TAK NAK 1CARE! (VERSI BM)

“Penambahbaikan” sistem perkhidmatan kesihatan yang dinamakan 1Care untuk 1Malaysia kini hampir sedia dilaksanakan dan ia memang benar-benar menakutkan.

Kerajaan BN telah menjual idea 1Care di media massa sepanjang tahun 2011. Gambaran yang diberi berseri-seri tetapi tiada maklumat yang tetap yang telah diberi selama ini. Sekumpulan rakyat prihatin yang menggelarklan diri mereka #taknak1care berjaya mendapatkan maklumat dalaman dan telah memulakan kempen Tak Nak 1Care di facebook yang hangat dibincang orangramai.

Pendedahan mereka pada halaman Facebook Tak Nak 1Care cukup membimbangkan pihak berkuasa, hinggakan Timbalan Ketua Pengarah Kementerian Kesihatan, Datuk Dr Noor Hisham Abdullah sendiri telah menyertai perbincangan di halaman facebook tersebut untuk cuba mengawal keadaan. Bagaimanapun, beliau setakat ini tidak dapat menjawab atau memberi penafian mutlak kepada apa-apa maklumat yang didedahkan pada halaman facebook itu. Akhirnya, tiada lagi ulasan diberi beliau melainkan berkata "belum ada apa-apa yang diputuskan lagi, tetapi walauapapun ia akan memberi manfaat kepada rakyat" berulang kali.

Bagaimanapun, Timb KP telah mengakui bahawa Malaysia kini sedang menjalankan proses pelaksanaan 1Care sehingga sejauh separuh prosesnya. Blogger ini tertanya-tanya - bagaimana boleh melaksanakan separuh sesuatu benda yang tidak wujud lagi, seperti yang ditekan oleh Timb KP?!

Saya difahamkan bahawa tahun 2012 akan nampak pelaksanaan 1Care dipertingkatkan. Kita boleh melihat pelbagai artikel dalam media arus perdana mengetengahkan kelemahan sistem perkhidmatan kesihatan kami. Ini sengaja dilakukan supaya rakyat akan disediakan untuk menerima mesej bahawa “penambahbaikan” sistem penjagaan kesihatan amat perlu. Undang-undang yang akan membenarkan pelaksanaan 1Care ini mungkin diluluskan tahun ini. Oleh itu, kita tidak mempunyai banyak masa untuk menghentikannya.

Saya tidak akan membincangkan struktur 1Care di dalam rencana ini. Untuk maklumat lanjut, sila "Like" halaman facebook #taknak1care. Ada pelbagai maklumat mengenai 1Care di situ, juga beberapa perbincangan yang bernas, termasuk perbincangan panjang dengan Timb KP KKM sendiri, dan maklumat baru sering di-post. Anda juga boleh mencari Youtube untuk video Tak Nak 1Care.

Buat masa sekarang, saya hanya ingin meninjau masalah dan soalan-soalan yang timbul daripada "penambahbaikan" 1Care ini.

Pertama, saya percaya 1Care berdasarkan beberapa andaian yang berlandaskan dasar yang silap.

Andaian 1:
Kerajaan Malaysia tidak mampu membiayai penjagaan kesihatan awam lagi.

Walaupun kerajaan BN membelanjakan jauh kurang untuk perkhidmatan kesihatan (hanya kira-kira 2% daripada GDP) berbanding negara-negara yang lebih kurang sama tahap kemajuannya, tahap perkhidmatan kesihatan Malaysia agak tinggi. Malah badan-badan antarabangsa mengakui pencapaian baiknya. Kos rendah dan keberkesanan yang tinggi ini menunjukkan bahawa Malaysia telah pun mempunyai sistem perkhidmatan kesihatan yang baik sekarang. (Ini adalah titik yang amat penting untuk diingati apabila anda membaca seterusnya.)

Tetapi walaupun perbelanjaan kerajaan untuk kesihatan adalah antara yang terendah di dunia, kerajaan BN mengatakan bahawa ia tidak lagi mampu membiayainya, walaupun hanya 2% daripada KDNK. Kerajaan kini sedang merancang untuk memaksa semua rakyat membayar sehingga kira-kira 10% daripada pendapatan bulanan mereka ke dalam skim Insurans Kesihatan Sosial (SHI) untuk berkongsi kos perkhidmatan kesihatan negara. Ini tidak masuk akal! Bukankah kos pembiayaan perkhidmatan kesihatan awam dibayar oleh hasil titik peluh pembayar-pembayar cukai? Mengapa pula sekarang kita diminta untuk membayar lagi?

Seharusnya kerajaan BN selesaikan masalah pemborosan, pembaziran, rasuah dan aliran wang haram ke luar negara dahulu dan bukannya memaksa rakyat membiayai tingkahlaku yang tidak bertanggungjawab mereka.

Sebaliknya, kita lihat kerajaan BN membelanjakan hasil titik peluh pembayar cukai ke atas banyak projek yang "lebih penting" dari perkhidmatan kesihatan awam, seperti:

- RM 1 bilion - Menara Mega,
- RM 12 bilion – Skandal PKFZ,
- RM 3 bilion - kapal selam yang tidak boleh menyelam,
- RM 50 bilion - projek MRT yang hanya meliputi km beberapa
- RM 250 juta – projek lembu negara yang dijadikan projek kemewahan diri.

Dan jangan kita lupa
- RM 1 trilion - aliran wang haram ke luar negara

Jika kerajaan dapat mendapatkan semula hanya sebahagian kecil daripada semua wang yang telah disia-siakan ini, negara kita dengan mudah boleh membiayai bahkan mengembangkan sistem perkhidmatan kesihatan awam untuk beberapa generasi akan datang! Sebaliknya kita melihat kerajaan BN tidak mempunyai niat untuk menghentikan amalan membazir dan rasuah mereka. Mereka jelas tidak mengutamakan kepentingan rakyat.

