Sitoh Yih Pin
Singapore
“Madam, apart from a healthy diet and regular preventive health checks, one of the key elements of keeping healthy in our silver years is to pursue an active lifestyle. Playing and participating in sports is a fun and engaging way to do so. Granted that as one ages, we may not be able to participate in intense sports activities.”
“Mr Chairman, as a market-oriented, open economy, there will be, over time, inflows and outflows of foreigners who live and work in our country, alongside fellow Singaporeans. These foreigners come from different backgrounds and cultures and take on work in various forms as PMETs, skilled or manual workers.”
“Madam, many Singaporeans are very excited about the Kallang Alive Masterplan announced at the Prime Minister's National Day Rally last year and are looking forward to how the plans will revitalise the Sports Hub and its surrounding areas.”
“Mdm Chair, Singapore's arts sector has matured over the years with globally recognised artists and companies supported by world class venues. Importantly, local audience support is critical in building a vibrant arts scene engaged with the Community.”
“Yes, Sir, I will keep it very short. I would like to thank the entire MCCY team and all the speakers for their speeches. With that, I ask for leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $2,270,827,200 for Head X ordered to stand part of the Main Estimates.”
“Sir, I thank the political office holders for their responses. Sir, in the last few hours, several media outlets reported that Lady Gaga will be performing here at the National Stadium. I think four concerts in May this year.”
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“Naysayers argue that as we grew more affluent as a people, we are no longer as hungry. They say that we no longer possess that fighting spirit and the desire to succeed. I disagree. The people I see around me are just as hungry. Our students are often ranked top internationally. Singaporeans in sports and the arts are being groomed to take on and grow with the best around the world. Our goals in life may be different now but I do not think there is less desire to succeed. It is true though that the dreams and aspirations of Singaporeans have changed. They are more diverse. It is no longer only about three square meals on the table, a roof over the head and good sanitation. Now, people also want choices. They want to be included in discussions and be consulted. Views are becoming increasingly more diverse as our social fabric becomes more complex. They have access to the world and, sometimes, want it all. This is to be expected as we grow as a country and as a society. We are after all, a First World country now. Madam, change is inevitable. I spoke on this at the President's Address in 2014. To not change is to not improve. If we seek improvement, one must change. It is what we do and how we adapt that matters, but we must never allow ourselves to lapse into complacency that has befallen other successful First World countries. Never fall for the seductive nectar of basking in a "Good Life" without hard work and constant striving to improve. But Mdm Speaker, I look around at my colleagues in this House and Singaporeans at large, and I feel confident of our country's future. I said earlier that, as a country, we have some strong characteristics. The one that is not commonly applauded is "resilience". A resilience running through the Government and the people as one.”
“We cannot afford to let our guard down. We must always stay ahead of the game. If we do, the next 50 years will be better than the last. Since October 2015, there have been rapid global changes. Many simmering issues have reach boiling points. We head into uncertain times and unchartered waters. Mdm Speaker, the President reminded us of the ever-present security threats we face from terrorism. The terrorists have again struck close to our border at our neighbour. Our security agencies apprehended 27 individuals in Singapore who were planning an attack overseas. No one is completely safe. The threat is real. Economic uncertainty looms. Oil and commodity prices have fallen drastically. Stock markets are volatile. Big developing economies are slowing down and showing signs of distress or are undergoing corrections. These are really strong ill winds that will have severe repercussions on us. The challenges we face now are not unlike those in 1965. Then, we separated from Malaysia. The British announced their withdrawal in 1967. We had no potable water. We could not even defend ourselves. We had nothing. We were right at the bottom. But we were blessed with strong leaders and a united people who rallied behind their Government. They were men and women made of steel. They saw opportunity in adversity. They knew the special characteristics of Singaporeans; penchant for hard work; willingness to cast aside communal and religious divides for the common good; thirst for education and skills; unity to succeed and, above all, resilience in their hearts. The "never say die" attitude. Madam, admittedly, we started at a lower base in 1965. Times have changed. Fifty years of hard work has earned us strong reserves. We have good infrastructure and a modern city.”
“But Mdm Speaker, credit must be given where credit is due. The Government listened. It recalibrated. It acknowledged the areas of concern. It worked hard at building and rebuilding its relationship with the People. It was not easy. How was it done? The "Our Singapore Conversation", led by Minister Heng Swee Keat, was a national initiative aimed at improving communication between the Government and the people. From all accounts, it was an unqualified success. But more importantly, what enabled the change was not any single national initiative but the entire mindset of the Government. Prime Minister Lee Hsien Loong led his Ministers and office-holders in cutting through the red tape of bureaucracy and communicating directly with the people. Senior leaders explained difficult policies. There was a determined and concerted attempt to get the people to "buy in". A wave of new initiatives on many fronts for the young and the old were launched. The Government did not stop there. Unlike many other governments, it "walked the talk", and the people responded. The GE2015 results speak resoundingly loud and crystal clear. This is, however, just the beginning of a new journey. A new and fresh journey in which the Government and the people, having come together in 2015, must work even harder and build a future together for our country as we march towards our next 50 years. If we fail, we will all go down together. As a nation, we have our limitations. We do not have natural resources and, as a little red dot, stand exposed to be battered in this global arena of constant calamities. All we have are people of true grit, will power and determination. Page: 12 So, we journey afresh knowing what we have, what we do not have, but stand "always prepared". We cannot afford to be complacent.”
“Madam, the President's Address for the Opening of the Thirteenth Parliament has set the tone and direction for our country. Twenty-fifteen was said to be a watershed year for Singapore. It was. We celebrated our nation's 50th anniversary, mourned the passing of our founding father, Mr Lee Kuan Yew, and had the first General Election (GE) since Independence where all parliamentary seats were hotly contested. The results of 2015 are plain for everyone to see. I need not dwell on that. It marked a coming together of Singaporeans and their Government, a sense that we are together in this journey. After GE 2011, it appeared as though there was a "disconnect" between the Government and the people. I spoke on the paradigm of "trust" at the Budget debate in 2013. I appealed to the Government to listen better and communicate more. I also spoke on the "out of touch" politician at the Budget debate in 2014. It was not a critique of individuals or the Government. It was never meant to be. It was to say, from my heart, what I heard about the perception of "disconnect". Madam, GE2015 had also been a soul searching and humbling experience. I speak for myself and other hon Members of this House when I say that many of us did not expect the resounding support and result. I entered politics in 2001. I lost twice. I won the third time but by the skin of my teeth or 114 votes to be exact. In 2015, I won again. This time, I was supported by 66% of the voters in Potong Pasir. You should think that I would be a happy man. Well, I am, but I also feel a much heavier burden. I feel that I now have the unenviable but proud task of living up to all the expectations and trust that my voters have placed on me. I am sure that each and every Member of this House feels the same.”
