1Care: A retirement gold mine for the Najib and Hisham clans?

1Care, as well as other products that carry the ‘1’ tag, is controversial. Not controversial as in innovative or traib-blazing but sad to say, controversial as in 'rip-off' and 'shady'. It is something that Prime Minister Najib Razak should serious pause and contemplate, rather than allow his advisers to browbeat him into pushing it through.

For 1Care, it is not merely about dealing with the speculated 10% tax deduction that will go into a national medicare pool. The problems with 1Care are deeper and darker than just paying good money for sub-par service and medication.

Best value for the govt, not the people

The real goal of 1Care is to generate the best ‘value for money’ situation for the government. Not the people.

1Care effectively allows the government to have control over how much ministerial allocation from the Health Ministry is to be to channeled to health care. Rather than burdening their coffers, the Najib administration has decided to throw the cost to the citizens, but with the added caveat that they maintain control and decide for us, who and where we can go to seek medical attention.

Health Ministry deputy director for the National Health Financing unit Dr Rozita Halina Hussein said that 1 Care would have to be made mandatory. Frankly, 1Care can only work if it is mandatory. Otherwise, no one would sign up. Since 1Care forces citizens to subscribe to what the government wants, and since the government maintains full controls, Malaysians can be sure Umno-BN and its friends will benefit.

Nepotism and family packages

Incidentally, Dr Rozita Halina Hussein is the sister to the Home Minister Hishammuddin Hussein Onn and cousin to Prime Minister Najib Razak. Talk about 'family packages'!  So forget any notion that 1Care will be scrapped. It will be implemented at all costs.

As pundits from both sides of the political divide opine, not only does the Umno-BN gravy train travel to many destinations with this deal, 1Care also provides the Najib and Hisham clans with their retirement nugget should they lose power in either GE-13 or the upcoming Umno party polls.

1Care is based on the UK’s National Health Service (NHS), which has been in place since 1946 and is governed by the Health Ministry. The NHS is a free service to all residents of the UK, including members of the armed forces who are working abroad. British citizens who reside outside of the UK are subject to charges regardless of whether they have paid National Insurance contributions. The service is financed from mandatory national insurance taxation paid by employees directly from their salaries and supplemented by an obligatory contribution form employers. Self-employed persons have to pay the full contribution themselves. The onus is on the employer to deduct contributions from its employee’s wages. Dependant family members and vulnerable groups like the unemployed are exempt from contributions.

Private hospitals in the UK are owned by private companies. There are many incidences when private patients will be treated in an NHS hospital because the private hospital lacks the specialist equipment. In these cases, the private patient is given their own room and is treated before NHS patients. Emergency patients supersede all patients both private and NHS.

Huge fundamental differences between 1Care and UK system

But Malaysia's 1Care differs from the UK NHS on many fundamental points. While in 1Care you are assigned a general practitioner (GP), you can't choose. Under the NHS, citizens are free to register with the GP of their choice. If you need to consult a doctor, you have to make an appointment at his practice or if you need urgent attention, you can call him to your home, attend the surgery on a speculative basis or visit your nearest emergency department.

And since the NHS has been in place since 1946, the system is matured and the GPs are professional in their task of ensuring every citizen gets the best service possible. For 1Care this may not be possible. There is uncertainty as to what actual services will be provided by Malaysian GPs, the Ministry of Health has yet to provide a comprehensive and detailed guideline as to what form of sickness is covered under 1Care.

At the end of the day, chances of patients receiving the most appropriate health care may depend on how lucky they are. If you get a good, well trained and experienced GP, you may walk away fine and well. But pull a bad apple out of the basket, the results may not be pretty. And as with all things in Malaysia, the politics of the day and vested interest from politicians and corporations determine and cloud the quality of services provided.

Who will protect Malaysians from their doctors

1Care is also meant to save cost, which would mean citizens may find themselves getting the cheap side of medicare for the tax they pay. This may mean the lowest quality, far below what Malaysian taxpayers' money can fetch in a level market. As Malaysians cannot choose under 1Care, they could end with the 'cheapest' service available and all in the name of national cost-savings!

And since the Malaysian Health Ministry will determine the services and the GPs that citizens will see under 1Care, how sure are we that no form of racial and religious bias is at play when a doctor sees an assigned patient?

This goes beyond issue of cost or medication, but straight to the heart of the doctor’s role in ensuring that his patient gets the best health care possible. And with the GPs being the front-line operators, the possibility of non-rational decisions being made is high. Under 1Care, the GPs will determine if and when you should receive additional treatment for what ails you. Who will protect the citizens from bad, negligent or simply sub-standard doctors assigned to them by their government?

Healthcare is a right

The Najib administration must bear in mind that health care is a mandatory provision for any Malaysian citizen. It is a right not a privilege. It should not be decided based on the economics of the day. Or gain for the future for a particular group of politicos. It should not be thought of as a product with a clever brand. Yet, this is what we see now in Malaysia.

What is wrong with the current system that has sustained the nation for 50 over years? Would not it be better to improve on the current medicare system? Make it more efficient and user-centric rather than to revamp and start anew?

The introduction of 1Care shows that there are serious problems in how Malaysia's money and priorities are being managed. There would not be a need for 1Care if the current funds, allocated to health care is well manage.

Health care spending will increase as the population grows and matures. This is normal. Yet, in Malaysia, the spending on health care seems to be leaking elsewhere and now citizens are made to pay upfront for a service that will short-change them. One wonders why Health Minister Liow Tiong Lai, caught red-handed for lying to the people about the police tear-gassing Tung Shin hospital, has chosen to support the initiative.

1Care is wrong for Malaysia, and if this government listens to its people, it should ditch the plan immediately or risk total rejection by the people.

Malaysia Chronicle