Andaian 2:
Sistem perkhidmatan kesihatan memerlukan satu rombakan dahsyat

Malaysia mempunyai sistem dwi-lapis yang agak berkesan. Semangat dan pemahaman di kalangan rakyat ialah mereka yang mampu akan pergi ke perkhdimatan kesihatan swasta. Mereka yang tidak mampu, akan pergi ke perkhdimatan kesihatan awam. Yang berpendapatan lebih tinggi akan menjaga diri mereka dan mereka juga rela membayar cukai (hanya 10% daripada penduduk adalah pembayar cukai) supaya kerajaan menyediakan perkhidmatan kesihatan untuk 90% lagi penduduk yang berpendapatan lebih rendah.

Sistem dwi-lapis ini telah berjalan dengan baik selama berpuluh tahun (ingat, keberkesanannya diakui di peringkat antarabangsa) walaupun ia kini mempunyai beberapa masalah. Tetapi kebanyakan masalah-masalah ini sebenarnya berpunca dari dasar-dasar kerajaan yang tidak sesuai dan juga kekurangan penguatkuasaan peraturan dan kualiti. Keadaan ini mudah diselesaikan dengan pengurusan kerajaan yang mantap.

Masalah kesihatan yang paling utama sekarang adalah keuntungan luarbiasa dan pengurusan kewangan sektor awam yang tidak bertanggungjawab. Langkah pertama dalam apa-apa proses penambahbaikan sepatutnya ialah untuk menyelesaikan dua masalah ini. Tetapi nampaknya seolah-olah k'jaan tiada niat membuka langkah ke arah situ. Sebaliknya, mereka ingin melaksanakan skim Insurans Kesihatan Sosial (IKS ataupun SHI) untuk membasuh tangan mereka dari tanggungjawab membiayai kos perkhidmatan kesihatan awam.

Andailah sistem penjagaan kesihatan Malaysia benar-benar buruk sangat sehingga ia memerlukan satu rombakan yang dahsyat. Tak bolehkah kerajaan kita belajar dari negara lain di mana sistem mereka berjalan lancar tanpa membebankan rakyat? Tetapi sejak 20 tahun yang lalu, k'jaan seolah-olah tidak pernah memikirkan mana-mana sistem kecuali sistem penswastaan dan mewujudkan sistem SHI.

Andaian 3:
Penswastaan ​​dan SHI adalah pilihan reformasi terbaik

Di negara-negara di mana hampir tiada perkhidmatan kesihatan awam (seperti Amerika), SHI mungkin menjadi satu kelegaan. Dalam sistem yang diswastakan, perkhidmatan kesihatan dianggap sebagai satu produk, dan keuntungan diutamakan. Tetapi perkhidmatan kesihatan bukan seperti produk biasa - anda boleh memilih tidak membeli suatu kereta, tetapi anda tidak boleh memilih untuk tidak mendapat serangan jantung. Anda boleh kembalikan suatu baju untuk mendapat refund, tetapi anda tidak boleh kembalikan pembedahan yang sudah dijalankan. Keadaan ini menjamin bahawa pembekal perkhidmatan kesihatan akan sentiasa menguasai pasaran mereka!

Dalam konteks itu, SHI memberi penjagaan kesihatan sejagat pada harga berpatutan apabila diperlukan. Orangramai hanya perlu kurangkan sedikit wang perbelanjaan setiap bulan kerana gaji dipotong untuk membayar skim SHI. Ia merupakan satu alternatif yang baik berbanding keadaan di mana orangramai tidak mampu membayar untuk lawatan / preskripsi doktor yang mahal, penjagaan jangka panjang seperti kencing manis, atau perbelanjaan penjagaan kesihatan mendadak dalam kes-kes seperti kanser atau kemalangan.

SHI yang dilaksanakan dengan baik juga boleh berfungsi sebagai kaedah mengawal penyedia perkhidmatan kesihatan. SHI boleh menuntut kualiti dan akauntabiliti dari penjagaan kesihatan dengan mengehadkan pembayaran jika terdapat amalan yang buruk dan pengurusan kewangan yang tidak bertanggungjawab. Sudah tentu, sistem SHI mempunyai kelemahan, tetapi ia masih lebih baik daripada pasaran kesihatan swasta yang terlalu mahal sehingga di luar kemampuan ramai orang.

Tetapi Malaysia TIDAK mempunyai sistem perkhidmatan kesihatan yang diswastakan sepenuhnya, jadi kita tidak perlukan sistem SHI untuk memperbaiki sistem kita. Tetapi sebaliknya, kerajaan BN kini sedang MEWUJUDKAN keadaan-keadaan teruk itu, dengan mengswastakan keseluruhan sistem perkhidmatan kesihatan melalui 1Care! Ini supaya mereka boleh mewujudkan dasar perkhidmatan kesihatan yang serba baru dan melaksanakan sistem SHI di Malaysia! Ini seperti menghantuk kepala sendiri dengan tukul supaya ada alasan untuk membeli Panadol!

Mengarut sungguh!

Sekarang mereka tidak berani menggunakan perkataan "pengswastaan" kerana rakyat memikul beban berat disebabkan dasar pengswastaan ​​dahulu. Perkataan popular sekarang ialah "Autonomi" yang bermaksud membolehkan pembekal perkhidmatan kerajaan memutuskan dasar sendiri tanpa campur tangan kerajaan - seperti dasar harga, sebagai contoh.

Jika terjadi keadaan sebegini, tiada apa yang akan menghalang hospital kerajaan daripada bertindak seperti suatu perniagaan yang mengaut keuntungan.

Andaian 4:
Jumlah penduduk yang berpendapatan tinggi akan cukup untuk membiayai sistem SHI.

