Kanwaljit Soin
Singapore
“Mr Speaker, Sir, I would like to ask the Minister to give a response to an exclusion in clause 2 (b) which amends section 10 to deem any maintenance payment received by a parent or a child under a maintenance order not to be income subject to tax.”
“Clarification, Sir. I realise that. But I would like to know what is the policy, what is the thinking, that you can allow a parent who gets maintenance not to have to pay income tax. A parent is an adult. But you do not give the same privilege or right, I would say, to a wife who gets a maintenance ordered by the court.”
“My point is no income tax is charged for maintenance payments received by parents. That is what the Minister said about clause 2. But yet when wives receive maintenance from their husbands, those maintenance payments are subject to income tax. Why is there a discrepancy?”
“So I would like to ask what is the Minister's thinking. Why is it that the maintenance of a parent is not considered income, because it is for the subsistence of the parent, while the maintenance for a wife which is for her subsistence is considered as income?”
“If the letter of authority is not stampable, then this may become a recourse of getting around the stamp duty and income tax rules affecting sub-sales. Another issue to be considered is the timing of the payment of stamp duty. With the amendment, this has to be paid at the time of the signing of the sale and purchase agreement.”
“Would the Minister have, in hand, figures to show how many Singaporeans who go abroad to study medicine come back to do their housemanship in Singapore for the last three years? Dr Aline Wong: I do not have the figures on Singaporeans who come back to do housemanship for the last three years.”
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“" Indeed, the challenge to Singapore shall be formidable, in particular, from China and then Vietnam. The people of China and Vietnam have great similarities in culture and believe in discipline, hard work and thrift to those in South Korea, Taiwan, Hong Kong and Singapore. Now that they have discarded their Communist system and embarked on the free market economy, there is no reason why they cannot catch up and even overtake those countries. Indeed, the challenge to Singapore shall be formidable and Singapore can rise to the occasion. But old tested methods, such as having a good infrastructure, stable government, attractive tax regime, are not enough. China and Vietnam's costs shall always be lower than that of Singapore. They have more abundant labour and land. Investors shall go to the places where they can make the most profit. In the future, Singapore may not be the favoured place to invest for foreign investors. They shall be looking towards China and Vietnam and other countries in the region. Singapore must ultimately fall back on its people to meet the challenge and earn the income for Singapore. In this respect, Singapore must produce abundant intelligent risk takers, entrepreneurs and leaders in industry and business. I have contended in the past that under our present authoritarian style political system, it is difficult to produce the great numbers of intelligent risk takers, entrepreneurs and leaders in industry and business. Our society at the moment is too closed, too strict, too much fear and too much control. The Government wants almost absolute control in every area of life in Singapore. The Government has made it a point that they must be seen to be the one who can take the initiative.”
“Thus, I suggest that all those over 65 should have a Senior Citizens' Endowment Fund started for them with annual contributions from the budget surplus. In 1992, only 46% of CPF members who withdrew their CPF at age 55 years had set aside the full Minimum Sum and this indicates the gravity of the situation for the present group of senior citizens. Also with these statistics, that is, only 46% had the full Minimum Sum, raising the Minimum Sum at this stage is not going to have a great deal of practical relevance until more people have built up bigger CPF balances. Furthermore, with the present trend of longevity, there will be a significant increase in the proportion of those who are frail aged. Generally, the onset of frailty can be considered at age 75 or over and thus we have to consider extending MediShield cover to the aged until the end of their lives and not have a cut-off point as at present. Mr Speaker, in conclusion, we have achieved a great deal in the 30 years since independence but we cannot rest on our laurels. The road ahead is even more challenging and this needs our combined efforts and commitment using our hands, minds and, especially, our hearts. Mr Chiam See Tong (Potong Pasir): Mr Speaker, Sir, thank you for allowing me to speak today. Singapore's economy has done well over the last 30 years. But there is no guarantee that Singapore's economy shall continue to grow as it has done before. The President in his Address has warned that: "The international environment is becoming more competitive. Fast growth in the region means more opportunities but also formidable challenges. Countries with abundant land, low wages and hardworking, intelligent workers want to plug into the world economy.”
“According to one estimate, Mr Speaker, in the year 2000, which is not too far away, 19% of men and 34% of women reaching 60 years of age will not have any CPF to depend on. A report by the Advisory Council on the Aged puts the figures much higher. At the present time, according to one estimate, about 20% to 25% of the people in the labour force are not covered by the CPF scheme. A certain proportion of those not covered, that is, unpaid family workers, contract workers and some of the marginal hawkers are likely to be faced with inadequate resources to finance their old age. Thus, for the next 15 to 20 years, we will have an interim situation where old age security is not assured. This applies to the older men and women, the poor self-employed and home-based workers. We have to make provisions for this fairly serious social and economic situation. The recommendations that the Government should consider are: (1) Compulsory gradual CPF contributions for all self-employed. (2) Encouragement of home-makers (most of whom are women) to start CPF accounts in their own names to which their working relatives can contribute. The Minister for Labour has promised that he is agreeable to making this scheme known widely. (3) The setting up of a Senior Citizens' Endowment Fund from the budget surplus. In my opinion, it is even more necessary than the Edusave account for each student. The old people of Singapore have literally contributed their sweat and toil to make this country successful and we are reaping the fruits of this success. Acknowledgement of their unselfish efforts and a little dose of filial piety make it mandatory that we should do something tangible for their old age.”
