Aline K. Wong
Singapore
“The ENABLE (Encouraging Achievement and Better Learning) programme gives additional support to those who are not achieving their potential. Our curriculum has given more emphasis to critical and creative thinking skills.”
“Can I just take one more second on the waiting list because Mr Ahmad Magad mentioned that the waiting list is long? There are 18 SPED schools now which cater to about 4,000 children. Of the 18 SPED schools, eight have waiting lists.”
“Sir, I am sure the Member in his meet-the-people sessions has also encountered cases where some families pleaded for priority to be admitted on grounds of, say, the child's sickness, or that the mother is working and is unable to bring the child to school, or that the grandparent cannot manage to take care of so many grandchildren.”
“I think he did not hear what I say. For both of these families, someone who lives within one kilometre or next door and someone who lives right on the border of this one kilometre, or of any delineation you choose to draw, my point is that for both of them, this is their nearest school.”
“Principals, as part of their duties, are always alert to what is happening in the school. They have also been given guidelines, in the Principals' Handbook, on discipline and the code of conduct which is expected of the teachers and staff members. But having said that, all these things are not foolproof.”
“It will continue to stagger the rental increase to market levels for assignment of tenancies, subletting cases and for tenants who are renewing their tenancies for the third time. Shop lessees can also apply to convert to shorter leases to reduce the cost of servicing their mortgage loans.”
The complete record
Every one of 777 lines we hold for Aline K. Wong, in date order, each linked to its source. Free to read, in full, without an account. Page 11 of 16.
“Under the circumstances where the Party Whip is not lifted, voting is compulsory but speaking is not, I beg the First Deputy Prime Minister to interpret the silence of some Members judiciously.”
“We have always maintained that people who hold different viewpoints from the Government and feel strongly about them should form their own political parties. People who do not wish to do so are not lost to the nation. They can still play an important role and make contributions to policy-making. They can serve in various capacities on our statutory boards, advisory councils, GPC resource panels, Town Council management committees. They can make recommendations to our Select Committees, to the various feedback channels. And what about our think tanks? We are getting more and more of them. In our system, as in many parliaments or congresses, a lot of policy deliberations actually take place during the committee stage, where professional advice and technical details are sorted out. Experts make their testimonies in open hearings, while Members of Parliament decide on the broad principles. Thus, I fail to see what the six NMPs can do in Parliament which the present Backbenchers cannot do also. Besides, if an issue is put to a vote, would the six NMPs make much difference to a House where the ruling party holds 80 seats? If one day the PAP has only a slim majority, are we going to abolish the NMP seats just in case they may tip the balance? Finally, Mr Speaker, Sir, it is difficult to mention the sentiments of the Backbenchers on this Bill. A public comment on the Bill is that it is an indirect indictment on the present Backbenchers' performance. But I do not think we should be too concerned over such comments. What should rightly concern us are the logic, the necessity, and the implications of this Amendment for the country's entire political process.”
“Our Ministers can stand up to the Opposition; our Backbenchers can tackle them. The six non-elected or nominated MPs are supposed to be non-partisan. They are supposed to voice independent views and not to play up to the gallery. However, my guesses are, I hope I will be proven wrong, but my guesses are the pressure is on them to step in where the Opposition has failed for lack of good ideas, or for lack of sharp opinions. Even the First Deputy Prime Minister has grouped them as non-government MPs together with the Opposition Members. The pressure on them is to criticize the Government, because if they do not, the people will be disappointed. But the irony is that if the nominated MPs out of their own convictions, out of their own independent thinking, agree with the Government's policies, the people will think they are the Government's yes-men or yes-women. Another irony is that if the NMPs perform well in the eyes of the public, they will only whet the people's appetite for more opposing voices in Parliament. Are we then to amend the Constitution again to increase the number of NMP seats? If the NMPs do not perform well, are we then to abolish the seats because they failed to raise the quality of debate in Parliament? If we do, the people will think we cannot tolerate dissent. I think we will be caught in a bind, whichever way. And where is the end to this satisfying the public's desire for more opposing voices in Parliament? The Bill, unfortunately, looks as if we are bending over backwards to accommodate people who do not want to enter politics in the first place. People who do not want to enter politics have their various reasons. I think we should respect their wishes.”
“But a more important point is the one pointed out by the Member for Ayer Rajah, ie, nominated MPs are likely to be armchair politicians if they do not do any grassroots work. I think that is a far more important point and a very valid point. Individuals have very bright ideas and they can have very bright ideas, but if they do not and cannot relate their ideas to the ground and face the realities of society in politics, how are they going to make meaningful contributions to a political debate? That is where the constituency work is necessary. For me, even the holding out of a promise that more women can enter into the Chamber does not move me from deviating from my fundamental principle that parliamentary seats should be based on elections and representation. Let me move on to the other aspects of the Bill. I think its objectives, in spite of the First Deputy Prime Minister's explanation, are still not very clear. Is it simply to incorporate a broader spectrum of viewpoints into our debates? Or is it not also meant to satisfy the people's desire to see more opposing voices in Parliament? Both have been mentioned. We already have an Opposition in Parliament. If the Opposition Members are not doing their job well, let the people throw them out at the next General Elections.”
“We need the Government's help particularly in terms of child care facilities, part-time work, better leave schemes, equal medical benefits and even the legal provisions to make sure some employers do not discriminate against women in the employment practice. With this kind of support, we will be able to manage our family and our career and still be able to come out in politics. Bangladesh and Pakistan have been mentioned as examples where special seats are reserved for women. Bangladesh and Pakistan, however, have a vast majority of the population living in rural areas. The countries are poor. The greatest majority of the population are still illiterate, particularly the women. Women there are subject to all kinds of inequalities and even oppression. It is a credit to the government and to their parliaments that they should reserve some seats for women. I myself have known some professional women from Bangladesh, Pakistan and India who are academics and who have fought for the women's rights and, hurrah to them, they have gained seats for women in Parliament. But those reserved seats are to make sure women in those countries can have the opportunity to go to school, to get health services, to be able to participate even in economic and social life, because otherwise the social, cultural traditions of the society would not allow women to do so. Our situation in Singapore is very different. It is no compliment to say that women need to be exempted from constituency work, otherwise we cannot manage well. The four of us here have proven that we can do it all. Some hon. Members: Hear, hear!”
