Janil Puthucheary
Singapore
“Sir, I thank Ms Lee for her two supplementary questions, which address what are our targets and what is it that we measure. Indeed, the issue of how we should think about recycling and waste disposal will be at the heart of our review of our Zero Waste Masterplan.”
“Another strategy that we are embarking on is the strengthening of the reuse of waste residue and treated toxic industrial waste before and after they are landfilled.”
“Sir, about half of our recycling material is exported. It is processed overseas. There are business arrangements between businesses here in Singapore and businesses in the region or overseas, to be able to handle the recycling of waste and recycling of material, whether domestic or non-domestic, already today.”
“Sir, I thank Ms Poh for her questions. Indeed, we do have to shift behaviours. The incentives and disincentives around recycling and waste disposal are an important part of it. We will consider her suggestion on looking at the fees.”
“The heat advisory that goes out is clearly defined. In my original answer, I explained what a heat wave was. There are clear definitions that we have been using in Singapore since 2016, if I recall. It was then last revised in 2023.”
“Sir, in the planning of schools, the Ministry of Education ensures that our students can access a primary school near their homes. Except for a small number, 15 of Special Assistance Plan schools, all primary schools offer the three official mother tongue languages.”
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“Mdm Speaker, I had a second supplementary question about whether most youth offenders were previously identified as being at-risk individuals.”
“Mdm Speaker, I would like to ask the Minister a couple of supplementary questions, please. He has rightly pointed out the need for a significant deterrent effect. For youth offenders, the effectiveness of this may be reduced because of the lack of understanding and awareness. Are there further measures that the Ministry can take to work with at-risk individuals to try to prevent them from offending in the first place? My second supplementary question is: of the youth offenders that he has identified, is there some sense how many of them were already previously identified as at-risk? Is that a Page: 41 difficulty that we face when most of them are not knowingly identified as being at-risk of committing such an offence?”
“Will the civilian officers and the community wardens be given legal protection to the same extent as a regular Police Officer should anything happen to them while they are on duty? Whether the officer concerned is a civilian specialist, a community warden, an APO or a regular Police Officer, the public needs to recognise the important work that they do, we need to cooperate with the Police's work to keep us all safe and to recognise the good work of these men and women who step forward to serve. This Bill also proposes that the various SPF logos, insignias and uniforms be protected, and anyone found using the logos, insignias and uniforms without permission may be jailed or fined. It would apply to those distributing or selling these items. There are retailers who are stuck with stocks of these products and they are unsure of what they should do to avoid committing an offence once this Bill is passed. Is there any way that they can be given time to clear their stock? Could an interim period be given to sell off these stocks, especially apparel, to full-time NSmen, provided that these servicemen provide proof of their identity in the force? Madam, an effective SPF is crucial to maintaining the Singapore we are proud to call home and I support the Bill. 2.03 pm”
“The Singapore Police Force or SPF has kept Singapore safe and secure. We are fortunate to enjoy a home that is a thriving global city without high crime rates and no threats to personal safety. This is due largely to having a capable, efficient and trustworthy Police Force. This Bill seeks to enhance the operational effectiveness of our Police Force in several ways, including manpower assistance. It will enable the Ministry to equip civilian officers, such as forensic specialists and community wardens, with powers to assist the Police with their duties. While this measure will boost the capacity and reach of the Police Force, I have some concerns that I hope the Minister can address. Firstly, what will be the extent of the training and evaluation of the Civilian Officers, to ensure that they have the skills and competence to carry out their tasks, and to keep the public, themselves and their fellow officers safe in the line of duty? Secondly, will they have the same authority as regular Police Officers to engage the public as needed? Madam, the SPF has had APOs in service for some time. As a result of this Bill, the legal powers of the APOs will be affected. Will this have an impact on their ability to be effective in the front line of police duty? Do APOs have the skills and competencies needed to carry out their duties effectively? Page: 61 There have been several recent cases of members of the public being abusive, threatening or violent towards our Police Officers. While this behaviour by a small section of the public is of concern, representing an indifference to the uniform and what it represents, it is likely to be a factor within the environment that our SPF officers would have to operate in.”
“Mr Chairman, the recruitment and retention of preschool teachers in the anchor operator and partner operator preschools is crucial in new towns like Punggol. While we can make spaces available for the operators to build childcare centres and kindergartens, the recruitment and retention of the teachers become the rate-limiting step for the number of spaces that can be made available for the children. And I am concerned about what are the plans of the Ministry to increase recruitment and retention for preschool teachers. The second issue I would like to bring up is the issue of the Anchor Operator (AOP) Scheme and the new Partner Operator Scheme with respect to Mother Tongue Language provision. There is quite a lot of effort put into the provision of Mother Tongue Language teaching in primary schools so that our primary schools provide an environment where children of all backgrounds get an opportunity to mix and socialise and learn about each other, and this may be as important in the preschool sector in bringing on board new partners and in developing the Anchor Operator Scheme. What is the Ministry doing to assist the provision of Mother Tongue Languages across all four Mother Tongues in the preschool Page: 153 sector? Clustering Preschools”
“I would suggest that this regulatory framework should be studied and reviewed with the aim of reducing the cost required to develop and own a new product. All these would, hopefully, give a few Singaporean businesses the foundation, the research grounding, the market and market experience to have high quality, affordable Page: 113 locally-developed hearing aid that might be able to serve the needs of a rapidly ageing Asia. We spent millions of dollars in altering our physical environment so as to provide barrier-free access to our citizens who face challenges in mobility. There are other barriers that can prevent one from seamlessly integrating with the society on a daily basis. I have highlighted hearing loss as one, and I hope that the Ministry will see this as a pressing need in making Singapore a more inclusive society for all. Disability Prevention”
“We could have a prize offered on a shared basis by both the public institutions and the private sector to incentivise the Singaporean start-up to translate the engineering into a product to bring to market. We would also need to change to the market environment, firstly, by making the use of hearing aids more socially acceptable. I am always struck that the taxi uncles and various people are quite happy to have a very large Bluetooth earphone, sometimes with a blinking light, but the seniors, including my elderly relatives, are very concerned that their hearing aid are as discreet as possible. What if we develop a hearing aid that was externally indistinguishable from the Bluetooth headphones or the iconic white headphones of a particular brand of smartphone. Further, in order to incentivise the research and the business, we could make some changes to ensure that they will have a larger market to serve by increasing the number of seniors who would be eligible for a subsidised hearing aid provided that it was locally developed and below a certain affordable cost. One further variable would be the issue of the regulatory framework. I agree that the recommendation, prescription, maintenance and ongoing service of the device and the user should continue within a well-regulated framework as cause of hearing loss may well be a disease. However, headphones that are used for listening may be worn for just as much time and may potentially generate just as much damage if used incorrectly. To classify one as medical device and the other as an IT peripheral is anachronistic and adds to the cost burden of developing a new product.”