“If we want strong and good family life to go hand in hand with our spectacular economic growth, then I request the Prime Minister to reconsider the appeal this year which happens to be the International Year of the Family. Old Age Security Now, Mr Speaker, I shall speak on old age security. According to the CPF Board, members retiring at 60 who have contributed continuously for their full working lives (which is about 35 years) at the rate of 40% of net wage can expect a retirement income of 20% to 40% of the last take-home pay, a property commensurate with their income level and health care under the Medisave scheme. This augurs well for the young generation and, therefore, we will not have to worry in the future for the young people who are in the labour force today. However, for those of us who were over 20 in 1975 (and I am one of them), we will not be able to meet even the modest levels of retirement benefits estimated by the CPF Board. This is because before 1975, the CPF rate on net wage basis was below 40%. It has been estimated that in the year 2015, those over 20 in 1975 will constitute 0.6 million people which will add up to about 20% of the population. Also, there is a gender difference in CPF balances. For women below 45 years of age in 1989, average balances were closer to that of their male counterparts. After the age of 45 onwards, males have nearly twice the CPF balance as compared to the women. For the present cohort of women aged 55 and over, they may face financial difficulties in old age, given the average low CPF balances they and their spouses have. This situation will become accentuated with time as women are expected to outlive their spouses by at least five to eight years on the average.”
“A survey was done in Singapore in 1990. 90% of a representative sample of 1,464 women with secondary or higher education stated that the most desirable life situation for them was to be wives and mothers. For a modern society like Singapore, the result of this survey is a good indication that family values still prevail and, therefore, let us not make it difficult for these young women to enter marriage by insisting that the most desirable life situation for them is a subordinate role in that marriage. That is one reason why women who want to marry decide not to marry. Questions asked about married life should not centre on whose responsibility it is to take care of the children or old parents, or whose entitlement it is to be given medical benefits for the children but, rather, on what are the needs of the children and the aged, and how a couple can best meet these needs. The other vital area for strengthening the family and its values is the integration of work and family responsibilities. According to Japan's Youth Crime Department, fathers who spend long hours at work and who are regularly absent at dinner tables create problems for the family. Men then have to re-evaluate their position at work and at home. They must consider coming to the centre stage and seriously taking their roles as fathers and husbands. Simply designating them as "heads of households" is not going to change family values for the better. That is wishful thinking. In last year's Budget debate, I made an appeal to the Prime Minister to initiate and institute a national strategy for the integration of work and family responsibilities.”
“Now, let us look at another aspect of family values. In 1989, a survey of 2,115 Singaporean men by the Ministry of Health, the National University of Singapore and the World Health Organisation showed that one in 10 men had engaged in casual sex during the previous 12 months, mostly with prostitutes. Many of the men visiting prostitutes had unprotected sex. In last year's Budget debate, Mrs Yu-Foo Yee Shoon brought up the issue of men venturing abroad for business and also having casual sex and even starting second families. All these concerns need to be addressed as they have deleterious effects on the family. We should not just sweep them under the carpet and pretend that these problems do not exist. We need a coherent and consistent family policy which strengthens families and goes beyond maintaining the status quo. The President also mentioned demographic changes that have serious social and economic implications. Mr Speaker, we will not be able to solve the problems of fewer marriages and low birth rates until and unless we accept and promote a new understanding of marriage as a more equal relationship. Some of the social research shows that the long-lasting marriages that are really happy and satisfying are the egalitarian ones, where both husband and wife share in the major decisions. The family is changing and it is important to allow for growth for every member of the family. Let us not build a family system which depends on the subordination of women. These families will not be strong and self-reliant and our daughters will reject marriage if that is the model forced upon them. Our daughters want marriages with interdependence between the husband and wife for mutual benefit of the family. Let us consult our daughters for their views on marriage.”
“In Singapore, we have to ensure that children are not born out of wedlock. Fortunately, it is highly unlikely that we will go the way of some western countries with soaring illegitimacy rates because of the following reasons: (1) Social stigma. (2) Lack of welfare for these children and mothers. (3) Non-qualification and therefore non-availability of HDB flats for women with illegitimate children. So where will these single parent families live? (4) Availability of abortion unlike some other countries. Let us, therefore, not get agitated with this phenomenon of single mothers with illegitimate children and worry that this will mushroom in Singapore. However, we will continue to have some single mothers with children, caused either by the death of the spouse or by divorce, even if we institute measures to mend marriages and not to end marriages. In most divorce cases, the mothers want custody of the children because women tend to be more family-oriented. In these cases, the family composition has changed but it is still a family. Some of these families (about 4,000 in number) live below the minimum household expenditure, that is, a family of four living in a 1-room flat with a disposable income of $510. These families deserve a hand to help them to become self-reliant. Such subsidies should not be considered as hand-outs. These well-deserved subsidies could consist of: (1) low cost childcare to enable the mothers to work; (2) help in buying small HDB flats; (3) arranging schemes for work to be done at home by these mothers who may be looking after the children and the aged at the same time; and, (4) the Small Families Improvement Scheme should be extended to some deserving families where the fathers have deserted the family.”
“This event would give participants a valuable insight into parliamentary procedures and a further opportunity for young people to air their views on issues that they felt were vital and important to them. Subjects covered in the Bills could include motor vehicle licence age, ethnic integration, paternity leave, anti-smoking laws, compulsory community service for students, etc. The Youth Parliament would promote involvement in the community and a heightening of awareness about people and their concerns. It would promote rational debate and a tolerance of other people's opinions. Most importantly, it would be an invaluable educational experience for young people who will one day have to elect honest and competent Members of Parliament. Family values Mr Speaker, we have talked endlessly about the importance of family and how it forms the basic building block of society. We have also talked about what we do not want in families, that is, divorce and single parents. We have raised often the spectre of single mothers and the deleterious effects on society, eg, crime, unsocial behaviour, state dependency and the creation of an underclass. I think we should look at this problem of single parents more insightfully and analytically. The term "single parenthood" covers a variety of social situations - from the unmarried young mother to the middle class divorcee and the middle-aged widow. All these single parents cannot be tarnished with the same brush. It is the illegitimacy rate and the children born out of wedlock that give rise to the attendant culture of welfare dependency, crime and social despair. Many children in single parent families, for example, children brought up by widows often do better than those in two-parent families.”