“Yes, Madam. Once again, Madam, I thank our Members for their contributions and our Ministers and Minister of State for their responses. With that, Madam, I beg leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $12,691,000,000 for Head J ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $431,000,000 for Head J ordered to stand part of the Development Estimates. (proc text)] Page: 136”
“It is part and parcel of the SAF mission of engaging in diplomacy so as to secure our peace and stability. At this juncture, I would like to ask if the Minister for Defence can share with the House the experiences that the SAF has learnt from its overseas missions. Page: 97 Of course, there are limits to how much or how frequent we can deploy our SAF assets in such missions. The first restriction or precondition is that other countries must welcome and invite us, as we make the first effort to offer our assistance. The second consideration is that as a largely conscript army, we must be conscious that we do not expose our National Service boys to unnecessary and great risk. Even so, I would encourage the Minister for Defence to consider putting MINDEF and SAF on a more pro-active footing. We may not even need to wait for a crisis or disaster to take part in humanitarian efforts. As we celebrate SG50 and the hallowed institution of National Service, and as SAF develops and matures, it is also time to actively develop the third stated mission of MINDEF and SAF – which is diplomacy. [(proc text) Question proposed. (proc text)]”
“Goodwill from SAF Overseas Missions Madam, let us now also revisit what is the stated mission of MINDEF and SAF. "The mission of MINDEF and the Singapore Armed Forces is to enhance Singapore's peace and security through deterrence and diplomacy, and, should these fail, to secure a swift and decisive victory over the aggressor." 4.45 pm Logically, the first mission of SAF must be to act as a deterrent. Would-be aggressors are deterred from attacking us because of a strong SAF. The second mission of SAF is the terrible task of destroying our enemies as quickly and comprehensively as possible when war starts. As opposed to soft power, which I had talked about earlier, SAF is the rawest and most obvious form of hard power we have. But it can also be a tool for soft power. Diplomacy is soft power in action. As stated in the mission of MINDEF and SAF, diplomacy helps to enhance peace and security. The SAF has done this many times in the past through our overseas missions. Examples include helping our Thailand and Indonesia neighbours during the 2004 Tsunami, earthquake relief efforts in New Zealand in 2011, the flood relief efforts in Kelantan, Malaysia, late last year, as well as our Navy helping Indonesia in the recent tragic Air Asia QZ8501 crash in search and rescue. These are important missions where our SAF has contributed significantly in many ways that are beyond the obvious. These missions contribute to better mutual understanding, respect and trust. Countries and armed forces that go through hardship together and, hence, understand, respect and trust each other more are less likely to go to war with each other. It is in our self-interest to be a good neighbour.”
“Many will also believe that the SAF-VC scheme is also SAF Volunteer Corps Version 1.0. Actually, it is not even Version 2.0 but probably Version 3.0. Version 1.0 can be found when the People's Defence Force (PDF) Bill was passed on 30 December 1965, shortly after Independence. Three months later, some 3,200 males had volunteered to join the PDF. This was before National Service was introduced in the form as we know it today. But given our small population, a volunteer PDF cannot adequately meet the defence needs of Singapore and, hence, Dr Goh had to introduce "modern" National Service Version 2.0 in 1967. And even when we introduced National Service in 1967, there was also a Volunteer Scheme of sorts that started in tandem. Many skilled individuals volunteered to help to kick-start the SAF's development of capabilities. One example is the SAF Medical Corps which began in the 1960s with many volunteer doctors and nurses who need not have done National Service. The Medical Corps is now a professional branch of SAF, highly trained and equipped to perform difficult missions in many parts of the world, as we have seen when they are deployed in many disaster relief and rescue missions. Madam, but its leadership began as a largely volunteer one. Many of them are now in their 70s and 80s, and some have sadly passed on. The Minister of Defence will be familiar with some of these giants in the medical field, such as the late Dr Jimmy Choo, Dr Earl Lu and Dr Richard Yung, our previous Permanent Secretary and Director of Medical Services, Dr Kwa Page: 96 Soon Bee and many others. I hope that even as MINDEF honours our Pioneer National Servicemen as part of SG50, we also remember these pioneer volunteers that helped to shape SAF in its formative years.”
“At the Second Reading of the Bill, then Acting Colonial Secretary Andrew Gilmour explained to the Legislative Council that the main purpose of the Bill was to give the Government the power to introduce National Service whenever necessary in order to meet the defence needs of Singapore and to ensure that the responsibility of defending the Colony could be spread fairly among the population. Page: 95 National Service Volunteer Corps The National Defence Ordinance came into effect on 1 March 1954 and the colonial Government then tried calling up 1,000 youths through a ballot after some 24,000 eligible persons were registered. This attempt did not go smoothly as some 500 Chinese High school students demonstrated against the new law on 13 May 1954. They clashed with the Police. This incident later came to be known as the National Service Riots of 1954. Madam, what is the main lesson we can learn from the failed Nation Service Version 1.0? The first and main lesson is that people who perform National Service must believe in defending something that belonged to them. The Colony then belonged to the British, not to the youths who were called up. As Second Minister for Defence Chan Chun Sing said weeks ago, "The most powerful weapon that Singapore and SAF have is not something that we buy overseas, not something that we can build, but something in our hearts. It is the desire and the willingness to fight for our independence, to remain independent so that we can determine our destiny for years and generations to come". National Service Version 1.0 failed because the most powerful weapon, the heart, was not there. Version 2.0 succeeded because we were independent and our heart was, therefore, in the right place.”
“Madam, I beg to move, "That the total sum to be allocated for Head J of the Estimates be reduced by $100". Madam, 2015 marks both SG50 as well as SAF50. Last month, MINDEF kicked off the first in a series of commemorative events with SAF50@Vivo. I would like to begin by asking the Minister for Defence to share with the House his thoughts on the significance of SAF50 and what the Singapore Armed Forces (SAF) intend to do to honour the contributions of our SAF pioneers? Madam, last year, I encouraged people to sign up as an SAF Volunteer in this House. I am happy to hear from SAF that since then, some 800 persons have applied to be SAF volunteers under the SAF Volunteer Corps, or SAFVC Scheme. Around 50 successful applicants will begin their Basic Training as early as next month. We should be happy and proud that so many have come forward to take part in the SAF-VC and to share in the National Service experience and make their own National Service commitment. Madam, National Service is almost as old as the nation itself. It began when then Defence Minister Dr Goh Keng Swee moved the Second Reading of the National Service (Amendment) Bill in March 1967. He also announced that 9,000 males born between 1 January 1949 and 30 June 1949 would be called up for National Service. By mid-April 1967, more than 90% of the 9,000 males eligible for National Service had registered. You may think this was Singapore National Service Version 1.0. I think many in this House, including myself when I found out, will be surprised to know that this is actually National Service Version 2.0. National Service 1.0 began as early as 1952, when the National Service Bill was tabled on 4 March.”
“Madam, I thank our Members for their contributions and our Ministers and Senior Minister of State for their responses. With that, Madam, I beg leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $444,279,100 for Head N ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $45,000,000 for Head N ordered to stand part of the Development Estimates. (proc text)] Page: 94”
“Maybe MFA can consider setting up a Directorate of Soft Power to look into and quietly manage the soft power that Singapore has. But having said that, this Directorate will have to be nimble, subtle and work with great finesse. As Joseph Nye also said, "the best propaganda is not propaganda". Madam, as we celebrate SG50, perhaps it is also time for us to take stock and reflect on how we can expand our international space, enhance peace and make more friends through quietly managing and promoting our soft power. [(proc text) Question proposed. (proc text)] Relations with Malaysia and Indonesia”
“Our hospitals attract many patients from the region and the world. While some may criticise and say that this takes away precious resources that can be used to help Singaporeans, our well-designed and well-run hospitals, our world-class doctors and nurses, and even as Mr Lee Kuan Yew had said – a thing as basic as our safe blood supply, contributes to Singapore being a regional medical hub. And being a medical hub that people from all countries flock to for medical treatment is also a great reservoir of soft power. In the area of education, our reputable world-class public universities that attract talent from the region and abroad, both in the form of academic staff and students, are also bastions of soft power. Our meritocratic system, aided by the prestigious scholarships we give to young people from around the world, adds to our projection of soft power as well. And here, I know some parents and students will disagree with me. Even our Maths syllabus and textbooks, now used by many schools in faraway places, such as schools in the United States (US), also contribute to our cause for more soft power. Yes, a Singapore mathematics textbook used overseas is also a symbol of soft power. 2.45 pm Page: 63 Madam, I can go on and on. But I will stop here. I think, as a small state, we cannot escape from the frailties and realities of being one. No one owed us a living in 1965 and no one owes us one either now, or 50 years later. We need to stay relevant. We need to be successful and extraordinary. This will require extraordinary human endeavour on our part, as Mr Bilahari also said. But it is also true that some norms of relevance will evolve with time. Soft power is a rapidly evolving norm of relevance and success.”