“Among our present Backbenchers, including the two Opposition Members, we have 23 Members who are managers or business executives, two bankers, five doctors, four lawyers, 10 academicians, two teachers, seven trade unionists and one journalist, making a total of 54. I should think these backgrounds cover sufficiently the various functional groups' concerns, without our having to appeal to functional group support in electioneering. Besides, if we were to allow functional groups to enter politics as such, we would be contradicting our past stance that professional bodies should stay clear of politics. The possibility that this NMP scheme can hold out greater promises for women to participate in politics has been made much of. Yes, women are under-represented, I agree. Women are hard pressed by their career and family responsibilities, I agree. The question is: Has the PAP looked hard enough for woman candidates? Are we looking for certain kinds of women among our candidates? Are we willing and ready to open up our range of possibilities to include women who, for example, in the political outlook are rather more radical, so to speak? What about having women from a wider range of background and not just concentrate ourselves on people who have family, career and the kind of political outlook which squares with our way of thinking? What about women who are single? What about housewives who are well educated? If we look wide enough, perhaps we can find more. But of course it is still doubtful. I am not one to say that women do not need Government's help. We do.”
“Each of us here represents a certain number of constituents who voted us in. They are the people who authorise us to make decisions that affect their lives. By contrast, the proposed six nominated MPs are not representing anybody other than themselves. Yet they will have the power to vote on most policies. Does this not constitute a case of power without accountability? I do not deny the fact that some parliaments have nominated Members in their midst. The First Deputy Prime Minister has tabled a list of 20 parliaments within the Commonwealth which have nominated Members. Examples mentioned are Botswana, Seychelles, St Vincent and the Grenadines, Solomon Islands, Uganda and others. But the question is why are these countries mentioned and why not other countries such as Australia, New Zealand, France, Netherlands, USA, which have no nominated Members? The point is if we want to be unique, we can be unique. If we want to quote precedents, there are always precedents. We must, however, just maintain our own principles. I would have less difficulty in accepting this Bill if the additional Members are brought in as representatives of various functional constituencies after they have been duly elected by these groups. However, this will open our doors to lobby group politics with dire consequences for the entire process of governing. It would be far better to maintain our present system where the MPs can come from all walks of life and be counted on to represent the various strata of society. The Member for Ayer Rajah has mentioned a broad range of our MPs' background. But let me put some figures and accuracy into his statement.”
“Thirdly, why do some good people abstain from joining politics even though they have much to contribute? I cannot deal with these issues here one by one. There are actually plenty of political analysts who can offer very incisive comments. All I wish to say is that, to a great extent, these issues have become issues because of our success. The PAP has succeeded so well in delivering the economic goods that affluence actually and naturally brings political apathy to the greatest majority of the population. Affluence has resulted in political apathy. Secondly, we have succeeded so well also in identifying and implementing the correct policies that people are actually convinced and indeed take for granted the basic premises of our policies. This explains why there is a lack of ideas on true alternative approaches, and the tendency for a lot of our policy debates just to concentrate on implementation details. Thirdly, the PAP has also succeeded in gearing its policies towards the broad spectrum of society. Therefore, we have been meeting the aspirations of the broad masses. Fourthly, we have maintained very high standards in selecting our election candidates and, in the words of our Party leaders, "scoured the earth" to invite people who wish to join us to join. So the problems or the issues we think this Bill is designed to address are actually the problems of our success. Let me instead concentrate on this Bill, its questionable features, and its implications. On the surface, there is nothing wrong to include new voices in Parliament. However, nomination deviates from one of the most fundamental principles of democracy, ie, the principle of representation. Democratic governments derive their legitimacy from the mandate given by the people through free elections.”
“Mr Speaker, Sir, to begin, I think it is not quite fair to say that not a single MP had objected to the political vision as stated in the President's Address which included a reference to the fact that the Government was going to have non-government MPs. At that time, the idea was merely floated around and our normal practice is to thrash out the details of the scheme, both in formal and informal discussions, and the public debate only takes place when a Bill is tabled in Parliament or when it is tabled as a White Paper or Green Paper. So I do not think it is quite fair to say that since we did not object at that time, therefore we should have no right and should not speak up and object now. Ever since this Bill was tabled in Parliament, I have been struggling over how to debate it. This is a constitutional amendment, a very serious matter. By logic and by convention, the PAP Party Whip cannot be lifted. Yet, this Bill involves a number of very complex issues, contains some questionable features, and has long-term implications for both the nation and the ruling party. Sir, I think I would be amiss in my duty as a Backbencher if I do not lay out very frankly my views about the implications of this Bill. The issues that underlie the presumed necessity of the amendment are complex. Questions that come immediately to mind are: what is the role of the Opposition in a place where the great majority of voters desire the ruling party to govern on, because of its integrity, its competence and proven record? Second, why is it that the Opposition parties have consistently failed to become credible, whether in terms of their policies or in terms of the quality of their candidates?”
“First, what is the reason for not extending this ban to private offices? People who work in offices where people smoke will be inhaling this polluted air for eight hours of the day. Second, in extending or enforcing this ban in public entertainment areas, I think we need to have some consideration for tourists and people who have to do entertaining of foreign clients in certain places, eg, restaurants in hotels, hotel lobbies and such like. I do not know whether the Ministry has already conducted some dialogue sessions with people who own these establishments and see whether some way can be devised to accommodate the tourists. These establishments can be required to install separate ventilation systems or improve upon the present ventilation systems so that smoking and non-smoking areas will not get mixed up in the air circulation. I hope we can find some way of accommodating this kind of business clientele. After all, our campaign should be aimed at Singaporeans. We cannot hope to convert four million tourists every year who pass through Singapore to become non-smokers over night.”