“One area of change will have to be our education policies which appear to stress narrow labour market requirements and underestimate the importance of a capacity for critical analysis of social and political issues. We are therefore ending up with a technologically trained but politically illiterate young citizenry. The President voiced his concern when he said: 'Only the people can make sure that the government pursues prudent and responsible policies, by electing honest and competent Members of Parliament to form a good and clean government.' Another way of encouraging active citizenship is by the strengthening of civil society. Some progress has been made - we have the full implementation of the NMP scheme, the registration of private think tanks and citizen groups and public debate in the media. We need to encourage more community-based organisations interested in social issues. We also have to carry out some surveys to assess the degree of understanding of Singapore's political process among young people in the community and take appropriate action. At the level of secondary schools and junior colleges, we need to re-examine our civic and parliamentary education courses. In these courses, we should not be force-feeding students with facts but with the skills and understanding necessary for effective participation in society. I propose, Mr Speaker, that we have a "Youth Parliament" which could involve about 70 to 80 delegates from the junior colleges. These delegates could select party leaders, conduct party room meetings and debate Bills in this Chamber over two to three days.”
“Besides our growing obsession with material success, there are other long term concerns that will affect the future of our nation and, Mr Speaker, I am going to address them under three headings: active citizenship, family values and old age security. Active citizenship The Prime Minister has expressed his concern over the reluctance of people to take up positions in the political arena. This is a serious worry. How do we overcome this? How do we get our young people to understand how our social and political system works and imbue in them the motivation and capacity to participate meaningfully and constructively in public affairs? At present, among the young people there seems to be a combination of ignorance, apathy, and some cynicism about political participation and public service. This retreat from public service, Mr Speaker, is opening the way for a victory of self-centredness over a sense of community responsibility. An editorial in the Straits Times noted that "the brainy ones and the super achievers of today's generation, those the PAP wants in, feel no compulsion to enter public service." One can also detect the despair which a chairman of a Residents' Committee felt when he talked to the press on motivating young people for community affairs: 'I do not know how I can reach out to this group of people. Most do not even respond to our request for feedback.' This may be because for the majority of young people, ignorance has led to apathy. After that, powerlessness sets in as young people feel that their views and needs are not being taken into account and they feel that there is nothing they can do about it.”
“Let me give you the sorry example of some young women whose material cravings have persuaded them to offer sex for sale in order to sustain a high spending life. This was reported in our media. We also hear of some other young people who have been devoting their energy and time to making money single-mindedly at the stock market at the expense of their study and even work. Community and public service is the last thing on their mind. Who are the role models for these young men and women? People whose worth is measured in dollars and practically nothing else. Economic success is of course of paramount importance to Singapore and has brought about considerable economic security, happiness and social development but the danger now, Mr Speaker, is to see most things in terms of only dollars and cents - we know the price of most things and the value of very few. The ethos of this world view was captured well by a Straits Times journalist under the caption: "No Money No Talk". Well, we have to talk about this aspect of our lives now. We have to put the economic imperatives at the upper end of our scale of priorities but not as the raison d'etre of our lives. If we do so, then after the initial euphoria of monetary rewards, there will be a backlash. Remuneration alone cannot continue to motivate people and money cannot buy happiness. After a certain period, money can, if misapplied, kill a worker's desire to do his or her best. According to the work of dozens of social scientists, when we do something only for monetary reward, we tend to become less interested in what we are doing.”
“Mr Speaker, Sir, I rise in support of the motion in the name of Mr Loh Meng See. We should be proud to be Singaporeans. The unrivalled success of our tiny island nation has assured us a place in history. We can list all the advances we have made in our economic and material progress and these indicators continue to impress the rest of the world. The sceptics have been converted. The President in his Address said: 'Our short term issues are well in hand. My Government's focus is therefore on long term policies to position ourselves for the next stage of nation building.' It is therefore time for us again to look at ourselves and examine our ethos and our values and our responsibilities towards some long term trends in our country. Mr Speaker, our supreme goal cannot just be the quantity of money we have, our GDP and our rate of economic growth. What should matter as well is the quality of our life and the morale of our society. We will have to address these long term concerns if we are to continue as a successful and cohesive society. If we do not, crass materialism will take over resulting in the breakdown of our values of motivation, self-regulation and self-awareness. In the quest for material gains, there is the tendency to believe that nothing succeeds like excess. Lavish dinners, flashy new cars, expensive club memberships, branded goods and excessive consumerism cannot sustain for long the spirit of our people. Unfortunately, at this stage, we and our youth seem to be vigorously aspiring only towards these material goals. Most of us try to achieve these with hard work. Others have already begun the downhill slide where the end justifies the means.”
“Mr Speaker, Sir, I think our Prime Minister and our Ministers must be paid well and, in Singapore, we are doing the right thing in revising their salary scales upwards. But I find it puzzling and a little demeaning that we must talk about how much remisiers and other people in the private sector earn. We must pay our Ministers a very good salary so that they and their families can live well. But the motivation for becoming leaders should be partly altruistic. Furthermore, the respect and recognition given to our leaders far outweigh what our CEOs and our remisiers get in our society. I think there is no need to justify the pay increase for our Ministers with comparison to the private sector. There is no need to be defensive. On another point, Mr Speaker, Sir, as the Deputy Prime Minister has said, civil servants expect to be paid fair wages, commensurate with their responsibilities. And as the total pay package includes medical benefits, will he consider giving a higher pay rise to female civil servants to make up for their lower medical benefits? I am sure we also want to stem the possible exodus of female civil servants from the public to the private sector. And if we do not pay equal wages for equal work, which is a principle adopted in the civil service since 1962, then there will be dissatisfaction among the female civil servants and this will lead to lower work morale and possible resignations from the public sector. Furthermore, in Singapore, we are known to mean what we say and therefore I think it is high time the civil service subscribed completely to the principle of equal pay for equal work for both men and women.”
