Angry Doctor

Thursday, April 08, 2010

Elite-bashing

There has been several letters to the ST Forum this week 'bashing' elites, in response to this article by Ms Sandra Leong.

Many of the anecdotes on the cluelessness of the 'elites' are pretty funny - angry doc's favourite is this one:

"A church-mate who lived in a landed property in District 10 - definitely not an RGS girl, and I venture to guess, not even a graduate - once, in all sincerity and innocence, prayed for all those who had to take public transport and live in HDB flats, for God to give them strength to bear these trials. "

Of course, there is no one agreed definition on what makes a person an elite, which makes it hard to discuss the issue intelligently. But what worries angry doc is an assumption that many people hold, exemplified by what Ms Leong wrote:

"... the pursuit of intellectual excellence to the exclusion of character or value excellence breeds an exclusionary attitude to the rest of society. Many of the products of our top schools forget they have to give back to the society that allowed them so many opportunities."

What is implied there is that people who are successful owe a debt to society, and that if they refuse to "give back" to society, there is something faulty with their character or values system.

But angry doc would like to ask: who in society is calling for this debt to be repaid? On whose behalf is Ms Leong calling for elites to "give back"? What makes us think that we are entitled to the time, effort, or the fruits of the labour of those in society who have succeeded?

"Opportunities", you say? Certainly most people could not have succeeded without the infrastructure which 'society' created (schools, roads, utilities, a civil service, industries), but does that entitle us to make demands on them? Did society create all these infrastructure so that these people could succeed, or did we do so because we wanted to utilise these infrastructures ourselves, so that we too could have a chance to succeed? Society may have provided the opportunities, but by claiming that we have a right to the fruits of their labour, we are dismissing the importance of the individual efforts which made the success of these people a reality - we are laying claims to the result of something which we did not give to. The opportunities were open to everyone, but we choose to ignore the 'debts' of those who did not succeed, and present an invoice to those who did and have something to "give back". Makes good economic sense, of course.

angry doc is not against people who feel that they want to contribute to society - certainly there is nothing to prevent them from doing to; society provides many avenues for them to do so. What puzzles angry doc is why some people feel the need to claim that others must do so too.

To conclude, angry doc would like to do some "Ayn Rand spouting", via youtube...




(For readers who are unfamiliar with "The Fountainhead", here is a succinct summary...)

Labels: ,

posted by angry doc at 6:00 pm

75 Comments:

  • Good one. You question "the obvious" which may actually be propaganda and ideology drilled into us.

    By Anonymous Anonymous, At April 09, 2010 4:16 pm  

  • "What puzzles angry doc is why some people feel the need to claim that others must do so too."

    In the model which you described, peoples' successes can be fundamentally attributed to two factors - societal support and individual effort.

    Hopefully we can both agree that, in your words, every member of society has, from a moral or philosophical perspective, an equal debt to society and that if they refuse to "give back" to society, there is something faulty with their character or values system.

    If you are denying this debt, are you not guilty of the same crime - dismissing the contributions of society to the successes of these people?

    What you are questioning is, why "elites" should shoulder a disproportionately larger burden of this debt, since, assuming that society provides the same amount of support to all members, their successes were due to their own efforts.

    Well, I feel you have misinterpreted Ms Leong entirely. The point she raised was that as a result of their cloistered upbringing, "elites" tend to forget they have an obligation to society at all, and not that they have a larger "debt" persay.

    These are two entirely different things.

    To provide some answers to your original question - it all boils down to the values which a particular society holds dear.

    In terms of pure logic, it may not make sense for society to be "entitled to the time, effort, or the fruits of the labour of those in society who have succeeded".

    However, values cannot be superceded by logic - they are simply how a society has chosen to conduct itself. It may be easier to think of values as the rules and regulations of a private club, and the "debt" you speak of as the price for membership of that club.

    Some reasons why certain societies choose this path:

    1) The rich are in a position to give more; the principle of giving within your means.

    2) The re-distribution of wealth creates a more equal and sustainable society, thus strengthening the social fabric and society as a whole.

    Ask yourself why most countries in the world implement a progressive marginal tax rate (i.e. the rich pay a higher % of their income as tax) and you have your answer.

    By Anonymous Melbourne, At April 10, 2010 9:00 am  

  • "Well, I feel you have misinterpreted Ms Leong entirely."

    Well, I dont think so, Melbourne.

    The rich already "give back" more in the form of taxes - that is legislated; what Ms Leong seems to be suggesting is that they be guilt-tripped into giving even more.

    I know why most nations have a progressive income tax - I just don't think the answer is satisfactory.

    By Blogger angry doc, At April 10, 2010 9:25 am  

  • Atlas Shrugged but actually Atlas is not as important as they think they are.

    The Atlases might think they are the one who are holding up the entire society BUT they had forgotten they are part of that same society.No one will suffer because those Atlases left, people will always survive.

    By Anonymous Onlooker, At April 11, 2010 11:06 pm  

  • Who are the elite? Doctors like angrydoc, lawyers like um... Mr. Wang used to be, PAP MPs like WKS?