Prestasi Keluaran Dalam Negara Kasar (KDNK) dan data ekonomi makro tidak cukup untuk mengukur kebolehan rakyat sejagat membiayai sistem SHI. Kita mesti mengambil kira keadaan sebenar di akar umbi. Faktor seperti jurang pendapatan, kadar inflasi dan kos hidup perlu dititkberatkan. Kini, jurang pendapatan semakin melebar, kos sara hidup makin melambung dan kadar inflasi rasmi tidak mencerminkan realiti. Tetapi data makro ekonomi mungkin memberi gambaran bahawa terdapat kelas perpendapatan tengah yang besar yang mampu menampung skim SHI ini.

Tambahan pula, penunjuk ekonomi kerajaan sangat mencurigakan. Tahap kemiskinan rasmi ditentukan sebagai pendapatan isi rumah RM800/bulan. Tetapi dalam Bajet 2012, Perdana Menteri mengakui bahawa pendapatan isi rumah yang kurang daripada RM3000/bulan mempunyai masalah kewangan. Angka rasmi menunjukkan kadar inflasi ialah kira-kira 3%, tetapi kajian bebas menunjukkan bahawa inflasi dalam bandar mungkin setinggi 10%. Perbezaan ini ialah kerana kerajaan mengukur kadar inflasi dengan harga barang-barang yang bukan lazim dibeli oleh kebanyakan rakyat Malaysia.

Pelaksanaan sistem SHI berdasarkan data kabur dan mengelirukan mungkin akan membawa bencana kepada rakyat yang sudah dibebani dengan kos sara hidup yang tinggi!

Keghairahan kerajaan BN untuk melaksanakan 1Care berdasarkan andaian cacat dan tanpa mengkaji keadaan rakyat sebenarnya hanya menunjukkan sikap tidak peka mereka. Jelas sekali, kepentingan rakyat adalah jauh dari fikiran mereka.

Selain daripada masalah-masalah yang timbul dari andaian cacat ini, 1Care juga menimbulkan beberapa isu yang merisaukan.

Isu 1:
Cukai berganda, tiada faedah tambahan

Konsep SHI tidak munasabah dalam konteks Malaysia. Seperti yang dijelaskan sebelum ini, Malaysia diakui di peringkat antarabangsa kerana mencapai sistem penjagaan kesihatan yang berkesan dengan perbelanjaan yang sangat rendah.

Dengan pelaksanaan 1Care, rakyat Malaysia kini akan membayar cukai, DAN SHI DAN premium insurans swasta mereka. Jika kadar SHI adalah munasabah dan pakej manfaat meliputi semua keperluan kesihatan, orangramai mungkin tidak mempunyai masalah dengan itu. Yang tidak berpuas hati mungkin hanya syarikat insurans swasta kerana mereka akan kehilangan perniagaan.

Tetapi maklumat dalaman mendedahkan bahawa Kementerian Kesihatan telah menjemput syarikat-syarikat insurans menyertai Kumpulan Kerja Teknikal 1Care yang sedang meneliti butiran pelaksanaan 1Care. Kita tidak mendengar apa-apa aduan daripada mereka walaupun pelaksanaan 1Care hampir sampai ke pertengahan prosesnya. Maka, kami boleh menganggap bahawa perniagaan mereka tidak terancam oleh SHI 1Care.

Maklumat dalaman juga menunjukkan bahawa semua bayaran bulanan kami kepada SHI 1Care hanya akan mendapatkan perkhidmatan kesihatan asas (Pengamal / Klinik Am). Walaupun begitu, rakyat MASIH perlu berkongsi kos (co-pay) bagi ubat-ubatan dan aksesori perubatan. Dan penjagaan kesihatan lanjut (perkhidmatan hospital / pakar) TIDAK DIBIAYAI oleh SHI. Jadi rakyat MASIH akan perlu membayar dari saku atau bergantung kepada insurans swasta, sama seperti kita sudah pada masa ini. Tak hairanlah tiada syarikat insurans swasta mengadu - pasaran mereka langsung tidak digugat oleh skim SHI 1Care!

Inikah yang dikatakan penambahbaikan pada sistem yang kita ada sekarang?! Adakah kerajaan BN benar-benar ingat rakyat akan menerima sahaja paksaan untuk membayar dua kali untuk mendapat satu sistem baru yang akan membebankan mereka dengan kos penjagaan kesihatan yang lebih tinggi tetapi tidak memberikan apa-apa faedah tambahan?

Isu 2:
Integrasi sektor perkhidmatan kesihatan awam dan swasta akan menyebabkan kos melambung

1Care akan mengintegrasikan perkhidmatan penjagaan asas awam dan swasta serta menyamakan yuran mereka. Secara praktikal “doktor kerajaan” tidak akan wujud lagi. Semua doktor akan dibayar kadar swasta di bawah 1Care (maklumat terkini adalah bahawa satu lawatan akan dicaj RM60, dibayar oleh skim SHI). Pasti kos perkhdimatan kesihatan asas akan meningkat dengan mendadak.

Doktor 1Care juga ditugaskan menjadi "penjaga pintu" (gatekeeper). Tiada siapa yang boleh berjumpa mana-mana pakar atau dimasukkan ke mana-mana hospital tanpa surat rujukan dari doktor 1Care. Ini menimbulkan persoalan yang besar – melihat yuran klinik dan doktor telah pun diselaraskan dengan sektor swasta, adakah yuran hospital awam / perkhidmatan pakar juga akan mengikut?