“Sir, Singapore, being a small country with birth certificates, the enforcement should be much easier than in bigger countries. Would the Minister consider that enforcement is not going to be a problem?”
“Sir, in view of the fact that some children do not register for school and in view of the Prime Minister's concern about the drop-outs from school, would the Minister reconsider his decision not to have compulsory education?”
“The flexibility given to CPF members in the use of their Medisave, which is protected by Government, is an opportunity not to be missed. I hope the Government will not impose too many conditions like in the case of CPF endowment policy. The scheme to allow purchase of health insurance through Medisave should be simplified so that many will be able to afford and take advantage of it. Finally, Mr Speaker, I would like to take this opportunity to congratulate the Committee members for their contributions to the standards and control of the cost of health in the country. I support the motion.”
“The proposed system, where employers have to channel up to 2% of payroll to Medisave, as an incentive, favours those who stay healthy. This is because when an employee stays healthy, the balance in his Medisave will accumulate and the money can then be used to buy insurance to protect him against high medical bills should he fall sick later. This is a better form of assurance, especially for younger workers. However, there is concern among some older workers who will be changing jobs after 1st January 1994. They fear losing out because of this scheme. They fear that the money contributed into their Medisave account will not be sufficient to pay their medical expenses or to buy insurance coverage against prolonged treatment. I hope the Government will provide guidelines for employers so that this group of employees will not be adversely affected by the scheme. I would also like to support the proposal to use Medisave for purchase of insurance under MediShield II or for purchase of private insurance. This is a wise idea as it enables the buyer to ensure his ability to pay hospital bills and, at the same time, encourage him to save. In the Malay community, insurance schemes like life and family insurance are still not well-accepted. Maybe as a start, this health insurance would convince some quarters that the benefits might one day save their lives and alleviate their families' burden. Health insurance is rather different in objectives and functions from other insurance schemes. Health insurance is like a tree that provides us shelter. The money saved through the scheme is like the seeds we sow that will grow and flourish and one day yield the benefits for us to reap. No one can anticipate illness or misfortune. The existing Medisave might not be sufficient when needed.”
“Mr Speaker, we maintain good health not through exercise alone, although that is one of the most effective ways. Controlling our diet is equally important. Cutting down on cholesterol intake helps us avoid heart problem and other diseases. Singaporeans should be more careful about their diet, and this message goes especially for the Malays. Malay food tends to have high cholesterol levels, which is a cause of heart problem. According to 1991 statistics, out of 1,850 deaths among Malays, 845 were due to heart disease. That is 45% of deaths in the Malay community. The percentage is even higher viewed in comparison with other communities. The percentage of all Singaporeans who died of heart disease in 1991 was only 36%. I would like to urge community organisations, which are in closer touch with the masses, to enhance awareness of this issue by conducting dialogues and exhibitions and by distributing pamphlets, especially for the benefit of the Malay community. The Government can also play a role by promoting health-consciousness among Singaporeans while they are still in school. Our school curriculum should include subjects which emphasise the importance of health care and how one can stay healthy. A 'healthy body, healthy mind' campaign should be launched in our schools as a foundation on which we can develop greater health awareness. I would like now to touch on the issue of additional Medisave contributions by employers. This proposal is a good one as more workers, faced with unforeseen circumstances, can thereby find a way out. The existing system only benefits those who fall sick frequently and need prolonged treatment, but provides no incentive for those who have been taking care of their health.”
“Finally, Mr Speaker, Sir, I would like to express my dismay and disappointment with the Finance Minister's statement that female civil servants will continue to be discriminated where medical benefits are concerned. It is very disheartening to the female half of the population that when it suits the policy-makers, they choose not to apply the principle of meritocracy. By announcing this new discriminatory medical financing scheme for civil servants, two basic principles are not being respected. One, the principle of equal pay for equal work that has been adopted by the civil service and, two, the Women's Charter which states that the husband and wife have equal rights and responsibilities in the running of the home and care of the children. I would implore the Finance Minister to reconsider the position if he wants Singapore women to give their full support towards nation building. Mr Umar Abdul Hamid (Ang Mo Kio GRC)( In Malay): Mr Speaker, Sir, I rise to support the motion. The findings made by the Committee in its mission to identify and resolve the problems of health care costs are welcomed. I agree with the stand that Singaporeans must play the principal role in this matter. All of us must bear the duty of being health-conscious. Staying healthy is a personal responsibility and the incentives provided by the Government should not become an excuse to take health for granted. Moreover, being too dependent on Government handouts and guarantees is not an attitude to be encouraged. We should take advantage of Government subsidies only as a last resort, when we fall sick despite having taken good care of our health. They should not be an incentive to neglect our health.”
“The public sector currently provides 75% to 80% of hospital care and 25% of primary health care. This sector employs just over 50% of the doctors in Singapore. Because of the public sector's large share of the medical services, the Government's rate setting influences that of the private sector and cannot, therefore, be considered competitive or market-determined. Another step that will help to improve services and raise efficiency is to integrate our rather fragmented medical health system. Too many admissions into the subvented hospitals occur through the Accident and Emergency Unit and are, therefore, unplanned. There can be better coordination between the referring physician and the speciality in the hospital to which the patient needs admission. Another area that needs looking into is the payment to subvented hospitals for subsidised patients on the basis of adjusted patient days. This encourages keeping subsidised patients longer in hospital to maximise the subsidy and discourages ambulatory care. The private and public sectors should be able to learn from each other, to support each other and to provide services for each other. Anyone needing treatment can only benefit from such a development. People who choose to buy health care outside the subvented hospitals and polyclinics benefit the community by taking pressure off the public sector and add to the diversity of provision and choice. Mr Speaker, Sir, to achieve our health objectives require a shared commitment from all those with responsibilities for health - from Government, medical personnel and from each individual. What we want is a system whose main objective is quality, the efficient pursuit of health and the equitable distribution of health care resources.”
