Tan Cheng Bock
Singapore
“As I said, we have not done much. We must not be captured by our old style of managing the old. The new old, as I said before, are better educated and travelled, and are very knowledgeable. So we must quickly explore new ways and methods to meet the expectations of the new old.”
“If we only have such a small pool of talents in Singapore because of our population size, we should spare no effort in seeking every such talent.”
“Thank you. I accepted the Minister's reply on the different pricing in the outpatient polyclinics and the hospitals. My point is that the patient's problem has still not been solved. Whenever a doctor refers a patient from a hospital to an outpatient clinic, he still has to pay more.”
“Six out of the nine items were much more expensive. Sir, I am asking why is there such a difference. Is this a one-off incident or is it going to be a norm? How can doctors in the hospital then refer patients back to the outpatient clinic if the patient is going to pay more?”
“I move this amendment to ask the Minister what is the Ministry's stand on seat belts to be made compulsory for primary and kindergarten buses. I heard over the radio that the Ministry is reviewing the case. There are two issues here, question of cost and question of safety. I think safety has a higher weightage over cost.”
“I also want to commend the NTUC for working with the Government to put this package together. I believe that without the NTUC's representation in putting forward the workers' case, the workers would not be able to benefit so substantially this year from this package.”
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“But in the long-term, it is not a complete answer because, even if you leave your industrial land prices at two-thirds of where they are today, there will be land in other parts of Asia which will be cheaper. We cannot match them on price, dollar-for-dollar. What we have to do is to match them overall, in terms of land, capabilities, manpower, skills, infrastructure and offer a value proposition which makes sense for people to come to Singapore and invest in Singapore. Even then, it is uphill because the Chinese are building up their capabilities considerably. You have heard BG George Yeo talk about this and many of you have visited and seen it too. We have to reassess our overall strategies and decide what we can do in manufacturing, and if manufacturing possibilities are going to be more constrained now, what we can do in services, which is the many different types of service industries. There is no quick answer. I do not have a solution today. It is something which the Government is studying and will take several months to consider. Mr Inderjit Singh and Mr Chiam See Tong also asked whether removing anti-speculative measures will lead to sky-rocketing property prices. I think in the present circumstances, that is not likely. The market is down. If you get what the stock market people call "a dead cat bounce", which means it hits the ground, it bounces up and falls dead again, that will already be a slight improvement from where you are. At some stage, the mood will change and the market will take off again. At that point, we will deal with that situation. We have been through the cycle many times. I was the one in 1996 who announced the pricking of the bubble and in 1998, we had to reverse that and here we are reversing the last of it.”
“Lastly, on local enterprises. Dr Jennifer Lee asked about the PWD Corporation moratorium taking away projects from the private sector. I think she does not have to worry because out of $3.5 billion worth of accelerated infrastructure projects, only about $100 million worth of contracts will go to PWD Corporation under the moratorium. But we have to abide by the moratorium because that is a legal obligation. If you break that, then you have to compensate PWD Corporation and apart from the expense of it, it is right that once we have made a commitment, we should stick by that commitment and not lightly change it. There are enough jobs to go around. PWD Corporation is now a private company - $3.5 billion minus $100 million is $3.4 billion - I think there is enough gravy. Anyway, PWD Corporation is not a construction firm. It is only a consultancy firm. Even if PWD Corporation does the consultancy, the actual construction will be done by many other players in the industry. Next, land-related measures. Mr Inderjit Singh asked about permanent cost reduction for the future, for example, on industrial land because the rebate is temporary and this is a longer term problem. He has a point because, in fact, it is a longer term problem, because our companies in Singapore are competing against companies which are operating in Malaysia, China, Vietnam, and their land prices are going to be lower than ours for a long time to come, and not just for these next one or two years. So, what do we do? We could adjust our industrial land prices down and keep it there for sometime. That is possible.”
