Goh Chok Tong
Singapore
“This is what your father said during the debate on the Nassim Jade episode: "The proudest thing (for your mother) are her three children − upright, well-behaved and honourable... They are brought up straight, they are likely to stay straight. It is like, as I have said, a code of honour. If you break that code, you have brought shame...”
“They are not just the headaches of the Prime Minister and his team. They are not just the headaches of the PAP. They are also the headaches of the Workers' Party and every Singaporean. On their own, the Prime Minister and his team cannot resolve them. They require us, the Members of Parliament, and the people, to work with them.”
“The national financial education programme, MoneySENSE, continues to work with partners such as the Association of Banks in Singapore (ABS) and the media to educate consumers on the responsible use of credit facilities and the factors consumers should consider before taking on debt. PROPERTY AGENTS' COMMISSION RATES 2.”
“Mdm Halimah Yacob asked the Minister for National Development (a) in 2008, what is the takeup rate for the interim rental housing scheme that is provided to those without homes; (b) what are the reasons given for rejections under this scheme; (c) whether the rental rates were affordable; and (d) how many applicants had rejected the rental…”
“MAS is working with relevant government agencies and stakeholders to study the issue carefully, and to consider the various proposals that have been raised, including the feasibility of introducing a no-fault regime.”
“Mdm Cynthia Phua asked the Minister for National Development (a) if he will provide an update on (i) the use of sustainable alternative materials in the construction industry and (ii) the cost of construction materials in view of increasing inflation rates and rising oil prices; and (b) how will the high material and labour cost impact on…”
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“b Inclusion of lump sum compensation along the lines of the Workmen's Compensation Act with effect from 1st October, 1975. c Providing lump sum compensation for disabled servicemen whose degree of disablement is not serious enough to warrant discharge. Previous to October 1977, such compensation was given only to servicemen who were discharged. d Incorporation with effect from 2nd January, 1981 of the new ceilings of lump sum compensation introduced by the Workmen's Compensation Act then. The disablement benefits are under review to keep them in tack with changing socio-economic conditions in Singapore. The solitary case of 100% disablement in the period 1977-81 involved a National Serviceman private who was paralysed waist-downwards when the 3-tonner he was travelling in overturned on 30th September, 1981. He was given medical leave with full pay until his release from National Service on 16th June, 1982, after he was confirmed as 100% permanently disabled. After his discharge from hospital, a wheelchair with foam seat and a toilet commode were purchased for him. Subsequently, a ripple mattress was supplied him on the recommendation of the Rehabilitation Centre at Tan Tock Seng Hospital. In February 1982, the SAF Central Welfare Fund gave $10,000 as temporary financial relief to the family. Following his discharge from National Service on 16th June, 1982, the following benefits were given: a A lump sum disability compensation of $20,000. b A lump sum of $15,000 for constant attention. c A monthly allowance totalling $300 as disability pension and allowance for lowered standard of occupation. KAKI BUKIT ESTATE (Summonses under State Lands Encroachments Act) 6. Mr J.B.”
“The SAF (Pensions) Regulations cater in addition for various allowances to be paid to servicemen discharged from the SAF on account of permanent disablement due to service, the range of allowances and amounts depending on the circumstances of each case. The types of allowances provided for are: a Disability pension. b Allowances for constant attention, applicable only to cases of 100% disablement. c Allowance for lowered standard of occupation, applicable only if the disablement renders the serviceman incapable of following the regular occupation before his service, and of following any other occupation of an equivalent standard. d Treatment Allowance, for approved treatment, provided the sum of this allowance and the disability pension does not exceed the rate of pension payable for total disablement. e Allowance for wear and tear of clothing resulting from the use of artificial limbs or similar reasons. f Child education allowance if the totally disabled serviceman has children. A National Serviceman who is disabled due to service is entitled to free medical and rehabilitative treatment for his disablement at Government clinics and hospitals even after his release from National Service. Disablement equipment and aids such as wheelchair and artificial limbs are also provided free. In addition, the serviceman's unit and the Central Welfare Fund play their part in the welfare of disabled servicemen as follows: a Regular hospital or house visits. b Hardship grants and ex-gratia payments, depending on the needs of each case. c Re-assignment of jobs and vocations as appropriate. Compensation terms have been improved over the years, the more important milestones being: a Replacement of the Federation Army Regulations, 1961 by the SAF Pensions Scheme Regulations, 1971.”
“134 National Servicemen incurred various degrees of permanent disablement due to service over the last 5 years, as follows: Year 1977 1978 1979 1980 1981 Total Number 16 20 40 36 22 134 The degree of permanent disablement as defined in the SAF (Pensions) Regulations is identical to those in the Workmen's Compensation Act. Thus the loss of a little finger is defined as 10% disablement if one phalanx is involved, 15% disablement if 2 phalanges are involved, and 20% disablement if 3 phalanges are involved. Loss of thumb involving both phalanges is 50% disablement. 100% disablement pertains to loss of two limbs, loss of both feet, total paralysis, and other such cases of extreme injury. Of the 134 cases in 1977-81, only one was 100% permanent disablement. 92.5% of the cases involved less than 30% permanent disablement. Degree of Permanent Disablement 100% 71-90% 51-70% 31-50% 11-30% Up to Total 10% No of 1 1 2 6 33 91 134 Cases % of 0.7% 0.7% 1.5% 4.5% 24.6% 67.9% 100% Total Of the 134 cases, 57 (42.5%) involved accidents during military training and exercises. The remaining 77 (57.5%) arose from accidents not connected with military training and exercises, as when a cook carelessly caught his finger in a meat grinder. Under the SAF (Pensions) Regulations, National Servicemen are given the same types of compensation benefits as regular servicemen. The benefits can be categorised into two parts: a A lump sum payment to compensate for permanent disablement due to service. b Allowances, as appropriate, to meet the basic needs of disabled servicemen. The lump sum compensation for permanent disablement is identical to that in the Workmen's Compensation Act.”