“Although the British Empire is no more, British soft power is evident in its educational, banking and sporting institutions. The British take their soft power so seriously that in May 2013, their Parliament actually appointed a Committee on Soft Power to examine and report on the use of soft power in furthering the United Kingdom (UK)'s global influence and interests. Another but older example is that of China in the Tang Dynasty, where its cultural and linguistic influence over Japan remains firmly embedded till today despite it never having conquered Japan. Page: 62 I think Singapore has quite a large amount of soft power. We just do not really think about it or give ourselves sufficient credit for it. One obvious example is our Singaporean food. The crowds that gather at Singapore festivals abroad are not just Singaporeans. There are many foreigners who love eating our food, whether in Singapore or abroad. Do not underestimate the amount of soft power in a humble plate of Singapore chicken rice or a bowl of laksa served in London or Sydney. Another obvious source is that of successful Singaporeans in the entertainment scene. Dick Lee, JJ Lin, Kit Chan, Stephanie Sun and so on. They have embellished the image of Singapore and increased its soft power. Another element of soft power is in our air connectivity: our Changi Airport hub and Singapore Airlines, SilkAir and even our budget airlines. Madam, notwithstanding our size, our tourist destinations, such as Botanic Gardens, Gardens by the Bay, the Integrated Resorts (IRs), the Night Safari and the Zoo and so on – they also contribute to our soft power. Even our clean streets, or, as the Environment and Water Resources Minister will point out, our "cleaned streets" is a source of soft power as well.”
“The good news is that no-one takes Singapore as a political joke anymore. A strong economy, a credible Singapore Armed Forces (SAF) and our role as a transport, finance and trading hub mean that we are relevant. But relevance has to be revisited, reassessed, and cultivated constantly. Norms of relevance for a small state always changes because the world around us is always changing and small states cannot dictate what makes it relevant to others. One of the concepts of staying relevant is soft power. The concept of soft power is not that new. It was first coined by Harvard professor Joseph Nye in his 1990 book, "Bound to Lead: the Changing Nature of American Power". He said, and I quote, "A country may obtain the outcomes it wants in world politics because the other countries – admiring its values, emulating its example, aspiring to its level of prosperity and openness – want to follow it. In this sense, it is also important to set the agenda and attract others in world politics, and not only to force them to change by threatening military force or economic sanctions. This soft power – getting others to want the outcomes that you want – co-opts people rather than coerces them." Madam, soft power can be simply described as getting people to do what you want by attraction or co-optation rather than coercion or payment. ESM Goh had mentioned that one of our three foreign policy objectives is that of expanding international space. I believe growing soft power helps to enlarge this international space significantly. An often-quoted example of a country having lots of soft power is South Korea. Their soft power is embodied in their serials, pop music, food and travel destinations. Another example is that of Britain.”
“Madam, I beg to move, "That the total sum to be allocated for Head N of the Estimates be reduced by $100." Madam, at the S Rajaratnam Lecture given on 17 October 2014 by Emeritus Senior Minister (ESM) Goh Chok Tong, he highlighted three objectives that have shaped Singapore's foreign policy over the decades. They are: (a) Preserving Singapore's sovereignty; (b) Enhancing peace in Singapore and the region; and (c) Expanding the international space that Singapore has, which is what I am going to speak about. Key to all these objectives is the underlining strategy of relevance and international self-assertion. Madam, the survival record of small states in this history of human civilisation is, simply put, not good. The city states of Greece no longer exist. Small states in ancient China in the Spring and Autumn and Warring States eras did not last for more than 300 to 400 years, at best. Mr Bilahari Kausikan, our former Permanent Secretary at the Ministry of Foreign Affairs (MFA) and now Ambassador-at-Large, said in a recent lecture on 27 January 2015 that for a small state to survive, it must be relevant. And for it to be relevant, it must be successful and extraordinary. I agree with this concise if not terse observation. This is because, as he noted, the world will probably get along fine without Singapore as an independent and sovereign country. In the same lecture, Mr Bilahari also said that he was told that Mr Lee Kuan Yew had once said that "small states are a political joke". I know this is kind of hard to stomach and kind of a massive wet blanket as we prepare to indulge in some joyful celebrations as we approach SG50. But it is the kind of hard and Page: 61 stark truth that Mr Lee Kuan Yew has often talked or written about.”
“Admittedly, competency is always a work in progress and we can always improve, even if we make missteps along the way, such as the delay in improving our infrastructure and capacity of our public services, as our Prime Minister had mentioned recently. But by any international standards and in the large scheme of things, our PAP Government has always been competent. This Budget is a bold one although it, too, is a work in progress in our never ending efforts to put our political philosophy into policies, programmes and actions. We will only get better and better. Mdm Speaker, I support the Budget. 12.12 pm”
“Madam, in recent years, our Government has done many things that benefit the poor and the vulnerable. We have come up with the PGP, MediShield Life, more childcare centres, more buses, more education grants, more HDB flats and so on, and the list goes on. We have passed laws that protect the vulnerable, such as on human trafficking and the mentally disabled and even the everyday consumer. And this new Budget underscores this commitment with the CPF refinement measures and the Silver Support scheme. Both these initiatives will provide greater support for older workers and senior citizens. They clearly exemplify the compassion and empathy in us. So, I asked my doctor friend again, "Will the politics of empathy always triumph over policies and programmes of compassion?" Here is his answer: "In the short run, yes. But in the long run, no. Compassion without empathy is like a cold fish. Empathy without compassion is like a con-man. Whether you are a doctor or a politician, there is a third element that is as equally important as empathy and compassion. That is – competence. If all your patients do not recover and get worse or die prematurely, then, in the long run, everyone will know you are a bad doctor, even when you have the best bedside manners. Ultimately, you have to solve your patient's problems. You need to be technically competent in addition to having empathy and compassion." While we may not be very rational beings, in the long run, we all have to face reality, whether in relationships, in the career we choose or the politicians we vote for. And a Page: 12 competency check is also a good reality check. Madam, Singaporeans have had 56 years of experience with PAP's competency, starting in 1959 when Singapore achieved self-government.”
“Most of these 19-year-olds could not really describe the difference. He tells me that the politically correct answer is both empathy and compassion are equally important. But in reality, on the ground, it is different. Empathy is more important than compassion in the short run. A patient is naturally drawn to a doctor with empathy even if, internally, the doctor has little compassion. And sadly, a doctor who is full of compassion for his patients will come across as a cold fish if he cannot demonstrate empathy. Empathy includes feeling the disappointment, frustration and anguish of fellow Singaporeans that may have felt defeated in one way or another. Madam, defeat is a very painful process, as I should be able to empathise from my repeated and prolonged experiences. But at least in this country, anybody that may have felt Page: 11 defeated will always find new hope and be able to forge a path towards new successes. Compassion, on the other hand, is the feeling of distress and pity for the suffering or misfortune of another and often includes the desire to alleviate it. How a voter relates to a politician is not much different from how a patient relates to a doctor. They are quickly drawn to the one with empathy. Empathy is taken as a reliable proxy for compassion. But, in reality, it takes a person far longer to realise that his doctor or political leader has compassion and sincerely wants to help him. But the ability to empathise often does not truly reflect deep compassion. You can empathise, but do you really do what it takes to help the poor and the needy? And you know what? Voters may still vote for certain politicians and political parties because they think these people and parties can empathise and, hence, have compassion as well.”