“As for the SME bank and SME lending terms, in general, I have a lot of sympathy for the idea that SMEs ought to have access to funds and we should have schemes which will help them where they have specific problems, because they do not have a track record, where they cannot borrow because they do not have ability to prepare the documentation and their justification, but they have good business ideas and they should proceed. But I think setting up a SME bank is not a very viable proposition because in this day and age, to be a bank, you have to be a big bank. Unless you are a very large bank, you are not able to muster that ability and capability to assess customers, to have the economies of scale to lend, even to SMEs. Some of the biggest SME lenders in Singapore are big banks, including foreign banks, and amongst the local banks which are not small, there are a few who have a reputation for having a SME clientele. I do not think it is the size of the bank which is the problem. It is the orientation of the bank, whether it is focused on lending this sector, and has people who understand how this sector works, and can tell who is a promising entrepreneur and who is just telling a good story; or whether it is not or is unable to have a feel because the staff do not speak Teochew, or maybe they just do not know how the business culture works. I do not think the SME bank is a solution. What we have done with the Local Enterprise Finance Scheme plus the micro loans, plus the loan insurance, I think, will help significantly. The last time we had a problem in 1998, we had expanded these loans. That already made a considerable difference. This time, we are loosening the terms further. Let us see how it works out. If we need to, we can do some more later on.”
“One, Government should ask banks not to recall loans, not to panic, reduce interest rates, mortgages. Mr Leong Horn Kee said to keep the umbrella open and others also would like, maybe, bigger umbrellas. The very brief answer is that interest rates are already coming down and you can see the banks reducing their prime rates. The more basic answer is that if the Government advises banks not to foreclose on their loans, to forebear, to lend more generously in a downturn, the Government takes moral responsibility, and if something goes wrong with the bank, then the Government has to answer for it. The bank will come to the Government to say, "I did this. Now my loans have turned bad, you have to bail me out." And that is a very serious moral hazard. Mr Chandra Mohan said that banks have a national duty because they have a precious licence. Firstly, we have introduced competition into the banking sector so these licences are not that scarce. There are many banks which are competing for the business. Secondly, the first national duty of the bank is not to run into trouble and the way not to run into trouble, is to make prudent decisions, long-term decisions, but careful ones, hard-headed decisions, assessing which company is viable and should have its loan extended or rescheduled; which company is not viable, and they better cut losses. And the shrewd banker is the one who knows how to cut his losses with a bad customer, but knows how to extend a line and keep his good customers through an upturn and a downturn. Some of our Singapore bankers are very shrewd bankers. Those of you who are in the business will know which are the shrewdest ones and it shows in their bottom lines. I am not a commercial banker and it is not my business to go and tell them whom to lend money to.”
“Finally, the biggest question on tax which many MPs raised - Mr Chay Wai Chuen, Mr Low Thia Khiang, Mr Chandra Mohan and Mr Lew Syn Pau - is why not reduce GST. It is a lot of money. With a stroke of the pen, you can waive and distribute largesse all around. It is precisely the wrong thing to do. We want to achieve a certain objective with a certain budget. The Government still needs money. I cannot just forgive all taxes this year. The tax has to come from somewhere. What is the least bad tax? There is no such thing as a good tax because all taxes are bad. Nobody volunteers to pay tax but, of all the taxes we have, I think the least bad tax is the GST. It is broad-based, it does not weigh heavily on the poor or the rich; it does not weigh heavily on any particular good; it does not weigh heavily on any particular group of companies. It is uniformly spread over the whole economy and its revenues can be used for other worthy purposes. If we want to achieve a specific objective, I would say, raise money from the GST which is already there and we will use that to achieve our objective, reduce business cost, property tax, incentivise businesses to profit, corporate tax rebate, incentivise individuals and help them have some money in their pockets, personal tax rebates, asset share with Singaporeans, lower income groups, New Singapore Shares - I use the money, I distribute that. It is $11 billion. What should this $11 billion consist of? I think we are better off having it consists of these specific items, each with a particular purpose, rather than reducing the GST which just distributes money all round without solving any problem. Next, I go on to assistance to local enterprises. There are three points.”
“If you want to save them, that is fine. If you want to invest them, that is fine. If you want to use them to hire a maid and pay the levy, that is fine also. It is your choice. You have the freedom. Let us not decide for you that it is good that you have a maid, or it is good that your child goes to childcare instead of staying at home with your parents and parents-in-law or grandparents-in-law. So we have not gone for maid levy, childcare, specific items. We have gone for broad approaches which leave people the maximum flexibility to decide what they need, what is their most urgent requirement. Mr Chay Wai Chuen asked for landlords to be compelled to pass on their property tax savings to their tenants. This is an old issue which we have looked at many times because, on previous Budgets, we have also had property tax rebates and we have also wanted it to go through to the tenants. And while we can do it for JTC, HDB and Government tenants, we have not been able to do it for the private sector. We have decided it is not wise to do it for the private sector because the tenancy agreement is a private contract between the landlord and the tenant. They settle the terms, they settle the price. If the terms are not right, either the landlord will kick the tenant out, or the tenant will quit and go somewhere else. And the next tenancy agreement, which is signed, will take into account the newer, lower property tax and the newer, more relaxed property market. So we have not compelled it. Given a soft property market, there will be pressure on the landlord to pass it on anyway because if he did not pass some of it on, the tenants will just go elsewhere.”