“Mr Speaker, Sir, precisely. If the amendment is not effected, then we are actually asking the Ministers and the Prime Minister, who would have otherwise earned a pension under the existing Parliamentary Pensions Act, to personally sacrifice a large sum of money which is due to them. They would have earned the pension under the Parliamentary Pensions Act if they were to step down from office. Have I put the point across? If I may repeat, under the existing Parliamentary Pensions Act, certain Ministers would qualify for pension if they are not office holders, that is, if they step down from Ministerial office. So what we are, in fact, asking them to do is to make a personal sacrifice of what they would have earned, because they could now retire as Ministers, enjoy the pension, get a job outside; and new Ministers have to be appointed in their place. So there is no saving whatsoever on the Budget. We are, in fact, asking the Ministers who have worked very hard for the benefit of the country to make a sacrifice which is not very proper. This Bill merely seeks to rectify an undesirable anomaly. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Hon Sui Sen]. Bill considered in Committee. [Mr Speaker in the Chair]”
“Mr Speaker, Sir, if the Prime Minister and the Cabinet Ministers who have earned pensions, having served the required term, were to retire and a new Prime Minister and Ministers are appointed, they too will be earning a salary. So, is there any saving at all to the Budget? Pensions will be paid to the Minis- ters and the Prime Minister who have retired and new Ministers and a new Prime Minister will be earning a new salary. So there is no saving whatever to the total Budget. Mr Speaker, Sir, I am trying to pin the Member for Anson down on his point that, given the grim picture which he has painted about the economy, Ministers should not enjoy what is due to them because it adds a cost to the Budget. The point which I am making is that if you were to argue logically, if Ministers who have earned their pension under the Parliamentary Pensions Act were to resign, new Ministers have to be appointed and be paid salaries. So the argument that there is a saving is not logical.”
“Mr Speaker, Sir, I wish to ask a point of clarification from the Member for Anson. Am I right in interpreting that he is not against pensions being paid to Members of Parliament and Ministers? In other words, what is his stand on pensions being paid to Members of Parliament? I want that point to be clarified first. Leaving aside this particular Bill for the time being, what is his stand on pensions being paid to Members of Parliament or Ministers?”
“Mr Speaker, Sir, there is a contradiction in the question posed by the hon. Member. He has mentioned that at the moment employers provide medical benefits to their employees regardless of their wages. In other words, if an employee has to go to the hospital, whether he earns $200 or $500 a month, he would be reimbursed or be given the same benefit. The Medisave Account is not intended to replace the employer's medical benefit scheme. So if the employer were to pay a fixed amount to the employee regardless of his earning capacity into his Medisave Account, the employee would in effect be given double medical benefits. He is already enjoying fixed medical benefits under the present medical benefit scheme and if at the same time he is to enjoy a fixed amount, it could come up to 20% or 30% of income for the lower income worker. The Scheme which we envisage can be modified, however, by employers. Good employers may wish to top up beyond the 6% envisaged for their good employees. There is nothing to stop them from doing so. As for his suggestion that we consider a minimum, I think that is a valid suggestion. If the income of certain workers tends to be on the low side and is unlikely to increase over time, perhaps a minimum would help the employee to build up his Medisave Account. But this is something which we would like to look into carefully before we decide. MULTI-TIER FAMILY HOUSING SCHEME (Effect on Waiting List) 9. Dr Tan Cheng Bock asked the Minister for National Development how many multi-tier families have applied for housing under the priority allocation scheme and how has this affected the waiting time of other ordinary applications.”
“Sir, if his Medisave Account earns interest, then if it goes into the red, he has to pay interest. If the Medisave Account does not earn interest, then, of course, he will not be charged any interest.”
“Mr Speaker, Sir, for those who are not working, their hospitalization expenses will have to come from the working member's Medisave Account. As for the self-employed who do not have a CPF account, our present thinking is that they too must voluntarily have a Medisave Account. This can be done by perhaps charging these people a fee on a cost basis unless they have a Medisave Account, in which case they will get a rebate on the cost which they have incurred for staying in the hospital. This will provide the necessary incentive for the self-employed to start a Medisave Account.”