“There are a number of mechanisms to assist in the purchase of hearing aids from the Centre for Enabled Living, the Agency for Integrated Care. These are means-tested and much appreciated by the beneficiaries. The real problem is the underlying cost which is a significant barrier. A hearing aid is essentially a microphone, a speaker and a processor. These are components in every smartphone which retail for significantly less. The engineering has to be of a high quality for it to be adequately miniaturised. But the two main reasons for the high cost are the market oligopoly – there are about six companies worldwide, three are active in Singapore – and the regulatory framework for these devices. The second factor, the regulatory framework, imposes a high cost on the development and testing processes of a new model and further constrains the process by which can be made available in the market only through licensed practitioners. Page: 112 I would like to suggest that this is an area ripe for disruptive innovation. If we in Singapore could develop a cheap and effective hearing aid, leveraging on the excellence in precision engineering that we have, together with the biomedical sciences we could have a product or a series of products which will have significant market as the rest of Asia ages along with us. We will engage two of the growth clusters – applied health sciences and advanced manufacturing – described in the Budget. How might we do this? We could begin by supporting this initiative within the engineering departments of our Institutes of Higher Learning with dedicated research grants.”
“Madam, Singapore's fast-ageing society will bring about a host of challenges and issues in healthcare that may require a rethink in terms of how we provide assistance to those who are in need. One particular area which I would like to highlight which requires more attention is people who suffer from hearing loss. The increase in number of seniors who have gone through evaluation tests for hearing loss: 6,800 in 2010 up to 8,600 cases in 2012 and the figures will keep increasing. There is no single cure for age-related hearing loss because there is no single disease and often there is no specific disease but, rather, a process associated with advancing age. People of any age with hearing loss become more socially isolated, become less able to contribute to conversations and are unable to engage effectively with family and friends and be part of everyday social life. This can lead to a significant reduction in the quality of life as it impacts on social interactions, the willingness to venture out of one's home, the ability to easy access public resources and the enjoyment of culture entertainment in public spaces. Hearing aids help and often can be life changing but they are extremely expensive, especially those that are comfortable and provide good sound quality. Prices range from $500 to as high as more than $6,000. With an average life expectancy of a device about five years, there is also a significant recurring cost. Very often, a senior using a hearing aid for the time will choose a simpler, cheaper model but then becomes frustrated with the fit and the sound quality, and end up not using it, retreating back into relative social isolation.”
“I hope that such a framework would lead to an increased use of such devices in an appropriate way and a decrease in the demand for cars.”
“Mdm Chair, the pace of technological development is high, with significant innovations and inventions being brought to the market for last-mile personal mobility solutions. It is especially driven by improvements in battery technology, allowing a fairly small device to transport an individual for reasonable distances, especially to and from a major public transport node. Examples include light-weight electric scooters and small electric self-balancing unicycles. Each new device appears to come to the market ahead of regulatory consideration. So, often, the first question upon receiving the device is: is it LTA-approved? Sometimes, LTA, on questioning, neither specifically approves nor bans the device, an example being the recent issue with electric scooters. This leads to a situation where a group of users is left uncertain about whether they can utilise the device as intended and, if an incident or accident occurs, how best to deal with it and where they should be using these devices. These devices potentially offer excellent last-mile solutions because they are light and easily stowed on public transport. They are non-polluting, with no emissions as they are battery-powered and have the potential to allow a car driver to far more easily make the transition towards becoming a public transport commuter. Page: 91 I would support their further development and use in appropriate situations. Rather than evaluating each technology or device long after it starts to become popular, can we develop a consensus framework about how to decide if a particular device for usage is acceptable or not so that, if and when a new device is made available, it is immediately and reasonably swiftly clear where it can and cannot be used and how it can be used.”
“Sir, the MSO initiative was very well-received when it was announced by Prime Minister Lee at the National Day Rally, highlighting the underlying frustrations of many in dealing with problems that cut across very arbitrary administrative boundaries, as you pointed out, Sir, involving different agencies. How effective has it been at its mission and intent to coordinate across these agencies? Are there further areas where cross-agency and cross-Town Council coordination would be beneficial both at the municipal and national level? MSO's Network of Agencies”
“Mdm Chair, the PGP was significant not just for the scope and scale of the policy and the underlying philosophy but also for the considerable effort put into communicating the changes and its implications to the beneficiaries involving multiple media, a range of messages and tools, the use of dialects, as Page: 38 well as face-to-face communication through the PG Ambassadors. This unprecedented effort is well appreciated by the seniors and their families. 12.45 pm There are likely to be other policies and policy changes which are as complex or as important in the future and it would be important for these to be communicated in as optimal a way as possible. Are there learning points from the PGP communication efforts that the Government will take forward towards other important issues in the future?”
“Mdm Chair, the safety of all road users is something that we will have to continually work at, as young people learn to drive, as seniors continue to drive for longer, as more people of all ages ride a motorbike or cycle and as the different forms of commuters come into contact more often. We are lucky to have such well-maintained and well-constructed roads, but these are a temptation for some drivers to speed. In newer towns like Punggol, especially where people have not yet moved in, these well-constructed and well-maintained wide, straight roads are a natural venue for illegal racing. Despite its unending nature, road safety is important because the lives at stake often are not the culprits, they are the innocent victims. The culprit is the person who chooses to drive at excessive speed and the victim is often the pedestrian or the passenger. Could the Minister please provide an update on the road safety initiatives and how effective these interventions have been?”