“Sir, I have only a few points to add to what the Member for Pasir Panjang has just said. I support the Bill for the obvious reason that we must do everything we can to try to reduce further the proportion of smokers among our population. One way is by curbing advertisements. I particularly welcome the provision banning the giving away of free samples of cigarettes. In our daily activities, we come across distributors giving away free cigarettes at balls, dinners and dance functions, etc. They could be very tempting for people to light up. I personally, however, feel that by banning advertisements in Singapore, probably our efforts may be nullified by the fact that our population is still exposed to advertisements in foreign publications and TV channels from neighbouring countries. So I would urge the Ministry to concentrate further on public education to target our campaigns at the young. I find it particularly disturbing to see very young children starting to smoke. Peer pressure is one important reason why they do that. How can we counter that? I think the Ministry should come up with some very innovative strategies. In our goal to achieve or to shape a smoke-free nation, we have to be a little realistic. In every country, in every society, there is bound to be a small proportion of adults who cannot give up. And so long as they do not smoke in the presence of others, thus harming others' health, I think they should be left to decide pretty much on their own whether or not to quit, now that they know that it is harmful. Since the extension of the ban on smoking in public places is now being mooted and will be in force very soon, I would also like to take this opportunity to ask the Minister two questions.”
“I think with or without the parents' demand, it is the duty of our educational professionals to think in terms of the interest of our students and to re-introduce Confucian Ethics in some form or other into second language teaching, or into the new Moral Education teaching, because I think only then would the original objective of the RK programme be preserved. 2.30 pm”
“" They would argue that Confucianism in itself is not a religious subject and it really should not be treated on the same status as the others in the programme. But in my mind, no matter how I regret the decision, I feel that you cannot separate it from the rest of the programme because once we have accepted it as part of the programme, there is no other choice. So the question is, how to put back some Confucian Ethics or some elements of it into the teaching for our Chinese students in the Moral Education lessons or, as I said, in the extended version of the second language. Sir, I think the Chinese community itself must also ask a very deep question: why is it that even when Confucian Ethics is a compulsory subject, only 17.8% of the students are taking it as compared to 44.4% who are taking Buddhist Studies? I think this is a very soul - searching question and we should really look at ourselves very honestly. It is said that it is easier for the students to pass Buddhist Studies than Confucian Ethics. If our parents hold this pragmatic orientation towards Moral Education in our children, I do not think it is fair to blame these things on the Ministry of Education or the set of texts. I do not know whether Chinese parents now feel that we have missed out on a golden opportunity. When Confucian Ethics was taught as a Compulsory RK lesson, we did not ask the children to take it. Now it is going to be gone. Are we going to ask or pressurize the Ministry of Education for further consideration?”
“In the lacuna left behind by the dropping of Religious Knowledge from the school curriculum, then the question is what can we put back. Moral Education is already being taught at Secondary 1 and Secondary 2 levels. Should the new Civics course be introduced at the upper secondary level? I do not know how this will work out in practice. But if the new Civics course is to be a mere extension of the present Moral Education course emphasizing universal humanistic values or even incorporating the new set of core values, I doubt very much if there is enough course content to occupy the Civics course for two further years of studying. The more appropriate place for the teaching of cultural values, ie, values specific to our major cultural traditions, is the teaching of the second language. Lessons in the second language should be expanded in terms of cultural and historical content, as well as introducing students to literary works in that particular language. So in lieu of the Civics lessons, students can be given additional hours in the second language with this increased cultural, historical and literary contents. The Ministry of Education should not rule out this possibility. Otherwise I cannot really imagine how you can fill two more years of Civics lessons with good enough content. As far as the Chinese community is concerned, Sir, I think the advocates of the teaching of Confucian Ethics are going to be very disappointed. We have just heard Mr Ho Kah Leong speaking up for this segment of the Chinese population. Personally, I also feel a sense of loss at the fact that Confucian Ethics will also have to be dropped along with the other subjects. Some people may even think of the eventual demise of Confucian Ethics as a case of throwing out the baby with the bath water.”
“In our situation, I think the complexities become more so because race and religion are quite closely linked to each other. In that light, in the past few years there has been a noticeable increase in the racial awareness of our population because we have discussed so many racial issues in the open, about political representation, about educational privileges and fertility. So the awareness of religious and racial differences has not arisen because of the RK programme in itself. Be that as it is, then it is by a coincidence of a number of factors external to the Ministry of Education that the RK Programme has been caught up with racial and religious sensitivites. In my mind, the only way to resolve the problem is to ask the most fundamental question about the whole programme. The most fundamental question is whether the Government of a secular state should be involved in the teaching of religion. In my mind, the answer is a very clear, no. Having settled that, the next question is how to phase out the programme. I think the way proposed by the Minister is entirely fair to the students. The students' interests would have been taken care of and I should say this is very characteristic of our Minister's way of dealing with things, to be very fair and keep promises. The question which now remains is: what kind of formal teaching should take the place of Religious Knowledge so that the original objective of the programme can still be achieved? The original objective, ie, the rationale behind the introduction of Religious Knowledge was our concern that younger Singaporeans have become so westernized as to lose the sense of their cultural roots. So Religious Knowledge was supposed to transmit cultural values rather than to teach religious beliefs.”