    I'm sure everybody mentioned above worked hard to get their success. But why are they so successful? angrydoc is well-paid because he is a doctor. And doctors are well-paid because...? , none of which is attributable to angrydoc himself. Our society is structured in such as way that lawyers/doctors/PAP MPs are well-compensated, whereas engineers/teachers/librarians/artists are less so. It has nothing to do with their hard work. If angrydoc pulled a John Galt, someone else would just have become a doctor, and society would not have been poorer for it.

    I am reasonably successful; no surprise, I worked for it. Guess what, I also worked for many things that I do not have (if you never encountered this, you are extremely privileged or spineless). I know that the latter case will be far more common if it weren't for opportunities that I have. I do what I can to give others more opportunity, but it is hard work, and there's only so much I can do in my position. If others did the same, the world would be a much better place.

    Face it, we are privileged. If you feel guilty, you can always ignore your guilt, you know --no one is forcing you. Or you can read Ayn Rand (not a solution for me, her prose is repetitive and poorly written. Also, I outgrew her juvenile philosophy).

    By Anonymous Anonymous, At April 12, 2010 3:10 pm  

  • Angry Doc, I'm not sure if I understand your blog post. Let me know if this summary is wrong: People get what they deserve, because "the opportunities were open to everyone", and so people deserve what they get. They therefore have no claim on what anyone else gets, and what anyone else chooses to give them is then a matter of generosity and choice rather than obligation.

    Isn't there something missing from this line of thought?

    By Blogger SM, At April 12, 2010 3:56 pm  

  • "Our society is structured in such as way that lawyers/doctors/PAP MPs are well-compensated, whereas engineers/teachers/librarians/artists are less so. It has nothing to do with their hard work."

    Maybe renumeration is not directly linked to the 'hardness' of the work (I am pretty certain a construction worker has a physically 'harder' job than I), but it has everything to do with how society 'values' things. A celebrity can make more money appearing at an event than angry doc makes in a month.

    Society is structured thus because of supply and demand, but just because I make more money because I can supply what is in demand is no excuse for others to lay a claim on the money I made, as long as I made them honestly. angry doc quitting medicine may not have an impact on society, but if enough doctors do so there will be a healthcare crisis - just look at the Philippines.

    If you want to "give back" to society for the opportunities they afforded you, Anon, feel free to do so; I don't feel guilty for my success and I don't have a need to self-flagellate on a blog.

    By Blogger angry doc, At April 12, 2010 5:26 pm  

  • The fundamental question here, SM, is whether or not people have the right to lay claims to other people's time, effort, or the fruits of their labour without their consent.

    Ms. Leong asserted that those who are successful "have to give back to the society", I contend that she has no right to tell them how to utilise their time and resources.

    By Blogger angry doc, At April 12, 2010 5:34 pm  

  • The fundamental question here, SM, is whether or not people have the right to lay claims to other people's time, effort, or the fruits of their labour without their consent.

    So, your answer to this question would be No. My answer to this same question would be Yes.

    I will merely explain my position and leave you to ponder it, or not, as you wish...

    1. The ownership of time, effort, and fruits of labour

    To this, I venture you would say that your time is your own, your effort is solely yours, and the fruits of your labour are solely yours. With your caveat that it is for as long as you consent.

    The time for many of us, is not solely ours. There may be aged parents to care for, to whom we feel gratitude and obligation. They taught us how to write and speak, and from there springs all our success. If that is insufficiently convincing, we also do not migrate and leave aged parents to die because we are bound by the laws of the State we live in and not only by our own wishes. You may say that we can hand off the care of aged parents to paid helpers, but the inheritance of income inequality then comes into the picture. Meritocracy is all pretty and good but a child from a very poor family will never have the same chances at success compared to one from a rich family - wealth is inherited, and control of one's time is generally inversely proportional to wealth.

    Where your effort is solely yours, I'm not sure what your contribution to the infrastructure of the society is, but I certainly didn't have anything to do with creating and having running water and electricity and public buses at the moment I was born and even up till now. We lay claim on other people's effort all the time when we use the societal infrastructure. Taxes? Sure, my $100 a year of taxes will only buy me maybe a short length of water pipe, if I had to fix my water supply myself.

    Fruits of labour is a little more contentious. The very concept of the fruits of one's labour implies that there is a pre-existing fair allocation of "you do labour and you will get your share of fruit". You have said that you have made the smart choice to maximise the fruits per unit labour by becoming a doctor, fulfilling supply and demand, and therefore this smart choice entitles you to everything you can get from it. The fact that you have a nice fruit share, and are thus successful, is not in doubt. The question that I think is generally asked in opposition to your thought is, who or what determines the fairness of your fruit share? If it is entirely due to your own time and efforts from the very moment you took your first breath, entailing no obligation to any other people, I have nothing else to say.