“Mdm Chair, our heartland neighbourhoods are changing. In rapidly growing new towns like Punggol, we have larger numbers of young couples and families moving in. They are living away from their extended family and childhood friends. Families are increasingly fragmented and deep networks of trust and social reciprocity have yet to be formed. The nature of the threat of crime has also changed, as was described by my colleague, with more scams and cybercrime, less violence and housebreaking. These changes will continue for some time and the nature of the challenge for Home Team officers will change. Page: 12 How has SPF modified its processes to better engage with residents and improve trust, neighbourliness and a sense of responsibility? Are there new skills, processes and techniques that the officers need at hand? How has this been balanced with the need to keep our neighbourhoods secure in the face of changing threats? Community Policing”
“Madam, as our population ages and grows, as the nature of criminal and terrorist threats changes, as described by my colleagues, the resources of the Home Team will continue to be challenged. In particular, the most valuable and critical resource is the men and women who choose to serve as Home Team officers. These officers continue to develop professional skills over their years in service, and the experience of a senior frontline officer is something that cannot be replicated nor automated. No amount of productivity initiatives will be a substitute for an experienced, well-trained officer. What steps have been taken to improve recruitment and retention for the Home Team? In particular, how will older and experienced frontline officers be supported and encouraged to continue in their profession, as these are skills that cannot be replaced? Securing Borders”
“But they have been wielded with a clear leftist intent, which unambiguously aims to redistribute wealth and maintain significant state influence over the means of production. The redistribution has not always occurred directly from one hand to the other. It more often occurs across generations. But it occurred and it continues to occur. The redistribution has always been limited by a recognition that any position has to be sustainable over the long term, in order to secure our future. Not short-term populism but long-term investment. I echo and strongly support Member Liang Eng Hwa's call for long-term financial sustainability to be explicitly made a part of Parliament's mandate through the Select Committee process. Madam, we enjoy the freedom from extremism in politics, we enjoy the middle road, the broad consensus and yet still have effective national and social policies. This freedom to be moderate and yet successful is not to be taken lightly. But it is easy to remove, to destroy and to ignore. All it takes is a short-term populist political approach and we have lost it, lost the freedom to be moderate.”
“When there is no mandated boundary, no accepted process for resolution, there is every incentive for interested parties to manipulate the discussion to extremes of view. We hope we take a different approach, an approach that starts from a position of service and addressing the broad middle ground consensus, then shifting out from that position, an approach that emphasises unity. Unity of purpose. One united people. "Marilah Kita Bersatu" – come let us unite. Page: 28 We are and will always be a work in progress, and the boundaries are not permanent but are revised on the basis of broad community engagement. This system gives us a particularly rare and precious freedom. It gives us the freedom from being divided by extremist views; the freedom from having to take polarised positions in order to be effective. The issue of musical instruments during Thaipusam street processions, for example, shows that while the regulations are in place, there is room for considered polite discussion. Through engagement, the Hindu Endowments Board has obtained approval for the singing of hymns. And there are further discussions that are ongoing. Our unwritten social compact, our history and our social fabric have given us this very important freedom – the freedom from extremism, the freedom to be moderate and yet still be effective in politics and effective in policy. To not have to be extreme in order to be politically successful. The freedom from social polarisation. Marilah Kita Bersatu. In politics, the best place is in the middle, the best place in terms of serving the nation and the people. The middle ground is where we are and where we need to be. The policy tools have often been market-driven, right-leaning, economically accurate.”
“But both began as far away from the middle as possible, as far away as they thought they could get. Both the customer and the salesman think to themselves, "What can I get away with, how far can I push this?" How do we get to a middle price that allows the salesman to make a profit and the customer to be satisfied he got a bargain? In this example, starting from two extremely different positions, is probably the best and most satisfying way to have that type of shopping experience, perhaps. But how do we get to the middle of a political and social debate? Is starting from extreme positions good for us as a nation? In politics and social or civic discourse, it can be hard, if not impossible, to shift from an extreme position once entrenched. Real harm can result from an extremist position, with no compromises and no middle way. Real harm – that point does not need to be belaboured. If we begin from a position that everything is negotiable, that the position will shift on the basis of who shouts the loudest, who is boldest, bravest and willing to risk it all, then we start from extreme positions. Just like our shopper, we are looking for a bargain; we start from an impossible position, knowing that it is to our advantage, so that the price is as low as possible. In politics, in social discourse, in charting a path for our society, if we are driven by narrow interests, it results in extremes of behaviour: loud, raised voices, hyperbole and posturing to get out the vote, to get people riled up, to get people to take a stand. Eventually, a compromise is arrived at but, sometimes, there is danger along the way.”
“We need the freedom to be able to tell the story, to be able to discuss its implications, to be able to have a discussion about the reality of public speech and to find ways to look at this situation without heated tempers and clenched fists, the freedom to find a better way forward in peace and as one united people. With our strong stance on security, defence, on maintaining the vigilance against drugs, crime and terrorism, we have the freedom to live our lives without fear. With our economic success and social safety nets, we have the freedom from poverty and its deprivations. With an excellent education system, we have the freedom from a path set at the time of birth and we have the freedom of a meritocracy for each of us to strive along a path of our own choosing. The SkillsFuture credit scheme gives us the freedom to change course, to take a different path at a different time of our life and it gives us the freedom to choose and to make that choice when it suits us. SkillsFuture credit, together with several other initiatives and schemes that address adult learning and retraining, gives us the freedom to be daring, Page: 27 to be adventurous, knowing that we will have further opportunities to learn new skills, train in new disciplines and follow new paths. Madam, I move on to a slightly different type of freedom and one that may require some explanation, no hashtags this time. Imagine, if you will, that we are shopping and we enter a shop with no price tags. There are still a few shops with no price tags. Both the customer and the salesman know that the sale price of the item is negotiable and that after each offers a starting price, the bargaining will lead to some eventual agreement somewhere in the middle.”
“He was likening that policy to fascism in a public Page: 26 demonstration of his criticism. He thought he was being sarcastic or funny, perhaps. The photographer was there as part of his work. The arguments online got increasingly heated; offence was taken on both sides and, eventually, Facebook unilaterally took down the photograph on the grounds that it was offensive. Within Hong Lim Park, this protestor could express his disagreement in what was, arguably, a very disagreeable way. Online, his protest was removed. The photographer could do his work to document the incident but, online, his image, his work, was deemed to be inappropriate. Who was right, who was wrong? Was Facebook overreacting or was it protecting a public space from an offensive image? Was the young man misguided or seeking to be inflammatory? Was the photographer reporting the news or being an activist? Who should have exercised self-restraint or self-censorship? There is a further twist to the tale, just to add to the irony of the situation where as a result of the protests of netizens, Facebook has restricted the freedom of speech that a Singaporean enjoys at Hong Lim Park. The topic of protest at Hong Lim Park had a hashtag like most protests do and the hashtag of this protest was #FreeMyInternet. In this instance, the freedom that the protestor wanted was a "Free" Internet. What he got was the online mob, the free unfettered online mob expressing a narrow extreme point of view from each contributor. He got a unilateral restriction on his expression. The freedom that he and we have is the freedom to express our views in person, in a way that we cannot on social media without significant push back. But most important is the freedom we need.”