“For most employees, it is, therefore, an improvement over their present medical benefits scheme. The Medisave Scheme is not intended to replace the current medical benefits schemes provided by employers. It does not cover outpatient treatment, for example. Employers who currently provide medical benefits to their employees may, however, consider modifying their medical schemes to take into account Medisave. For instance, an employer may stipulate that his employee must be responsible, through his Medisave, for the first few dollars of his hospital bill. The employer will take care of the rest. This will provide the employee with an incentive to stay well. Another possible modification is for the employer to upgrade the ward-eligibility status of the better workers. For example, an employer may require all his employees to pay for hospitalization in Class C wards out of the latter's Medisave Account. He may then put the better worker in Class B or Class A wards and paying for the extra charges. Mr Speaker, Sir, it may take me a few more months to finalize the Medisave Scheme. To be sick and unable to afford basic medical treatment is utter misery. We want to ensure that such misery does not befall any Singaporean. There are now many more aged sick who find themselves abandoned by their families because they have become a burden to them. With Medisave most Singaporeans will in future be able to pay for their basic health care with dignity long after they have retired. For those who cannot, they will still be treated. Medical treatment will not be denied to anyone, young or old, on the ground that his or his family's Medisave Account has run out.”
“A detailed study of past hospitalization records shows that more than 90% of Singaporeans were hospitalized only twice or less during the last 10 years. 44% were hospitalized only once, 12% twice and 35% never. 5% were in hospital three times and only 4% more than three times. The hospitalization incidence includes admissions of mothers at the 0 & G wards. We calculate that at a contribution rate of 6% of salary, most households will have sufficient savings in their Medisave Accounts to cover their expected hospitalization expenses. Our calculations were based on charges for treatment in Class C wards. Class C will continue to be heavily subsidized in this decade to ensure that Singaporeans can afford basic hospital care should they need it under the Medisave Scheme. It is possible that some Medisave Accounts may not have sufficient funds to cover hospital costs at the time of hospitalization. For instance, a young worker who has just started working may not have accumulated sufficient savings in his Medisave Account. If he or his family member falls sick and requires hospital care, we may allow his Medisave Account to go into the "red", i.e. giving him the equivalent of a bank overdraft. He will pay it back through subsequent contributions to Medisave. To answer the second part of the question, we know that at present:- (a) not all employers provide medical benefits to their employees; (b) very few employers extend medical benefits to the dependants of the employees; and (c) not many employers extend medical benefits to their employees beyond retirement age. The Medisave Scheme covers all family members. It takes into account the employee and his spouse's hospitalization needs after retirement.”
“Mr Speaker, Sir, the Medisave Scheme affects every Singaporean. I will, therefore, discuss the Scheme with various civic organizations and other relevant bodies before finalizing it. As it is, three talks with 150 CCC members are planned for next month. I will, therefore, not be able to furnish full details of the Scheme today. I will, however, outline my Ministry's thinking on the subject. At present, the combined CPF contributions from an employer and his employee amount to 45% of the worker's salary. This rate is expected to be raised to 50% within the next three or four years. A portion, equivalent to 6% of the salary, will be reserved to form a Medisave Account. The Medisave Account is an individual savings account to meet hospitalization expenses; it belongs to- the particular employee. It is not an insurance account. The contribution is, therefore, not an insurance premium. As the combined contributions to CPF are subject to a ceiling which, at present, equals to $1,350 per month, the 6% contribution to Medisave will also be subject to a ceiling at $180 per month. The employer and the employee will contribute equally, i.e. 3% each. Should the employee be hospitalized and incur a hospital bill, he may withdraw from his Medisave Account to pay for the bill. The Medisave Account also extends to his immediate family members (spouse, parents and children). In other words, he can also withdraw from his Medisave Account to help pay the hospital bill incurred by any of his immediate family members. In deriving at this contribution rate of 6%, my Ministry took into account:- (a) the frequency of hospitalization actually experienced by Singaporeans over the last 10 years; (b) the length of hospitalization, and (c) the services rendered to the patient while in hospital.”
“Mr Speaker, Sir, the Air Force Recruitment Centre was established in 1973 to handle the recruitment of all Air Force vocations. 25,779 males and 2,906 females have applied to become pilots with the Republic of Singapore Air Force since then. Of the total number of 28,685 applications, 908 applicants, comprising 900 males and eight females were selected for flying training. AMUSEMENT CENTRES (Control over operations) 13. Mr Yeo Choo Kok asked the Minister for Foreign Affairs and Minister for Culture (a) how many amusement centres there are in the Republic; (b) whether he is aware that video games available at these centres have an undesirable influence over school children and teenagers; and (c) if the Ministry of Culture has any plan to tighten control over the operation of these centres.”
“The chronic sick in Trafalgar Hospital belong mainly to this category. I will be surprised that they would apply to the Home for the Aged at Jalan Payoh Lai but, nevertheless, it is a matter which I think we can sort out when we have the full facts. I would also assure the Member for Anson that no patient from Woodbridge would be asked to go back to their home unless they are certified by the doctors that it is safe to do so. Sometimes they suffer from relapse and that is because they do not take the drugs which are prescribed to them. The reason for getting the patients to go back to the home environment is, in fact, to help the patients to overcome their mental difficulties. Home environment is all-important to help the mental patients recover from their mental illnesses and if you were to build half-way house it might be defeating the very basis of our treatment which is to get the patients to go back to the home environment where parents, brothers and sisters can help them adjust to society. So I do not think at this stage a half-way house in the treatment of these patients is justifiable.”
