The New Economy - The Delusion of Costless Idealism

Thank you for inviting me to speak. I came to know the Hong Kong Democratic Foundation through my dear friends Dr. Patrick Shiu and Mr. Alan Lung. Lung was my schoolmate in St. Paul's College. Recently, we have stopped talking about schoolwork, and switched over to other subjects of mutual interest. Dr. Shiu has been a comrade in many projects, from winning a prize in a doctors' badminton tournament, to medical relief work in the flooded province of Hubei, and more recently, he joined me as a member of the Hong Kong Medical Association.

It is, therefore, an invitation I can't refuse, when Patrick asked me to speak, and Alan suggested that I talk about my first year in the Legislative Council. My first year in the Legislative Council, actually started a few years before I was in the Legislative Council. For what happened over a number of years, I was rewarded or punished, depending on how you look at it, with the seat in the Legislative Council to represent the Medical Functional Constituency.

After the handover in 1997, the effect of a health care system dominated by the public hospitals (or in short the Hospital Authority) is becoming increasingly apparent. Over a decade's time, Hong Kong people have gotten used to low cost, high quality, and comprehensive health care, and have come to regard receiving such care as a right. As a result, public hospitals have been flooded with patients, whilst the clientele of the private hospitals diminished to the extent that the survival of most private hospitals is seriously threatened.

At times of plenty, the Government can afford to meet the expectation of the people with public money. In the 11 years since the establishment of the Hospital Authority, the public health care budget increased from 6 billion to 30 billion. Ninety percent of the 30 billion went to the Hospital Authority.

In the 11 years since the establishment of the Hospital Authority, the public health care budget increased from 6 billion to 30 billion. Ninety percent of the 30 billion went to the Hospital Authority.

In times of plenty, it might be even in the interest of the Hospital Authority to strengthen the expectation of its patients and potential patients. Thus, patients were no longer known as patients, they were instead called customers. Customers, as in other businesses, were treated in a manner to attract their patronage and increase in their consumption. The ever-increasing expectation of the customers, and their strong demand for service, has given the Hospital Authority the political support for its expansion. The rewards to the Authority are more public money, more senior posts, and the domination of health care in Hong Kong.

The sad fact of life is that times of plenty won't last forever, and there is a limit on how much public money can be used to fuel the expectation and demand of the customers (or to be more exact, the consumers).

When public funded health care has been so good for such a long time, there is no way the Government can turn away the customers of the public hospitals, and it would be almost impossible to ask them to pay more. The only course of action the Government can take is to demand the Hospital Authority to produce more for less. When the front line staff were already labouring under various enhancement of efficiency programmes and long working hours, the Hospital Authority introduced a new pay scale for doctors in the year 2000, despite the strongest ever protest. The new pay scale means a pay cut, despite increased workload and responsibility. The public doctors were angry, they were at the same time depressed. I'm sure they still are angry and depressed. They are depressed because apart from the Hospital Authority, no other realistic employer is available. With the domination of health care by the Hospital Authority entering the private market becomes no longer an option.

When heavily subsidized service becomes the norm, private medical practitioners who have been earning an honest living by providing cost efficient and personalized service to their patients are often regarded as too expensive nowadays. I'm sure that if the unit cost of the service of the Hospital Authority is available for comparison, private service will be found equally, if not more cost efficient.

When heavily subsidized public service is so readily available, for example, free-of-charge 24 hours access to the public hospitals through the accident and emergency departments; there is very little incentive for Hong Kong people to take out insurance for the service of the private hospitals.

Private doctors fear a declining livelihood and they are as depressed as their public sector colleagues. They are depressed because there seems to be no way that they can stop the decline. Doctors also suffered a dramatic decline in their respectability. When receiving low cost high quality health care becomes a right, doctors become servants responsible for upholding this right. The care and the devotion of doctors could be taken for granted, because it is the right of patients to receive their service. Failing to cure a disease could sometimes be regarded as an infringement of a personal right. Culprits causing medical incidents must therefore be severely punished.

To quite a few people, not only to receive low cost, high quality health care is a right, this right must be further protected by a low cost and expedient medical complaint and redress mechanism. It is widely believed by doctors that substantial amounts of public money have been used to settle medical complaints out of court, sometimes regardless of the merit of the complaints. The public system seems to be the only place where the right of the patients can be upheld.

The people have been demanding for the ideal, without trying at the same time to behave more like ideal citizens. Ranking health care policy makers and Hospital Authority officials have been doing nothing to change this unhealthy mindset; instead they are doing everything to reinforce it. They talk too often about strengthening quality assurance in health care, but they have been silent on the fact that quality does come at a price.

Hospital Authority officials talk too often about strengthening quality assurance in health care, but they have been silent on the fact that quality does come at a price.

Doctors feel betrayed by their leaders. Many at the top of the hierarchy of the profession have become administrators and policy makers. They have been in the leadership for long enough to be held responsible for the state of the profession. Doctors demanded change in the leadership. If doctors can vote for all the medically related key positions, I'm sure that we'll see quite a few new faces. Unfortunately, the highest medically related position doctors can vote in or out of office is their representative in the legislature. I can still feel the very high expectation of doctors when they cast their votes in the Legislative Council election. 60 percent of the registered voters, or 5000 of them cast their votes. That was the highest ever turnout in an election of the functional constituency. Doctors hoped for a leader that could lead the profession out of the quandary, but I doubted how many of them could really understand that the power of a Hong Kong legislator is rather limited. The real power is in the hands of the executive-led Government of the Hong Kong SAR.