“It then became adopted by the hacker group Anonymous as a way to conceal their identity; and now, young people around the world, as a symbol of rebellion against authority, deciding to be non-conformist by all wearing the same mask, providing significant royalties to a corporation that owns the copyright, are wearing this mask. This protestor wore this mask, initially a symbol against fascism in the movie, initially a terrorist mask, and, in response to something said on stage, snapped off a Nazi salute – right arm out-stretched, palm face-down. The use of this Nazi salute is a criminal offence in some countries in Europe, given their history of fascism and anti-Semitism, so, it is not surprising. Imagine him, wearing this mask, throwing out this Nazi salute and his photograph was taken. Nothing else of note happened at Hong Lim Park that day. There were no mysterious black vans, no complaints, no Police presence, no violence, no arrest. Hong Lim Park carried on in peace, as it often does. Madam, I will not show that image, that photograph. I find it disturbing. I also believe that the young man has no comprehension of the symbolism behind the Guy Fawkes mask, nor the Nazi salute. Have I exercised self-censorship in not showing the image, or have I exercised self-restraint in avoiding further discord? The photographer, Mr Shawn Danker, who gave his permission for this story to be shared, was employed that day to report on the events, and he reported on the events and uploaded this photograph to Facebook. Unsurprisingly, it attracted a very vigorous and lively debate online. The point was made repeatedly that the man in the photo and the photographer were not supporting the Nazis or their memory. The protestor was criticising a policy that he felt was wrong.”
“Mdm Speaker, thank you for the opportunity to speak. Like many who spoke before me, I am concerned about the long-term sustainability of the measures and programmes described and I look forward to the Deputy Prime Minister's speech, hoping he would be able to assure us of the long-term sustainability of the spending plans, that the risks we are taking are well-calculated and well- considered. Madam, I intend to speak on freedoms and, in particular, provoke some thought about which of the freedoms we have which we are prepared to sacrifice for further freedoms we want. Do we recognise the freedoms we have? Page: 25 If I could reframe the point made by Ms Chia two days ago, in her excellent speech, we may want the freedom to spend our Central Provident Fund (CPF) money as we wish. Are we prepared to sacrifice the freedom we have, to be financially independent? We need the freedom to be able to age gracefully with comfort and security. The freedoms we want, the freedoms we have and the freedoms we need. Allow me to use a real incident to highlight the difficulty of deciding what is right and wrong, and what is the right path and the right balance for us, when it comes to that difficult topic of freedom of speech. Two years ago, at an event at Hong Lim Park, a photographer on assignment took a photo of a young Singaporean protestor. And this protestor was wearing a Guy Fawkes mask. Guy Fawkes was an assassin and a terrorist who attempted to bring down the English monarchy 400 years ago by trying to kill King James. And this mask, this effigy, was celebrated on Guy Fawkes night, made famous in the movie "V for Vendetta", where the protagonist "V", who is an anarchist and protesting against the fascist state, wears this mask to conceal his identity.”
“They will assume that universal healthcare coverage for life is the natural way such things should be done and they will not understand the anxiety their parents and grandparents had about growing old and not being able to afford healthcare. It is only good and right that we can remove this fear, calm this anxiety, and provide all Singaporeans the healthcare that they need. Madam, I support the Bill. 2.45 pm”
“There is a very simple test, called the urinary cotinine, using a urine dipstick to test for a substance that is a by-product of tobacco, which remains in the body for a week after smoking. If the individual's urine is positive, how about requiring them to pay a larger portion of the bill? If we do not have a mechanism like this, the true cost of that person's smoking is passed on to all Singaporeans as a result of increased healthcare expenditure. This method that I have suggested would not affect the premiums paid, nor would it deny a citizen access to healthcare. It would not affect the charges for healthcare prior to the first diagnosis of a smoking-related disease. But having been admitted for smoking-related diseases, this becomes a very powerful incentive to quit and if you are far-sighted enough, of course quit long before you have a smoking related disease. We have considered discounts, penalties, rewards and rebates as a means to shift behaviour in many other spheres of life, from purchasing goods and using power to parking. Why not use it as a mechanism to encourage people to give up smoking? Mdm Speaker, in conclusion, the Jubilee Babies born this year will grow up in a society where they have automatic inclusion into a universal healthcare insurance scheme, allowing them affordable access to some of the best healthcare in the world. They will enjoy a public healthcare system that is robust, effective and sustainable. They will not believe there was ever a time when this was not available. They will not believe that there ever was such a thing as an exclusion criterion. The idea of being "uninsurable" will be unfamiliar to them.”
“Moving on to my last point, Mdm Speaker, I had previously spoken in the House about smoking cessation and the benefit this would bring to the health of our nation. I continue to believe that the best course of action would be to enact the Tobacco Free Generation Proposal, a ground-up initiative conceptualised here in Singapore, and rapidly gaining attention around the world, where individuals born in the year 2000 and later are prevented from purchasing cigarettes. This does not fall within the remit of MediShield Life, but the shift to universal provision of healthcare insurance gives us an opportunity to reconsider the issue. The universality of the MediShield Life scheme and the attendant risk-pooling means that the problems of smokers are now all our problems. The impact of smoking-related diseases will increase the premiums for all Singaporeans, unless we continue to act to help people stop smoking. I applaud MOH and HPB and many other institutions for the hard work they do in this area, but more needs to be done, and I fear it will be many years before we can see the last case Page: 66 of smoking-induced cancer. I have a suggestion. It would not be my first choice, but if we cannot achieve a tobacco-free generation through a legislative mandate, how about using the economics of MediShield Life to help drive the right behaviour? Specifically, if a person should be discharged, not admitted – you do not know what is happening to you when you are admitted – from a public hospital with a smoking related disease; thereafter, for all costs related to the same disease, should he not have to pay a larger proportion of the bill if he is still smoking? And how might we know that if he is still a smoker?”