“Sir, perhaps I could answer the point. It concerns my Ministry more than the Ministry of Social Affairs. There is a Home Nursing Foundation where about 60 nurses are available to attend to the needs of non-ambulant aged parents who are in the circumstances described by the Member for Anson. The Home Nursing Service is available to people who belong to this group where their own children are unable to look after them for personal reasons. I am surprised to hear that some 10 applications have been made by the Trafalgar Hospital to the matron of a certain home. Either my official has misin- formed me or the Member for Anson has been misled by the matron, so I will be happy to have the facts from the Member for Anson, because it could be a case of my being misinformed or the Member being misled. May I say that Trafalgar Home or otherwise known as Trafalgar Hospital is a hospital for leprosy patients. Those who have recovered, what you call "burnt-out" cases, but have no place to go back to are put into Trafalgar huts. So I will be surprised that patients of this category from Trafalgar Hospital -”
“Sir, the Member for Thomson is a level-headed person and my Ministry will take up his timely suggestion to make mention of the comprehensive preventive occupational health programme in the National Health Plan. Dr Chau Sik Ting: In view of the Minister's level-headed reply, I beg to withdraw my amendment. Amendment, by leave, withdrawn. The following amendments stood on the Order Paper Supplement:”
“Sir, I think we can ask the press to publish the whole section on Health and let the public be the judge.”
“Well, may I just make one final point, that my colleagues and I have every intention of building on the efforts of the first generation leaders so that our children and our children's children will have an even better life. We will do this through hard work, prudent management of the economy, the health services, our resources and savings. We will not throw Singapore away to charlatans, opportunists and irresponsible scallywags. They have a lot of bluster but no bite.”
“- and we want to pay the doctors and nurses better and, of course, those in Divisions I, II, III and IV better, the sums just do not add up. So there is a relevance between what I am touching on in transport as well as housing and the other areas which do not concern health. "Profits" appears to be a dirty word to some people. But "profits" is not a dirty word. "Losses" is a dirty word. "Surpluses" is not a dirty word. "Deficit" is a dirty word. Without profits and surpluses, how is the SBS going to get the capital to buy new buses and improve the services for the public? There is no need for the PUB to make a profit because the PUB has no shareholders. No one receives any dividends. But it must make a surplus every year in order to pay for future development. Most of us here are fathers, I believe. Our instinct is to work hard and save for our children unless we are totally incompetent, lazy and irresponsible, so that our children will have a bright future. Every primary school child knows the story of the grasshopper and the ant. The ant worked throughout summer to save food for the winter. Unfortunately, we in Singapore have got to work like ants, saving food for the future. The grasshopper played in summer, living on subsidies, and perished in winter. The Workers Party owes Tay Boon Too a big sum of money. It teeters and totters on $18.47 in its account. I think there is a lesson here for us. If an aspirant to political power cannot manage the financial affairs of his own party, never trust him with SBS, PUB, HDB or the health service. The reserves which these institutions have accumulated for future expansion and for the benefit of the next generation will be down to $18.47 very quickly. We will then be sorry but it will be too late. 7.30 p.m.”
“- then we are all in trouble. This has a relevance, Mr Deputy Speaker, Sir, because we cannot talk about subsidy or free services in isolation. The Government governs the whole country. If we want to have free medical services, cheap transport, heavily subsidized housing, lower taxes, higher income reliefs for the poor which also apply to the rich - An hon. Member: Money from the sky!”
“Nationalized and, of course, the services will have to be provided cheaply to the public, not just efficiently. We have no quarrel if it is cheap and efficient. But if it is inefficient and cheap -”
“In May 1980, when I was the Minister for Trade and Industry and long before I had any inkling that I would be transferred to the Ministry of Health, I suggested to the Minister for Social Affairs to set up a committee to look into the care of the aged. That was as far back as May 1980. The committee completed its report in September 1981. I believe his Ministry is looking into the recommendations with a view to implementing the recommendations in the report. I want to come back, Sir, to the question of free medical service, subsidies, and suggestions of more welfare. In the debate in Parliament so far, the Member for Anson, if I read him correctly, wanted to achieve an efficient and comfortable public transport. He wanted the public transport to be nationalized. He did not quite use the word "subsidy". So I might have read him wrong.”
“The effort must begin at home with parents looking after the young, teaching them the tradition of filial piety through their own example of looking after their parents. They must set the example of looking after their parents if they hope their children would look after them when they become old. The schools must play a part; hence the teaching of moral and religious education. Even the HDB can help by giving priority in its allocation to three-generation families and also through its mechanism of joint balloting. It is recognized that sometimes circumstances are such that the children are unable to look after their parents, not because there is no abiding tie between the children and the parents but because of personal circumstances or maybe the aged are without children, relatives or friends. To take care of such difficult or unfortunate situations, we would like to encourage voluntary organizations to take a more active role. These institutions manned by volunteers have that extra warmth which state institutions cannot hope to match. The Chinese clan associations have always looked after their aged sick, the infirm and the destitute. It is an obligation born out of comradeship and the spirit of mutual help as a migrant group close ranks in a strange foreign country. Various temples and churches also play their part. We want to work together with these voluntary organizations much more closely in the future to take care of the problem of those who may not have families to look after them. My Ministry together with the Ministry of Social Affairs is looking into this. I hope no one will claim the credit of forcing the Government only now to look into the problem of the aged sick.”