“And after reviewing all of them, we came to the conclusion that there was not going to be a quick pick-up, a V, but neither was it going to be an indefinite recession, an L, but it would be a U. A paper was deliberated, discussed, accepted and adopted as the basis on which GIC operated and, indeed, on which the Government also made its assumptions and plans for the economy. So the best opinions can be wrong. If there are other opinions outside, we will try and pick them up, but this is not something which we can tell for certain, even without 11th September. Looking forward, it looks gloomy now. We cannot say for sure that it will not pick up within 12 months or 18 months. Things will turn. Nobody can predict when. But we are at this pass. It is a grave situation. We have implemented an $11 billion package to deal with this. The first bundle of measures we have had are the tax measures. Some hon. Members have asked for additional enhancements. For example, Dr Vasoo asked for waiver of income tax on retrenchment benefits. I am happy to say we agree to that straightaway because, in fact, retrenchment benefits are not subject to income tax. Dr Vasoo also asked for rebates on maid levy and childcare. We have not done this. The reason is that even now with the maid levy at a constant level - it has not been increased - the number of maids has been going up. In the middle of a recession, the demand is still there and we have just left the levy as it is. We have decided that rather than help people with levy, childcare or maids specifically, it is better for us to reduce income taxes, give you a tax rebate, New Singapore Shares. The money is yours, the assets are yours, the shares are yours, it is up to you to decide what you want to do with them.”
“38 pm BG Lee Hsien Loong: Mr Speaker, Sir, I thank all the Members who have spoken on this Ministerial Statement and have supported it. As it has been a long day, I shall endeavour to be brief. I will begin with what Mr Inderjit Singh said, questioning the predictive ability of MTI. I freely admit that MTI's predictive abilities are limited. As the Minister said day before yesterday, we have been high by too much about as often as we have been low by too much. But that is the nature of our economy. It is open, it is very dependent on external conditions. Nobody can be sure which way the world economy will go. Therefore, we cannot tell which way the Singapore economy will go. We can guess, but we cannot be certain. At the beginning of this year, there was a serious question what would happen to the US economy. It had slowed down. Was it going to be a V, was it going to be a U? Would the recovery come back because it is a cyclical problem, or was there a deeper structural issue? And there was a range of views amongst the best analysts -Morgan Stanley, J P Morgan, Goldman Sachs - all the people who have a vested interest in predicting what is going to happen. They put out their various opinions, arguing persuasively, some that it would recover quickly, others that it would be a deeper longer haul. And we were quite concerned about the matter, to the extent that GIC had a special study done internally, comparing all these different views and analysing them, particularly a view from Stephen Roach of Morgan Stanley who was the most pessimistic of them all, with good reason, and trying to come to some conclusion which of these views was correct.”
“But that is how we have done it at the constituency level, I am sure not only in my constituency, not only in Bukit Timah, but also in all the other constituencies. So when I heard the hon. new Nominated MP calling the CCC "this new animal", I was a little bit lost. This CCC has been around for years, and the CCC has been the best body to dish out these funds to the people. They know the ground. Well, maybe she is new. Let us forgive her. But having said that, I think the call for retraining is important, because we must seize this opportunity now. We must really go and entice our workers to go for retraining. The new jobs are going to be different. They are no longer the same. And this special "People for Jobs Traineeship Programme" is very good. We must encourage that and I support it very strongly. The package, as presented, is more than reasonable, and it will take quite a while for it to sink in. But I am happy that we are able to respond to this current economic downturn with another package so soon after the first package. We are all in this together. Everyone will have to chip in - the unions, the Government and business. We will accept the pay cuts, we will overcome, because we have the resolve. We have the means, we have the political will and we are a united people. Finally, Mr Speaker, Sir, Mr Chiam called these off-Budget measures a political ploy. Why should we apologise? If it is a political ploy, so what? I think there is no need to apologise that this package is a political ploy. There is an election coming, but that should not be the reason for us not doing this, which is necessary and right. Moreover, we are using the surpluses saved throughout these five years in office to help Singaporeans ride through this crisis. 6.”