Ini memang sebahagian daripada rancangan 1Care. Tak "adil" lah jika pakar kerajaan dibayar kurang daripada rakan-rakan di sektor awam dalam sistem bersepadu yang baru ini. Timb KP KKM sendiri membayangkan ini dalam satu ulasannya di halaman # taknak1care. Khusus beliau mengulas bahawa:
"Bagi pakar atau doktor, jika saya berjumpa 10 pesakit sehari atau saya berjumpa 100 pesakit, gaji saya sama sahaja. Jika anda cekap, anda akan diberi lebih banyak kerja. Ini adalah sistem yang kami ada sekarang."

Melihat 78% daripada katil hospital di Malaysia dimiliki oleh kerajaan yang juga mengendalikan 74% daripada kemasukan hosptial, bayangkan apa yang akan berlaku apabila semua kemudahan kerajaan ini mula mengenakan kadar swasta di bawah 1Care. Kos penjagaan kesihatan akan mencecah langit! Kebanyakan rakyat masih tidak mempunyai insurans dan mereka tidak akan mampu mendapat perkhidmatan kesihatan di bawah skim 1Care baru ini.

Lebih-lebih lagi, perkembangan ini akan mempunyai kesan penggandaan. Salah satu kesan yang saya boleh anggarkan adalah dalam sektor insurans. Faedah SHI 1Care hanya meliputi perkhidmatan terhad GP, maka syarikat insurans swasta perlu menaikkan caj premium mereka dan menghadkan pembayaran pampasan untuk memastikan keuntungan mereka tidak terjejas.

Jelas sekali, pembaharuan 1Care kerajaan BN akan membuang rakyat di tepi jalan dalam usaha mencapai sistem yang menghargai lebih keuntungan lebih daripada nyawa.

Isu 3:
Jaringan keselamatan sosial akan lenyap

Sistem perkhidmatan kesihatan awam kita menjadi pilihan utama bagi golongan berpendapatan rendah. Mereka berpeluang mendapat perkhidmatan penjagaan kesihatan yang baik, dengan harga yang rendah. Tetapi, walaupun 1Care belum dilaksanakan sepenuhnya, caj hospital kerajaan kini tidak lagi murah. Bilik di beberapa hospital kerajaan sekarang sama harga dengan hospital swasta. Yuran lain mungkin lebih rendah dari sektor swasta, tetapi masih ia boleh mencecah beribu-ribu ringgit untuk pembedahan mudah sekarang. Ramai orang berpendapatan rendah akan sukar membayar kos perkhidmatan kesihatan awam seperti ini. Fikirlah, keadaan semakin teruk dan 1Care pun belum dilaksanakan sepenuhnya lagi!

Dalam Bajet 2012, Perdana Menteri mengakui bahawa isi rumah yang berpendapatan kurang daripada RM3000/nulan mempunyai masalah kewangan dan perlukan bantuan wang tunai RM500. Kira-kira 60% daripada isi rumah Malaysia berpendapatan di bawah tahap ini. Macam mana mereka boleh dijangka mampu menyumbang sehingga 10% pendapatan mereka ke dalam SHI 1Care ini? Bagaimana jika mereka perlukan penjagaan jangka panjang / perkhidmatan pakar jika tidak ada lagi sistem perkhidmatan kesihatan awam? Di manakah mereka pergi sekiranya mereka mengidap kanser, kencing manis atau tercedera parah dalam kemalangan – pergi jumpa dukun dan sinsei di kampung ke?

Dengan peluang pengswastaan dibuka luas, mungkinkah "penambahbaikan" sistem 1Care ini akan mengikut cara Amerika, di mana perkhidmatan kesihatan dilihat sebagai peluang mengaut keuntungan lumayan kerana pesakit tidak boleh menolak? Di bawah konsep "autonomi", unit milik kerajaan bebas boleh membuat keputusan itu tanpa gangguan dari kerajaan dan rakyat tidak akan dapat berbuat apa-apa.

Kesimpulan
Banyak isu-isu yang membimbangkan sedang menimbul, mengikut pendedahan skop dan struktur 1Care. Tetapi setakat ini, kerajaan BN tidak mempunyai jawapan untuk rakyat.

Maklumat yang dikumpul (banyak dokumen rasmi boleh didapati dalam internet, termasuk laman web kerajaan) menunjukkan 1Care akan mewujudkan lebih banyak masalah daripada menyelesaikannya. Malah, pelaksanaan konsep SHI 1Care sebenarnya akan memusnahkan sistem cekap yang kami ada sekarang, mewujudkan semua masalah sistem perkhidmatan kesihatan swasta Amerika DAN mewujudkan masalah-masalah BARU kerana liputannya yang sangat terhad. 1Care mungkin akan menjadi pengswastaan yang paling membahayakan rakyat Malaysia yang pernah dilakukan oleh kerajaan BN!

Kerajaan BN seharusnya memperbaiki kelemahan sendiri dan menekankan kepentingan yang wajar dahulu dan bukannya memaksa rakyat tunduk kepada “penambahbaikan” yang penuh keraguan! Kerajaan BN perlu ingat bahawa mereka ditugaskan untuk menyediakan penjagaan kesihatan dan perkhidmatan asas yang lain kepada rakyat, dan bukannya membangunkan skim untuk membolehkan mereka menikmati kerja yang kurang dan wang yang lebih. Kami dah muak dengan dasar penswastaan ​​kerajaan yang memaksa rakyat mengeluarkan darah mereka bagi membayar monopoli yang tidak cekap seperti perkhidmatan telefon, air, elektrik, pembetungan, pelupusan sampah, perkhidmatan pos, pengangkutan awam, dan lain-lain lagi. Kini pula, kerajaan BN mahu menswastakan satu lagi perkhidmatan penting - penjagaan kesihatan!

Rakyat tidak harus menerima sistem 1Care ini. Kami tidak sanggup diperlakukan sebegini lagi. Demi diri kita sendiri dan anak-anak kita, kita harus memastikan skim 1Care ini tak akan pernah wujud di tanah air kita ini!