“But he is an honourable man, a god-fearing man, and I have no reason to doubt the sincerity of his compassion. I mentioned just now that the problem of the aged sick will become a more and more serious problem in the years to come. In 1957, only 4% of the population were over 60 years old and the number was 55,300. This is not the figure of the aged sick but simply of people over 60 years old. In 1980, the absolute number had gone up to 173,622. By the year 2000, we would have a population of 270,000 people over 60 years old. So the problem of the aged sick must increase over time, and we should move in to anticipate - as we are now doing and as we have, in fact, done earlier - the problems which will loom in the years to come and solve them before they become a real problem. No society can call itself civilized if it does not take care of its old. It is a barbaric, uncivilized society that turns its back on its elders. Caring for the old, particularly the infirm and chronic sick, is first and foremost a family responsibility. Institutional care must be the last resort as it can never replace the warmth and comfort of the family home. It must never become the first choice. It is all too easy to shunt aged parents and grandparents into state institutions and we must not make it easier by thoughtlessly encouraging this. We must guard against the transfer of responsibilities from the family to the society. If our society ever becomes one where the old are discarded like old socks, then it is a society not worth preserving or working for. Our philosophy in resolving this problem is this. Each family must be encouraged and facilitated to look after its elders.”
“I am not being funny because there are places available in Woodbridge and people are not turned away to private homes. I have checked this again and again with the Director of Medical Services and I have myself visited Woodbridge. That is the position as of now. There are places available in our chronic sick hospitals, Woodbridge and Trafalgar Home. And this can be easily checked by making an application. If the Member for Anson is genuine in his concern for the aged sick, then it is a laudable concern because the problem of the aged sick is indeed a very serious one. And I am not drawing any conclusion. If it is just a ploy to win a few votes, then I think he would have demeaned himself by using the poor, the chronic sick as political cannon balls.”
“If the Member for Anson does not believe me, he can apply for a place in Woodbridge and he will find he can get a bed in Woodbridge. [Laughter]”
“I think once again, Mr Deputy Speaker, Sir, that that is based on rumour.”
“May I ask, through you, Sir, whether he has visited Trafalgar Home and the Woodbridge Hospital where we have quite a few hundred chronic sick patients?”
“Those - [Interruption]. Sir, I believe I should not be conversing with the Member for Anson. If I do so, I should do so through the Chairman in the appropriate manner. We are not a give-away society and we have no intention of giving away our society through free medical care for all regardless of the capacity to pay. We are conscious that there is a group of Singaporeans who through no fault of their own sometimes cannot afford to pay for the subsidized rates. But the way to take care of this problem is to give them a conscious specific subsidy and not to have a system that is so generalized that anyone can take advantage of it, even those who can afford to pay the token rate. A generalized subsidy system is unfair. It would only overload the system and in the end the strain must break it. Our approach is to give free medical attention to those who deserve it, including those on public assistance or in social welfare homes. In the last 2 1/2, years, fee remissions were given to 2,743 in-patients and 9,324 out-patients. These patients were treated free in the hospitals. 7.15 p.m. We have a school health service that also screens students and those who are under-nourished or appear to be under-nourished are given free feeds, Ovaltine, sugar, groundnuts, milk, eggs. Quite a few students who appear under-nourished - maybe there is no relation between their under-nourishment and their household income but they appear under-nourished - are put on these health foods under our school health service. And I should not forget to mention free spectacles and free dental service to the poor students. The Member for Anson showed concern for the poor, the chronic sick and the aged sick.”
“I thought it was not for free just now. Now it is for free. Does he not know that the percentage of C-class beds in the hospitals has been 83% for over 10 years until last year? We have taken steps to reduce it to 71% this year. 83% of our hospital beds belonged to the C-class rate where the quantum of subsidy was 90%, $7 per day in C-class, which means a subsidy to the tune of 90%. Anyone in Singapore can have access to the C-class ward. Hence, the reason for the very high percentage of beds in C-class. Those earning more than $750 were also taking advantage of C-class rates. Hence, our taking steps to lower the proportion of C-class beds from 83% to 71% last year. At the same time, we also felt that there was a demand for better class wards, the B2 and A1 wards. The 90% subsidy excludes the capital cost. The cost of providing one bed is $200,000. Of course, we have got to amortize it over a period of years. The capital cost is $200,000 per bed, and this has not been taken into account in the calculation of the subsidy for patients in C-class. If 10% fee recovery is too high, then perhaps the Member for Anson is advocating that it should be made free for all citizens. But I have lost track of his thinking. It has somewhat befuddled me. On the one hand, he said that it should not be provided for free and, on the other hand, he has been shouting, "free". So I do not know his real position. We are not a give-away society.”