    2. Consent

    I think we can agree that a child has no capacity for informed consent, by sheer societal definition of what a child is, as well as developmental physical milestones. Your parents, supervisors, and mentors therefore shape you when you are young. Your success is therefore in some measure theirs. Not totally, because when you reached the teenage years you started to make your own choices and take responsibility for them. But in a child's formative years he has no say in the "best" way he wants to be educated to become successful, because he is not informed enough. He has no capacity for consent. Put a child far back enough with unwise parents and mentors and ineffective teachers, and he will not be able to "catch up" in the remaining years of his life. It's called comparative advantage, in economics.

    This is all I wished to say. Thank you for your time.

    By Blogger SM, At April 12, 2010 6:53 pm  

  • Well, SM, does any of the things you have written entitle Ms Leong or anyone else to lay claim to what is mine?

    (And do you really only pay $100 in taxes each year?)

    By Blogger angry doc, At April 12, 2010 7:27 pm  

  • And to quote Carl Sagan:

    “If you want to make an apple pie from scratch, you must first create the universe.”

    By that kind of reasoning we are not entitled to anything we have and should let people like Ms. Leong tell us what to do with our time, minds, and energies, shouldn't we?

    By Blogger angry doc, At April 12, 2010 7:30 pm  

  • Dude, you said "the fundamental question" etc etc without addressing my summary. So I addressed your fundamental question, which was taking your word at face value, it being, you know, your Fundamental Question. Your question itself had nothing to do with Sandra Leong's article on elitism, or even meritocracy. It was more along the lines of "what is mine is mine".

    I pay far less than $100 in income tax each year. Haven't totalled up the GST and conservancy charges etc.

    By Blogger SM, At April 12, 2010 8:52 pm  

  • This comment has been removed by the author.

    By Blogger SM, At April 12, 2010 9:07 pm  

  • On further thought, perhaps you and I are operating from different viewpoints because you think that Singapore is meritocratic ("opportunities were open to everyone") whereas I don't think so. Remember the news on how 50% of PSC scholars lived in private housing, which was far more than the proportion of all students who lived in private housing? They probably could buy as many books as they wanted, their house had the space to store them, excellent Internet access, a study room etc.... Things like that.

    By Blogger SM, At April 12, 2010 9:42 pm  

  • "I pay far less than $100 in income tax each year."

    0_o

    OK.

    I pay a lot more than that, so do excuse me when I take issue with people telling me that I must give more back just because I came from an "elite" school, and that I have bad character or values if I don't.

    "Your question itself had nothing to do with Sandra Leong's article on elitism, or even meritocracy."

    I think my Fundamental Question goes right to the heart of Ms Leong's article, which isn't really about elitism or meritocracy, but collectivism.

    Now it's true that I didn't lay a single inch of the pipe that brings water into my toilet, or poured a single mix of concrete in the flat that I live in, but then neither did Ms. Leong. However, I do pay as much for every single drop of water I use and for every inch of the roof over my head as anyone else does. What's mine is, as you rightly noted, is mine. If society wants some of it for itself, let them take it from me by force via legislation - but don't try to make me present it as a gift by guilt-tripping me: Ms Leong's stand isn't really about giving, but about claiming a right to give away other people's possessions.


    As for meritocracy, I think I have a different definition of that from you. You seem to think it is about everyone starting on as level a ground as possible - I think it's about the best man for the job, regardless of how far he had had to come or how hard he had to work for it. I don't think effort or background should come into it - I would rather have a lazy doctor who makes the diagnosis and gives the correct treatment most of the time, than a hardworking doctor who doesn't; whether they came from rich or poor families are totally irrelevant to me as a patient.

    Being born into a rich family does confer advantages (I was not), but I have friends who come from rich families but don't do well academically or professionally, and friends who have had to get by on spartan budgets while they went through university and their early career and who are doing very well now. So 50% of PSC scholars come from rich families - is that really a problem as long as these scholars can deliver what is expected of them? Should we insist on a distribution that reflects our demographics just to be politically correct?

    I don't think Singapore is a perfect meritocracy, but it doesn't follow that more redistribution will necessarily be better.

    I do not begrudge the rich or their being able to give their children a headstart - all of us want the best for our children and it would be terrible if we were unable to use our resources to make that happen. As long as we do not use our resources in a fraudlent or corrupt manner, I don't see how we have abused our fellow men.

    Let me end by putting the FQ (slightly modified) to you: Do you think you should have the right to claim that I "have togive back to the society" over and above what I already do now in the forms of taxes and National Service?

    By Blogger angry doc, At April 12, 2010 9:49 pm  

  • Elite = 'elite' school:

    As you said in your blog post, no one agreed definition on elite :)

    but for what it's worth, I think that Sandra Leong was referring to a very very small minority of erm, young persons perhaps around my age with iron rice bowls, who constantly lament how the cities of their undergraduate and postgraduate universities are so very very much better and more FUN! and generally all-round wonderful, such that they simply cannot stop lamenting the fact that they are, erm, stuck in Singapore for a while and cannot go on their 3X-yearly holidays. I am not sure if you have met any of these young people. I try to avoid them like the plague, particularly since their studies were funded by my elder friends' and relatives' taxpayer money and their complaints make my teeth itch. Even though their success was achieved entirely through their hard work and appropriate parental nurturing. I hear that, like what Ms Leong has written, some of them are settling down in Singapore and marrying amongst themselves and may possibly reproduce little unhappy clones of themselves. But that is not my problem. I doubt Ms Leong was referring to people like you or me.