“For the purposes of protecting the finances of our public institutions and in order to achieve parity with the requirement placed on Singaporeans, I would like to suggest that MOH consider mandating healthcare insurance for non-Singaporeans that are here for a prolonged period of time. This would not fall under the remit of MediShield Life, and so should not affect the risk pooling. It should be an entirely commercial insurance product, with no risk to the public finances, and it need not be comprehensive in terms of healthcare coverage. Essentially, there are two minimum options, either coverage for catastrophic large hospital bills, over a certain threshold, or to cover the repatriation of the person to their home country. But in order to drive this process, it needs to become required, mandated by law, rather than voluntary. I am in no way suggesting that we need to close the doors of our emergency departments to non-Singaporeans, nor am I suggesting that we need to see documentary evidence of insurance pre-approval before providing timely and necessary care. At the frontline of public healthcare, we must still continue to provide help, care and treatment as needed, as soon as presented with a patient, as we have done. We should continue to allow non-Singaporeans to visit us and to utilise our excellent healthcare services, because that is the morally correct and human thing to do. But we should help to ensure that they can deal with the costs should something unforeseen and unfortunate happen, and that this should not be a burden on the finances of the Singaporean public institutions and, finally, to ensure that there are no loopholes for abuse.”
“Next, if I may draw your attention to clause 16, where significant powers of enforcement are granted to deal with defaulters from the scheme should they wish to leave Singapore. Essentially, this is to ensure that the scheme is truly universal and mandatory. I would like to contrast this with the situation of a non-Singaporean, who is struck by an unforeseen catastrophic illness and racks up a large bill at one of our public healthcare institutions, a bill they may not be able to pay. I realise that the comparison is not entirely appropriate as on the one hand, you have a national insurance scheme, and on the other hand, you have an operational cost recovery problem for the specific hospital. But if that bill remains unpaid, becomes a bad debt, as occasionally happens, this will affect the costs for our healthcare system, as the Minister has described, and lead to an increase of healthcare costs in general, and so, eventually, have an effect on the premiums. Philosophically, from the issue of social responsibility, there is also the issue that we are mandating an appropriate financial burden to provide the healthcare insurance coverage for Singaporeans, without making the same requirement on non-Singaporeans who may utilise Page: 65 our healthcare infrastructure. In general, this will not be an issue and most will pay their unsubsidised bills in full and on time. But where unfortunate circumstances overtake these non-Singaporeans, they may not be able to pay, even if they intend to. In particular, I am concerned about the non-Singaporean dependants, for example, children and grandparents, who will not be covered by the employer of the primary pass holder.”
“Madam, the peace of mind, the security and the safety net provided by a universal, lifetime insurance plan, with no exclusion on the basis of pre-existing conditions, are considerable and will put to rest many fears, concerns and anxieties. There have been questions about the sustainability and financial viability of the scheme. These have been discussed, debated and answered, but, in truth, we will always need to keep a close eye on this, as health and healthcare expenditures are very unpredictable. In general, however, Singaporeans should have peace of mind that they are much better protected from large hospital bills. I have a number of questions about MediShield Life. My first is about the process of a Singaporean opting out of the information discovery and that can either be the healthcare issues or their means and wealth. This comes with a cost, as discussed, of the citizen having to bear a higher premium. My question is about the process of opting back in again. How often will this opportunity be available? On a yearly basis? On a rolling basis? Is there a minimum time period for which the citizen will have to pay the higher premium? When the citizen opts in again, it is appropriate that the administrators of the scheme will need to have access to healthcare data from the period during which the citizen had opted out, so that the risks of possible pre-existing conditions can be assessed properly. However, would the income, wealth and means data from the time period that the Singaporean had opted out of means-testing, be then available and be scrutinised when they opt back in again? I assume that there is only a need for the scheme to assess the citizen's means at that point in time, but could the Minister please clarify this?”
“Mdm Speaker, MediShield Life has been debated extensively in the House and there was and is overwhelming support for the aim of universal healthcare insurance coverage for life, for all Singaporeans. We did not debate on whether the Bill goes too far. This is quite noteworthy. In many parts of the world, the idea of a mandatory, compulsory or universal healthcare care financing framework brings out the worst possible rhetoric and posturing from the political right, with accusations of welfarism and socialism. In the United States, the debate over the Affordable Care Act was particularly heated in this respect. On the other hand, in a place like the United Kingdom, where there are proposals to introduce market and insurance mechanisms to the NHS, it has also drawn accusations about heartless capitalism from the left. Here, in Singapore, in debating and discussing the changes to MediShield that take it to the next level, MediShield Life, this has not been the issue. We take it as read that we can use insurance, co-payments and other tools of the market to achieve what is essentially a fairly socialist aim, that is, the provision by the state of accessible, affordable healthcare for all. The Government is not being attacked for a welfarist or socialist position, quite the opposite, there are many calls to do more, provide more help, reduce the financial burden even further. And the response has not been one of ideology, but rather the practical reality – everything we do has to be sustainable, we must not burden our children of tomorrow with the bill from the political promises of today. We have moved past ideology, and that is something to appreciate, to be grateful for, and to Page: 64 preserve.”
“Mdm Speaker, supplementary questions, please. With respect to the 15%-20% of the budget directed towards administrative cost: firstly, is there a rising trend or a falling trend, and would MOH have some form of target and, if so, what is being done to meet that target? Assoc Prof Dr Muhammad Faishal Ibrahim: Essentially, if you look at the international benchmark, there is no set or widely accepted benchmark around the world. What we have looked at are some basic and common benchmarks and the figures for each year vary for the different types of work. We feel that our current approach of 15%-20% is appropriate at this point in time. Nevertheless, as I had mentioned earlier, we will do our best to see how we can facilitate the process of working efficiently – and I think at the heart of the matter is always to meet the needs of our patients – because we want to take care of the patients and give them the best services and outcomes. Page: 32”
“This position is predicated on the fact that much of the victim protection and victim handling are dealt with administratively or operationally. I agree with this. I believe it is necessary for the reasons I have stated and as others have. My question is to what extent is there oversight over this process? And, in particular, given that these are non-Singaporeans, what routes of appeal would they have should they feel aggrieved by the process or if they are not adequately or fairly treated? They would not have the normal routes of appeal available to a Singaporean. So, how might we increase their protection from the process in that way? In closing, Mr Deputy Speaker, notwithstanding my concerns and questions, I wholly and whole-heartedly welcome this Private Member’s Bill. It speaks to our intent to rise above pragmatism and address what is morally right and it hopes to make Singapore a better place in protecting the vulnerable and deterring an abhorrent criminal act, it also hopes to make the world a better place. Mr Deputy Speaker, I support the Bill. Page: 107”
“The one thing I would point out, though, or I would like to bring up, at odds with some of the Members, is I do not believe that this is a zero-sum issue, looking at the contents of the Bill, where we can divide it into penalties versus victim protection. The best victim protection we can have over time is prevention. It is to make us as unattractive a destination for human trafficking as possible to want this criminal business to go away. So, I do not see it necessarily as the amount of the Bill that is penalties versus the amount of the Bill that is protection. The penalties are there to protect the possibility of future victims. I have some questions about the handling of the trafficked person. Like Mr Zainal Sapari, I believe that we need to have a balance between the opportunity to have some employment versus making ourselves a more attractive destination by providing perverse incentives for people to come here or to come forward with false claims. I have a question about the possibility of false claims. Clearly, in the decision about what would be put in about victim protection, there is a concern about false claims. I would like to ask if this is a significant concern. Has it been an issue in other jurisdictions where similar legislation had been passed? Has a significant number of false claims come forward? Has there been evidence of Page: 106 significant abuse? I take note that our legislation cannot directly ape other jurisdictions. We have to be aware that it works in tandem with all the other pieces of legislation out there, as Mr Zainal Sapari has pointed out. So, it is appropriate that we start off with a limited set of measures in the Bill, perhaps with the consideration to go further in the future if it becomes necessary.”
