 trillion in funds.

This leaves a shortfall of $1.05 trillion ($2.93 trillion minus $1.88 trillion) in additional funding requirements which would require additional revenue generation.

2.) Additional Revenue Generators:

a.) Firms that are not offering coverage for some or all of their employees will pay $500 per uncovered worker with small businesses being exempted.  The authors also developed proposals for an 8.2 percent payroll tax or 1.78 percent gross receipts tax that would apply to new businesses.  This would generate an additional $623 billion in revenue.

b.) A 3.75 percent sales tax on non-necessities (excluding housing and utilities, education, food consumed at home) which would raise $196 billion in revenue.

c.) A net worth tax of 0.38 percent on net wealth greater than $1 million which would apply to only the wealthiest 12 percent of households.  This would raise $193 billion in revenue.

d.) Tax long-term capital gains as ordinary income which would raise $69 billion in revenue.

Here is a table summarizing the revenues generated through the four proposed funding sources:

Let's close with this graphic from the Kaiser Family Foundation which shows the net favourability of a national Medicare for All plan after hearing these arguments positives and negatives about this type of plan (i.e in favour minus oppose):

H.R.1384 has been referred to the Committee on Energy and Commerce and the Committees on Ways and Means, Education and Labor, Oversight and Reform and Armed Services, the places where all good bills go to die.