“If he has any evidence, let him produce it. If we use $600 or $750 as an indicator of those who should be given hospital services at a cheap rate -”
“If the Member for Anson does not believe me, I suggest he holds a baby show in Anson so that he can see for himself whether my claim that never before have our babies been so healthy and so well fed is true. [Laughter] If he does not want to hold one in Anson, the Member for Khe Bong can invite him to one which can be held in any constituency which he may choose. [Laughter] I would make another claim. Never before have our people better prospects of living to a ripe old age. This would put paid to whatever allegation anyone makes that we are not looking after our population, especially the old. If we do not look after our old, Singaporeans would not have a life expectancy rate of 71 years. Had we not been looking after our population, the Member for Anson would not be here to talk about it because there would be no people who would live beyond the age of 60. There would have been no old people in Singapore, or very few of them. For the developed countries, the life expectancy rate of the United States is 74; West Germany, 74; Australia, 73; Japan, 76 and United Kingdom, 73. For Singapore it is 71. And do not forget that we are in the tropics, not in the temperate zone. Our ASEAN neighbours have a life expectancy rate ranging from 50 to 61 years. So we are 10 to 20 years ahead in terms of living to a ripe old age in Singapore as compared to our neighbours. In India, 52 years; in other words the moment you are born in India, you will live 20 years shorter than those born in Singapore. That is their life expectancy. I believe the Member for Anson has at least one good doctor friend. He can ask the doctor friend or doctor friends whether he or they can produce any health indicators to prove that we have not taken good care of our people.”
“The whole lot will bring me to taxation and land acquisition which I think it is not necessary for me to do so. Members who are interested can borrow a copy from me later on. There was no copy-right, so we have photocopied it. [Laughter] It is a serious matter. Let me go on. I would like to offer irrefut- able evidence, hard evidence, to show that this Government has taken good care of the population, not just the rich, the middle income group, but every one in Singapore. One hard indicator of impoverishment and poor medical services is the infant mortality rate, infants who die within the first year of birth. If you have a high infant mortality rate, that is an indication of an impoverished society with an impoverished medical service. For Singapore for the year 1951, before the PAP took over, the infant mortality rate was 75.2 per thousand population. In 1960, just one year after the PAP had taken over, it dropped to 34.9 per thousand. In 1980, it was 11.7 per thousand. This in itself means nothing. We should compare it with the experience elsewhere to see whether we belong to the group that has better medical services or the group that does not have them. The infant mortality rate for the United States is 13. Just remember that for Singapore it was 11.7 or 12. For West Germany it is 15; Australia, 12; Japan, 8 (amazing) and the UK, 13. For the developing countries, Taiwan it is 25, Malaysia, 44; Philippines, 65; Indonesia, 91; Thailand, 68 and India, 134. Let me offer another hard evidence: maternal mortality rates, that is, mothers who die during childbirth. In 1951 it was 1.6 per thousand for Singapore. In 1960 it was 0.4 per thousand. In 1980, nil. Never before have our babies been so healthy, so well fed.”
“Sir, perhaps I should pass this copy, through you, to the Member for Anson, in case he has forgotten.”
“I have gone through it. To be fair to the Member, I will read the whole section on Health. 'The Party plans to take medical services to the people and to establish hospitals and clinics in various parts of the island to avoid hardships to our citizens in having to come all the way to hospitals in the city.' That, we should not find too much fault with. 'The Party is also concerned with the dissatisfaction felt by doctors and the medical staff in Government hospitals and will take steps to remedy the conditions with which dissatisfaction is felt.' Again, we cannot quarrel with that. That is all that is said about health. So I am surprised, or maybe I should not be, about his position on free medical service. I think a few days in Parliament have changed the thinking of the Member for Anson for the better. I do not know whether the Member for Anson is good at figures but, according to the data which I have here, those earning less than $750 household income comprise only 34% of the population. If we make our services free to all regardless of their capacity to pay, it means we are opening it up to a greater percentage of the population who earn more than $750. That was the point I made earlier in the day when I talked about those who can afford overloading the system to the detriment of the poor. Has the Government neglected the population, in particular the poor? We should not just affirm that we have, because that would be following the practice of the Member for Anson who simply asserted lie after lie hoping that the lie will become true.”
“That is right. [Interruption]. The Party objective went on to say: 'The Party would take active steps to introduce a free health service for all citizens without any discrimination based on wealth.' 7.00 p.m. Of course, there is the usual political catch. 'Today because our poor cannot afford to pay for the basic medical treatment, the rich with all the wealth will get the best treatment available in the country. The Party is committed to changing this.' What is the meaning of free medical service or free health service for all citizens without any discrimination based on wealth?”
“You have heard him, Sir, and he said that he has never said that. He is an honourable man, a god-fearing Christian. I have got his "Towards a Caring Society" published in 1976 and sold for a dollar. Nothing is for free! Under the paragraph on Health, this is what his Party aspires to achieve. In case he has forgotten what he has written, let me quote it to him: 'The Party is committed to immediate repeal of the charges that are now being levied at Government hospitals and clinics regardless of the capacity to pay of those seeking treatment.' What does this mean? "The capacity to pay" means whether you earn $1,000, you earn $600 or you earn nothing, you are entitled to free medical service. An hon. Member: But he said he never said that.”