“Neither of which are very rational decisions. I will not venture into the realm of marriage and spousal selection, but we all know that the heart rules the head in this area. Page: 10 And then, there is the issue of choosing a career. A doctor friend of mine told me that there is little correlation in choosing a specialty that earns the most money and one's academic performance in medical school. If everyone were economically rational, the smartest medical students would choose the best paying specialties, such as ophthalmology and surgery. Instead, there are many excellent students who become physicians and paediatricians, which typically pay less. I am fully aware that there are quite a few ophthalmologists and surgeons in this House and my comment in no way reflects on their academic ability relative to their peers. But even then, the fact that a few of them have given up their lucrative clinical practices to be in politics full-time is also, in itself, not a rational economic decision. Madam, we now move on to a third important area where people are often not rational about – politics and the selection of their political leaders. The same doctor friend of mine told me he used to sit on the interview panels that selected candidates for our local medical school, Yong Loo Lin School of Medicine. These candidates have to submit a personal statement to convince the panels why they would make good doctors if they were given a choice. Many of these personal statements contain words such as "compassion" and "empathy". This doctor friend told me that he would ask the candidates who used these words, "What is the difference between compassion and empathy, and which trait is more important to have as a doctor"?”
“Mdm Speaker, another year, another Budget debate. This is where the Finance Minister holds centre court. I do not envy Deputy Prime Minister Tharman's job. He has to balance short-term needs with long-term priorities and the demands from the various Ministries that are responsible for the wide range of functions that straddle the entire spectrum of Government functions: from ensuring national security to fostering economic competitiveness, funding health and social programmes, developing infrastructure to providing the finest education that our children need to compete in this world. Madam, coming up with the Budget is like juggling many balls in the air and ensuring none should drop. At the heart of it is the concept of allocative efficiency. How do we distribute limited amounts of money in a way that gives us the biggest bang for the buck? As our Prime Minister said recently, a dollar spent on healthcare means a dollar less to spend on other areas, such as education, housing or security. That is not to say healthcare is less important than education. But the truth is, we have a finite number of dollars to spend on a variety of needs and desires. And then there is the law of diminishing returns. The more and more we spend on one area, the less bang for the buck we get. So, it is probably wise to spread the spending to many areas in a balanced and equitable way. Madam, this is the rational view of things. But life is seldom rational. In fact, contrary to what is proclaimed in neo-classical economics about the rational economic man who makes rational choices to maximise his utility, most of the biggest decisions in life are not rational. Two of the biggest choices we make in our lifetimes are our choice of spouse and the career we choose.”
“Perhaps, we need to explain to people whether the assistance is conditional or unconditional, where the money is coming from, and whether we are moving towards the direction of Western countries whereby working people will have to bear a bigger burden. From what I understand, the Independent Review Committee has already recommended that employers adopt a more flexible and portable medical insurance for their employees, for example, upgrading their employees' current MediShield and IP plans. This would be a very good move. Apart from providing solutions to offset cost and restructure the medical benefits of the employees, we should also put more emphasis on public education to help Singaporeans understand. With more benefits, wider coverage and by bringing those with pre-existing conditions under the scheme, MediShield Life is a revolutionary move. Do not forget we also have Medifund and we do not need to pay high income tax of 30% or 40% like the Western countries. This kind of medical benefits is unique in the world. Even with MediShield Life in place, we should continue to promote healthy lifestyles. MediShield Life should not become an excuse for us to stop exercising. I fully support this Motion.”
“I suggest that we apply the same communication methods as what we have done for the Pioneer Generation Package by "dissecting" the policies so as to communicate with the seniors effectively and help them understand how they can look for the kind of healthcare they need. In fact, many people still do not understand that MediShield Life is a form of insurance. Some people wrote on my Facebook, "If I pass away, will my family members get anything?" MediShield Life is actually a medical insurance. People may not know what is deductible and what is co-insurance either. By the time they find out they need to pay out of their own pocket for the deductibles and co-insurance, they will say that insurance is cheating people. MediShield Life can help to pay for large medical bills. However, we need to be careful not to create the misconception that it can pay every single medical bill. After listening to my explanation, the residents said, "Oh, so, it is like that? It is not all-inclusive, it does not cover everything." Life is not plain sailing every day. Sometimes, we may discover that we are facing financial difficulties. Although the Independent Review Committee suggested that we should take stern action against those who default, I feel we should give people who are in genuine Page: 80 difficulties some breathing space. In addition, I think we should also give consideration to the unemployed and the seniors who have very little CPF and Medisave savings. How can we help them pay the premiums? I think the Government needs to give a more detailed explanation. Some people are worried how they can get help after the subsidy period ends.”
“There may be many more smaller hospital bills that are not covered under MediShield Life, and these will have to be picked up ideally by employers' coverage. Otherwise, individually, they will have to buy another insurance to cover the smaller hospital bills, if they do not want to pay cash. Mdm Speaker, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] MediShield Life truly reflects our aspiration for an inclusive society that leaves no one behind, from those with pre-existing Page: 79 conditions to the aged. As for young and healthy Singaporeans, the increased premiums may seem like a penalty to them. But this is obviously meant to encourage everyone – from family members to friends, neighbours and even strangers – to be responsible for their health and to have a better lifestyle. Despite the Government's repeated assurances that the premiums for MediShield Life will be affordable for everyone, there are still some residents who are not fully convinced. Recently, I went to the coffee shops and one resident came to me and said that at the moment he did not have any insurance. Now, because of this compulsory MediShield Life, he is forced to buy medical insurance. So, I asked him, "Does it occur to you what would happen if one day you fall sick and have to be hospitalised?" He said, "I have never thought about that". Maybe our Government is thinking too much. According to residents' feedback, Singaporeans hope that they will be able to pay for all the premiums with their Medisave. But not everybody has money in their Medisave. Insurance policies have always been very complicated, particularly for the lay people. This could be the main reason why some senior citizens do not seek comprehensive coverage.”
“While the increased premiums to cope with a more comprehensive healthcare scheme may seem like a penalty to the young and healthy, it clearly seeks to drive home the message of shared responsibility and paying forward, that is, to pay more when we are young and working so that, when we are old, premiums need not grow exponentially. In any case, in spite of the premium increments, the enhanced MediShield Life keeps medical expenses manageable for most, while shoring up various gaps. Based on feedback from the ground, Singaporeans, I believe, generally prefer to be able to pay their insurance premiums out of their Medisave accounts. On the other hand, premiums for health insurance policies offered by private insurance companies tend to go up exponentially with age, and it may be inevitable to pay a portion of the premiums out of one's pocket instead of paying the full sum via Medisave. In fact, I have received feedback from many of my residents over the last few years that their premiums from the private insurance companies have gone up tremendously. So, my residents are worried. With the introduction of MediShield Life, will their premiums be increased again? They worry that the companies will take this opportunity to increase the premium upwards. Perhaps, the Government needs to monitor the premium of IPs and asking them to break it down into MediShield Life, plus whatever that is extra. There are also residents who misunderstood that MediShield Life is all-encompassing. I have already heard residents talking about not renewing their existing insurance plans when MediShield Life kicks in. MediShield Life provides better protection against large hospital bills and expensive chronic treatment. Perhaps, we need to bring up awareness on what is a large hospital bill.”