“Pending the clarification from the Minister on the position of the mission schools, vis-a-vis the teaching of Bible Knowledge, let me also share my concern about the particular position of the mission schools in Singapore in view of their past contributions to our education efforts. Like the Member for Kampong Ubi, I also feel that the public is bound to ask the question that, after only five years of the introduction of Religious Knowledge, why is the Government now making the decision to change the status of the programme from a compulsory to an optional one? It would appear to have been a great waste of resources if the programme is scrapped only after such a short time. However, I also understand that circumstances are such that we have no choice but to change the status of the programme. What I do foresee is that even though we are making the programme an optional one from now on, in effect, I think the programme will die a natural death. Once Religious Knowledge ceases to be a compulsory subject and once it is no longer tied to the admission criteria for junior college and pre-university courses, I can see that the number of students is going to drop so drastically in a few more years and the whole thing will just die off. Another point is that even though the Minister has clarified for us the circumstances surrounding the change of the status of the programme, ie, an increase in awareness of religious differences among the population in the last decade or so, I must add that this is not necessarily due to the Religious Knowledge Programme in itself. Even in Singapore there has been a quiet revival of religious fervour. In fact, we already hear of occasions when some communities feel that they are encroached upon and feel quite upset about it.”
“As to where a patient should go to, is it a matter of free choice of the patients? Actually we hear that where a patient should go to for hospitalization is upon the recommendation of the doctors who are consultants to these Government hospitals or private hospitals. And also, when they go into A&E wards, will the ambulances actually take them to the designated regional hospitals?”
“Sir, from table 2, the NUH charges are much higher than the Government hospitals or SGH. May I ask the Minister why is this so? Does it mean that NUH has been making quite a bit of profit? Or what is the reason? The second question: for SGH's charges for surgical cases, the patient still has to pay on the average $500-$600 more for the representative treatments quoted. Does this difference in bill size have anything to do with the present practice of SGH to charge by itemizing the bill for every kind of surgical materials used, X-ray test, etc. If so, would the Ministry take steps to inform incoming patients of SGH of this practice so that the patient will know roughly beforehand what he can expect?”
“Thank you for the clarification. With that, may I withdraw the amendment. Amendment, by leave, withdrawn.”
“Sir, before I withdraw the amendment, I would just like to ask the Minister for a clarification. What does he mean when he said that he would deploy more nurses to the HNF programme if there is a demand for it? If he said that there is a shortage of nurses generally within the Ministry or Government service, I can understand him. But if he says there is no demand, what does that mean?”
“This would be close to where the old people are and also at a rental which is lower than what is now granted by the HDB to ordinary community organizations. Finally, the Primary Health Division should be given more funds to promote health education and provide health screening as well as rehabilitation services to the elderly. To cut down on total health costs for the nation, the Ministry must put a greater emphasis on primary health care, including preventive medicine, health education and health screening. I would like to ask the Minister a question. With Government hospitals becoming corporatized - now it seems to be the current term in this debate - what would remain of MOH's function in future? With the tertiary care and secondary care being hived off, so to speak, to the restructured hospitals, what would remain of MOH's major functions? Should we leave the provision as well as the quality of secondary and tertiary health care to the forces of the market alone? I do not believe so. The rationale behind the restructuring is to raise efficiency so that the Government hospitals would become more cost effective. While this may make the restructured Government hospitals more competitive with the private hospitals, this should not be a goal in itself. I believe that the Government hospitals must play the lead in cutting costs. They should show the way how better quality care can, in fact, be provided at reasonable cost to the consumers. They should set the standard for the private sector. I believe this is expected of the role of restructured Government hospitals. Otherwise, it is going to be very difficult to persuade the people that the Government hospitals are not going into the market just for the share of it.”
“There is no question that they require more help from both the MOH and the volunteers. Sir, the demand for home nursing visits has gone up steadily, from 42,500 in 1978-79 to 63,500 in 1986-87. In June 1986, a graduated fee scheme was introduced for such service, with the charge varying according to household income. Before that date, the service was provided free of charge. With the introduction of the fee, the number of home visits in 1987-88 dropped by some 6,200 visits as compared to the year before. This implies that the number of visits per patient has gone down, possibly because of the charges. Elderly patients requiring home nursing actually need repeated visits. And because the charge is the same for every visit, some families may find it unaffordable to pay for the subsequent visits. So may I suggest that the fee structure for home nursing services be further refined. The charge for second, third or subsequent visits could be reduced along the same line as subsequent visits to specialists are charged at lower rates after the first visit. In this way, patients may be encouraged to request the number of visits actually required for effective treatment. Coming back to the Home Nursing Foundation or the home nursing programme, there are several ways in which the Ministry can strengthen its support for the Home Nursing Foundation. First is to deploy more doctors, nurses and paramedical staff to the home nursing programme. Second, to work more closely with MCD and the Singapore Council of Social Service and other voluntary organizations to raise funds and recruit volunteers. Third, the MOH to negotiate with the HDB, or in the future the town councils, for more void deck senior citizens' health care centres to be established.”
“Sir, I beg to move, That the sum to be allocated for Head P be reduced by $10 in respect of Code PE 1500 of the Main Estimates. Sir, medical services for the elderly have become a pressing concern in view of our ageing population. At present, primary health care for the elderly is coordinated by a special department of health service for the elderly within the Primary Health Division of the Ministry. This department was established in 1985. This department plays a pivotal role in the coordination of health care services for our ageing population. However, the GPC notes that up to the present, this department is under the charge of two medical directors only. Given the amount of responsibility this department has to take, we would like to urge the Minister to strengthen the support of this department in every possible manner. Apart from giving this unit more administrative back-up, more doctors should be deployed to the senior citizens' health care centres so that they can have first contact with the elderly patients. We also feel that the support given by this department to the Home Nursing Foundation should also be increased. The Home Nursing Foundation was established as a voluntary organization in 1976, more than 10 years ago. While the demand for its home visit service has gone up steadily over the past 12-13 years, it has constantly been strapped by the lack of manpower and financial resources. The number of nurses seconded to the Foundation has not increased significantly over the years. And here I think we really should pay tribute to the 26 full-time staff nurses who have been seconded from the MOH to the Home Nursing Foundation. Between them, they have carried out over 50,000 home visits in 1987-88 alone.”