“Furthermore, it is important to retain employer-provided medical insurance to benefit all employees equally because there is, in Singapore, a rising curve of chronic morbidity, especially from diabetes and hypertension. Diabetes affects about 12% of the population above the age of 35 and there is a similar trend for hypertension. Another suggestion I have is for old age. We can think of another form of financing for health care. We could take 1% of the employee's salary from either the Ordinary or Special Account and sequestrate this into an account called "Old Age Medisave" which should only be used by the account holder after the age of 55 years. This scheme will allow self-reliance in old age for medical needs when there may not be much left in the ordinary Medisave account. Next, to provide good and affordable basic medical services to all Singaporeans. Conceptually, this appears sound but there are difficulties in practice. There is a lack of national consensus on what is basic medical care (I am talking of treatment as well, not just the conditions) and what is the treatment for many common medical conditions. Let me give you an example. In some subvented hospitals, patients with gallstones are treated conservatively, while in other subvented hospitals, the gallstones are quickly whipped out using video laparoscopy. Similarly, for osteo-arthritis of the knees, the treatment can vary from conservative treatment to surgery consisting of total knee replacement. Therefore, we need to have a national consensus on the scope and extent of basic medical care for both patients and medical personnel. Guidelines and protocol systems for common medical conditions have to be worked out. Next, to rely on competition and market forces to improve services and raise efficiency.”
“The present system allows a daily withdrawal of $300 for ward charges and, therefore, patients dare to opt for A Class. However, if for Class B, there is a co-payment component of, let us say, 20% for ward charges by the patient himself or herself, and for A Class, a co-payment component of 50%, then the Medisave holder will be deterred from opting for a ward class outside his or her means as ready cash will be needed to pay for A and B1 wards. I am sure the Ministry of Health could change the co-payment figure to one that is more reasonable. The scheme suggested whereby employers can make voluntary contributions into the Medisave accounts of their employees in lieu of part of their traditional medical benefits in kind, up to a limit of 2% of salary, I think this is a regressive scheme as the lower income workers will get less Medisave contributions than the higher income workers (I am aware of the cut-off level at $7,000). We will have the inverse law operating - "those that need it most, get it least". If a company buys an insurance scheme for all its employees, then the lower income workers are equally covered by the insurance medical benefits as the higher income workers. I propose that the new Medisave scheme should not replace the current medical benefits scheme provided by employers. The fear that if we allow tax free employer-provided medical benefits, it will aggravate the problem of over-use of medical services and inflate health costs as in the US is unfounded because, in the US, there is no tax cap, while in Singapore, there is a tax cap at 2% of the payroll.”
“How can we expect these households to exert personal responsibility for their own health because: (a) the parents lack the education to understand and be motivated by the healthy lifestyle knowledge disseminated by the Ministry of Health and thus, inadvertently, there are long-term ill effects on the helpless and innocent children; (b) the parents do not have the time or energy to cook meals at home; (c) the parents cannot do anything much about the type of oils and other unhealthy ingredients used by the hawkers in their food. Therefore, responsibility for one's health has to be shared by the people, the Government and other relevant personnel and organisations. Where there are threats to the individual's health from the external world, over which people have little or no control, it is the responsibility of the Government and others to take effective action on behalf of the community as a whole. Another instance of people being unable to take personal responsibility for their own health is when they are born with congenital deformities and inherited medical conditions. Now, I would like to touch on some aspects of Medisave and health financing. The Cost Review Committee concluded that with Medisave, the average Singaporean should be able to meet the cost of hospitalisation comfortably, especially if he or she chooses a ward class according to his or her means. This does not always happen because, in 1992, 18% of patients in Class A wards who used Medisave to pay for their hospitalisation had household incomes of less than $1,000. To help patients use their Medisave prudently, I would like to offer the following scheme. The withdrawal of Medisave for daily ward charges should be pitched at only B2 and C Classes and not at A Class which is the situation at present.”
“The primary health care budget has remained at about 11-13% of the Ministry's recurrent expenditure over the last few years although the absolute amount has gone up. The Health Review Committee recommends that "the Government should substantially increase its budget for health promotion and health education to improve the quality of life for Singaporeans." This recommendation has to be pursued with political will and commitment. 2. To promote personal responsibility for one's health and avoid over-reliance on state welfare or medical insurance. We have to recognise that health is determined by a whole range of influences from genetic inheritance, through personal behaviour, family and social circumstances to the physical and social environment - so opportunities and responsibilities for action are widely spread from individuals to Government. Let me give you one ordinary but pertinent example. Let us look at a household spending less than $1,000 per month. According to the Household Expenditure Survey, this includes 40% of the households in the 1987-88 Household Expenditure Survey. Such households spent proportionately more on food, especially cooked food. Of the main income earners in these households, 47% were production workers and 68% had primary or no education. 72% lived in 3-room or smaller flats. With a female labour force participation rate of just over 50%, many of these households would have both parents in the workforce. This family would have to rely more on hawker food for their daily needs.”