“There is a fear that the foreign worker is taking away a lot of our Singaporeans' jobs, and this has been addressed by DPM. I agree with him that the tightened criteria are very important, because he said that the profile of the working Singaporean has improved. There are more graduates and there are many Singaporeans who are tertiary-educated, and their expectations are very high. We send the best of our students to Cambridge, Oxford, Stanford, etc, to study. They come back, their expectations are high and, therefore, some of them will feel hurt. Hence, it is timely that we have a better set of criteria to employ our foreign workers. What I am saying is that we must not make Singaporeans feel less valued, and I agree with these stricter criteria now. A targeted approach to those who have lost their jobs is correct. I think Mr Chiam got it wrong. I do not know what he was saying. But let me say that no amount of rhetoric, no amount of great speeches can make a man happy, especially a breadwinner, when he has got no job. Therefore, our approach must be targeted. We must go straight to his problem, and his problem is that he needs finances to pay his PUB bills, his children's education, his transport bills. That is why we have to target it. So we provide the $200 to them. It is one of the various ways that the community is helping all these people. In the Bukit Timah CDC, all the Members of Parliament in that CDC are given a package, a certain sum of money, and they disburse this fund accordingly so that there is not too much red tape. If there is too much red tape, the poor fellow will be running all over the place to collect that $200.”
“Thus, the family support has shrunk and this created this sense of uncertainty, this fear and this worry. I see the only way out is job creation and job preservation. To do that, I think the Government has to provide that ambience for the business sector to be able to create jobs and to preserve the jobs. Looking at the package and listening to DPM, I know that there is a genuine effort to achieve these goals. And this package obviously contains a lot of assistance programmes to do this. But the man-in-the-street should not feel that the Government is helping this sector more than them because, if they will go through the package presented, there is a lot for them too. I am, therefore, glad to see many changes made to help businesses to survive. I remember our earlier assessment of the downturn. We put a lot of emphasis on cyclical cause for this downturn. But when I speak to businessmen, they always tell me, "Doc, there is a structural element there". This afternoon, listening to DPM, he has called for structural changes to be made to our economic health, and I am sure this would be supported very strongly by the business community. Singaporeans must be prepared for change in our lifestyle. We have to scale down our expectations in terms of expected income, job choices, housing, recreation and spending habits. No longer can we be too choosy about jobs, expect high income. We have to earn every cent, and not expect it. We have to take on jobs now taken up by foreign workers, including construction work. We have to review our maid employment. For example, we should encourage some of our Singaporeans who are unemployed to take up part-time housekeeping jobs. Hourly-paid jobs are also a way out in these difficult times.”
“Mr Speaker, Sir, I support this off-Budget package. We are able to do so because of our prudent management of our finances and resources. Mr Speaker, Sir, at my meet-the-people sessions, three major areas of concern and request kept recurring: 1) Requests for jobs; 2) Concern about the rising electricity and water bills, SC&C charges and their current mortgage housing loans; and 3) Inability or problems in meeting their hospital bills and education and transport costs and, for the business community, they always complain of no business or very poor business. I had wanted to see how Deputy Prime Minister would address these issues, and I must say that I am quite comforted by the fact that he has given very good assurances as to how these issues would be tackled. This time around, I can feel the urgency, the worry and the fear, more so than in the previous 1985 and 1997 downturns. This time, the effect is more widespread, involving white and blue-collar workers and involving many categories of our workforce, from the driver to the manager, young professionals and recent graduates. In the previous downturn, I remember when we offered jobs to some of those people who had no jobs, they turned it down. I can understand at that time why they did that, because there was a lot of family support. Many of the members of the families had jobs. So the family support was there. But this time around, I notice that they are less choosy and they would accept whatever jobs that we offer to them. I can understand that this recession must be quite widespread. Not only the manufacturing sector is involved, but the other sectors are also involved, and this has affected other members of the family.”