“The New York Times, in an article entitled "A World of Rising Health Care Costs" last year, revealed that having to inject more funds into healthcare has become a common predicament among industralised countries and some big developing countries. Our healthcare sector is also influenced by external factors. In fact, there was a big debate about pharmaceutical companies having different pricing for different countries, depending on whether they are classified as Third World or others. Instead of following in the footsteps of the struggling welfare states and placing the onus solely on the Government and national reserve funds, it is far more pragmatic and sustainable to have in place a healthcare model that emphasises "Shared Responsibility" and then, when necessary, more assistance from the Government. I have confidence that this enhancement of MediShield Life supports this model well. Dr William Haseltine, President and Founder of ACCESS Health International, was in praise of our subscription to the shared responsibility model. He referred to our CPF as "a big social stabiliser, and a big stabiliser of health", and suggested that the USA could solve some of its current problems by taking a leaf out of our books with mandatory health savings Page: 78 accounts and regulation of insurance company prices and policies. MediShield Life is a true reflection of the society we strive to be – one that is inclusive, leaving no one behind, from those with pre-existing illnesses to the aged. These were the vulnerable groups previously not insurable.”
“In today's healthcare setting, it is easy for one to rake up an astounding medical bill with just a surgery and a few days of hospital stay. Worse still, in some cases, it may have discouraged patients from seeking further treatment, such as chemotherapy and radiotherapy. Page: 77 I know of someone who was diagnosed with stomach cancer. At first, the family members did not want to tell him that he had cancer. But later on, the doctor said that the cancer had spread to the liver. After the operation, he needed to have chemotherapy, and that was the time the family members told their father that he had cancer. And the father told the children he did not want to have further treatment. He did not want to have chemotherapy. Why? Because he said he had some friends who had sold away their houses and their shophouses to seek treatment but eventually the friends still passed away. The upgrade to MediShield Life comes at a very timely moment and has addressed this ominous problem along with other concerns, such as incurring large medical bills when diagnosed with critical illness. Just now, the hon Member Mr Png Eng Huat mentioned that 100 million people in the world got into poverty because of medical expenses, if I listened correctly. It is precisely because we care for our Singaporeans and do not want our Singaporeans to go into poverty because of medical expenses that is why we introduced MediShield Life. I congratulate the Review Committee for their hard work, and I am pleased that the Government has deemed it fit to accept all its recommendations and move this Motion for the House to debate. We have often heard the argument that the Government could reduce healthcare costs. Yes, perhaps, but to what extent? Rising healthcare cost is an inevitable global problem.”
“Will this share of funding change with MediShield Life? Finally, I would like to once again express my appreciation to the MediShield Life Review Committee for their conviction and courage in coming up with the various landmark recommendations in the design of MediShield Life, and also to the Minister for Health for accepting these recommendations and in coming up with $4 billion to fund the transition period. Four billion dollars now and the $8 billion in the Pioneer Generation Package underscore the Government's determination to give Singaporeans peace of mind when it comes to the subject of healthcare costs. As I have said before, while $12 billion of funding may matter very little to Mr Tan in the street and Mdm Wong in the market, Mr Tan and Mdm Wong will find out that what they have to pay out of their pocket or savings will be very much reduced with the introduction of the Pioneer Generation Package and MediShield Life. I am very confident that our people will know and will feel the difference once the tyre hits the road. I support the Motion. 5.18 pm Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, with increasing life expectancy and inflation, public concerns from accessibility to quality and affordability of healthcare have been hanging heavily over the heads of Singaporeans. Senior citizens, in particular, especially those who have invested their hard-earned cash on their house and their children, would find themselves in a spot for not having invested on health insurance when they were younger. With significantly pricier premiums for their age groups or, even worse, a rejection from the insurers because of their age and/or because of pre-existing health problems, the dilemma becomes even greater.”
“I think it would be good if MOH can release MediShield's Loss Ratios for the last 20 years, and how it compares with private medical insurance, while taking into account that some front-loading and, hence, lower loss ratio may be desirable in a life-long insurance product, such as MediShield, as compared to a private one in which it is only as good as the year in which you have paid your premium. Going forward, it would be good, too, if MOH can also now declare upfront what are the actuarial assumptions for MediShield Life so that we know why and what we are paying for. For example, what are the life-expectancy, healthcare inflation and loss ratio assumptions in the design of MediShield Life? The actual performance of MediShield Life can then be monitored against its design assumptions by all interested parties and stakeholders when it is introduced. It will also facilitate benchmarking against other medical insurance schemes. This will give all MediShield Life users a better and collective sense of ownership and responsibility in making the system work. This disclosure of information will also enable all stakeholders to make Page: 76 informed decisions and constructive recommendations to improve MediShield Life. Madam, the last point I would like to add is whether the 3M framework of Medisave, MediShield and Medifund will take up a larger share of total healthcare expenditure. One of the common comments of the 3M framework, that is, Medisave, MediShield and Medifund, is that 3M only funds a purported 10% of total healthcare expenditure. Government expenditure now accounts for 40% of total healthcare expenditure, up from 33% a few years ago. That leaves about half of total expenditure to be still funded either by out-of-pocket, employee benefits or private insurance.”
“This is logical because if you think about it, we want several providers for a certain product or service so that, through competition, innovation and differentiation between providers, the consumer can benefit. But once a product is standardised, there is very limited if any scope for competition, innovation and differentiation to take place. Also, like C and B2, the B1 service is also a uniquely restructured hospital product in that it receives a 20% subsidy rate. Most private hospitals offer very few four-bedders and these beds are not subsidised. So, if the service product is standardised and unique to restructured hospitals and the insurance product is also now standardised, then, in theory at least, there is little economic sense for there to be many providers. In fact, a single insurance provider will enjoy economies of scale and better risk-pooling. Hence, I would like to call on the Government to consider taking over the administration of IPs for B1 services, just as it does for the B2 and C Class services. If it does so, it can also institute certain elements that private insurers are very hesitant to practise, such as front-loading of premiums and coverage of pre-existing diseases. Madam, the next point I would like to make is that I hope MOH can consider releasing some data and projections on MediShield and MediShield Life. A frequent comment is that MediShield is too "profitable" – it collects more than it needs because it pays out so little. This is not true.”
“Although there are many restructured hospitals offering B2 and C, by virtue of the funding formulas and the ownership and the appointment of board directors, the Government also has very good oversight and governance over these same hospitals. So, in systems design, we have good control over both the demand and supply sides of the equation, unlike conventional healthcare insurances in which there is little control over the supply side. Madam, if MOH can truly exert control over how B2 and C Class services are scoped and delivered and subsidised, then I think we can be very optimistic that MediShield Life will work. If costs and scope of B2 and C Class services are not well controlled and moderated, then two things will happen: first, premiums will have to go up significantly or out-of-pocket payments by patients will have to painfully increase. In the worst case, both will happen simultaneously and MediShield Life may fail as a healthcare funding policy tool. Madam, I would like to now spend a little time on my favourite MediShield Life Review Committee recommendation, that is, providing a standardised IP for B1 Class. Personally, I like this because it also addresses the sandwiched portion of our society. Those who are not poor but also cannot afford the un-subsidised A Class or private hospital charges, that is, the middle and upper middle class folks. Page: 75 But philosophically, I also have a problem with the IP continuing in its present form. I would like to suggest that the private insurers concentrate on providing products for A Class and private hospital services and exit the B1 segment.”