Jangan bagi mereka peluang, belalah nasib yang tersayang.

TAK NAK 1CARE! Sokonglah gerakan ini, sebarkan berita ini

TAK NAK 1CARE!

Healthcare "reforms" called 1Care for 1Malaysia are upon us and it's a truly frightening prospect.

The BN government has been selling 1Care in the MSM throughout 2011, describing it it glowing terms without giving away any details at all. A concerned citizens group called #taknak1care managed to get hold of some insider information and started a Tak Nak 1Care facebook campaign that's picking up steam.

The revelations on their Tak Nak 1Care Facebook page worried the authorities enough that the Deputy Director General of the Ministry of Health, Datuk Dr Hisham Abdullah joined in the discussions on the page to try and do some damage control. However, he has so far been unable to answer or categorically refute any of the information revealed on the page and has been reduced to repeating the mantra of "nothing has been decided yet, but whatever it is will benefit the rakyat".

But interestingly, the Dep DG has acknowledged is that Malaysia is currently about halfway through the 1Care implementation process. This blogger wonders how you can be halfway implementing something that doesn't exist yet?!

As I understand it, 2012 is when the implementation is supposed to be stepped up. Already we see various articles in the mainstream media about the drawbacks of our current healthcare system. This is done so that the rakyat will be conditioned to accept the need for healthcare reform. The laws authorising the 1Care reforms may even be passed this year. So we don't have much time to stop this train wreck from happening.

I won't be discussing the structure of 1Care in this article. For that, please “Like” the #taknak1care facebook page. There is a wealth of information about 1Care there, several intelligent discussions including long discussions with the Dep DG of MOH himself, and new information is posted often. You can also search Youtube for the Tak Nak 1Care videos.

For now, I would just like to explore the problems and questions that arise from 1Care "reforms".

Firstly, I believe 1Care is based on some fundamentally flawed assumptions.

Assumption 1:
The Malaysian government cannot afford public healthcare anymore.

Although the BN government spends significantly less on healthcare (only about 2% of GDP) compared to similarly developed countries, Malaysia is internationally acknowledged for our relatively high level of healthcare. This low cost and high effectiveness shows that Malaysia already has an internationally praised, reasonably efficient healthcare system already in place now. (This is a very important point to remember as you read the rest of this post.)

But despite the low, low government expenditure, the BN government is saying that it can no longer finance even the 2% of GDP for healthcare. It plans to force all rakyat to pay up to about 10% of their monthly income into a Social Health Insurance (SHI) to share the cost. This is ridiculous! Isn't the government's healthcare expenditure funded from taxpayers hard earned money? Why are we being asked to pay again?

The BN government should first solve the problems of leakages, wastages, corruption and runaway outsourcing costs instead of forcing the rakyat to finance their irresponsible ways.

Instead, we see the BN government spending taxpayers on more "important" projects such as the:

- RM 1 billion Mega Tower,
- RM 12 billion PKFZ fiasco,
- RM 3 billion submarines that don't work,
- RM 50 billion MRT project that only covers a few km, etc.

And let's not forget
- the RM 1 trillion in illicit capital outflow from the country.

If the government recovered even a fraction of all these wasted resources, our country would be able to easily finance even expand our public healthcare system for generations to come! But as it is, we can see that the BN government has no intention of halting its wasteful and corrupt practices. They clearly do not have the rakyat's interest as its priorities.

Assumption 2:
The healthcare system needs a complete overhaul

Malaysia currently has a somewhat efficient dual system. There seems to be an unwritten rule among the rakyat that those who can afford it, go to private healthcare providers. Those who can't, go to public providers. The wealthier taxpayers (only 10% of the population) take care of themselves and willingly pay taxes to provide free healthcare for the poorer 90%.

This dual system has worked well for decades (and internationally acknowledged, remember) although it has some problems. But most of these problems can be traced back to government policies and lack of regulation / standards enforcement. These can easily be solved by conscientious government intervention.

The most urgent healthcare problems now are runaway profits and irresponsible public financial management. Solving these two problems should be the first step to any reform. However, it would seem that the govt has little intention to go in that direction. Instead it wants to implement a SHI to wash its hands of its already low healthcare expenditure.

But for the sake of argument, let's assume that the Malaysian healthcare system is really so bad it needs a complete restructuring. There are many other countries whose models have worked very well with little financial burden to the rakyat. But our govt seems to have not explored any other model for the last two decades except privatisation and creating an SHI to pay for it.

Assumption 3:
Privatisation and SHI are the best reform option

In highly privatised places like America, reforms in the shape of an SHI could be a welcome relief. In a privatised system, healthcare is a product, and pricing strategies maximise profits. But healthcare is not normal product – you can choose not to buy a car, but you cannot choose not to have a heart attack. You can return a blouse for a refund, but you cannot return a surgery. These conditions guarantee that healthcare providers will forever enjoy a seller's market!

In such a context, SHI promises affordable universal healthcare in time of need, as long as people put up with a little less spending money every month after the deductions. It's a viable alternative to costly GP visits / prescriptions, long-term care like diabetes, or sudden catastrophic healthcare spending in cases like cancer or accidents.

A well implemented SHI could also function as a disciplinary tool for healthcare providers. SHIs can demand quality and accountability from healthcare by limiting payments for bad healthcare practices and irresponsible finances. Of course, it has its drawbacks, but it's still better than private healthcare being priced out of many people's affordability.

But Malaysia does NOT have a completely privatised healthcare system that an starting an SHI would improve. So, in order to justify this fundamental policy shift, the BN government is now CREATING the necessary conditions for it by essentially privatising the entire healthcare system through 1Care!! It's like banging your head with a hammer so that you have an excuse to buy Panadol!

Ridiculous!

