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04 March 2008

Are The Poor Left For Dead?

Following her path to recovery was this nagging question at the back of my head and in recent weeks and I was debating internally if I should blog about it for the longest time and hence the time lag between her "birthday" celebration and this entry. I met up with Chrissy over a game of golf during the Ch1nese New Year and had an in-depth talk with her over this question that has been flashing in my head over and over again.

The question?

Did she survive because she is financially comfortable? Would she have lived if she were poorer? 

Chrissy's background is what I would say above average and I was wondering if she got through this relatively (I stress the word "relatively") smoothly as a result of her financial standing? After all, aren't chemotherapy, marrow transplants and all related medication very expensive?

How would someone of lower income level be able to handle medical bills of this magnitude? Would they be left for dead simply because they can't afford the treatment?

Chrissy and I think the answer is YES and NO based on the following points, which we say upfront here that we may not be totally accurate.
  • Her medical bills were adequately covered by her insurance policies (hospitalisation and critical illnesses) and that she only had to pay for a small portion of the total bill which to her family and her was manageable.


  • Chrissy was lucky to have her insurance policies in place just a few months prior to being diagnosed with Leukemia. As a result, her insurance policies took care of a big chunk of the expenses. Problem is, how many of the poorer folks can actually afford an insurance policy? With getting food onto the table already a daily challenge, you can be sure that an insurance policy is definitely not on their list of priorities at that point in time.

    Ok, so that was an extreme example. Chrissy's total bill came up to the lower part of 6-figures and granted the insurance payout took care of the a big chunk of the bill, the balance amount may still be too big for some folks.

  • Pertaining to folks of the lower income level, she said that the Gahmen and various charitable agencies have adequate funds in place to help those patients who have difficulty with the treatment costs. However, she and I both agreed that there are quite a few of these people who have fallen through the cracks and did not receive the help that they could/would/should get.


  • Yes, there is money for treatment for the less financially fortunate. However, every cent of this money needs to be accounted for and so these aid givers have a responsibility* to stretch every dollar in order to make the money go to the maximum number of people possible. That means maximise the dollar to accommodate maximum number of qualified applicants.


    • In order words, every applicant must be stringently checked to prevent abuse by those who can afford the treatment but pretend they can't and thereby deny aid to the next genuine case. As a result of the various necessary procedures, the entire process will be relatively longer as compared to those who have the money to handle everything on their own. Procedures means forms and paperwork since accountability requires that of a transparent paper trail in the event an audit is in order. Can you feel the time ticking away here? I am not saying that we should abolish the red tapes. These are unavoidable as we need these checks and balances to keep the funds honest. The downside is that many a times we heard of stories that by the time the aid arrives after all the "administrative processing" is completed, the patient has already died.

    • Option of treatment shall be that of the most economical alternative i.e. saving 2 lives with cheaper medicine but taking twice as long will always trump saving 1 life in half the time with more expensive medicine. While cheaper medicine may not necessarily mean inferior in quality, Chrissy told me that the more expensive medication alternative are more effective i.e. cheaper medicine may still get you to the point of recovery but just not as fast as that of the more expensive ones.


    • Would aid be denied to those patients whom the aid giver think is a lost cause i.e. beyond point of recovery? Would the aid giver be forced to play to role of God to decide who is to be saved and who is not? With money being a finite amount, I won't be surprised if the aid giver have to decide to give the dollar to the first person in line but is already too sick and going to die with or without treatment or skip over to the next person behind him/her who has an actual shot at full recovery?
* assuming no peanuts, golden taps and other RenCirregularities.

Here's my take on the situation.
  • Yes, it is not possible to achieve parity between the haves and have-nots under the circumstances. What we have for the less financially-abled may not be perfect nor as good as those who have the money, it is in my opinion good enough. Not perfect but certainly not shabby.


  • Granted that using public money would mean a less straight-forward and a more tedious road to recovery (resulting in some of them not able to complete the journey), what the aid-givers must do is to ensure the fastest journey possible within their means i.e. no stupid ding dongs as a result of incompetent administration.


  • So the bottom-line here is to aim to be as self-reliant as possible. Chrissy is in her 30s when this happened and so do not think that there is no hurry to get all the various relevant insurance policies in place. Critical illness is not an "old-people" thing. It can happen to anyone at any time.


  • Still, it also doesn't mean that you should just run out to the first insurance agent you meet and put money down on the first policy that comes to you. You still need to do a bit of research to find that policy that would fit and best serve your interest and not the agent's pocket.

    Gerry also accurately pointed out the need to be covered adequately as one would still run into trouble if the chalked up bill exceeds your coverage.

    I suggest checking out http://tankinlian.blogspot.com. An excellent resource on the topic of local insurance.


  • If you need assistance, please put your hand up. The various charitable agencies do not have a radar that would sniff out those in need. As many as there are folks who received help and made it through the day, we speculate that they may be as many who didn't as a result of not asking for help. It could be ignorance i.e. don't know where to look for help or worse, don't know that help even existed in the first place or it could just be a matter of too much pride.

    Help starts with oneself and external help cannot be effective if internally you are not doing anything about it.
- Voxeros

1. CoWg0eSm0o left...
Tuesday, 4 March 2008 10:57 am
Well here's my simple take on this:
It's been quite well-known that the red-tapes in place for application of public funds for healthcare's pretty mad. While this is really bad for the patients (since as u mentioned, by the time aid arrives it may be too late), but well you may have to think from the perspective of the aid-givers and the govt. That they are not trying to encourage a socialist setting like overseas.
And yes...Leukemia's a really horrible disease. Chrissy's recovery will really serves as an motivator for my aunt who just got diagnosed with it, 5 years after her recovery from stomach cancer.


2. JayWalk left...
Tuesday, 4 March 2008 11:01 pm :: 
CowGoesMoo: Ahh.. spoken like a true Republican. Socialist similar to the Democrat, while noble is their idea not to leave anyone behind is more often than not, subjected to abuse by people who sit around doing nothing and expecting handouts. As the PAP has described, the so called "crutch mentality".

However, in legitimate cases, these administrators have a duty of urgency and not process these cases on a nonchalant mentality. Perhaps it is this part of the process that really rile people up, if any at all.

My regards to your aunt but from past experience, Leukemia if detected early have a high chance of recovery. I have another friend M1ke Norr1s who got diagnosed with Leukemia around the same time as Chrissy also fully recovered.


3. grasshopper left...
Saturday, 8 March 2008 7:38 am
i bery bery bery agree with your blog title. Unfortunately my family had to go thru a cancer horror-story recently. And to have personally went thru this drama, I would say that your chances of surviving increases with the amount of immediate cash you can spare. I can't say much as I know it's not the health care workers' fault. But after moving to a private cancer treatment center (=$$$$$), my papa's situation improved tremendously. sigh~


4. JayWalk left...
Sunday, 9 March 2008 9:55 pm :: 
Grasshopper: Glad to hear that your dad's ok. The problem with public money is that every applicant is has a fair shot at it. Problem is that is very difficult to decide who gets the first dollar, who gets the next and who gets the last?

Everybody wants to get the first dollar since cancer is one that is time sensitive but having to form a queue beckons the question why one patient is ahead of the other? Who makes this decision and how does he/she justify?

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