    Ms Leong's stand isn't really about giving, but about claiming a right to give away other people's possessions.:

    Hmm I instead got the vibe that it was really about how the above tiny but vocal minority of, erm, some young persons with iron rice bowls, were uncaringly elitist.

    Sandra Leong: "... the pursuit of intellectual excellence to the exclusion of character or value excellence breeds an exclusionary attitude to the rest of society. Many of the products of our top schools forget they have to give back to the society that allowed them so many opportunities."

    I had read this as opportunities in the sense of abovementioned provision of iron rice bowls.

    Meritocracy being the best person for the job:

    Yes. That's the definition in my book too. However I was thinking of how unequal starting points leading to unequal outcomes means that the young ones who make it didn't make it necessarily by the amount of hard work alone and really shouldn't be swanning about thinking that they're exclusively smart. This inequality evens out within the early years of a career - I'd say that after the first 4 years of work, it's only the job-related hard work that counts for your future career. But before then, there is room for humility.

    Rich parents pouring their resources into their children:

    Sigh. That's life, isn't it? On a related note, another forum letter by Lawrence Loh on the same article.

    Finally, no, I don't think you have to give back to the society over and above taxes and NS. NS is a huge tax in itself =P I hope you give up bus/train seats to old people though! ;-)

    And... the long comment is done.

    By Blogger SM, At April 12, 2010 11:32 pm  

  • Even if Ms Leong was referring to the whiny scholars now in civil service, I still don't think she has a claim over how they should spend their time or money.

    By Blogger angry doc, At April 13, 2010 9:09 am  

  • I agree that only the State can compel people to give up their time or money, and that some people would otherwise never give up what they feel is rightfully theirs. What I'm not convinced about is the singular argument that because just because one presently has something, one therefore must continue to have possession of it in the future. There is an external moral claim somewhere that one has rightfully earned it, and that is the notion I discuss and dispute. Nonetheless it remains true that no one can compel a person to give anything to anyone, except the State.

    By Blogger SM, At April 13, 2010 10:26 am  

  • So many interesting points raised in this post!

    I think the reason most doctors decide to become doctors is already to "give back," on their terms. It's just that the cost of their knowledge and expertise is often too high for many members of society to afford, hence the demand to "give back" for free (which is essentially what this comes down to). Once a precedent is set, volunteering one's time and skills becomes the expectation, a "debt" owed to society - or that part of society which apparently cannot afford your help on any other terms (although many of them can well afford a pack of cigarettes a day). And those who truly cannot afford your services are usually truly grateful for you gifting them and do not share the "you owe me" attitude.

    By Blogger Dr V, At April 14, 2010 3:42 am  

  • I enjoy reading your post, because it has brought new insights on a controversial topic.

    In my opinion, I see no fault in your view, both logic and ethics. The reasons being that it is consistent and the fundamental intention is positive.

    I have yet read Fountainhead but I've found Atlas Shrugged (written with a similar philosophical tone) to be thought liberating. I may not have grasped the full the extend of Rand's philosophy. However, I realised that it helps at keeping our opinions objective when needed.

    At the same time, I try to keep in mind that, in George Eliot's image, life is like playing chess with chessmen who each have thoughts and feelings and motives of their own. There are probably other reasons, both ideal and less ideal, why the culture is existing as such. On the other hand, for progress to take place, any issues that's likely to stun it will have to be first identified, as you did.

    Sometimes, leaders may have yet kept up with the current thinking trend and seek comfort in relatively outdated tried-and-proven methods. Or their intentions may well be otherwise. We'll just have to find out.

    I'm glad you'd brought this discussion.

    By Blogger hanmilo, At April 14, 2010 5:51 am  

  • Dr V,

    Yes, we do see patients who complain that they cannot afford healthcare but spend S$10 a day on cigarettes, use the latest handphone, and take yearly trips overseas.

    Most people CAN afford healthcare - they just don't WANT to.

    Their answer to the rising COST of healthcare is not to save or keep themselves healthy, but to call for the government to provide more subsidy or for doctors to charge less. I want to make a stand against that, and I hope my colleagues will do the same.

    By Blogger angry doc, At April 14, 2010 8:53 am  

  • hanmilo,

    I think The Fountainhead has more believeable characters and a less fantastical setting.

    Ayn Rand is a good writer, but she tends to let her philosophy get in the way of her story-telling.

    I believe a 'good' system of philosophy or politics must acknowledge two major realities in our lives: evolution biology and economics; the former tells us what drives a man, and the latter how he deals with other men. Any system of philosophy or politics which try to ignore these realities is bound to fail.