“Some of us, when we Page: 105 look back into our ancestry, we have personal experience of this affront to human dignity that is human trafficking and slavery. The suffering and deprivation that these people experienced are something we would always want to prevent, as has been highlighted by several Members. So, it is appropriate to pursue this course. I fully support the Bill and the measures proposed. I do have some questions and concerns. Several Members and Mr de Souza have highlighted the transnational nature of the crime, the fact that it involves multiple parties in multiple roles. The perpetrators that are likely to be identified in Singapore and prosecuted may be the tip of the iceberg – a single node in the web that stretches across nations and over time. Like others in the House, I wonder if the penalties described in the Bill are harsh enough. We are known to be a very stringent jurisdiction. Examples are drugs, the recent debate on remote gambling and the intent always being that our penalty regime and our processes produce a very significant deterrent effect. This is modern-day slavery, but it is also a very lucrative criminal business. We have heard suggestions that it is $32 billion to $36 billion; I have heard one source quote up to $100 billion and that is just sex trafficking alone. Will the described penalties be sufficient to have that deterrent effect in terms of the criminal business nature of this crime? One particular example we recently debated – the Remote Gambling Bill – has a fine of $300,000 to $500,000 proposed. In this Bill, we have $100,000 to $150,000. I would specifically call for higher penalties. I echo the calls for higher and harsher penalties that have been made by the other Members in this House.”
“This Private Member's Bill is quite significant and I congratulate Mr Christopher de Souza on seeing it through to its completion and working together with the many different partners that he has described. It is significant for that reason in itself, amongst others, that this is a partnership between the legislative body of Parliament as well as the Government Ministries and agency officers, as he has described, as well as civil society. This is not a Bill that is coming from a single quarter, but coming from across various quarters of Singapore's society. It is also an idea that has been in gestation for some time with the Inter-Agency Taskforce having been set up in 2010. Another reason why this Bill is significant is that it speaks to aspirations beyond our pragmatism. The primary beneficiaries, in terms of individuals of this Bill, are non-Singaporeans largely or almost exclusively. So, this is not a piece of legislation that is about pragmatism or economic utility; it is about what is morally right. It speaks to our aspirations about wanting to be a better society and making the world a better place. Our ability to debate this in this House and move on this issue, we must not forget, is founded upon our nation's peace, progress, economic position, the open nature of our economy and our prosperity. It is the same reasons that continue to make us a target and a transit point for human trafficking, as has been highlighted. We should also not lose sight of the fact that some of this has happened in our past history. It was called "forced migration", "indentured labour" and "forced labour" and, between the mid-1800s to the early 1900s, certainly a significant number of people were trafficked, if you used the modern terminology, from India and China.”
“Mdm Speaker, I have two supplementary questions for the Minister. When a child or any vulnerable person who is known to the Ministry or any other agencies suffers an injury or unfortunate death, is there a need for a Page: 23 formal review process or inquiry? Some jurisdictions have Standing Committees or confidential inquiries where any death or injury to a vulnerable person is automatically investigated to identify systemic issues, especially those that exist among agencies. Would the Minister consider that there is a need for this in our circumstances? My second supplementary question is: in terms of separating a child from a family, it is necessarily a very difficult decision to make, and the bar is set appropriately high. My question is to what extent are resource constraints a factor in this consideration? In particular, do we have sufficient resources for fostering? Do we have enough families that are stepping forward or volunteering themselves for foster care and is there anything we can do to make available that path to provide an appropriate home and a place of safety for these vulnerable children?”
“Page: 94 Mr Deputy Speaker, Sir, the review of MediShield Life marks an important phase in the development of our unique model of public healthcare and financing – one that is studied around the world and admired by many. Singapore is at a point in our history where we can be bold about new boundaries and plan ahead for future challenges. But we must remain true to our principles and ensure that these changes and the new schemes are sustainable for the long term. Sir, I support the Motion. 6.02 pm”
“That is exactly what we expect to see: the money is paid in, it is paid out to people who need it, and some is put aside so that it can continue to pay people who need it. The purpose of MediShield Life – and MediShield in the past – is only to help Singaporeans with large hospital bills. The comparison is inappropriate. Is it just a small matter, a technical term – Loss Ratio versus Incurred Loss Ratio? First thing is, it involves millions of dollars, hundreds of millions of dollars, so, it is not that small a matter. If I can give Members an analogy of the extent of this inappropriate comparison – what Mr Giam has done is analogous to trying to compare two companies. One is an American for-profit company and the other is a Singaporean social enterprise. In trying to compare the financial position of these two companies, on the one hand, he has said, "Tell me everything about this company – your income, your expenditure, your profit, your loss, your liabilities, your debts, your total financial position." And then, looking at the Singaporean company, he said, "I want to know the cash flow." On the basis of that, he has compared the two. It is completely inappropriate, and it is a misrepresentation of the financial position of MediShield in the past and going forward. I am sure these are honest mistakes, which represent a misunderstanding. This is a complex series of issues, but the record needs to be set straight. The facts need to be on record. We all need to work at making sure that Singaporeans understand the truth of our financial position, our policy intent, and where we will be, going forward. I hope Mr Giam will join me in fixing the misunderstanding for Singaporeans and helping them to understand the true situation of MediShield and MediShield Life.”