“In fact, many countries can learn from our experience. Instead, we have adopted an unnecessarily dismal and fearful attitude that our health care costs will escalate beyond control and this has coloured our whole outlook and philosophy towards health care so that affordability has become the key word and excellence seems to be taking a back seat. I think we do ourselves an injustice by thinking along these lines. We can continue to be prudent about health expenditure but excellence will be compromised if there is an over-riding emphasis on cost control. In fact, we have to recognise that since we have become an affluent society with higher expectations and since we are also aging, we can afford to think about changing our mindset to allow national health expenditure to rise gradually, judiciously and equitably without developing a crisis mentality. In fact, the aged of tomorrow will be better off than the aged of today as the former will have better Medisave accounts and more personal financial resources than the aged of today and, therefore, again the picture is not going to be so bleak. Instead of viewing basic health as a commodity, and I am talking of basic health, we have to some extent adopt the human capital or investment approach which holds that a certain amount of Government subsidies on health care is justified because the social costs and benefits of good health outweigh its private costs and benefits, not least in improving the productivity of the labour force. A worker is only as good as his health. Now, I would like to refer to the health care philosophy propounded by the Government in the White Paper and make some suggestions. 1. To nurse a healthy nation by promoting good health.”
“The comparable figure for education is 17% and a whopping 24% for defence. Thus, the Government's budget for health is a very prudent figure of 5-6% of the total expenditure. Not only has this figure come down but the Government subsidy of national health expenditure has also been coming down. According to the main report of the Review Committee on National Health Policies, and I quote from it: "As a share of Government health expenditure, the subsidy has been falling steadily from 88% in 1965 to 75% in 1985, after which the percentages of subsidies dropped to 57% in 1990." As a percentage of total private consumption expenditure, private health expenditure was only 5.4% of the total compared with 18.6% of the total for education. Thus, we cannot refute the fact that both public and private expenditure on health in Singapore has remained steady and constitutes a very reasonable and manageable proportion of the total national expenditure. Of course, the absolute amount spent on health has increased but so has the absolute amount spent on education, housing, defence, etc. What is important is that we do not spend an increasing percentage of the GDP each year on health so that the other sectors of national life are affected adversely and, so far, there is no evidence to suggest this. Thus, I feel that the Ministerial Committee's fears that health costs will escalate much beyond 3% of GDP and we will get into the predicament of the US where the country's competitiveness has become blunted because of the high health component cost are not justified on present evidence. Our experience with health care expenditure has been a positive and heartening one and we should be congratulating ourselves and the Government for a job well done.”
“If there is an adjustment made for this population increase, then the average yearly increase comes down to 10%. When inflation is factored into the analysis, the average yearly increase is reduced much more. Thus, the average rise in yearly increase in health spending is also modest and will remain so as our health system is not based mainly on taxation or insurance. On the other hand, Singapore's economic growth, as captured by the per capita GDP or PPP, is something that we can be proud of and even boast about. The per capita GDP for Singapore is US$17,000 while for Japan it is US$18,000. Japan spends about 6% of its GDP on health and this figure has remained relatively constant in spite of social insurance and universal coverage since 1961. However, in the US, the figure has increased alarmingly. It was 11% in 1989 and 14% in 1992. Drastic surgery is needed to mend America's health care system because it is the biggest public policy mess of the past two decades. There is no valid comparison at all with Singapore's generally well conceived health care system and we should stop this practice of comparing two entirely different entities. With health expenditure of only 3% of GDP, Singapore is getting first world standards of health care at less than half the cost that is incurred in some first world countries. Thus, there is no great burden on the nation as a whole where national health expenditure is concerned. Now, let us look at the burden of health expenditure on the Government. In 1964, Government health spending was high and accounted for 20% of its main expenditure. It then began declining steadily to 7% in 1970 and in the 90s, the amount spent on health is only about 5-6% of the total Government expenditure.”
“Thank you, Mr Speaker, for giving me the opportunity to speak. I would like to declare my interest as a surgeon in private practice. Mr Speaker, Sir, Singapore enjoys high standards of health care. We are a centre of medical excellence in this region. We should aim to build on our past and present achievements by providing even better health for our citizens and better service for patients. We have to ensure that the quality of health, the standard of health care, and the response to emergencies remain among the best in the world, and able to fulfil our aspirations and needs and match our resources. Sir, the White Paper on Affordable Health Care is a well written document with some good and innovative concepts but is weighted towards the subject of affordability as the title suggests. The focus on health has to be addressed not only on affordability but also on equity and quality. Let us first look at national health expenditure and see the trends for the past 10 years so that we can predict the future direction of health care costs to the nation. From 1982 to 1984, national health expenditure accounted for 2.5% of the GDP each year. In 1985, it was 2.9% and then 3.4% in 1986, after which it came down to 3% in 1989 and it was 3.1% in 1992. Thus, for the last 10 years, the figure has stayed static at around 3%. Hence, there is nothing in the pattern of our past and present history to suggest that we are going to have an explosion of health care expenditure. Between 1980 and 1990, the average yearly increase in health expenditure for both public and private sectors was 11.2%. However, part of this increase in health spending occurred by virtue of the larger population size.”
“Sir, would the Minister consider converting the island into a cultural attraction so that it becomes a tourist asset for us?”
“Sir, would the Minister reconsider his decision because we go round building Malay villages and then we destroy what is authentic and real and predates 1819? Could I remind the Minister that although the younger people have left the island, the older people are there and every Sunday and weekends, the younger people visit the island and it is a thriving community of our living heritage?”
“I know that they have been given notice to quit by the end of the year. Would the Minister please consider revoking or shelving this order before a dialogue can occur, otherwise it will be too late to do that? Another supplementary question is: would the Minister give me the cost-benefit analysis of making a landfill in one of the other nearby islands rather than making a marine landfill, including Pulau Sakeng and the neighbouring islands?”
“Sir, would the Minister confirm whether the inhabitants have been asked to leave by the end of the year, and that is one of the reasons why the number is going down? And would it be possible for the Minister to revoke or shelve the order so that a dialogue can take place and we can assess the cultural value of the island?”
“Sir, is the Minister aware that Pulau Sakeng is the last Malay kampong and is a very valuable part of our cultural heritage and that an economic value cannot be put on an inadvertent destruction of our cultural heritage?”