    By Blogger angry doc, At April 14, 2010 9:02 am  

  • I believe a 'good' system of philosophy or politics must acknowledge two major realities in our lives: evolution biology and economics; the former tells us what drives a man, and the latter how he deals with other men. Any system of philosophy or politics which try to ignore these realities is bound to fail.

    Necessary. But not sufficient?

    (Minor point: not evolutionary biology. More precisely, sociobiology and evolutionary psychology.)


    (i can't spend any more time on this comments thread, work calls. Sorry. Have a good day.)

    By Blogger SM, At April 14, 2010 1:33 pm  

  • let's boycot this angrydr
    He has no heart and does not want to give back to society what society has given him.

    By Anonymous Anonymous, At April 14, 2010 2:44 pm  

  • Oddly despite your "what is mine is mine" randian outlook, you seem to accept the legitimacy of your gains being distributed to the less able (or lucky) through taxes collected by the state. Shouldn't you in principle denounce your taxes paid to the state as theft as well? But you don't-hence showing that you are cowardly as well as selfish.

    By Blogger Koh, At April 15, 2010 5:07 am  

  • I discussed my view of taxes here, Koh:

    http://newasiarepublic.com/?p=16920

    All of Ayn Rand's characters (as well as Ayn Rand herself, I believe) paid taxes.

    By Blogger angry doc, At April 15, 2010 8:23 am  

  • First of all, society doesn't lay claim to your taxes. If you find any particular country's taxes too high, you are free to leave that country and find one with a lower taxation level, say Somalia.

    Secondly, as to why you have to pay more for policing and civil defence, it is because you derive your economic output from a well run society. Suppose we cut $1000 from the police budget, who do you think stands to lose more from the increase in crime? The man who makes $500 a month or the man who makes $10,000 a month?

    By Blogger Fox, At April 15, 2010 11:28 am  

  • Society is structured thus because of supply and demand, but just because I make more money because I can supply what is in demand is no excuse for others to lay a claim on the money I made, as long as I made them honestly.

    Yes, you made your money honestly but would you have made that money if we had no Medical Registration Act? If Indian doctors were allowed to come into Singapore and set up shop freely, what would happen to the wages of Singapore doctors? Can you truly lay claim to the wage differential?

    By Blogger Fox, At April 15, 2010 11:46 am  

  • Fox, we already went through all that on the other blog...

    By Blogger angry doc, At April 15, 2010 12:01 pm  

  • Angry Doc, perhaps you could elaborate your position on taxes in another full blog post? I'm interested to know if there is some amount of taxes you will pay happily despite your claim that what is yours is yours through your own effort without any societal influence. And why, if so.

    By Blogger SM, At April 15, 2010 12:13 pm  

  • Angry Doc,

    I think that in the other blog, you could not distinguish the concept of opportunity cost from accounting cost. How ironic that when you are paid, you are paid on the basis of opportunity cost and not accounting cost.

    Also, have you thought about the consequences of reducing public medical subsidies or public health expenditure?

    To be consistent with your stand, will you be willing to support lower public subsidies for medical training (since the government will not need so many doctors and nurses), a reduced medical school intake and lower salaries for doctors and nurses working in the public health sector?

    By Blogger Fox, At April 15, 2010 12:27 pm  

  • "... your claim that what is yours is yours through your own effort without any societal influence."

    I didn't claim that. My position is that societal infrastructure and opportunities are available to all, and to demand more from those who make more of it is unfair.

    By Blogger angry doc, At April 15, 2010 12:33 pm  

  • "To be consistent with your stand, will you be willing to support..."

    1. lower public subsidies for medical training (since the government will not need so many doctors and nurses),

    Yes, but I don't see how what I am proposing will reduce the need for medical workers.


    2. a reduced medical school intake and lower salaries for doctors and nurses working in the public health sector?

    Again I don't see how what I am proposing will reduce number of medical students, or lower salaries for medical workers.

    The value and cost of healthcare and total expenditure will remain the same - it is the 'out-of-pocket' payment that will change (along with government expenditure). I believe people should take greater responsibilities in their own health, and their own healthcare expenditure.

    By Blogger angry doc, At April 15, 2010 12:49 pm  

  • "Again I don't see how what I am proposing will reduce number of medical students, or lower salaries for medical workers.

    The value and cost of healthcare and total expenditure will remain the same"

    No. Total healthcare expenditure - public and private - will decrease once subsidies are removed. This is simply a matter of supply and demand.

    If no subsidies for public healthcare were offered, people will consume less public healthcare and less healthcare in general. The total expenditure on public healthcare will *decrease*. Fewer people will visit public clinics and hospitals. They will either turn to alternatives (like private doctors or TCM) or forgo medical treatment for discomforts they believe they can put up with or they will put more effort to improving their health.

    Let's say that we have 1000 doctors serving 100,000 patients in hospital X. Suppose subsidies are removed. The patient load will decrease and only 80,000 patients are served. Hence, only 800 doctors will be needed. What will the hospital do? Terminate 200 of them as well as cut the salaries of the remaining 800.