“Implicit or otherwise, the MediShield Life Review Committee already has built in the elements of control and moderation in its recommendations, the most important being the recommendation that MediShield Life can be used no matter what class of beds the patient chooses, from C to A, but the withdrawal limits will be pegged to B2 and C Class bills. In other words, the A Class patient and the B2 patient will withdraw the same amount of money for Page: 74 the same treatment from MediShield Life. Madam, herein lies the most critical success and differentiating factor of MediShield Life from other insurance schemes, especially private insurance schemes. For any insurance scheme to work well, aside from relying in good actuarial practices, one has to contend with three factors: one, the size of the insurance premium; two, the payout; and, three, the out-of-pocket portion, that is, the difference between the total healthcare bill as given by the healthcare provider and the payout. Most healthcare insurance providers cannot control the size of the healthcare bill. They can only control the premium and the payout. In other words, other than in very limited cases, the healthcare insurance provider has little control over the healthcare provider. But MediShield Life is very different. In effect, the Government controls all three aspects of the ecosystem. By pegging payouts to B2 and C Class bills, it has put into place control and the avoidance of mission overreach. The offering of B2 and C Class services is essentially that of a monopoly run by restructured hospitals that are wholly owned by MOH.”
“(f) To foster a spirit of collective welfare through healthy Singaporeans funding a small portion of the additional premiums of less healthy Singaporeans in order to achieve universal coverage. Mdm Speaker, each of the above six demands is, in itself, already a formidable policy aim to be achieved, let alone all six. But if we just reduce MediShield to its elemental state – MediShield Life is essentially about healthcare financing. Healthcare financing can also be divided into two broad elements – funding and payment. Actually, to the man in the street, or the auntie in the market, they are not very much interested in how healthcare is funded, even if policy wonks are so obsessed. For example, whether the Government funded the Pioneer Generation Package, which is essentially also about healthcare financing, $800 million or $8 billion makes little difference to Mr Tan or Mdm Wong. Mr Tan or Mdm Wong is primarily interested in payments – how much are they going to pay for the remainder after Government funding. So, the two biggest things on everyone's minds are: how much will the premiums be in the long run? And, two, how much will the payouts be when we need to use MediShield Life? These two aspects will determine whether MediShield Life will work and achieve its policy intents in the long run. I am quietly optimistic that MediShield Life will work as long as the Government can maintain control over the MediShield Life ecosystem. Yes, the key word is "control". Control is not a nice word. In this Internet Age, it is probably a politically incorrect word. But I would like to proffer that control is exactly what is needed for MediShield Life to work. The other is moderation.”
“Madam, I wish to congratulate and thank the MediShield Life Review Committee, led by Mr Bobby Chin, on their hard work and extensive recommendations. The Committee has managed to strike a good balance between several competing demands in coming up with their recommendations. These demands include: (a) The need for MediShield Life to be financially sustainable so that there is no inter-generational transfer of liabilities. We have avoided the situation in which our children and our grandchildren end up paying for our elderly's healthcare costs, other than within the same family unit. (b) To reinforce the original aim of MediShield which is to pay for large healthcare bills, while leaving smaller bills to be paid for by other means, either by out-of-pocket payments, Medisave, employee benefits and so on. MediShield Life rightly pays more than the old MediShield for the big bills. (c) To avoid the two main pitfalls of private insurance schemes, which are adverse selection and moral hazard; which, in layman's terms, means "cherry picking" by insurers and "buffet mentality" by the insured. The scheme is all-inclusive, even for those with pre-existing diseases, and deductibles and co-payment remain as key features. Page: 73 (d) To give Singaporeans peace of mind – there is now no lifetime limit-caps and annual limits of withdrawal have been substantially raised. (e) To keep MediShield Life premiums affordable and well within what the vast majority of working Singaporeans contribute in terms of Medisave contributions so that there need not be out-of-pocket payments to fund MediShield Life premiums.”
“While we may argue and disagree over policies and ideologies, we should not give Singaporeans an unduly rosy picture of the world. A populist view of the world is that we can keep our serene and certain dimension indefinitely while ignoring the other reality of rapid change. That somehow, we can resist the forces of globalisation and global competition. Or at the other extreme, along with the tides of change, we change so much that we lose our values and moral compass in the process. Yes, we can still have our little and familiar comforts like eating our nasi lemak, our mee pok and roti prata at our hawker centres and coffee shops each morning, wearing our most comfortable shorts and slippers, but at the same time, we cannot ignore the fact that Singapore has to stay relevant as a city-state and each Singaporean must have the relevant skillsets, the right attitude and, most importantly, the moral compass and values to survive in this world. In conclusion, the future belongs to the people that embrace change. This holds true for all of us politicians in this House. This also holds true for the man in the street. Madam, I support the Motion.”
“By widening our NS commitment through the Volunteer Corps, more people who have a stake in Singapore can now also understand the vulnerabilities of the country and the need for NS. There is thus more common ground and better understanding among more people, which can only be good for resilience. The reality of a small city-state in a tumultuous world necessitates NS. With NS, we have a strong SAF and a strong Home Team. Singaporeans can then enjoy the other dimension of a stable and safe environment. This is what I mean by conflating the two realities into a coherent experience that makes sense. Madam, the other way is the old way. As the saying goes, "Honesty is the best policy." The Government has to be honest in presenting the fact that there is no escaping both realities. Singaporeans have to be ready for change, even as Singaporeans want their leaders and Government to respond and change. Our education system also has a very important role to play. Even as we equip Singaporeans with skills for the globalised marketplace, MOE, in its Addendum to the President's Address, has said it will place great emphasis on transmission of values, so that our children will have the strong character and moral compass to anchor themselves in a fast changing world. Yes, even as we respond and adapt and change, we need to hold on to our values steadfastly. Our sense of what is right and wrong, what is just and unjust, should not change. The mass media has a role to play too. And, here, it must be said that their role is a difficult one. There are so many forms of mass media nowadays that it is hard to be heard. Page: 57 Finally, I think the Opposition in this House also has an important role to play.”
“This is a life that is serene, certain and warm. This is the reality we are comfortable with. On the hand, there is another dimension that exists. A world where more ideas and disruptive technologies are spawned faster than ever before, and idea and technology diffusion take place in a matter of days around the world. A world where faraway incidents can occur which can directly impact Singaporeans and Singapore almost immediately. An environment of rapid, vertiginous and gut-wrenching change. This is also reality. Page: 56 To survive as a city-state, Singaporeans have to accept both dimensions of existence. But that is easier said than done. Not many people can seamlessly move from one dimension of reality to the other. How do we conflate the two realities into a coherent experience that makes sense to Singaporeans? National Service and Total Defence are two of the most important ways to achieve this, obviously. Our NSmen are taught to be resilient even as they see how vulnerable Singapore is as a small nation. In fact, one can say that our ideology is one of resilience arising from vulnerability and the co-existence of both concepts. In the same vein, I therefore strongly support the recent suggestion by CSNS to start a Volunteer Corps for females, new citizens and PRs. NS has been a privilege and sacrifice exclusively to Singaporean males. Often, I hear of girlfriends and wives complaining that they feel completely left out at gatherings when their boyfriends and husbands "zone out" and start talking about their NS experiences. Well, here is your chance not to be left out anymore. Join the Volunteer Corps!”