“In the Cash Grant Scheme, it was $1,500 as the cut-off point. In view of the rising cost of living and the fact that the Cash Grant Scheme was introduced many years ago, would the Minister consider increasing the threshold of the cut-off point? Mr Yeo Cheow Tong: Sir, we do not believe in indexing the various thresholds or cut-off points to inflation. This Scheme is more attractive and those who really require help should come forward to seek assistance under this new Scheme. SATELLITE BROADCASTING 11. Mr Lau Ping Sum asked the Minister for Information and the Arts, in view of Rupert Murdoch's purchase of STAR TV and plans for the distribution of satellite programming across the Asian continent, whether Singapore has any plans of its own to embark on satellite broadcasting.”
“Is the Cash Grant Scheme still in practice or has it been abolished?”
“Would the Minister tell the House how the predecessor Cash Grant Scheme and the Small Families Improvement Scheme differ in their policy objectives?”
“But what about the opportunity cost lost? Because while the students are doing an ineffective exercise, they could be doing something that is effective.”
“Sir, would the Minister of State assure the House that any physical exercise programme introduced in schools in future will be under the supervision of trained PE teachers?”
“I agree with the Minister. But I am wondering whether there are any measures to get women more interested in science and technology because that would be using our manpower and womanpower wisely for the next century.”
“Sir, would the Minister consider keeping in view that there is a fair representation of local women in science and technology?”
“While maintaining the principle of meritocracy, we must not forget a caring and communitarian approach towards the less fortunate 20% in our society who need the help of the rest of society, especially the top 20%, so that we have a level playing field, a point mentioned by Dr Arthur Beng. Only when we have a level playing field, then all of us can play soccer, even though we may take up different positions in the game. The other thing to remember is that we must enjoy the game together and play it to the best of our ability, but with fairness to all concerned. Finally, it has been noted in the Report many times that sharp simultaneous price increases in health, education, transport, etc. were partly caused by the uncoordinated timing of the different Government Ministries, both within each Ministry and also between the different Ministries. Sir, this unacceptable and worrying practice has to be checked, as has been recommended in the Report. A possible solution is to have a permanent Government appointed Cost Review Committee, and all future Government price and fee increases should be monitored and assessed by this Committee so that the public is buffered from financial earthquakes and will only feel minor tremors. With that, I support the motion.”
“These 3-room resale flats are limited in number and older singles are also vying for them. Our present system is making it hard for those in rental flats to become home owners. With the massive upgrading exercise of HDB estates, the value of each apartment is increased by doing up the exterior and interior. This is done with public money with owners only paying a small amount. Thus, the occupiers of these upgraded flats should be required to stay in their flats, for example, a further minimum of two years before selling it, otherwise they are capitalising on state funds. If this sort of regulation is not instituted, then the price of HDB apartments may be pushed up further. Now, education, Sir. At present, the subsidy rates for students at independent schools depend on monthly household income. If the family income is below $2,000, the subsidy of school fees is 50%. If it is below $800, the subsidy rate is 100%. Since this scheme is working well, why can we not use it for university students? Just as the lower income families find it a burden to send their children to independent schools, it is also a financial burden when their children go to university. So for those really poor income families, below $800, the subsidy rate in the university could be pushed up to 100%. Also, the children's education grants for those eligible for the Small Families Improvement Scheme should continue to university, and not stop at pre-university. Quite rightly in Singapore, we have shunned the slippery slope of welfare benefits for all and sundry. However, we have to look at our whole policy of subsidies, as was pointed out by the hon. Member for Tampines GRC.”
“If the patients in these two ward categories, ie, B2 and C, need expensive high-tech care, they should go through a means testing, and co-pay a percentage of the cost of the service that is commensurate with their means. For A class wards, there should be no subsidy at all for both basic and high-tech care, while for B1, the long term subsidy rate of about 20% is acceptable. In order to encourage people to become more self-sufficient where medical care is concerned, every Singaporean over the age of 21, working or non-working, should have a Medisave account. This has become feasible as CPF accounts for Group A Telecom shares have been opened for many non-working Singaporean adults. This account could be used to put in extra money by citizens for Medisave purposes. The criteria for Medifund usage should only be financial difficulty and should be spelt out and publicised more widely. It is unfair to penalise a full-time housewife and give her low priority for Medifund because her husband has been errant and did not contribute to Medisave or MediShield. How can she be blamed and penalised for her irresponsible husband? In fact, she is to be sympathised and supported, especially if her husband does not work regularly or is in a DRC or is in prison. As for public housing, the HDB stopped building 3-room flats in 1987. I agree with the CRC that the HDB should start building 3-room flats again. Besides being more affordable to newly married people, they have to think of the plight of those living in 1-room rental flats who find it impossible to upgrade, as they have limited choices, either to upgrade to a 4-room or 5-room flat, which is a big jump, or to buy a resale flat from the open market.”
“Furthermore, we are gearing towards a high-tech and a knowledge intensive phase in our industrial policy and this is going to disadvantage the bottom 15-20% of our society even more, unless we take cognisance of this and I think the Report has done this, but I am reiterating it. Unless we take cognisance of this and make a concerted attempt to help them to upgrade, social cohesion will be affected. Thus, we have to address the feelings of those lower-income households as "having been left behind". Another fact to consider is that lower income households tend to have more children than higher income families, and thus the dollar of the lower income homes has to stretch further and price increases, therefore, may be felt more acutely by them. Sir, I am going to turn to the different areas of concern where costs have risen. Health costs. High costs have been attributed to high manpower cost and advances in medical technology, besides other reasons. In fact, the higher manpower costs were also contributed by the use of medical technology because of the necessity of specialised personnel to operate the wherewithal of high technology. Thus, it would seem essential to separate medical costs into two main categories: (a) costs arising from provision of basic medical care and (b) costs arising from value added care. For example, the use of high technology. The cost arising from the provision of basic medical care should be heavily subsidised, as the health of our population is one of our most precious resources. Thus, for B2 and C classes, basic health care should be provided at a nominal rate. Yes, I know that the subsidy is high but again I am making a point.”