    How utterly noble of you.

    By Blogger Fox, At April 15, 2010 1:11 pm  

  • "The value and cost of healthcare and total expenditure will remain the same."

    Let me give you an illustrative example. Let's say that public expenditure of health care is about $2 billion dollars a year in Singapore and private expenditure is about $2 billions dollars, giving a total of $4 billion.

    Suppose the PM feels generous and decides to allocate $5 billion a year to health care. Do you really believe that after spending $4 billions in providing public health care, MOH is unable to spend the additional $1 billion?

    By Blogger Fox, At April 15, 2010 1:45 pm  

  • "No. Total healthcare expenditure - public and private - will decrease once subsidies are removed. This is simply a matter of supply and demand."

    You are correct. I was wrong about the costs and manpower requirements then.

    "What will the hospital do? Terminate 200 of them as well as cut the salaries of the remaining 800.

    How utterly noble of you."

    I don't see anything wrong with medical workers whose expertise are no longer required being terminated. Do you? Do you believe we should continue to keep them employed even when their services are not required? I certainly don't think that it is my right to continue taking pay when I am not providing value to my employers in return. It is not the hospitals job to give me a job - it is my job to make sure that I am worthy of a job.

    I enjoy discussing the issue with you, Fox, but I'm afraid our points of view are so diverged there will be no end to this. I don't mind continuing, but I think the audience may be becoming bored.

    You see: to me you are just a bleeding-heart socialist parasite, and to you I am just a blood-sucking capitalist parasite, aren't I? :)

    By Blogger angry doc, At April 15, 2010 1:56 pm  

  • That's not the point.

    If not for public health care subsidies which directly funded your medical school training and pays your current salary, your opportunities would have been much more limited. Mind you, you are probably more of a beneficiary of this system of public health care subsidies than any of your patients. Medical school fees would have been much more expensive and your salary as a doctor working in the public sector lower. You enjoy a wage differential because of this system of subsidies.

    And yet you still decry public health care subsidies when the alternative would have been much worse for you. Did you complain about public health care subsidies during medical school? Oh, taxation and subsidies only become a moral issue only when you pay them, not when you were a medical student. You believe that you are entitled to every cent of your salary even though a wage differential exists in your case precisely because of the subsidies.

    By Blogger Fox, At April 15, 2010 2:44 pm  

  • Fox, I am not allowed to discuss the terms of my employment and renumeration publicly, so I won't answer the parts of your comments relating to my salary.

    "Did you complain about public health care subsidies during medical school? Oh, taxation and subsidies only become a moral issue only when you pay them, not when you were a medical student."

    Yes, I was not aware of the issue when I benefitted but did not contribute. That is the problem with socialism.

    By Blogger angry doc, At April 15, 2010 3:05 pm  

  • So, true to your principles, are you in favour of removing subsidies for medical school?

    Are you also in favour of reducing the number of public medical workers and their salaries?

    By Blogger Fox, At April 15, 2010 3:17 pm  

  • " are you in favour of removing subsidies for medical school?"

    Yes.

    "Are you also in favour of reducing the number of public medical workers and their salaries?"

    Not directly, but if you mean if I will still be in favour of it as a direct consequence of reducing medical subsidy, then I would say: if it happens, then let it happen. I am not in favour of creating unnecessary work just to make keep healthcare workers employed at a high salary.

    By Blogger angry doc, At April 15, 2010 3:24 pm  

  • Angry Doc:

    Hmm. I see. I had entered this discussion early on to help you clarify and think through your libertarian position, but then had to leave. I am glad that Fox now is spending his time doing that for you. Also, I must add that it is not important to me that you swing over to the bleeding-heart socialist side, but rather that you understand your own position thoroughly, so that you have a firm foundation on which to recommend the changes you wish to see. Without this thorough grasp of the principles of your own position, your recommendations will be susceptible to logical attack.

    We have earlier agreed that Singapore is not a perfect meritocracy. In my eyes that carries greater weight towards encouraging redistribution than in yours. This is a fundamental difference in value judgment that will not resolve by sheer logic.

    Have you considered your current taxes to be a form of retrospective gratitude for your medical-school subsidies, though? Since you are now no longer unaware of the issue unlike when you were a medical-school student.

    By Blogger SM, At April 15, 2010 4:06 pm  

  • "Have you considered your current taxes to be a form of retrospective gratitude for your medical-school subsidies, though?"

    No. Local grads are bonded to MOH for a number of years after graduation.

    By Blogger angry doc, At April 15, 2010 4:19 pm  

  • In other words, your bond repays that societal debt.

    Which also means that your salary during those years was artificially depressed below the "correct" market value?

    By Blogger SM, At April 15, 2010 4:25 pm  

  • "Which also means that your salary during those years was artificially depressed below the "correct" market value?"

    You can say that.

    A doctor could also buy his bond off.