“We will come to that by and by. I will give another example of a Chinese patient, aged 15 years. He comes from a family of six, consisting of his 50- and 45-year old parents, two brothers and two sisters in school. They were living in a shophouse. His father was unemployed since 1978 because of his sickness due to hypertension, while his mother worked as a cleaner earning about $310 per month. His elder brother was a first year student in the Nanyang University at that time. His second brother worked as a welder earning $290 per month. The total family income was about $600 per month. This boy was in hospital for about three months. The size of his bill amounted to $1,190 and this was also remitted. The Member for Anson in his usual form made the allegation that the Government has failed to look after the needs of Singaporeans. But before that, in my own assessment, the Member for Anson has changed his attitude somewhat towards medical care. He is now saying that medical care should not be made available free to all, but only to those who belong to the poorer group.”
“Case number one. An 85-year old Indian Singaporean was admitted to Sembawang Hospital and stayed there for about five months sometime last year. He was suffering from chronic ulcer of the left foot and chronic obstructive lung disease. The patient is a widower. He was living with his daughter, son-in-law and a 15-year old grandson. In this case he was on public assistance for several years but this was stopped in January 1980 when his daughter started working. However, his daughter was subsequently medically boarded out as a sweeper. She was then, at that point of time, receiving treatment for a chronic skin disease at the Tan Tock Seng Hospital. The patient's son-in-law worked as a sweeper earning about $350 per month. Unfortunately, he.was a habitual drinker and had received warnings about his poor job performance due to frequent drunkenness. His grandson did odd jobs on and off and earned about $100. So here there is a family with an income of about $450. The fee remitted amounted to $2,176. The case was looked into and the fee was remitted.”
“But I would disabuse you of the notion that free medical service is available to only those on public assistance or the truly destitute. There are people, in fact, with incomes around the $600 level whom we have looked into depending on the merits of each individual case and have decided that there are justifications for fee remission. While we subsidize heavily C-class hospital beds, it is considered that there are some people in Singapore who, because of their financial situation, are unable to meet even this low subsidized fee, and when such a situation comes to our attention we ask our medical social workers to investigate and free medical service is given on each justifiable case. Perhaps I can answer the question better, Sir, by giving a few examples. These are real examples, not just statistics. An hon. Member: Not rumours.”
“But he was using the term "lower income" Singaporeans who aspire to buy cars. Was he serious when he made the statement, or was he aiming at something else? Anyway, we need not debate the point, That is not the fundamental point.”
“Sir, neither am I aware that those falling within this group are in a position to buy cars. But in the debate here the other day on public transportation, the Member for Anson was making a point in favour of car owners and I believe he was trying to show as much sympathy as possible for them.”
“Sir, we can take it that the Member's understanding of "poor", i.e. those who are in need of subsidized or free medical services, will be those whose household income level is below $600 or $700. Would this be the same group of people who aspire to buy cars? The Member for Anson was making a point, I think two days ago, that the lower income group aspires to buy cars. Would this be the same group of lower income Singaporeans that he is talking about?”
“His mother wanted to use this to encourage more such donations. Incidentally, on the same day a live donor transplant was also carried out between siblings of another family. This patient is also doing well. Kidney dialysis cannot be seen in isolation as a form of treatment of chronic renal failure. Kidney transplants must complement the process. To conclude, I have taken note of the Member for Thomson's concern for patients suffering from renal failure, and we will do as much as we can to help solve the problem.”
“This will be done. The Ministry will also consider the Member for Thomson's suggestion of providing more facilities for self-dialysis at appropriate new centres. This will take quite some time but we would put in more facilities, subject to manpower and resources constraint. Voluntary or community organizations can also and should supplement the efforts of the Government. An example is the National Kidney Foundation's Haemodialysis Project at the Kwong Wai Shiu Hospital which is coming on stream. This will provide facilities for 40 patients. Facilities are also available in the private sector, but I agree these facilities are often beyond the means of many of the patients. Haemodialysis is no substitute for kidney transplant to achieve a better prospect for cure. The public can help to ensure a better lease of life for the unfortunate renal patients by supporting the Kidney Bank. A successful kidney transplant will not only give renewed hope to the recipient but will also create a vacancy for those waiting their turn for dialysis. There were only 18 kidney transplants done in 1980, due to the lack of live or cadaveric kidney donations. More of such transplants can and should be carried out if more donors are forthcoming. A few days ago a 20-year-old Malaysian male was the unfortunate victim of a motor-cycle accident. He sustained fracture of the skull with severe brain damage, from which he did not recover. His mother gave her consent for her deceased son's kidneys to be donated. The cadaveric transplant benefited two of our patients-on 13th March this year. So far, one of the two cadaveric kidneys is functioning well. In keeping with the mother's wishes adequate publicity will be given to the donor, the late Mr Ang Kee Seng.”