“I would ask parents, Members of this House and members of the public to focus on the value-addedness of the ranking exercise rather the usual focus on the absolute ranking. 4.30 pm Mr Ang has suggested that instead of ranking, we should use banding instead. To introduce a more well-rounded and complete framework for assessment, we introduced the school excellence model in 1999 that allows schools to assess themselves on how well they have achieved, both academic and non-academic outcomes. In addition, the school excellence model appraises management processes as well, since good processes will ensure sustained results. Mr Ang may be happy to know that banding of schools is practised under the school excellence model. Depending on how the school assesses itself, to appraise itself in one of five bands available, and with the first year's assessment as a base, the school will then chart its own progress, self-improvement strategies and track its improvements up the band or to the next higher band over time. The school excellence model will also include other things which are non-academic in nature, including how they perform in other areas. May I come now to multi-racialism in schools? I completely endorse what Dr Tan Cheng Bock has said. There are many principals and teachers in this House today as well, and I urge them to take that message away with them.”
“One of the objectives of school ranking is to provide schools with a yardstick to improve their performance. This is not unique to Singapore. I am a little surprised that Mr Ang says that UK does not reveal their ranking data. As far as I know, they actually do and also in quite considerable detail. In Singapore, our ranking is really very mild and gentle. We have something like 350 schools, 200 primary and 150 secondary. We do not rank the primary schools. Of the 150 or so secondary schools, we rank 50 of them. In many places, including UK, and in many states in the United States, they rank them from top to bottom. In some states in the United States, the avowed aim of putting the schools at the bottom is to name and to shame them into doing something about it. I can quite honestly say that in Singapore, I am not ashamed of any of the schools that I have. In our system, a good education takes place in all of them. In our system, we find it necessary and useful to just rank the top 50. In a sense, there is a band of the top 50 schools for Express stream and the top 40 schools for Normal stream. I have distributed the data earlier on. In fact, my Ministry's focus in the ranking exercise is not on the absolute ranking of the schools, but the value-added ranking, because if the best students go to a particular school, I do expect that that school would turn up on the top with an absolute ranking. What I am more interested, and what parents should be interested in, should be the value-added ranking, which is to say, if a particular school has a student population of this characteristic and this school is able to get more out of these students than would have been normally expected, then there is something special about this school.”
“I would particularly like to thank him for all his suggestions and comments today. The reason that I have responded to him so fully is because I take his views very seriously, and I know that many people take his views very seriously and give them a lot of weight. So, I felt it was important for me to respond to his comments as completely as I could today, just to make sure that there is a clear understanding on the issues. I would like to inform Mr Ong Ah Heng that, with the exception of two secondary schools, whose transition to the single session system is tied to the completion of the new buildings, all the other 160 secondary schools and three full schools are now operating single session. There are 48 primary schools operating single session, but most of them are new schools, and yet to achieve full enrolment. When they do, they probably have to operate on double sessions. Either that or they are schools in mature estates facing falling enrolment, or they are primary sections of full schools. The single-session programme is a significant step forward for secondary schools and it has allowed schools to benefit from greater flexibility in the use of curriculum time and resources. Our schools can now introduce a wider range of enrichment programmes to cater to students of different abilities and family backgrounds. The Ministry of Education will consider whether to have single session primary schools when PRIME is closer to completion. Sir, education is a partnership among schools, parents and the community. No matter how good a job our schools, our principals and our teachers do, they cannot and should not replace the love, concern and support of the home. Let me turn now to school ranking.”
“Young children of different races play and fight together, without a care of each other's race or language. Being innocent and fresh-faced, they enjoy the warmth and company of each other without prejudice. Thus, from young, we must avoid segregation of pupils for administrative convenience. We must, for example, encourage non-Chinese pupils to join China tours instead of taking only Chinese students. Basketball should not be a sport only for Chinese students. Teachers must have a high level of awareness on this subject. It must be internalised in them so that they can handle sensitive situations by not offering hamburgers to Malay students, or beef to Hindu students. Also, schools, such as Special Assistance Schools and madrasah schools, should develop their own programmes to allow students to understand the way of life of other races. Thus, fundamental to just tolerance is this need to teach our students each other's culture and social behaviour. When our children from young are constantly doing and experiencing multi-racial social norms, it will not just be blind acceptance of racial tolerance. Multi-racialism must be based on a strong foundation of understanding, knowledge, action and deeds in schools that will carry them into their workplace and HDB estates. Thus, I hope that the Ministry will encourage schools of their very important role of promoting multi-racialism in Singapore. RAdm Teo Chee Hean: We have not been able to answer all the points that Members have raised today. If Members do wish to pursue these matters with my Ministry, I will be happy to receive their letters or queries and we will try to respond to them, including those cuts that we were not able to take today under the main Head. I would also like to express my deep respect for Dr Wang.”