“The Way of the Small State has never been easy in human history. Many city states and small states have come and gone with the sands of time. The city states of ancient Greece and the states in ancient China, such as those during the Warring States and Spring Autumn periods are examples. The present and future are actually even more challenging for the following two reasons. Firstly, in the past, might is right. The big can and do eat up the small through military conflicts. For the last 60 years, America, as the pre-eminent power of the world, has introduced a rules-based system that has benefited small states, such as Singapore. We hope that as we move from a unipolar to a multi-polar world, other great powers will also subscribe to a rules-based world rather than a "might is right" world. Secondly, with the Internet and mass media, the dissemination of information and the velocity of change has quickened exponentially. We can no longer shelter our people from external changes and pressures. Indeed, the velocity of change with the Internet has shrunk the world and, perhaps, with this shrinking, the small state seems even smaller now and there is no respite. Madam, as a small state, we do not make the rules on how the world is run. So, let us focus on the second point, which is how the world is now a smaller place and a faster changing one. There are two dimensions that we Singaporeans live in. On one hand, it is a dimension of immediate familiarity and calm. You wake up, send your kids off to school, go to work and after a day's work, return to your family and your home. You like to spend a Saturday morning at your neighbourhood coffee shop and maybe in the afternoon, go to the nearby supermarket. You know things will always be there as you expect it to be.”
“We live in one of the fastest growing regions in the world, and we also live in one that is highly interesting. The Pacific and Indian Oceans and the surrounding seaboards will be the grounds where continental powers and big countries meet to contest in the 21st Century. The emphasis has shifted from where the focus has been since the Middle Ages, which is the Atlantic Ocean. Hopefully, such contests will not result in military conflict. In North Asia, an assertive China, an emergent South Korea and a resurgent Japan, together with an American leadership that is trying to run a great balancing act between all parties will hopefully find a new peaceful equilibrium for co-existence. In Southeast Asia, we will have to contend with simmering territorial disputes in the South China Sea that has the potential to boil over at short notice, as we have seen recently between Vietnam, Philippines and China. Against this volatile and complicated backdrop of changes, what is Singapore's response? Recently, I read a book called "Hard Choices: Challenging the Singapore Consensus" by Mr Donald Low and Mr Sudhir Thomas Vadaketh. It is an interesting book, although I do not Page: 55 exactly agree with a few points made by the authors. One of the points made is that Singapore should move from a sense of vulnerability to that of building resilience. Madam, I think this dichotomy of choice between resilience and vulnerability is unnecessary. We need both a sense of vulnerability and resilience. The choice is not between vulnerability and resilience but between vulnerability and complacency. Resilience is definitely necessary. This is no more obvious in the case of Singapore, a small state tucked away between large countries and continental powers.”
“NS is already a time-honoured, if not, sacred institution in Singapore. I am glad that the Government is not content with what it has achieved and continues to make NS even more relevant and to secure more support and buy-in from not just Singaporeans, but from employers and companies that hire Singaporeans. Page: 54 If there is one thing we can learn from all this, it is that the Government and People's Action Party Members of Parliament are not only ready for change, we have embraced change. Change that is contextually appropriate. Change that has not just been for change's sake. We can refine the way we do things when only evolutionary and incremental change is needed. We can completely redefine and reframe issues when profound and disruptive change is necessary. We need to if we are to progress as a nation. And more changes are to come, as evidenced by the President's Address last week. In our Pledge, we say we want to "achieve progress for our nation". But as Robert Kennedy so famously said, "Progress is a nice word. But change is its motivator. And change has its enemies". So, change will not be easy. It will be painful, and more often than not, layered with ample doses of anxiety and fear. But change has to take place. Not just for the Government and Ministries that run this country, but for every Singaporean. Paradoxically, change is more painful when things are going well. Change may meet less resistance when things are not going well and as management consultants put it – there is a "burning platform" where everyone sees the need and therefore are committed to effecting change. To quote Abraham Lincoln, "The dogmas of the quiet past are inadequate to the stormy present". The present around us is indeed stormy.”
“Mdm Speaker, change. They say the only constant in life is change. There are many kinds of change. There is evolutionary change. There is incremental and superficial change as opposed to disruptive and profound change. As Winston Churchill put it, "To improve is to change. To be perfect is to change often." Madam, we are now halfway through this Parliamentary term. For decades, the Government has listened to the people, has laboured for the people and has led the people. We have seen changes. Where the system is working well, the Government has tweaked and refined the system. Where the system needs a comprehensive relook, we have made profound and fundamental changes. This can be seen in how the Government has launched the Pioneer Generation Package and revamped the HDB property sector. The Pioneer Generation Package is not means-tested and this represents a major departure from our prevailing norm underpinning our social policies. New HDB flat pricing has also been de-linked from prevailing land prices; a practice that has been in place for decades. In education as well, we are seeing change not just at the policy level but at the philosophical level as well. We are also seeing fundamental changes to our public bus system – right down to the model of financing and ownership and not just bus operations. Madam, even in defence, we are making major changes to our NS system. Defence is traditionally not an area that we see great changes in, given the inherent limitations of geography and demographics in Singapore. But as you can see, the Committee to Strengthen National Service (CSNS), which is chaired by the Minister for Defence, is making some very far-reaching proposals that will strengthen Singaporean's support for NS.”
“Actually, if you add in the $8 billion dollars allocated for the Pioneer Generation Package, which is essentially about healthcare, the total amount comes up to $15.1 billion. So, for the first time in our history, in an oblique way, healthcare has topped the Budget expenditure list. Page: 86 Madam, as the saying goes: "Our Government has put our money where its mouth is". It is primarily about healthcare and it is about the people who need healthcare most – our Pioneer Generation.”
“MOH-run nursing homes can set the standards for others and be at the forefront of innovation in developing new services and systems in the nursing home sector. With operational experience, MOH can then develop a better regulatory framework. MOH can better understand the operational constraints, funding realities and manpower shortage that nursing homes now experience. In other words, the best way to stay in touch with the real world is to do-it-yourself (DIY). There is nothing like being at the frontlines, feeling the heat of battle on a daily basis. Madam, at the beginning of the Budget debate last week, I mentioned that politicians and public servants should not be out of touch. Since my first participation in the Budget debate in 2012, I have consistently chosen to speak on broader themes that I have felt will always be relevant in politics, whether for now or well into the future. I did the same again this year. I have chosen this COS health debate to revisit this out-of-touch topic, because the highlight of this Budget is really about the Pioneer Generation Package, which is about healthcare. The Pioneer Generation Package could not have been invented overnight. Our Government must have spent a lot of time and effort understanding the hearts, minds and the needs of our Singaporean families. Madam, we have a common saying, "上有高堂，下有妻儿”. Translated it means "we have our parents above us, and our wife and children alongside us". This package provides middle-age Singaporeans, like myself, great peace of mind knowing that our Pioneer Generation parents will be well looked after. Madam, this year's Budget is really about healthcare. The Budget for MOH, at $7.1 billion, is the third largest, after MINDEF and MOE.”
“Madam, It is one thing to stay for a few days in a six- to eight-person cubicle in a general hospital, and it is another thing altogether to spend one's final days staying for many months, if not for several years, in a nursing home also in eight-person cubicles without any personal space and privacy. Even if the elderly of today are willing to spend their last days in such an environment, will the elderly in 20 to 30 years' time be willing to do so? Even if we cannot afford a cubicle for each resident, can we not consider housing the residents in smaller cubicles of two to three beds? This is just one such aspect of addressing the privacy and dignity needs of our patients. The larger issues are how nursing home care is structured, delivered and funded. The sector is dominated now by VWOs and supplemented by the private sector. The majority of beds are subsidised and funding norms are determined by MOH. In terms of operating subsidy, if I am not mistaken, the entire amount of subsidies given to eligible nursing homes in Singapore annually is less than the subsidy enjoyed by a single large general hospital, such as TTSH and NUH. The result is that while we are planning, building and operating First World general hospitals all over the island, the ILTC sector, in particular that of nursing homes, are operating under less than First World realities. We can hold our own Page: 85 against the best general hospitals in the UK, Australia, Japan, Sweden, Denmark and so on. But when it comes to nursing homes, the impression I get is that our nursing homes lag behind the best in the world. Madam, I would like to suggest that MOH operate a few nursing homes itself, similar to how MOE is now running a few kindergartens. Such a move will achieve a few purposes.”