Of course, now they won't dare to use the “P” word as the rakyat had put up with so much hardship due to past privatisation policies. The popular euphemism now is “AUTONOMY” which allows indivdual government units to decide policies independently without government interference – like pricing policies, for example.

If that's the case, what's to stop government healthcare facilities from acting like for-profit organisations?

Assumption 4:
There will be enough high income earners to significantly contribute to the SHI.

Using GDP growth and macro economic data as an indication of citizens' financial fitness for implementing SHI is flawed. We must take into consideration grassroots conditions such as income disparity, inflation and cost of living as well. Right now, the income disparity is widening, cost of living is skyrocketing and official inflation rates do not reflect the realities on the ground. But looking at macro economic indicators may give the impression that there is a large middle class that can afford a compulsory SHI.

Plus, the government's economic indicators are highly suspect. The official poverty level is determined as RM800/mth household income. But in Budget 2012, the PM acknowledges that households earning less than RM3000/mth have trouble making ends meet. Official figures show inflation at about 3%, but independent studies show that urban inflation is probably at a rate of 10%. This difference is because the government measures inflation rate with prices of goods that are not typical purchases of most Malaysians.

Implementing a univeral SHI based on such vague and confusing financial data could prove disastrous to the rakyat who are already burdened by high costs of living!

The BN government's rush to implement 1Care based on flawed financial assumptions without a proper study of the rakyat's situation only demonstrates their insensitivity and misplaced priorities. Clearly, the rakyat's interest are the furthest from their minds.

Besides the problems these flawed assumptions create, 1Care throws up several issues of concern as well.

Issue 1:
Double taxation, zero additional benefit

The SHI concept itself is ridiculous within the Malaysian context. As explained earlier, we are internationally acknowledged as having achieved a reasonably efficient healthcare system at very low expenditure.

With the introduction of 1Care, Malaysians will now be paying taxes, AND the SHI, AND their private insurance premiums. If the SHI rates were reasonable and the benefits package covered all healthcare needs, many people would probably have no problem with that. The only people unhappy would be the private insurers as they will lose business to the SHI.

But insiders have revealed that insurance companies are included in the MOH's 1Care Technical Working Groups working out the details of 1Care implementation. And since we do not hear any complaints from them even when 1Care implementation is halfway through, we can safely assume that their business has not been threatened.

Insiders also reveal that all our monthly payments to 1Care's SHI only gets us Primary Healthcare (General Practioners / Clinics). Even then, the rakyat STILL has to share the cost (co-pay) for medicines and medical accessories. And tertiary care (hospital / specialist services) is NOT COVERED AT ALL by the SHI. So the rakyat will STILL have to pay out of pocket or depend on private insurance, just like we are already doing now. No wonder private healthcare insurers' are not complaining - their market remains undisturbed by 1Care, right!

How is this supposed to be an improvement over our present system?! Does the BN government really expect the rakyat to roll over and accept being forced to pay twice for a “reformed” system that burdens them with higher healthcare costs but delivers zero extra benefit? 

Issue 2:
Integrating public/private healthcare sectors will drive costs up

Since 1Care integrates public and private primary care services and standardises their fees, there will essentially no longer be any "public" GPs. All GPs will be paid private rates under 1Care (latest information is that it will cost RM60 per visit, billed to the SHI). So we can definitely expect primary healthcare costs to suddenly rise significantly.

1Care GPs are also required to be "jaga pintu" (gatekeepers). No one can see any specialist or be admitted into any hospital without a 1Care GP's say-so. This leads to the big question – since public GP services and rates have been rationalised, will public hospital/specialist services also be integrated and their charges standardised?

This is very likely as it would not be “fair” for government specialists to be paid less than their private counterparts in this new integrated system. The Dep DG of MOH himself hinted at this in one of his comments on the #taknak1care page. Specifically he commented that:

"For a specialist or doctor if I see 10 patients a day or I see 100 patients the salary is the same. If you are efficient you be given more work. This is the system we have now."

Since 78% of hospital beds in Malaysia belong to the government who also handles 74% of admissions, imagine what would happen when all these government facilities start charging private rates under 1Care. Healthcare costs will shoot through the roof! It is also reasonable to assume that most of our uninsured population would no longer be able to afford healthcare under this new 1Care scheme.

What's more, this development will have multiplier effects. One of the effects I foresee is in the insurance sector. Since 1Care's SHI benefits only cover limited GP services, private insurers will have to raise their premiums and limit their payouts to ensure their profitability is not affected by the tsunami of rising costs in tertiary healthcare.

Clearly, the BN government's 1Care reforms will dump the rakyat in the wayside in pursuit of a system that values money more than life.

Issue 3:

Social safety net disappears

Our public healthcare system has always been the primary choice for lower income groups. It is their chance to get good, almost-free healthcare. However, even before 1Care is fully implemented, government hospital charges are now no longer “negligible”. Rooms in some government hospitals now cost as much as private hospitals. Other fees may be much lower than the private sector, but can still run into thousands for a even simple surgical procedure.As it is now, many poor household find it hard to pay for public healthcare - and 1Care hasn't even been fully implemented yet!

In Budget 2012, the PM acknowledged that households earning less than RM3000/mth have trouble making ends meet and a RM500 one-off cash aid makes a big difference. With roughly 60% of Malaysian households earning below this threshold, how can they be expected to contribute up to 10% of their income into 1Care's SHI? How will they be able to afford expensive long-term / tertiary care if there is no longer a public healthcare system? Where do they go if they have cancer, diabetes or are seriously injured in an accident - back to the dukun and sinsei in the villages?

With the floodgates of privatised rates thrown opened, what's to stop our “reformed” 1Care system from going the the free-for-all American way, where any service within the healthcare industry has the potential to be monetised, subdivided and monetised again? Now that the “autonomy” concept seems to be given free reign, government owned units can freely make such decisions without interference from the government and the rakyat won't be able to do anything about it.