“We would like to thank the Minister for his reply and may I withdraw my amendment. Amendment, by leave, withdrawn.”
“I would just like to ask the Minister to answer my suggestion that the Medisave Auditing Unit be expanded. I think he has forgotten to answer that point. Mr Yeo Cheow Tong: My apologies. I totally agree with what Dr Aline Wong has brought up in terms of the Medisave audit. We are looking into how we can strengthen the unit and how to introduce automated systems for processing the claims and, more importantly, to allow us to set up a database where we can then closely monitor usage in terms of by doctor, by disease group and by hospital. I think that will allow us to have a better idea of where the money is going to and how it is being utilized.”
“Thus, it is imperative that Medisave accounts be kept in a state of health for old age use. I would agree with the use of Medisave to pay for premiums for catastrophic health insurance. But if Medisave were to be used for other kinds of health insurances we should be very careful in our consideration.”
“At the same time, private hospitals have been conducting in-house professional or medical auditing since January 1988 to check on Medisave claims. These two measures are inadequate. Thus, the Ministry of Health established a Medical Audit Unit in June 1988 which is a step in the right direction. Between June and December 1988, this unit examined 7.3% of the total of 47,254 claims from private hospitals and it is gratifying to know that no real abuse has been detected so far. But to forestall the possibility of future abuses, we need to conduct Medisave auditing on a more comprehensive basis. There is need to strengthen this Unit, give it more manpower, and invite some professionals from outside MOH to serve on its panel. In addition, it would be better if the Unit can coordinate with CPF to conduct financial auditing at the same time. The amount of work involved of course is great. But as the experience of other countries shows, financial and medical auditing are effective instruments to curb abuses such as over-investigation, over-charging and over-stays in hospitals. In the United States, information on hospitals and medical practice groups which are found to consistently deviate from the established norms is circulated among public and private hospitals and among the insurers. This constitutes significant professional and consumer pressure on the errant practitioners. While our situation does not yet warrant such high pressure tactics, we should still take the necessary steps to provide quality assurance for the consumers. An expanded Medisave Auditing Unit within MOH would be one such measure. Medisave's function is mainly to enable the population to pay for hospitalization, the need for which will definitely increase with old age.”
“I have raised this issue before and let me not take the time away from other speakers on this question. Sir, as I said, subsidies are a taken-for-granted starting premise for the provision of medical care. It is in the nature of subsidies that, once given, it is very difficult to withdraw from the population. Moreover, it is not just people's affordability which is involved here. What is involved are people's perceptions of the Government's responsibility in providing such an essential service as medical care. Thus, in the United Kingdom, the proposals to change the NHS (National Health Service) along the lines of restructuring and privatization so familiar to us are meeting with great resistance, not just from the population but also from the professionals. The NHS has been in existence for over 40 years. Its philosophy of socialized medicine has become a symbol of pride to the British nation. No doubt the system needs heavy revamping but the moral of the lesson is that the UK government has to proceed with great care and it is still not certain whether it will succeed. In the United States also, Medicare and Medicaid, two big elephants, represent some core values in America's sense of social responsibility towards the needy and underprivileged. Thus, rather than doing away with these systems altogether they are experimenting more with cutting costs, reducing abuse and providing legislative support for alternative forms of health care systems such as the health maintenance organizations. I think we can learn from their experiences. Sir, Medisave auditing was introduced on an ad hoc financial auditing basis by the CPF in 1986. This was formalized in 1988.”
“Sir, SGH is the flagship of the Government hospitals. Is it equitable that the poor will no longer be able to obtain hospitalization at the new SGH? Theoretically, patients can go to the other Government hospitals and distance is not a problem. But if we were to examine the bed complements at the other Government hospitals which will be completely redeveloped by 1994, one finds the number of C class beds is going to be drastically reduced, except for Woodbridge Hospital which will still have 79% C class beds. At Kandang Kerbau Hospital, the proportion of C class beds will be reduced from the present 40% to 15%. While this may not pose a problem to maternity cases because people now have fewer babies and are happy to pay for better wards for each delivery, what about the gynaecology cases? Would there be sufficient C class beds for these cases? Similarly, at Toa Payoh Hospital, the proportion of C class beds will be reduced from 81% to 18%, and at Tan Tock Seng Hospital, from 77% to 22%. Do we really need to make such drastic reductions at such a rapid pace? 1994 is only five years away. Is it not possible for more C class beds to be retained with the possibility of converting to B2 beds later when the indications become clearer over a longer period that the present trend of people opting for B2 beds is not just a temporary phenomenon? The Ministry has often stated that the reduction in C class beds is a response to the population's shifting demand for B class beds. While this is true, the GPC feels that the rise in demand for B2 beds has a lot to do with the people using Medisave to pay for better comfort now rather than to save it for medical needs later. In the process, many will find their Medisave accounts insufficient for later use.”
“The National Health Service in UK represents one end of the continuum, where free medical care is given upon demand or universally. This system has spawned serious inefficiencies and has been heavily abused. Thus, the UK government is currently reviewing the system, and a White Paper has just been published. At the other end of the continuum perhaps stands the United States. A great proportion of medical care in the United States is provided by the private sector with third-party payments from insurance. However, even in the United States, the federal government together with the state governments still account for as much as 40% of the total health expenditure, the bulk of which goes to Medicare and Medicaid. But, like the NHS in the UK, both these programmes are having serious strains. So the US government is making strenuous efforts to cut down on the abuses to these two schemes. In terms of providing basic medical care to the nation, our MOH has done very well. But as Singaporeans become more affluent, demanding better quality services, the question arises as to how much of this better quality care should be subsidized and how much the consumer should bear the increased cost. Thus, the subsidy question should consist of two distinct levels. By and large, we have followed the right direction: we provide C class and B2 beds, as well as B1 and A class beds with differential rates of subsidies. It is important that we continue to maintain these two categories of beds in all restructured hospitals. C class beds must be retained for those who cannot afford the B2 beds, because the average bill size for B2 beds for both medical and surgical purposes is double that for C class beds. Thus, the GPC notes with concern that SGH will no longer have C class beds.”