“It is not, therefore, uncommon to hear that patients in acute hospitals are waiting for days if not weeks for a bed in the ILTC sector. Hence, I am glad to note that MOH will devote much more resources to developing the ILTC sector, especially the nursing home sector, because the need is there and also, it is far cheaper to build and run an ILTC bed than an acute hospital bed. Madam, capacity-building in the ILTC sector is only half the answer. The next issue is that of quality of life. Page: 84 From time to time, I visit my relatives, friends and residents at our hospitals. For those that are elderly and very sick, I notice the following things are important to them: to be in as little pain as possible; to have their moments of privacy; to maintain their human dignity; and to spend time with their loved ones. I will now dwell a bit on the second and third point – that of privacy and human dignity. These are abstract ideas that are hard to quantify but so very important, especially when a person is ill, lonely and vulnerable. Madam, I am given to understand that MOH is now in the process of finding operators for 10 nursing homes it is currently building. Like what Minister Khaw Boon Wan mentioned about the integrated healthcare hub in Woodlands, these homes need to take into account the needs and expectations of not just today's elderly, but also those in 20 to 30 years' time. I note that the standard configuration for these nursing homes that are being built is an eight-person cubicle, similar to what has been in existence for some time.”
“Madam, please allow me to declare my interest that I am a director of a healthcare company known as Talkmed Group Limited, and I have two brothers who are doctors. Page: 83 I wish to commend the Minister for Health for the many initiatives his Ministry is embarking on this year to address our healthcare needs, in particular, that of the elderly. Much attention has been drawn to the recent bed crunch in our acute general hospitals. And with each crunch comes the calls for more general hospitals to be built. We certainly need more general hospitals. Madam, just as importantly, we also need more intermediate and long-term care facilities, such as community hospitals and nursing home beds. Let me give you an example. In some developed economies, the community hospital may have twice the number of beds than the general hospital next to it. And then there are many more nursing home beds compared to community hospital beds. Given the much longer stays that almost all community hospital patients experience, this makes a lot of sense. In Singapore, this numerical relationship is reversed. We have been building community hospitals next to our general hospitals, but in terms of number of beds, the community hospital is only a fraction of the general hospital. According to 2012 MOH statistics, we had 11,000 beds in acute hospitals and specialty centres. We have roughly the same number of beds – also 11,000 – in the intermediate and long-term care sector (ILTC), of which the vast majority, about 9,500, are nursing home beds. This ratio of roughly 1:1 between hospital and ILTC beds needs to be addressed quickly. The average patient stays in a nursing home for months if not years; a community hospital patient stays for weeks and an acute hospital patient only stays for a few days.”
“The other plank of our defence philosophy is that Singapore must remain relevant to the world and it is in the interests of the world's major and regional powers that Singapore remains an independent, sovereign state. That is why Singapore must remain plugged into the world community and our little country punches above our weight in the diplomatic world. A small state tucked away, forgotten by the world, is also a state ripe for the picking by aggressors. Sir, Mr Lee Kuan Yew and other founding fathers have said on more than one occasion in the past that no one owes us a living. Actually, I think it is more elemental than that. No one even owes us an existence.”
“The defence of a physically small country like Singapore is also limited by both the size of our population and the size of our defence budget. Larger countries can afford larger armies and larger budgets, especially when their economies grow. We are seeing this phenomenon of rapid growth in some defence budgets around us. I think this is natural. While we need not fear this, we should also be sensitive to this and recognise that both the rules of the game and the game itself are changing. The SAF cannot lie idle while such developments take place. We have always placed about a quarter to a third of our Government Budget or about 4% to 5% of our GDP on defence expenditure. This has always been the biggest Page: 156 ticket item in the Budget. We should remain committed to these expenditure levels. We should also resist calls for National Service to be shortened to only a year, as suggested recently by Mr Tan Kin Lian. As recent events have taught us, we cannot rely on people, be it others or even ourselves, remembering history to keep the peace. The best way to achieve peace and security for Singapore is for everyone to know that they cannot possibly win a war with Singapore and that starting a war will exact a terrible and unacceptable price for the aggressor. This message has to be repeatedly, if not continually, communicated to all Singaporeans and others beyond our shores. Not just to this generation, but for the generations to come. Most importantly, this message needs to be backed by the commitment and sacrifice of all Singaporeans, especially our SAF regulars and NSmen. We will do so as sensitively as possible but, when the going gets rough, we will also respond appropriately.”
“Without a growing economy, we cannot possibly fund our education, social and health programmes in a sustainable and responsible way. We can argue how Page: 155 fast should our economy grow, but no one should argue that our economy cannot shrink or stagnate – it needs to grow. As for defence, without an effective SAF, a would-be aggressor may start a war with Singapore because the aggressor thinks this war can be won. As Sun Tzu said, the supreme art of war is to subdue the enemy without fighting. The hard truth of defending Singapore is that we have few strategic alternatives. Singapore cannot fight a protracted war. And the reasons are obvious. Unlike Russia in World War II, we cannot trade space for time or hope for inhospitable climate before mounting an offensive. We live in the balmy tropics and we only have 710 square kilometres. Unlike the Chinese in the Korean War, or the Vietnamese when they fought the Americans, we cannot absorb massive casualties and wear the enemy down. We only have 4 million to 5 million residents. We have no natural terrain obstacles around us that can prevent or even slow an attack. While we may think of the seas around us affording us some comfort, the waters around us are no obstacles to air warfare and modern long-range weapons, especially in a built-up city like ours. That means we are left with the strategic option of securing a quick, decisive and crippling defeat of our enemies once war starts. And while we want to only have friends in this world, we should leave no doubt in any potential aggressor's mind that the SAF is trained and equipped to do just that. I, therefore, fully support the efforts of the Minister for Defence to keep the SAF the best trained and equipped armed forces in the region. This is by no means an easy task.”
“Sir, there is a colloquial saying in Chinese that goes roughly like this: "There are people who will conduct business at the risk of losing their lives, but there is certainly no one that will conduct a business that will certainly result in a loss." In Chinese, it goes like "会丢了命的生意有人会做,不过没有人会做肯定亏钱的生意". Drug trafficking is one such example. People will try and smuggle drugs knowing fully well that they may go to the gallows. But no one will sell you a plate of mee rebus for 50 cents when it costs $1.50 to produce that plate of mee rebus. Sir, the same principle applies to wars. Wars are started for one reason and one reason only – someone thinks that a war can be won. Some may argue that wars can begin for many reasons. For example, some people think that World War I was started by accident when an Austrian royalty was assassinated. Many wars were also started out of religious differences or fervour. But if we distil the facts, we can almost always find that the party that started the war believed they could win, whether by sheer might or even aided by supernatural power. This belief needs only to be momentary before a nation passes the tipping point and starts a war. 7.00 pm In the history of mankind, city-states have not had a very good record of existence. Many have come and gone through the millennia. Can Singapore be different? Actually, everything about the survival of Singapore boils down to two things – our economy must grow and our armed forces must be equal to the mission of defending Singapore. I know, critics will tell me that there is more to government than the economy and defence, such as education, health, looking after our elderly and poor, transport and so on. I also agree. But the key word here is "growing".”