“Sir, the Member for Thomson has touched on a difficult area of medicine. I sympathize and I feel strongly for those so unfortunate as to be afflicted with renal failure. The problem of patients with chronic renal failure is not unlike the problem of the aged sick and the chronically sick; for example, patients at Trafalgar Hospital and Woodbridge Hospital. It is an area where we can never do enough because of the magnitude of the problem and the unfortunate fact that the sicknesses are long lasting, unlike episodic illnesses which can be treated in the hospitals, where the patient is cured and dis- charged. Nevertheless we must do as much as we can for the chronic sick, including those who suffer from renal failure, within the limits of our manpower and financial resources. Each year we register about 150 patients with chronic renal failure, 60% of whom are between the economically productive age of 20-49 years. Treatment of patients with chronic renal failure is presently limited to dialysis and/or kidney transplants, dialysis being the established procedure for the prolongation of life in terminal renal disease and renal transplant the apparent cure. Presently, a haemodialysis machine costs $25,000. The recurrent cost of treating each patient amounts to $10,000 each year. To cope with the problem of chronic renal failure a renal unit was established in Singapore General Hospital in 1968. A self-dependency dialysis unit at Alexandra Hospital was set up in July 1974. This facility can cope with 54 patients, far below the required figure. I have taken note of the suggestion of the Member for Thomson that the self-dependency dialysis unit at Alexandra Hospital should mount an additional shift so that 22 more cases will be made available to such patients.”
“Sir, the Member for Telok Blangah has one good quality. He persists at a problem until he gets it solved. He wrote to my predecessor on this subject in 1980. He raised it in Parliament with me last year, and he is now raising it again. As a result of his persistent championing of mothers and young babies, the Ministry's Pharmaceutical Department conducted tests on the suitability of using freeze-dried ampicillin granules. Based on these tests and the lower tender prices than originally expected, the Department decided in May 1981, i.e. two months after the Member raised it in Parliament, to purchase dried ampicillin granules. As from June 1981, dried ampicillin granules instead of capsules have been supplied to paediatric patients. It is simple to mix the granules with water before use and the mixture can be more easily taken by young children. The granules cost four times more than the capsules. Last year when they estimated it, it cost 10 times more. Hence the reason for the switch.”
“Therefore, I can give the assurance to the House that no one need fear that he would have inadequate savings in his health account to finance his hospitalization needs. Even if he does not have sufficient savings in his account and even though the insurance does not cover him adequately, in other words, he is a true indigent, a destitute, he will be fully taken care of by the hospitals. Patients will have to pay a little bit more than now at the point of hospitalization. I can assure the Member for Kebun Baru that hospital charges will creep up slowly and almost painlessly. Class C will continue to be heavily subsidized so that all can have access to medical care. The truly indigent will be treated free as of now. They will not be turned away. 6.15 p.m. The Health Plan will not reduce the take-home pay of employees. It may or may not increase the financial burden of employers. We are still working that out. But if employers are required to contribute, it will be a token amount, tied in with our move towards company welfarism. The sums have to be carefully worked out and the intricacies of the scheme carefully thought through. I know Members are see-thing with questions but I would ask them to hold their horses. They can have a field day later when the details are finalized and made public. I believe I have answered all the queries of the Members who touched on this subject.”
“To solve their financial problem their governments have to periodically increase taxes or the levy on wages. People must be motivated to stay well and minimize their visits to the hospital or the clinic. They have to pay something at the point of consumption to prevent over-use. This is the basic philosophy behind the Plan we are working out for Singapore. We are studying the feasibility of a compulsory health savings scheme. Unlike the levy in West Germany or France, the fund collected will belong to the individual employee. It will not be siphoned off into Government's Consolidated Revenue nor will it be lumped in a common insurance pool. It is a savings scheme, not a pre-paid health insurance scheme. This will be the critical difference between our plan and those now found in the UK, Australia, France and Germany. If a person needs to go to a hospital, he will have savings to meet the expenses. If he stays well, the money is his. The savings scheme would be sufficient to take care of the hospitalization expenses of the wage earner and his dependants. Over the longer term, if we project 20 or 30 years from now, when the current workers who have funds in their savings scheme for health purposes grow old, they will have sufficient funds in their savings account to look after themselves in old age when the need for medical attention is more. But there are people who are more prone to illnesses or long illnesses. We are therefore also considering a partial insurance scheme to take care of these people. For this group of people, the savings in their health account would not be sufficient to look after their needs. There will have to be some kind of a partial insurance scheme to finance the hospital expenses.”
“Sorry. For France, it should be 3% from the employee and 11% from the employer. For Singapore, a levy on wages may not be a bad idea because it is forced saving to finance future consumption of health services. Most people forget or tend to forget that they must save to look after their health needs, just like they have to save to buy new clothes or HDB flats. A levy on wages is, therefore, not such a bad idea. It is better than general taxation because it is a specific tax for a specific purpose. The Achilles' heel of the health system in the UK, Australia, USA and other advanced countries is not the method of financing but the lack of control in the utilization of medical services. It is also our vulnerable spot. Human beings are selfishly shrewd. Having paid for health services in the form of taxes or levies, they naturally want to consume them to get their money's worth. Patients are known to have collected vitamin and iron pills, under the British National Health Service, not for themselves but for their dogs. In the US, those on welfare are also known to have stretched the definition of dependants to include dogs, cats and other four-legged pets. Surgeons become liberal in using their scalpels and physicians in dispensing medicine. All those countries with a pre-paid comprehensive national health system have learnt to their horror that the demand for health services is virtually bottomless since direct payment at the point of consumption is either nil or insignificant. The system has a built-in bias towards over-using the medical facilities. It contains no disincentives at all to minimize usage. It does not motivate people to stay well. Most of the national health schemes, therefore, suffer from insolvency. All are extremely worried about the escalating costs.”