    By Blogger angry doc, At April 15, 2010 4:40 pm  

  • So what is the "correct" market value for a HO/MO? And should we give discounts to patients under their care during the fresh-grad mortality peak months? (I'm trying to give a mildly ridiculous example here.)

    By Blogger SM, At April 15, 2010 4:48 pm  

  • "So what is the "correct" market value for a HO/MO?"

    A HO has no 'real' market value since he cannot practise independently.

    For a MO the value would be whatever a private medical group is willing to pay him, or whatever he is able to make himself otherwise.

    "And should we give discounts to patients under their care during the fresh-grad mortality peak months?"

    I have no opinion on that at the current moment.

    By Blogger angry doc, At April 15, 2010 4:52 pm  

  • Okay. So there is a certain cost to training the MOs who have for some reason or another chosen to stay to serve out their bond, this cost adds on to the debt. In that sense, I can't tell whether the societal debt has been entirely paid off during the bond period or not. That is my best answer.

    Whereas you seem confident that it has been entirely paid off.

    By Blogger SM, At April 15, 2010 5:01 pm  

  • Why wouldn't they want me to pay it all off while they can?

    So that they can keep telling me I have to "give back to society" for the rest of my life afterwards?

    By Blogger angry doc, At April 15, 2010 5:51 pm  

  • That is also a good point =) I don't know.

    The slippery idea here seems to be that of "correct" worth. Or as Fox says in the other blog, cost and price are not the same. Or as I previously said, the external moral claim somewhere that one has rightfully earned it, who or what determines the fairness of your fruit share. It is as easy for them to say that you (a general you) have not paid up a debt, by some accounting, as it is for you to say that they can't possibly expect you to keep paying forever and by another accounting you would have reached some point where what you get really is earned by you alone. Maybe there isn't really a terminal point like that?

    For example, I'm not sure what price and taxes I would now pay, for the simple fact that I was born into a safe clean environment with appropriate medical care. It may be truly my entire life's worth, since if those conditions hadn't existed, I would have died shortly after birth.

    And education. And clean water. Etc etc etc....

    By Blogger SM, At April 15, 2010 6:11 pm  

  • Unless I move to another country (society) AND change citizenship as symbolic repudiation of this society. But neither you or I are doing that at the moment.

    By Blogger SM, At April 15, 2010 6:18 pm  

  • Dont waste your time on this heartless doctor

    We are getting better doctors from overseas who are better trained and committed to Singapore

    http://www.physician.mohh.com.sg/download/pre.employment.grant.pdf

    By Anonymous Anonymous, At April 15, 2010 6:33 pm  

  • Yup. So committed that we only have to pay them up to $50,000 a year while they are in medical school to make them come back...

    http://www.channelnewsasia.com/stories/singaporelocalnews/view/1050299/1/.html

    By Blogger angry doc, At April 15, 2010 7:01 pm  

  • SM, I guess we need to ask ourselves whether the people who are clamouring for us to "give back" are the same people who gave to society to begin with. :)

    It's easy, as you noted, for anyone who is part of this society to claim that I owe them a debt, but whom exactly do I owe a debt to? Let each man who makes a claim present me a bill, a detailed invoice, and I will pay or not according to whether your bill is accurate.

    To try to guilt-trip me into giving endlessly is just low.

    By Blogger angry doc, At April 15, 2010 7:08 pm  

  • Are HO/MO paid on the basis of where they went for medical school training? In other words, are NUS MBBS HO paid less than say HO who got their MBBS from Australia or Ireland?

    By Blogger Fox, At April 15, 2010 9:04 pm  

  • "Why wouldn't they want me to pay it all off while they can?"

    Because there is a built-in probability for you to continue working in the public health sector.

    That was the official justification as to why female applicants to medical school were at a disadvantage.

    By Blogger Fox, At April 15, 2010 9:19 pm  

  • "Are HO/MO paid on the basis of where they went for medical school training?"

    Sorry, Fox, I can't discuss that.

    By Blogger angry doc, At April 15, 2010 9:37 pm  

  • OK. Are housemen paid on the basis of where they went for medical training? I'm not asking anyone to divulge specifically how much they are paid.

    By Blogger Fox, At April 15, 2010 10:35 pm  

  • Sorry, Fox, I can't discuss that.

    By Blogger angry doc, At April 15, 2010 10:59 pm  

  • ai yo
    ho pay is $11.4K and MO pay is $12.3K

    http://www.salary.sg

    By Anonymous Anonymous, At April 15, 2010 11:06 pm  

  • "ho pay is $11.4K and MO pay is $12.3K"

    Wow. Is that per month, or per year? :)

    By Blogger angry doc, At April 15, 2010 11:14 pm  

  • the bond is now 441k for 5 yrs bond
    so it is about 7.3k a month

    last I heard
    starting pay for ho is 2.6K + call +7.3K = 9.9k + call

    By Anonymous Anonymous, At April 15, 2010 11:30 pm  

  • Plus bond?

    Didn't we have this discussion before?

    I can see how this is going...