“Sir, the question of rising charges at government hospitals and at the OPDs or Outpatient Clinics, is a concern of many Members of this House. The GPC on Health, in particular, has discussed this question with the Minister and his officials on numerous occasions. We have conveyed both our concern over the affordability of government medical services to the lower-income groups as well as the confusion in the public's mind regarding the restructuring of government hospitals. The latter is taking place at the same time as the rate of subsidies is being reduced. Thus, in the public's mind, restructuring is still equated with privatization, and privatization equated with rising charges. I suppose with the change of names of Government hospitals such as SGH to become Singapore General Hospital (Private) Ltd. or the former Middle Road Hospital to become known as the National Skin Centre (Private) Ltd, and so on and so forth, does not really help in the minds of the public to understand this issue of restructuring. Sir, the GPC supports the principle of restructuring. It gives more autonomy to the hospitals which therefore would have more freedom and flexibility to run their services more efficiently. We also understand that, with rising operational costs and improvements in the standard of services, the cost of medical care is bound to go up. Government medical services are still heavily subsidized and this will remain so in the years to come. Sir, the provision of basic medical care for the population is the function of every government. Thus, countries across the world provide subsidies to medical care. The difference is only a matter of degree.”
“Sir, I beg to move, That the total sum to be allocated for Head P of the Main Estimates be reduced by $100. May I have your permission to speak on all three schemes under this cut?”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. The sum of $22,851,840 for Head R ordered to stand part of the Main Estimates. The sum of $14,881,000 for Head R ordered to stand part of the Development Estimates. Head P -”
“Before I withdraw my amendment, Sir, allow me just to clarify my stand. I had intended only to state my support for the use of the price mechanism together with some allocative procedures on the question of foreign maids. Like the Member for Sembawang GRC, I understand that working women have very little choice and that we must do our best to help them cope with the double burden of work and housework. I am totally heartened by what the 1DPM said and I must say that I find it very refreshing that Mr Shanmugam should carry on this crusade against housework; it is refreshing in the sense that my memory is recalled back to the famous treatise by Engels. This is without any intention whatsoever to implicate his views, but may I ask him, does he not think that relegating housework to foreign maids is tantamount to women taking advantage of their poorer cousins? The Chairman: Mr Shanmugam, you want to say something? We have time, you know.”
“I believe the Minister for Labour understands the plight of working mothers. Although the MCD is stepping up the provision of child care centres, we all know the number of centres now available or even by the end of this year will still be far from sufficient to meet the demand. One reason is we must have enough number of sufficiently trained child-care centre staff before we can provide the necessary resources and build those centres and get them running and all this takes time. Meanwhile, may I urge the Minister to be considerate in granting work permits to foreign maids according to the needs of the families. Working mothers with young infants, families who have aged parents and disabled members to take care of, obviously should have the priority.”
“Sir, I beg to move, That the sum to be allocated for Head R be reduced by $10 in respect of Code RK 1500 of the Main Estimates. Sir, the foreign maids levy will be raised to $200 in July this year. I support the Ministry of Labour's policy to curb the increase in applications for foreign maids through the price mechanism. There are those who complain that with the double increase, ie, one which was made at the end of last year and together with the one coming in July, this increase in the levy would mean that only the rich families would be able to afford foreign maids and therefore it is not fair. I do not agree with this view. Domestic help is not a basic good that should be equitably shared. We cannot allow the increase in demand to go on unchecked not only because of the social and cultural implications of having more than 40,000 foreign maids living in our homes but also because we can become overly dependent on them to do things which all of us should be brought up to do for ourselves and for our children. Foreign maids, therefore, should only be viewed as a temporary measure to make life manageable for working couples. But just like the case of foreign workers in the construction, manufacturing and hotel industries, when we become overly dependent on foreign maids, we would be caught one day helpless should the source of supply dry up. We can reduce this dependence actually if we take time to get to know our neighbours and to make more efforts to find out suitable care-givers perhaps through the MCD's Family Care Scheme. And for women who believe that housework should be shared jointly between husbands and wives, they will find that, in fact, husbands would not be persuaded to help out if there is already a maid at home.”
“Just a point of clarification. Students can apply for half of the tuition fees from the revolving loan fund. They can also get the other half from the university loans.”
“Would the Minister not agree that with this kind of restriction on the use of CPF funds, limiting it mainly to local studies, the scheme is more of a concession in principle than of any material assistance to families, since local students can apply for university loan schemes which are granted roughly on the same kind of principle and to cover the whole cost of the local tuition?”
“But I think the Ministry has already got evidence that after a few years of primary education, the language abilities of children who attended pre-primary classes are no different from those who attended non-MOE kindergartens. So this rationale for the pre-primary education to be undertaken by the Ministry of Education is also not there. Sir, the teaching of CL2 continues to be a very important challenge to the Ministry. But as far as the pre-primary programme is concerned, I wonder if the Minister can give us some indication as to whether or not he is going to accept the Auditor-General's recommendation. And if he is going to scrap the classes, what is he going to do with the existing facilities and the trained staff?”