“Just as the economic success of some countries is captured more by the purchasing power parity (PPP) figure rather than the GDP figure which is currently being used for cross-country comparisons, we in Singapore also want to have a measure of inflation of our cost of living that reflects not only our expenditure pattern but also our purchasing power and our aspirations. We will have to put our heads together and think of a suitable new index. The CPI does not reflect our need adequately. Furthermore, although the CRC Report states that low expenditure households generally experienced lower inflation than the general population during 1984-1992, at the same time, the Committee notes that a lot of Singaporeans with household incomes of between $500 and $1,000 a month might not be captured in official statistics. Therefore, we are not addressing the concerns of this group adequately and I think this comprises about 15% of households and this is the group that should be the concern of all of us who are more fortunate. Although both the Lorenz curve and the Gini Coefficient show that there has been an improvement in the income distribution among resident households between 1980 and 1990, we have to be concerned about the following facts: (a) The absolute gap in dollar terms between the lower income group and the others has widened. (b) Many lower income people are working overtime or have taken on extra part-time jobs and yet there is a widening of the absolute gap in dollars between them and the others.”
“But Singapore's remarkable progress in the last five years has defied norms and thus we have a predicament here where the CPI, calculated according to international norms, is not necessarily representative of the inflation that all of us feel. 3. The CPI is based on expenditure groups but the conclusions apply to income groups. The Department of Statistics believes that there is a strong correlation between income and expenditure. This may not necessarily be true in a high savings society. To put together a high income family with a low expenditure pattern and a low income family with the same expenditure pattern in a similar category may not capture the impact of inflation on the low income family. 4. The recommendation of the CRC for separate CPIs to be compiled and published for different income groups, ie, the lowest 20%, the middle 60% and the highest 20%, is very commendable, but I think we have to broaden this and focus it even further. (a) The bottom 10%. This group needs to be helped out of the poverty trap and we must know specifically how the cost of inflation affects them. According to the 1990 census, 13% of households had incomes of less than $900 and 4% of households had incomes of less than $350. (b) The pensioners who have fixed incomes. (c) The self-employed who do not get automatic yearly wage increases. (d) The single person households of which there are at least 6,500 consisting of old people living alone. Thus, the CPI is too general and aggregate a figure to be of tangible meaning to the majority of people at a micro level in spite of its international macro usefulness for cross-country comparisons.”
“But there is no doubt that the public's perception that there has been a sharp increase in prices in some areas is justified. Of course, some of these price increases were also justified and this has been explained in the Report. However, the overall inflation rate as measured by the CPI has hovered around 3%. How do we reconcile this? Therefore, let us turn to the Consumer Price Index. I have no doubt that the CPI calculation method is sound and serves as a comparable cross-country reference. However, there may be certain factors that blunt the accuracy of the CPI as an indicator of inflation where Singaporeans are concerned and I attempt to summarise this with my meagre knowledge of economics. 1. The 1992 CPI was based on the household expenditure survey of 1987-88, done five years ago. Obviously, with each passing year, from the time of the household expenditure survey, the CPI is less reflective of the current consumption pattern of the households. The CPI which will be calculated on the 1992-93 household expenditure survey will more accurately reflect the current inflation rate. 2. The household expenditure surveys of 1982-83 and 1987-88 were grouped around 1985 which was the recession period. And this could explain why there was little difference in the weightage of items in the baskets of the two household expenditure surveys. Also, the effects of the recession might have affected the expenditure patterns and price changes accordingly. However, since 1988, the structural changes that occurred in Singapore would have rendered the 1987-88 weights less representative. Here, I must stress again that for international purposes, I realise that a 5-year revision of the household expenditure survey is the norm.”
“Thank you, Sir, for giving me the opportunity to speak. The Report of the CRC is, on the whole, a commendable and very thorough piece of work. Its recommendations are especially praiseworthy and I endorse most of them. However, there are certain areas that require further clarification. There is no doubt that our standard of living has gone up in Singapore. Otherwise, we would not be the second most affluent country in this part of the world, next only to Japan. And for this economic feat, the Government and the policy makers have to be commended. There is, however, also no doubt that costs in some areas have risen sharply as detailed in the Report. To highlight some of these sharp cost increases between 1988 and 1992, the following examples will suffice. (a) Hospitalisation fees rose by an annual average of 8%. Specifically for 1990, in SGH, the ward charges for A and B1 wards rose by 21-29%. For Alexandra and Tan Tock Seng Hospitals, the ward charges rose by 12-23%. (b) University tuition fees went up by an annual average of 17%. (c) A 4-room Model A HDB apartment rose by 12.3%. A 5-room Improved HDB apartment rose by 15.7% and an Executive apartment rose by 18.5%. HDB flats sold in the resale market and private housing were also pushed up enormously. Some people say astronomically. (d) Public transport costs increased in 1991, not in the other years, by more than wages. (e) Car prices rose by 22% in 1992 and parking fees rose by 14% over the period 1988-92. (f) Indirect taxes increased by 11% per year between 1987 and 1992. During this same period, 1988 to 1992, the average annual percentage increase in nominal monthly earnings went up by 8.9% and this is something to be proud of.”
“Sir, would the Minister consider that if the owner has had the flat for five years and if the HDB buys it back from him, would they compensate him at the price that the HDB sells it to the next owner after claiming back arrears and all that is owed to the HDB?”
“Sir, would the Minister confirm that when the flat is revested or compulsorily acquired, the owners are compensated at the original price while the HDB then sells the flat later on at the posted price? Is that true?”