It was against this background that I got elected. The election was not an easy one; there were 4 candidates. The main reason why there were so many candidates was, I believe, because there was no straightforward solution for the problems of the medical profession, and there was no straightforward solution for the problems of our health care system. As doctors, we know that if there are many different treatments for a disease, there is no satisfactory treatment for that particular disease.

I got elected, as my electorate told me, because I have been bold enough to get to the core of the problem, even though I was unable to offer an immediate solution for the problem. One of my slogans for the election was "Health care reform starts with the reform of the mindset of our policy makers". I've been true to my belief and have been trying to reform the mindset of the policy makers, in particular, health care policy makers since my election. I've been providing aggressive, yet professional check-and-balance to the all-powerful executive-led Government, in the very specialized policy area of health care. I did this with the long-term interest of Hong Kong in my mind. I believe that the people of Hong Kong are intelligent enough to be confronted with the truth in health care. If Hong Kong genuinely wants health care reform, those who have been perpetuating the populists' illusion of a utopia in health care must stop doing so at once.

I might be guilty as a legislator for being too specialized in one area, but if my observations in health care can be applied to other policy areas, the mindset of quite a few people, both within and without the Government is in need of a reform.

Unlike countries that have gained independence from the colonial powers, none of the Government officials and none of our politicians have the experience of fighting to free Hong Kong from her former colonial master. They don't even have the experience of negotiating for the future of Hong Kong with the former colonial master on behalf of the people of Hong Kong. When China and Britain negotiated for the future of Hong Kong, our politicians sat helplessly on the sidelines. Neither China, nor Britain allowed the participation of the people of Hong Kong in the negotiation. The three-legged stool, with Hong Kong one of the legs, was unacceptable. When Chris Patten staged the fight with China, quite a few politicians jumped onto his bandwagon and formed the delusion that they have fought for the freedom and democracy of Hong Kong. When everything was decided between China and Britain, including agreeing to disagree, I doubted whether there was anything to fight for. Did our politicians even really put their own life and freedom at risk fighting for the freedom of Hong Kong? What political price have they paid?

Most Hong Kong politicians have received no such training and acquired no such credentials as the people to rule Hong Kong. They were on the sidelines before the hand over, and they remained on the sidelines after the hand over. Quite a few of them developed the mindset of a leashed guard dog. They bark aloud at anything suspicious, but they never have the opportunity to deliver a real bite.

The guard dogs undoubtedly will demand the ideal, especially when they are not required to deliver the ideal they are demanding. Freedom, democracy, equal opportunity, transparent and accountable government, more welfare, less tax, and low cost high quality comprehensive health care, just to name a few.

What these guard dogs do not know is how to put all these ideals together and make Hong Kong work. The same observation can be applied to the executive-led Government. The senior officers of the colonial civil service were largely retained and were propelled to ruling positions in their respective policy areas, but are these people who have been working all their life as implementors of the policies of the colonial government, ready to become policy makers themselves? For the few outside the colonial civil service, who were chosen for ruling positions, do they have the political maturity required of their jobs?

I would illustrate the interaction between politicians and government officials, and the effects of such interaction, by using examples from the policy area of food safety. Food safety is one of my favourite policy areas.

Politicians demand the Government guarantee the absolute safety of food, so that people can continue with their risky eating habits.

It is sad to see politicians making demands for the government to attain the impossible. It is even sadder to see government conceding to such demands without bringing out the truth. Politicians demanded that the government prevent another outbreak of bird flu by introducing even more stringent control on the live poultry industry, and at the same time keep the industry alive. The Government conceded. The truth is that the stringent control introduced will most likely kill the industry, but even these measures cannot guarantee that another outbreak of bird flu will not occur. Public money is being spent on a lost cause and delaying a rational discussion on the future of the proprietors and employees of the industry.

Politicians demand the Government guarantee the absolute safety of food, so that people can continue with their risky eating habits. It's already known that deadly bird flu is transmitted to man through close contact with chickens, but the taste of chickens that can be selected live from a cage was glorified recently in the Legislative Council. The government has been blamed for the recent outbreak in cholera, for not carry out enough enforcement action in restaurants selling raw seafood, when the most effective means to prevent cholera is to stop eating raw seafood. The government has been accused of trying to conceal from the public that a beef carcass was tested positive for E. Coli O-157. The test was done as a risk control measure of the slaughtering process in 4 out of every 5,000 beef carcasses. It was not done to guarantee the absolute safety of beef; absolute safety can only be guaranteed by cooking beef thoroughly.

Such accusations made by politicians were stupefying. The apologetic responses of the Government on these accusations were beyond my comprehension. The circus of accusations and apologies, may, however, serve some useful purposes. It may make the Government even bigger, by making the people more dependent on the Government. It may also help to perpetuate the delusion of the politicians that they have been doing something useful.

It is not fair to put all the blame for the present quandary of Hong Kong on government officials and politicians. We should, after all, be grateful for a peaceful transition. Hong Kong people ruling Hong Kong will take a bit of time to mature. Perhaps maturity will come earlier, if beginning today the people of Hong Kong can stop mourning about the departure of our former colonial master, and begin to accept not only Hong Kong, but also China as our home. Perhaps the people of Hong Kong, like most Chinese do, are willing to give their utmost to their home, without asking what they can get in return.

The above does not necessarily represent the views of the Foundation.