Conclusion

These and many other disturbing issues and concerns are turning up bit by bit, as the scope and structure of 1Care are revealed. But so far, the BN government has no answers for the rakyat.

The information gathered (many from documents available online, including government websites) indicates that 1Care will create more problems than it solves. In fact, the implementation of 1Care's SHI concept will actually destroy the efficient system we have now, reverse-engineer for us all the problems of the American privatised healthcare system AND create ALL-NEW problems because of its very limited coverage. 1Care could be the most dangerously ridiculous case of putting the cart before the horse that Malaysians have ever been subjected to by the BN government!

The BN government should fix its own fundamental flaws and get its priorites right first before subjecting the rakyat to such dubious reforms! The BN government should remember that they owe it to the rakyat to provide healthcare and other essential services, instead of washing their hands in the privatisation basin and kicking back to enjoy less work and more money. We've had enough of privatisation policies that forced rakyat to pay through their nose for inefficient monopolies that control phone services, water, electricity, sewerage, waste disposal, postal service, public transport, and the list goes on... Now the BN government wants to privatise and monetise another essential service - healthcare!

The rakyat should not take this lying down anymore. We must not be held ransom to this "You Money Or Your Life" 1Care system. We owe it to ourselves and our children to make sure 1Care is stopped dead in its tracks!

TAK NAK 1CARE! Join the movement, spread the word.

Malaysia Is Gonna Privatise Healthcare?

Good God! The people are getting poorer by the day as prices of essential items go up and up!

Taxes are going up too with the imminent introduction of GST.

But despite the record earnings of Petronas being funneled into the Malaysian government, despite the hundreds of GLCs that are supposed to make money for the government, despite the billions of ringgit of rakyat savings being held by govt via EPF, Socso, Tabung Haji, etc, the government is now telling the people:

"We don't want to provide healthcare for you any more. So if you don't have money to pay for your own healthcare, you can go and mampus la."

Why don't WE THE RAKYAT tell this government to go mampus themselves and vote their asses out completely come GE13?!

1Cop misbehaved at Tung Shin and no more?

Malaysia seems to be stuck in broken record mode. From goodie budgets designed to bribe voters presented since 2008 (more on 2012 budget in a later post), no empty feel-good rhetoric, to a million other issues that never seem to be solved, the same-old, same-old is repeating itself ad nauseaum.

In 2010, I wrote an article asking why only 1Cop was charged for young Aminulrasyid's killing, and no other action was taken regarding the Selangor (then) top cop Khalid lying about the incident, the subsequent official cover ups and denials, and the other cops involved in the chase who manouvered their squad cars well enough to enable the shooters to take out all Aminulrasyid's tyres and finally end his short life.

The official story (now become a criminal conviction) of a lone cop was responsible for the tragedy beggars belief. But it seems this is the modus operandi of the police. Because we see the EXACT SAME process in the Tung Shin incident during the Bersih rally. First: lies, Second: denials and cover-ups, Third: absolve all cops from responsibility, Fourth: single out one low-ranking cop to take all the blame.

The Malaysian Insider reports:

"City police chief Datuk Mohamad Salleh pledged today that action would be taken against the police corporal responsible for the tear gas incident at the Tung Shin Hospital during the Bersih 2.0 rally. "

Is it true that only 1Cop was responsible? Take a look at these videos:

 

This shows a squad of riot police, standing outside the perimeter fence of Tung Shin, firing several rounds of tear gas in the general direction of the hospital.

 

This clip shows 2 clouds of tear gas billowing out near the main Tung Shin Hospital tower, one towards the front the lobby area of the main tower and another at the building beside the tower.

This clip shows cannons shooting chemical-laced water into the hospital compound, as well as 2 clouds of tear gas - one near the lobby of the main Tung Shin tower which was dissipating, and another at the greenery at the back of the compound starting to billow. Another gas cloud billows at the Chinese Maternity Hospital entrance.

This clip shows a tear gas canister in front of the building next to the Tung Shin tower.

This is a gas canister fired into the crowd standing near the entrance of the Chinese Maternity Hospital next to Tung Shin.

This is a clip showing a cornered group deep in the Tung Shin compound at a dead end, and a tear gas canister flies in from ABOVE!

This is another shot of the same group after the gas has dissipated. It also gives a little background of the crowd's movement that caused them to seek refuge in Tung Shin.

If you had been keeping count, that's AT LEAST FOUR canisters triggered WITHIN the Tung Shin compound and one at the Chinese Maternity Hospital entrance. As far as I can place them based on the video footage, the locations are roughly as follows:

There's one more location that I could not pinpoint (the small chanting group), but based on the design of the pillars/lights in the carpark area it is definitely around the Tung Shin / Chinese Maternity car park area.

That's HELLUVA coverage by only ONE rogue cop. 

And that's not all.

Police have standard operating procedures (SOP) and a strict chain of command (COC) during an operation. This is absolutely essential, partly to PREVENT personnel going berserk and doing whatever the hell they liked.

Basically, sergeants are in charge of the ground personnel (who are lower-ranked) and coordinate their actions based on commands from higher ups. Use of force and type of force used are also subject to SOP which dictates what to do and when. Ultimately, these actions and commands are focused on one thing only - to achieve the objectives of the operation decided by the commanders.

Now, does it make sense that a lone lance corporal (second lowest rank in the force) breaks away from the SOP and COC, running amok with his tear gas rifle and NOBODY NOTICES OR STOPS HIM? When at that time, there were hundreds of cops around the Tung Shin area together with their commanders?

Where was his sergeant-in-charge - why didn't he order the fler to stop or even physically restrain him if necessary? What about the other cops? If they had orders not to fire tear gas into the hospital compound, why didn't THEY stop the so-called "rogue cop"?