“Instead, we should address two fundamental questions: First, is it the function of the Ministry of Education to provide pre-primary education? If not, what other alternatives are open to parents? Second, has the pre-primary programme served to give children a headstart in learning Chinese? With regard to the first question, I am of the opinion that the Ministry of Educa- tion's function is to cater to primary, secondary and tertiary education, just like ministries of education all over the world do. That our Ministry of Education has gone into pre-primary education was due to a pecular historical reason, ie, to help arrest the decline in enrolment in Chinese schools in the 1970s. But this reason is no longer valid now, because English has become the main medium of instruction in all schools since we implemented the national stream in 1987. Thus, pre-primary classes now are teaching both English and Chinese. And this is what most kindergartens run by private or community organizations are also doing. The fees charged by the kindergartens run by community organizations are affordable and the teachers are also trained at the Institute of Education. So I feel that pre-primary education can very well be left to non-MOE kindergartens. It can even be said that, since the kindergartens are not subject to the bureaucratic constraints of the Ministry, they can be even more flexible and more innovative. The second question, giving children a headstart in learning Chinese, is a major concern among the Chinese-educated parents. Their concern has been highlighted by the Chinese press. I sympathize with their concern.”
“No doubt, some of the Confucian values need to be adapted to our modern-day conditions. In fact, the two texts have attempted to adapt Confucian values to modern-day concepts of family living, and also to concepts about citizenship and democracy. One may argue, of course, whether the attempt to revise it especially as geared to secondary student levels is adequate or broad enough. But that is a separate question. Perhaps for the Member for Potong Pasir, if he has some difficulty in understanding Chinese, he should read these two English texts to begin with and see how Confucianism, in fact, can be adapted to modern-day conditions. For the Minister for Education, may I ask if his Ministry has actually begun to look at the RK programme, and when would a decision be made on the matter? If the programme were to be dropped, what does he propose to do with the resources that we have already put into the Confucian Ethics as a course? Let me now turn to the subject of pre-primary classes. On 29th January 1989, the papers carried a report on the Auditor-General's recommendation that the pre-primary programme should be scrapped. Pre-primary classes have become very popular with parents because of the longer hours and the lower fees as compared with kindergartens. Also, the classes provide a Mandarin-speaking environment, a more structured programme and better-trained teachers. It is therefore understandable that parents are quite disappointed by the Auditor-General's recommendation, especially since it seems to place so much emphasis on the cost factor. I believe cost-effectiveness should not be the main criterion for the Ministry to take a decision on the matter.”
“A decision on its continuation should be taken sometime in the future. RK was introduced as part of the Moral Education programme in 1984. The rationale behind its introduction was our concern that younger Singaporeans have become "deculturised". To counter this trend, emphasis is placed on teaching traditional values so that young Singaporeans can identify with their own cultural roots. So the teaching of RK has served a useful function of transmitting cultural values. But should it begin to show some negative indications for social harmony, as the Report has reason to believe, I think we must be very careful. We may have to drop the courses no matter how good the original intention was and how much resources we have poured into the programme already. However, dropping the programme would produce a lacuna in our school curriculum. At present, the Moral Education course for primary and lower secondary students only teach universal, humanitarian values. We may therefore have to inject more cultural value content into the teaching of the second languge. But even with this alternative, something is still going to be lost. For the Chinese in particular, the present course on Confucian Ethics is a most valuable source of cultural knowledge. The two school texts are comprehensive and are well-written, even if a bit heavy going especially if you read it at one go. A lot of resources have gone into their production, and into the training of the teachers. So how can we prevent such resources from going to waste? How can we still put back some Confucian ethics into the school curriculum? Sir, to the majority of the Chinese, Confucianism is Chineseness, ie, Confucian values are central to Chinese culture and personality.”
“Since Mr Chiam has talked about his views on Confucianism and one of the points I was going to make on the Religious Knowledge programme was also on Confucianism, I think I should deal with this matter first. The Member for Braddell Heights touched on the Report on Religion and Religious Revivalism in Singapore. Likewise, I believe we should also take a very serious look at this Report and for the Minister to consider whether this course on Religious Knowledge should or should not be continued. The researchers believe that the introduction of religious courses has a significant impact on the present and future religious development in Singapore. And they have recommended that the Religious Knowledge programme be reassessed, implying that if the undesirable consequences outweigh the desirable ones, then the programme should be dropped. The recommendation of the Report was based on several observations. First, Singapore, being a secular state, should keep religion and state separate. When religious courses are introduced into all schools, this principle of separation between state and religion is actually being breached. Second, in deciding on which religious courses to be taught as options in the RK programme, the Government is officially endorsing the chosen religions over the others. Third, when one religion begins to engage in active proselytizing or propagating its faith, then it may provoke a response from other religions. This would lead to competition and because religion is closely tied to ethnicity in our social context, competition may also lead to racial conflict. Sir, I believe the observations of the Report deserve our serious attention. And I agree that a close look at the RK programme should be made.”
“Mr Speaker, Sir, may I be allowed to speak on the cut on traditional values and religious knowledge first?”
“To that extent, we will be losing the very valuable past educational ties that we have been sharing with people from our neighbouring countries. Sir, I think this is a consideration which the Government probably has thought about deep and hard. It has come to this conclusion after weighing the pros and cons. But I am afraid opinion on this matter is going to be divided. So with that, may I urge the Minister for Finance. In having implemented this new system of budget allocation, not to give up his role as an overall watchdog of how individual Ministries spend and raise money, but to make sure there would not be foreseeable external economic, political or social costs to the nation. 3.56 pm [Mr Deputy Speaker (Mr Abdullah Tarmugi) in the Chair]”
“So what has happened is that there is a higher cost recovery from the students themselves. If this trend continues, I am afraid university education will become more and more the privileged of the privilege few who can afford it. This trend must somehow be alleviated and means must be found to help students along in meeting this part of their expenses. As for foreign students, nobody would disagree with the argument that foreign students should pay more than local students. This is fair and this is just. And at the University level, there has always been a quota, a limit on the number of foreign students so that we can benefit, from their presence, students can mix with students from other kinds of background, other nationalities, and they can benefit from this multiplicity of cultural and national backgrounds. The quota, on the other hand, limits the number of places taken up by the foreign students. But the hefty rise in tuition fees for foreign students, doubling what they were paying two years back, will cause a loss of goodwill among foreign students who come from our neighbouring countries. We must not forget a lot of the close relationship we have enjoyed with our neighbours can be attributed to the fact that Singaporeans and Malaysians and other people from Asean have shared common educational backgrounds, common educational ties. If the foreign students from now on find it impossible or very difficult to meet our tuition fees, they would not come. Or those who can afford them may find it relatively more attractive now to go to universities in other countries where there would be a greater range of courses, where they may stand a chance of settling down after their graduation.”
