I refer to the recent letter on a 'long-term solution needed for AIDS patients' (Straits Times, 23 July 2001). Mr. Kapur has rightly suggested that there is the need for a long-term solution to the AIDS issue, although his arguments, and the subsequent response by the Health Ministry, misrepresents or inadequately treats many of the key issues involved in the debate.
Specifically, a long-term solution is necessarily one that is sustainable; unfortunately, in his zealous quest for ensuring sufficient "socialisation of health risks", Mr. Kapur has overlooked this key prerequisite in favour of superfluous comparisons to other nations with circumstances far removed from our own.
First, it was asserted that "free and subsidised ARV drugs" are provided to the citizens of other countries. However, any form of a subsidy would involve imposing a cost on the fiscal system of the country. Such support is possible in developed nations due to their larger tax base, and in developing nations due to their preferential status that affords them cheaper drugs. Singapore, possessing one of the highest per capita incomes in the world but a population of only some 4 million, is sandwiched between these alternatives. On the one hand, we do not benefit from the softer intellectual property stance that allows low-cost, generic drugs to be produced; on the other, the relatively smaller size of our budget makes granting subsidies to AIDS patients a stretch of both the dollar and the imagination.
Second, to release subsidies to fund non-standard drugs would open a whole Pandora's box of problems. There is good reason why such drugs are not supported - if they were, there would then be the need to fund treatments for non-standard ailments as diverse as Parkinson's and tropical soil disease. This would place intolerable stresses on a healthcare system that already provides very excellent care for a very reasonable price. Given that AIDS is far from an epidemic in Singapore, it becomes even harder to justify public money going towards a cause that is both relatively uncommon and costly.
Mr. Kapur himself implicitly admits that subsidies are not a long-term solution - so why create such a crutch in the first place? It would only distort the incentives for individuals to take proper preventive measures. Yet, in promoting the idea that a "comprehensive national health insurance policy that includes provision of non-standard drugs" be implemented, the concept of a sustainable policy is once again ignored. A better way forward is to allow the private sector - including not just charities but also insurance companies - to take up whatever slack Medifund does not cover. This is a far more tenable approach that is economically supportable in the long run.
On a final note, even if cheap medication were made available through a system of subsidies and comprehensive national health insurance, the ability of the poorer patients to maintain a treatment course is questionable. A recent study by the San Francisco General Hospital has warned that unless there is at least 95% compliance to the strict drug regimen, the chances of treatment failure due to complications can increase by up to 50%. In practical terms, this involves taking about 20 pills, on schedule, on a daily basis. With so many uncertainties and so little assurance of success, spending the money on public education in AIDS is clearly superior in terms of both monetary and logical considerations.
Kapur, B. 'Long-Term Solution Needed for AIDS patients', The Straits Times, July 23, 2001. Online: http://www.straitstimes.com.sg/forum/story/0,1870,58995-995925540,00.html.