“He has compared this with the United States where, on the one hand, premiums are brought in, claims are paid out, money is put aside for unpaid claim reserves, money is put aside for changes in the contracted reserves, and money is put aside for contingency benefits. In actual fact, under the US system, other things are classified as claims, including quality healthcare initiatives. If we take the same approach for Singapore, we need to use something that we call the "Incurred Loss Ratio", where we compare the premiums that are paid in, the claims that are Page: 93 paid out every year, together with what we have to do to put aside to fund the liabilities, going forward. So, it is not a simple issue. This data is available through the CPF Board Annual Report and it is also available in the series of Parliamentary Questions that Mr Giam had asked before. If we do that and we calculate our situation in Singapore, what we find is the Incurred Loss Ratio is very, very different from what Mr Giam has described. It was 119% in 2011; 111% in 2012 and 91% in 2013. That averages out at 96% over the last five years. So, in our numbers and statistics, what we see is that MediShield is paying out claims and putting aside money it needs in order to pay out claims. It is not making a profit. This money is not disappearing somewhere. It is being put aside prudently. If we took an ideal situation and not-for-profit scheme – and the Minister has repeatedly said that MediShield is not a for-profit scheme – that number would be 100%. But it is going to vary on either side and that is exactly what we see. Some years, it is slightly more than 100%; some years it is slightly less than 100%.”
“Yet, these companies, understanding these schemes, understanding the significant amount of variation that puts their operations at risk should they breach that floor, are operating at 200% or more. This is the correct thing to compare with, not the absolute requirement from MAS of 120%. It is a misunderstanding and I hope that would be clarified. There is another misunderstanding, and this is something that Mr Giam has brought up today, at the recent debate on the President's Address – and he has also written about it on his blog about the Medical Loss Ratio. He described the Medical Loss Ratio as being 63% over the last 11 years, 75% in 2012. Those numbers are true if, and only if, one was considering the simple Medical Loss Ratio. That is, if you just take the premiums that are collected with the cash paid out in a given year, those figures are correct. His mistake, however, is to compare this with the Affordable Care Act in the United States, or ObamaCare, where he quoted 80% to 85%, and he is comparing these two numbers. He is not the only one to do so. There are a number of online commentators who have done something similar. The reality is that in ObamaCare or the Affordable Healthcare Act, the 80% to 85% mandate includes the direct claims. It includes the unpaid claim reserves, the changes in the contract reserves and reserves for contingency benefits. This is not the same as what we are talking about for the MediShield Life's simple loss ratio. So, let me state that again so that we are all quite clear. What he has described is a simple ratio between the premiums that are brought in and the claims that are paid out every year.”
“Sir, before concluding – I have some way before concluding and I promise not to repeat my infringements the last time I attended this podium – there are some issues I would like to address that Mr Giam had brought up, which I believe represent a misunderstanding. This misunderstanding is instructive. Our medical healthcare financing systems are complex. The changes to MediShield Life are potentially complex. And, misunderstandings, such as these, can arise, and they should be addressed adequately by MOH and other parts of the Government. The first thing I would like to address is the issue that he brought up of the Capital Adequacy Ratio (CAR), and he highlighted that the Monetary Authority of Singapore (MAS) has a requirement of 120% of CAR for private funds. He contrasted this with MediShield Life's – I think it was 163 or 167 that he quoted from his Parliamentary Question – and questioned whether this was appropriate. The thing to appreciate is that the 120% set by MAS is not a target for the funds, the insurance schemes, to meet. It is a floor. It is a floor that they must operate above. If they Page: 92 breach that floor, there are very, very significant regulatory requirements. It is inappropriate to compare the floor with the target that MediShield Life might have. What should we compare it with? Perhaps, we should ask ourselves what do the insurance schemes and other funds target as their Capital Adequacy Ratio. It is not 120% because that is what they have to stay above, and because of variations in cash flow in markets and the assets that are marked to market, they target a level of 200% CAR or more. These are the private for-profit companies. And you would expect, in order to maximise profit, they have to sail as close to the wind as possible.”
“One specific thing that I would be interested to find out about from MOH is: Singaporeans benefit from academic excellence at our tertiary public healthcare institutions. They benefit from cutting-edge technologies and treatments, as well as medical strategies that are informed by academic research on our population. This burden of research and academic pursuit is borne largely by our public sector, and, so, it is the public healthcare system that sets the bar. In other jurisdictions, the weight of insurance-funded healthcare has reduced the emphasis on research and academic excellence, primarily as a means of controlling costs. This has not always caused a decrease in the progress of the academic pursuits if there are funds available from alternative sources. Philanthropy is one good example in the United States, for example. In our society, there is not a significant investment in academia and medical research outside the public sector, and now, in our landscape with universal, national healthcare insurance in the public sector, will there be a pressure to reduce research and cutting-edge medicine in an attempt to reduce costs? Will Singaporeans continue to receive the best possible medical care in the public institutions, as they currently do and have appropriately come to expect? Will the public healthcare institutions be able to continue to pursue these missions of providing excellent care, training the future generation of healthcare providers, and developing better treatments to suit our population? Will the proposed changes affect these in any way?”
“Mr Deputy Speaker, I rise in support of the Motion. The universality of the proposals for MediShield Life is quite striking. The idea that every Singaporean will be covered from birth, that this would be an attempt to reach out to the whole of our society and nation, is a source of pride when I think about what it represents for our social mindset at this point of our nation's development. The idea that we will move from ensuring "we look after ourselves" to "we will look after ourselves and each other" is, to a significant extent, a very deep shift, and one that will set the stage for how we see ourselves, going forward. With a national healthcare insurance scheme, the issue of a healthy lifestyle for all is no longer an individual problem. As my colleagues Ms Tin Pei Ling and Dr Chia Shi-Lu have pointed out, the issue of a healthy lifestyle now becomes a national problem. Like them, I would be very interested to know the specifics of how MOH, HPB and MOE and the rest of the Government would go on to drive this issue of a healthy lifestyle because it will be the single most important thing that we can do to deal with the issue of rising medical costs, going forward. Even if we did successfully turn that process around today, it will take a number of years to see the benefits, many decades, perhaps. So, there will be a period of time when rising healthcare costs will prevail. I am heartened to hear so much has been put into the thinking and consideration behind making this scheme financially sustainable for the long term. But I Page: 91 would be interested to know, and to ensure, that there are mechanisms to review those Singaporeans who will fall through the cracks, especially with respect to their out-of-pocket expenses, and that has been mentioned before.”