No...the more likely scenario is that the objective of the operation that day was - "kick their ass, show them who's boss!" That's why all along cops' chain of command, nobody gave a rat's ass that hospitals and religious buildings are internationally recognised places of refuge. They didn't gave a shit what effects tear gas has on sick patients.Or rather, they were NOT ALLOWED TO CARE BECAUSE THE OBJECTIVES OVERRIDES ALL OTHER CONSIDERATIONS.

SOP was definitely breached, but it is obvious that it is not merely the responsibility of a lone "rogue cop". Even if it was only 1Cop firing the tear gas, the fact that he was not stopped by ANY police personnel present places ALL of them equally responsible for allowing it to happen. The Chain of Command must also be held responsible as they allowed tear gas to be fired into the hospital compound. And the responsibility must be extended all the way up the chain of command.

So how far up does that go?

It certainly can't be just the cops because they're supposed to keep the peace. And the best way to keep the peace would have been to discuss nicely with Bersih 2.0 to see how the rally could be carried out peacefully. If they could close off roads for massive street parties and marathons, why not for Bersih? Instead, we saw the police antagonising the Bersih organisers. Obviously they were under orders from higher ups. And if we trace the chain of denials, it extends from the IGP, Home Minister, Health Minister, and right up to the Prime Minister.

With so many eyewitnesses (including police personnel), video evidence, and official press statements, why would they repeatedly deny it ever happened? We can only conclude that they fear it will damage them politically, which would indicate that they are responsible somehow. Of course, if one has done no wrong, what is there to fear?

So for all the barefaced lies and denials that went all the way up to the Prime Minister himself, the blame and accountability for this shameful incident MUST ALSO go all the way up to the Prime Minister, as all of these people were knowingly involved in the incident or knowingly allowed the incident to happen.

Of course, this being the BN and their cronies, they are never going to admit accountability.

Ludah ke langit, terkena muka sendiri!

It's been a long time since I posted anything here on this blog. It just got to a point where it was so tiresome ranting about the lame political bullshit day in and day out. But with the political circus increasing its performances daily, I cannot help it.

This ridiculousness is getting even more out of hand. It is even worse than during the days when they were spinning left, right and centre to get rid of Pak Lah! So I can't stand it any more, I got to speak out and get it off my chest before I burst!

 I wish...

This piece of news I caught on NTV7 this afternoon had me rushing to the toilet bowl to meet my breakfast again, after it made the long journey up from my innards.

The PM was speaking at MCA's annual convention and was mocking the Opposition. But as he was firing off his mouth (no doubt congratulating himself for his wittiness), little did he realise what an embarrassment he was to himself and the MCA delegates. Anyone with half a brain would be able to see through the sheer hypocrisy, bigotry and partisanship that riddled his speech. But the PM and MCA delegates were obviously oblivious...

Among the choice bits that the station felt was newsworthy were the following snippets from Najib's speech. 

- Najib laughing at who Pakatan will put into office if they win Putrajaya. Among the choices Najib mocked was Kit Siang, questioning what kind of position they will give him - PM? DPM? The PM's subtext was clear: Kit Siang is Chinese - will the Pakatan be so stupid to elect a Malaysian Chinese to such a high position in Malaysia? What kind of thinking produces such thoughts? Obviously the type that says "over my dead body will any Chinese be given any position of real influence! To hell whether they are qualified or not!"

Ha. Ha. Ha. Did you just say "Chinese DPM"?

Hello Mr PM, you want to laugh at your own fantasies about what other people have not done or said, go ahead. But when you finish, can anyone anwer this: has any MCA fella even come close to smelling those positions, ah?  Please la, want to insult people make sure don't kena "kar kee lang" la!

Besides, the PM is mocking the possibility of a Malaysian Chinese holding the PM/DPM post at an MCA CONVENTION?! So low class! Reminds me of the other UMNO idiot Ali Rustam telling the Melaka PPP to get lost if they don't like UMNO's ways. And the bloody MCA idiots didn't even realise the PM's insult too all Malaysian Chinese. Some more laugh together...these people really no balls and no brains! Yet they still claim to be the relevant and legitimate representation of Malaysian Chinese!

 - Najib also mocked Anwar's ambition to be PM, while not being the president of PKR. Hello Mr PM, you are Malaysia's PM but you don't know Malaysian law ka? According to the Constitution, the Malaysian PM is elected by the majority of MEMBERS OF PARLIAMENT la...not by party! But I guess since your party UMNO/BN does not have the culture of following the law, your ignorance it's to be expected.

One more thing, you yourself only became PM by DEFAULT when your boss was kicked out. At that time you were NOT party president, but was only the Deputy President. Amacam kira tu?

- Mocked Anwar's family for being in PKR members and leaders, saying that it is a family-controlled party. Alamak, this one really takes the cake la. Mr PM, I'm shocked that you seem to forget that your FATHER was the 2nd PM (after he OUSTED the legitimately-elected Tunku), your COUSIN is currently the Home Minister and your WIFE is the de facto Assistant PM. Yang ni apa pulak?

Family controlled government / country?!

Please la Najib, people who live in glass houses really should not throw stones. Ludah ke langit, terkena muka sendiri!

National Health Insurance Scheme - A Sick Joke!

Watch this and spread the word!



SAY NO TO NATIONAL HEALTH INSURANCE SCHEME - it's just another way for the government and big corporations to milk the rakyat dry of the money!



Don't allow yourself to be screwed anymore! Go out and register as a voter and kick the BN's sorry ass out. Take our country back!

SAY YES to a Government FOR THE PEOPLE!

SAY NO to Government PROFIT FROM THE PEOPLE!

BUM 2010 - Be There or Be Square!