“That is why in the case of Dentistry and Medicine there is this bond that they must serve for five years after graduation. Mr Speaker, Sir, I suppose I should let the House know that I have two children who are attending NUS but I do not speak as a parent who can afford this fee raise. I am speaking on behalf of those who cannot afford the fee increase. So for families who made their calculations before their children entered the University, they are hit by this fee increase twice within the last three years and this really comes as a big surprise. It is said that they can apply to the Revolving Loan Fund from the Ministry of Education from which they can draw and cover up to half of the tuition fees. The second half they can apply from other loans at the University or at the NTI. But the upper limit to these other loans is only $2,000. And the actual amount a student would obtain is not necessarily the maximum. That depends on the financial circumstances of others including how many applications there are for these loan funds. So other means must be found to help the students who are caught in the financial bind and I think there is need for the University to raise the amount, the upper limit of this $2,000 loan, to help the students caught by this increase. The justification given for the sharp increase in tuition fees is the rise in the operational expenditure at. If we read the figures given in the Straits Times on the 8th March, it is noted that between 1987 and 1988 and 1989 and 1990, the total operating expenditure of NUS and NTI increased from $231 million to $351 million, that is a rise of 52%. Whereas the recovery from tuition fees would rise from $28 million to $62 million, that is a rise of 121%.”
“For Accountancy, Commerce, Arts, Social Sciences and Law students, the fee charged in 1986 and 1987, before the 1987 increase, was only $1,200. But the proposed fee now is $2,600. So the increase is, in fact, not 30%. If you only take the two years, 1987-88 compared to 1989-90, the increase will be 30%. But if you go back to the fee structure just before the 1987 increase, the three years will give you 117%. Of course, one may argue that you should average out the increase over a number of years and you should not, say, take three years back or four years back and make it out to be such a big increase. Let me finish this comparison by going over the other two faculties. For Architecture and Building and Engineering Science, the increase will be 158% over the last three years. For Medicine and Dentistry the increase will be 454% over the last three years instead of 85% only. The point I want to make is that there are students who enrolled in 1986/87, who are still going through these courses and have not finished. In other words, they would have been struck by the fee increase twice, and to them the increase was actually 117%, 158% and 454% and not 30%, not 29%, not 85%. For this cohort of students who enrolled earlier on, and would have made budget calculations when they entered the University, they suffer a tremendous hardship. No one disputes the fact that tertiary education is heavily subsidized. No one disputes the fact that students who graduate from the University or from the NTI are a very privileged minority in the population and therefore they should bear not only part of their educational cost but should also be paying back what they get from society and the taxpayer's money after they graduate.”
“At the same time, the new system clearly places more responsibility on the already powerful top civil servants in the individual Ministries. I hope that the individual Ministries and the officials, in their sometimes over-zealous pursuit of maximum efficiency in a narrow financial sense, would not incur political and social costs which are external to the particular Ministries. It is arguable that one such example is the recent increase in tuition fees at the NUS and NTI. I realize this issue is not particularly within the purview of the Ministry of Finance and probably the Minister for Finance will refer me to the Minister for Education later on. But let me take it as an example of where the considerations of one Ministry may have spill-overs onto the entire country in terms of having not only economic but also social and political costs. And therefore I wish to urge the Minister for Finance, being in the position of watching the budget in an overall sense, to be careful about allowing individual Ministries to tread on grounds which might have this kind of external costs. The raising of tuition fees for NUS and NTI came as a great surprise to many people. I think to use the word "bombshell" is probably not an over-statement. The fees at NTI and NUS were raised only in 1987, ie, two years ago. And to appreciate the magnitude of the present increase, one should not just compare the proposed tuition fees for this year beginning July 1989 with that which were raised in 1987 as shown by the tables presented in the Straits Times of 8th March. One should actually make a comparison between what is going to be effective in July this year, 1989, with what was immediately obtaining before the 1987 increase.”
“Therefore, by comparison, women who belong to the lower income groups and who drop out of the labour force to take care of the young children would be at a disadvantage. The finacial problems faced by women from the lower income groups are real and these are the people who need the additional income most. With the wife relief being raised from $1,000 to $1,500, there is a bit of recognition for the work of women at home which is unpaid. In view of the fact that the lower income groups actually need this wife relief much more and to a more substantial amount, perhaps the Minister for Finance could consider raising this wife relief for women who stay at home in order to give their unpaid work at home, especially in taking care of young children, a bit of recognition. Of course, in the final analysis, we all realize that financial incentives are only partially effective in encouraging procreation. This House has debated at length other measures including child care centres, part-time work, flexi-time work. All kinds of measures can be taken to encourage women to have more children as well as to stay in the workforce. I would not dwell on this now as I am sure other Members of the House would talk about these measures under the individual Ministries. Let me just say that apart from financial incentives as well as supportive measures, the Government should consider placing more emphasis on public education in order to change the attitudes of our population towards family life, parenthood and marriage. The 1989 budget is distinct perhaps, thirdly, by a radical departure from the past in terms of the block vote allocation system. Certainly, such a decentralization would increase the operational efficiency of the individual Ministries or units.”