“Sir, I will be very brief although this can be a very long subject to talk about. Sir, we have always used the word "tolerance" when we discuss race relations. But tolerance implies acceptance without questioning why. We should go beyond tolerance. Multi-racialism must never be taken for granted. We must work hard at it through actions and deeds. To do this, we must have an appreciation and understanding of the lifestyles, customs and habits of each different race. We have taken steps to ensure a good multi-racial mix at our HDB estates, by fixing the percentage of each racial group in an estate. Then, when we noticed, after the 1984 general elections, that people were voting along racial lines, we took immediate steps to prevent the possibility of having no minority representation in this House. Can you imagine this House of MPs of Chinese origin, and yet we tell the world that we are a multi-racial country? Thus, we introduced the GRC concept, where a member from the minority race is essential in a slate of candidates to be elected. And because of the rising religious fervour around the region and the world, we acted fast by introducing the Maintenance of Religious Harmony Act to preserve the right to practise without fear or favour. This will allow our multi-religious groups to conduct the practice of their faith in a free and fair way, as our racial groups practise different religions. These are positive actions that the Government took because we wanted to avoid racial conflict. Our historical past has examples of what can happen if there is a breakdown in racial harmony. These are actions taken after the events came to light. Therefore, the best place that we can start our multi-racial culture is our schools.”
“Sir, I thank the Minister for his reply and beg leave to withdraw my amendment. Amendment, by leave, withdrawn. The sum of $337,078,850 for Head U ordered to stand part of the Main Estimates. The sum of $9,727,568,500 for Head U ordered to stand part of the Development Estimates.”
“Sir, I beg to move, That the sum to be allocated for Head U of the Main Estimates be reduced by $10 in respect of Code UL 3100. Sir, every time I drive past the Padang, I cannot help but wonder whether we can replicate such a setting in our HDB new towns, ie, an open field, with the CC as the anchor building at one end of this field, just like the Singapore Recreation Club. The CC is an important institution in the constituency. It allows different races with different religious beliefs to interact and socialise. The CC is, thus, the common ground for all. A big field fronting a CC, I believe, is the best setting. In the evening, children and families can enjoy the open space and, more rewarding, I am sure the CC activities will attract more residents to attend. National Day can be celebrated on a grander scale at our constituency level. Can I, therefore, ask the Ministry to plan the constituency parks, allowing a big field for the CC, in future new towns? Dr John Chen Seow Phun: Sir, I fully agree with the Member. It is indeed a good idea as it will provide a wider range of community and recreational opportunities for residents at our parks, and also bring about better land use. I am pleased to inform him that NParks has been proactively working with URA and the relevant authorities to co-locate compatible facilities with parks, where feasible, and these include not just CCs, but also other facilities like child-care and so on. The examples include the child-care facilities at Katong Park, Telok Ayer-Hong Lim Green Community Club at Hong Lim Park, Tanglin Community Centre at Malcolm Park, and Tanjong Pagar Community Club at Duxton Plain Park, and they will continue to look for places to implement the idea.”
“Sir, I just want to seek a clarification from the Minister about this lift upgrading. We need 75% to agree for this upgrading. But if the lift landing is on alternate floors, there will only be 50% who is going to support it. And, if it is on every third floor, it is very likely that the others, who have lift landings, will not support it. So I am not so sure whether we can get 75% of the residents to agree.”
“My suggestion is that there must be a transparent medical record system to help overcome such problems so that medical records of those in one hospital can be passed on to another doctor of a different hospital in a different cluster for better patient care. One last point, Sir, is that doctors are now practising defensive medicine because of the fear of being sued ---”
“Many a time, a patient will bring a plastic bag full of medicine from the hospital. They are not cheap drugs, most having to purchase at the hospital pharmacy, and the supply is usually a month to 3 months. It costs hundreds of dollars at times, especially if the patient is multi-diseased, ie, they receive drugs from the cardiologist, from the diabetic specialist, from the kidney specialist. The poor patient is usually so groggy after the drugs he has to take and, sometimes, when I ask a patient whether he informed the various specialists about the different kinds of drugs he has to take, invariably the answer by the respective specialists is, "You just take my drugs." If there is a drug interaction, that can be very serious. Usually such patients, unfortunately, are not educated, and they have no ways and means to argue with the doctor or to seek better advice from the doctor. Most specialists or some specialists guard their turf too closely and, at times, I am sure, inter-relationships between physicians break down, at the expense of the patient. My suggestion is that the clinical pharmacists should alert the physicians if they come across such cases, so that a more rational approach to management can be achieved. Moreover, it is not wise to give them one to two or three months' supply. I think we should start off by just giving them two weeks of medicine to find out whether they do agree to the medicine. The situation, however, is sometimes complicated with the patient seeing doctors from two different hospitals. And, now, with the two clusters, from two different hospitals in two different clusters, this is where we will have to quickly rationalise how we are going to manage such patients.”