    Anyway, it always cracks me up when people claim that doctors are paid too much (and now "don't give back to society") but don't actually have an idea of how much doctors are actually paid.

    By Blogger angry doc, At April 15, 2010 11:40 pm  

  • Re bills and receipts to individuals:

    1. A HO has no 'real' market value since he cannot practise independently, as you have said.

    2. Anyone and anything which does not have a 'real' market value should die off due to capitalist competition in free markets, as you have described in the individualized bill and invoice model.

    so,

    3. No need HOs lah. We should just kill them all. They parasitize our time and resources.



    No?

    By Blogger SM, At April 16, 2010 11:46 am  

  • Now you are just playing semantics games, SM.

    A HO obviously has value - he receives a salary for his work. What I meant was that he cannot have a private sector 'market rate' assigned to him as he cannot practise in the private sector.

    "Anyone and anything which does not have a 'real' market value should die off due to capitalist competition in free markets"

    I wouldn't say that they SHOULD die off, but that is a reality. Even if something or certain groups of people with no 'market' value are supported by some fund, it is because someone finds value in supporting them.

    People used to be able to sell pet rocks - you don't see that now. And before NKF no one saw any value in funding dialysis for patients who cannot afford it. People spend or give money because they want something in return, whether it is in tangible or intangible form.

    By Blogger angry doc, At April 16, 2010 12:12 pm  

  • I must confess that I do not actually understand the Angry Doctor's position towards taxation. He has expressed some support towards it and then opposition in other posts.

    So what exactly is your position towards taxation? Do you oppose the concept of taxation? Under what circumstances are subsidies permissible in your opinion?

    By Blogger Fox, At April 16, 2010 12:28 pm  

  • I could equally say that it is disingenuous for you to say that HOs have value when they have no demonstrable market value beyond what the State gives them. It does not gel with the "individual buyer, individual seller" situation you favour. If MOH slices HO pay to public assistance levels i.e. a living wage, and holds fast to that decision despite protests, the HOs would really have to take it or leave it. They'd be totally trapped at those wages for that 1 year if they chose to continue to become certified doctors. In your view, would you then believe: haha those suckers, too bad. ?

    (I have nothing against HOs personally. They are just a convenient case study.)

    By Blogger SM, At April 16, 2010 2:27 pm  

  • Fox, I already discussed that on the other blog...

    SM, in theory MOH can turn housemanship into the 6th year of medical school and make the medical students do HO work while paying tuition fees (notice I say 'in theory' *wink*). How each medical student or prospective medical student wants to take that is their individual decision - I have no firm opinion on your or my scenario currently, except that our MOH has just announced that they will throw money at medical students overseas to come work here when they graduate, so either scenario is unlikely...

    By Blogger angry doc, At April 16, 2010 2:53 pm  

  • Angry Doc,

    I could never get a coherent account of your positions on taxation. Actually, I'm not so interested in your positions as I am in your reasoning behind it. I have reasons to believe that your positions are not so much informed by sound economics reasoning as they are by the ideological gut-feeling kind. This is entirely excusable because it is very likely that at no point of your education did you receive any formal or informal instruction on economics.

    Let me be more specific. Do you support taxation on cigarettes and cars in Singapore?

    By Blogger Fox, At April 17, 2010 12:53 pm  

  • "A HO obviously has value - he receives a salary for his work. "

    We have to be careful about what we mean by value here. Does a transaction automatically imply that the thing that is receiving the payment has a value? For example, the government receives payment from you in the form of taxes (income, GST, COE, property, TV licence, tariffs, etc)? Does it imply that it has value or at the least, the public services it renders have value?

    By Blogger Fox, At April 17, 2010 1:06 pm  

  • Assuming an efficient market whether it be strong, semi strong or weak, there must be value or perceived value in every transaction.

    By Anonymous Anonymous, At April 17, 2010 1:51 pm  

  • Sorry, Fox - I'm not going to entertain you anymore.

    I wrote the post to make a point, and I did - taxes is not the topic of my post. If you wish to make a point about taxes, you may want to do so at your own blog?

    By Blogger angry doc, At April 17, 2010 3:43 pm  

  • after reading your comments here http://newasiarepublic.com/?p=16920 i think we have similar ideas about the rich and taxing the rich, angrydoc. so what is a more 'equitable' system of taxation in your opinion? eg tax the rich less?

    By Anonymous j, At April 19, 2010 2:44 pm  

  • Why are people so interested n what a doctor thinks about taxes? :)

    Let's continue the discussion on the other blog, j.

    By Blogger angry doc, At April 19, 2010 6:37 pm  

  • i am interested in what you think about taxes not because you are a doctor, but because we have similar thinking. ;)

    By Anonymous j, At April 19, 2010 11:22 pm  

  • Oh Ayn Randian here ah - http://www.alternet.org/media/145819/ayn_rand,_hugely_popular_author_and_inspiration_to_right-wing_leaders,_was_a_big_admirer_of_serial_killer?page=1

    By Anonymous Anonymous, At May 12, 2010 3:05 pm  

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