TL;DR – You pay for me, can?
That was the first time I read about ElderShield. What is this Eldershield thing? Why are they talking about making it compulsory and why am I suddenly made to be a part of it? Do I have to pay? How much do I have to pay, and for how long? What about personal choice? What about personal liberty?
What is ElderShield?
According to the website of the Ministry of Health (MOH), ElderShield “is a severe disability insurance scheme which aims to provide basic financial protection to Singaporeans who need long-term care, especially in old age.”
In the event of a severe disability, ElderShield policyholders will be eligible to receive a monthly cash payout for a period of time, depending on the plan. ElderShield policyholders today have one of two basic ElderShield plans:
The payouts only come when an ElderShield policy holder is unable to perform at least three of the six Activities of Daily Living (ADLs) independently, with or without mobility aids (e.g. walking aids, wheelchair). The six ADLs are:
- Washing – The ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash by other means.
- Dressing – The ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical or medical appliances.
- Feeding – The ability to feed oneself food after it has been prepared and made available.
- Toileting – The ability to use the lavatory or manage bowel and bladder function through the use of protective undergarments or surgical applicances if appropriate.
- Walking or moving around – The ability to move indoors from room to room on level surfaces.
- Transferring – The ability to move from a bed to an upright chair or wheelchair, and vice versa.
Is it fair to force everyone to pay for ElderShield?
OK fine, I will agree that if I can’t perform three of those six ADLs in my old age, I would appreciate having some additional source of income to pay for the costs of taking care of me.
But, what are the chances that I get to that state?
Apparently, 1 in 2 Singaporeans who are healthy at the age of 65 is at risk of having a long-term disability over their lifetime. I might be the 1 in 2 Singaporeans who won’t have long term disability when I’m old. So, even if I pay for ElderShield, it’s not guaranteed that I’ll get anything in return.
So why should I pay?
For that matter, why make those other 1 in 2 Singaporeans who aren’t going to be disabled in their old age pay for ElderShield too? Currently, I get to opt out. And those Singaporeans who think that they won’t be disabled when they’re old can get to opt out. But if the recommendations are accepted, then I won’t be able to opt out of it. No Singaporeans will. All Singaporeans, even those who are healthy, will have to pay ElderShield premiums.
Is that fair? Why don’t let Singaporeans decide whether they want to take their chances?
Some experts say that making ElderShield compulsory prevents insurers from choosing patients who are less likely to claim. Insurers do that to improve the profitability or reputation of the provider. Those same experts also say that making ElderShield compulsory will make ensure that those who need ElderShield get the required protection at an affordable price. Because apparently when there is a choice to opt out, there are two groups who are most likely to opt out.
The first group are those who are likely to need the insurance the most, the poor elderly, are likely to opt out. And the second group likely to opt out are those who can afford to contribute to the risk-pooling and can afford alternative financing.
So making it compulsory will theoretically make the whole system more robust.
Can’t we use other government schemes funded by taxpayers?
But those improvement come at my own personal liberty. I would definitely appreciate the choice of deciding whether I need an insurance like ElderShield. If I have that choice, I would choose not to. Because I know in Singapore, if I desperately need money because of my health issues, there are many other schemes. Say what you will, our political leaders aren’t that stupid. If someone dies because he doesn’t have money for medical bills, that will look really bad on them.
So somehow, even if I don’t pay for ElderShield and I end up being that 1 in 2 Singaporeans who have a long-term disability, I’m sure I can find some government schemes to take care of me. There’s always Medifund if all else fails. And I wouldn’t have to pay for those schemes. Because they would be funded by the government budget.
So why should I take out my own money to pay for ElderShield?
Ya ya. I know… Government budget actually comes from taxpayers. But you see, I don’t pay that much tax. So… ahem… it’s actually those rich people who will be paying for my healthcare in my old age.
But what’s wrong with that?
I mean… if you earn enough to have the privilege of paying taxes, shouldn’t you also have the responsibility of taking care of those who earn less? If you don’t think you have that responsibility, then isn’t that very selfish of you?
So by making the ElderShield compulsory, the government is making every Singaporean, rich and poor, save for many years so that we can pay for our own care should we become disabled when we are old.
Isn’t that a bit regressive?
Of course, the government will say that they’ll provide some subsidies or whatever to make sure that every Singaporean can afford the premiums of ElderShield. But that still means that there’ll be some people (probably those like me), who’ll end up paying more for insurance than if I could opt out.
And knowing this Government like you and I know them, chances are they will go on ahead and adopt most, if not all, of the recommendations. Sigh.