“Madam, because we are talking about a social public good, it is, therefore, incumbent that we take a longer term, prudent approach, past one electoral cycle. I am glad that Mr Giam feels that medical expenditure is predictable. I and my professional colleagues would completely disagree. There is a lot of uncertainty about how costs will rise. Myself and my brothers and sisters in the healthcare profession are part of that problem because we keep researching and coming up with all kinds of ways to spend the Health Minister's money. Lastly, the example of SARS is a great example. It is precisely because of the prudent, conservative, risk-averse approach that we take on a day-to-day basis that when something like SARS comes along, the Government is able to step in and do what needs to be done.”
“Thank you, Madam. Mr Giam brings up some very good points. And if I could take them in reverse order. Firstly, we are talking about a public social insurance and he is comparing it with a private, for-profit environment in the United States. So, I do not think his comparison is valid. Secondly, I am loath to use the United States as the be-all and end-all for a model of where our healthcare system should evolve to. Even the policymakers and office holders in the United States would readily admit that the short-term electoral outlook significantly constrains their ability to take a long-term strategic vision for the healthcare system of their nation. Lastly, I would like to make one point, which is: what if he is wrong? What if Mr Giam's supposition that we could increase payouts is wrong and we should compare that to what if the current situation is the wrong decision? If the current situation where, as he puts it, the payouts are far less than the premiums collected, that is the wrong decision. We save a little bit too much. If he is wrong, and we pay out more, if we pay out more and he is wrong, what is the worst case scenario? The worst case scenario is that our public healthcare financing becomes insolvent and we are unable to support the healthcare needs of a generation possibly. This has happened in many other countries. The intellectually honest thing to do is to compare risks versus risks, benefits versus benefits, and worst-case scenarios against worst-case scenarios – not to cherry-pick the benefits of your proposal against the potential risks of the proposal in front of you. Thank you, Madam, for your indulgence.”
“The politicisation of healthcare would look like using anecdotes to create fear and anxiety, telling carefully selected stories about unusual situations with a view to persuading people that everything is bad and needs to be changed. The politicisation of healthcare would look like ignoring the hard work done by our healthcare workers of every profession in holding back the darkness and desperation that comes with ill-health and disease. It would look like pretending that healthcare workers are heartless automatons, rather than deeply caring human beings who are doing their best to care for the public. Above all, it would look like ignoring the excellent health and healthcare outcomes that we, as a nation, have achieved and will continue to achieve. Madam, with that, I thank you for your indulgence and I support the Motion.”
“To agree with someone else's policies is not compliant politics. If the policy is good and it achieves its outcomes for a better life for citizens, then attacking it does not generate better politics. If the Government has a good policy, then the civil service supporting it is not being compliant. It is serving the best interests of our nation. It is not enough to say you are supportive of good policies and good governance, in general. What you say and how you say it are both important, as are what you choose to say nothing about. When you fail to acknowledge the good, when you avoid discussion of consequences and trade-offs, when you spend a whole speech attacking one point you disagree with and fail to support all the others you should agree with, when you incite division in the name of diversity, when you silently support xenophobia in the name of nationalism, these are not the markers of good politics, no matter how much debate and diversity of opinion they may reflect. Madam, I have used healthcare as an analogy for politics and as a way of highlighting some ideas but, in concluding, I wish to return to it as a subject in its own right. Something that we have to get right, just as we have to get our politics right. I plead for the good sense, wisdom and experience of the healthcare professionals to prevail in serving the long-term good of the nation and to continue doing the right thing. I Page: 50 ask that we remain risk-averse with our public healthcare system and its finances. I hope that we can avoid using the politicisation of our excellent public healthcare system as an electoral tool.”
“Madam, I am not for a minute suggesting that debate and diversity of opinions are not necessary, but merely that they are not in themselves sufficient to help us navigate the difficult choices in the future. I have explained my concerns about how one provides a second opinion. One can in a negative way focus one's energy on the one point of disagreement and imply that one's opinion is outright better than the others. This approach would be self-serving, Page: 49 confrontational and serves the interest of the person giving the second opinion. The other approach would be collaborative, collegial, constructive. What you say and how you say it matter. What you do not say is observed very closely. A collaborative, collegial approach builds trust in the people for being honest and open. But far more importantly, it builds trust in the institution of the profession. And this is, ultimately, what we must strive for in politics, as in healthcare. As Senior Minister of State Indranee Rajah put it yesterday very eloquently, "politics is real". Madam, it is not that we do not have to improve things. We do. It is not that there are no gaps, no problems. There are. We need to invest in the expansion of services and, more importantly, in manpower. On the ground, it looks like that is exactly what we are doing. We need to develop an ecosystem that integrates research into education and practice. That is what we are doing; it is happening. We need to improve on-the-job training with the view to maintaining safety and, at the same time, improving the effectiveness of training. That is what I see happening around me. I support the Government's policies not because I am compliant but because the policies are getting the outcomes we need.”
“Thank you, Mdm Speaker. I am honoured by this opportunity and I promise I do not have another eight steps. One of the things that I stress with my students in my teaching is how to choose between two proposed solutions. In choosing between two proposed solutions in medicine, in academia and research, one has to be intellectually honest. The most common reason that I need to explain this to the students is that in that intellectual honesty, one must compare the risks of your proposed solution with the risks of your opponent's, and the benefits of your proposed solution against the benefits of your opponent's. The politicisation of healthcare can be easily recognised by the presence of this intellectual dishonesty, where the benefits of one's proposal are compared with the risks of one's opponent's. A good example of this type of intellectual dishonesty is another bit of sound-bite politics. Medical insurance premiums are higher than the payouts. There is a very good reason for that. Our population is ageing; there are uncertain risks in the future; there are likely to be rising costs. One has to take the holistic approach and understand the whole situation. What would be the risks if we ensured that payouts were the same as premiums? Is that a situation that we want – to ensure that payouts are the same as premiums? Would there be no risks associated with that? Would that be good for the long-term health of our nation and our future? We do not have to look very far or very hard for examples where short-term policy interests or short-term electoral interests have meant that the long-term health of a nation has not been served, where the attempts to reform a public healthcare system for the greater good have been blocked by the pursuit of electoral advantage.”
“Mdm Speaker, thank you for the opportunity. I support the Motion. Page: 47”