“A subsequent follow-up at the specialist clinics, after they get discharged, is also not subsidised, and they cannot use Medisave and this is where those on long-term follow-up, like those with hypertension, diabetes and heart cases will continue to pay high specialist consultation fees and high cost of surgical and medical procedures done at the outpatient level. This policy of no downgrading once you have opted for the expensive wards, like A or B1, is closely adhered to by most hospitals. This is where I appeal to the Minister to consider downgrading those who are retrenched, lost a job through stroke or accident. And I know that this has been given, but of course more can be done. For example, many workers who opted for A or B1 class while working, because of insurance coverage by their companies, lose this privilege when they retire. This is one group of workers who should be allowed to downgrade upon retirement. My advice is: Singaporeans must ask about costs. Know the healthcare system well. And, as doctors, it is our responsibility to explain to patients the cost options of a direct referral to hospital specialists, or indirect referral through the outpatient clinics to hospitals. A direct referral by a general practitioner to any restructured hospital is a very expensive way. An indirect referral through the polyclinic is the least expensive route. At the hospital end, counter staff at A&E must pay special attention to explain to patients the difference in pricing of the various hospital wards before admission. At Government level, Singaporeans must be assured that C class wards are given equally good medical care but without frills. There is one area which I would like to talk about - that is over-prescribing of drugs.”
“His frame of mind is one of anxiety and fear. He cannot think straight and he is eager to get hospitalised. His relatives are equally worried and stressed, and this is where his choice of ward, which should be C or B2, is upgraded to B1 or even A class. Children of the patient are prepared to use their Medisave to help out and so, at that moment, all caution is thrown to the wind. Admission to B1 or A, without any subsidy, would be very expensive. Thus, instead of having to pay only $244 for a 2-day stay, like my taxi-driver friend's wife, this patient would have to pay $1,272 for a similar 2-day stay. In an acute case, it is quite understandable for someone to make a wrong choice of hospital wards, because the circumstances are one of urgency. Nevertheless, it could be avoided if they are aware of the implications. However, in a cold case, going to get admitted to A or B1, when you cannot afford, is wrong and, in fact, stupid. Ill advice by relatives, who are not paying the bills, is quite common. Some children put their parents in A or B1 because they think they have Medisave, and they want to give the best care to their parents. This is very laudable. Some do not want to lose face if they stay in C or B2, or relatives might pass comments. The ones I dislike most are those giving the most expensive advice and they are not paying the bills. Choosing the wrong wards can be very costly. Sir, having opted for the expensive wards is not the end of the story. Many are not aware that this is not a one-time cost.”
“Sir, I want to bring a practical approach to this issue. We have given the people the assurance that healthcare is affordable to all. We have Medisave, MediShield and other insurance coverage to pay for health bills. Yet we get the common refrain that Singaporeans cannot afford to fall ill. I have looked at some of the hospital bills and I am convinced that, as a Government, we have actually done our best for those patients in C and B2, where the subsidy is substantial. Let me give you an example. A two-day stay at NUH for the investigation of a chest pain in a 6-bedded ward costs $1,272. However, after the Government subsidy of $1,026, this patient paid only $244, which was paid by her husband's Medisave. So in the end she did not have to pay any cash top-up. Similarly, when she was admitted for a day surgery to do a coronary angiogram, she only paid $5 cash. Her husband's Medisave deduction was $519 although the actual cost to Government was $1,890, a subsidy of $1,365. In other words, there is a substantial subsidy for C class patients. Yet we hear Singaporeans complaining of having to pay huge hospital bills, including outpatient hospital bills. It could be that such patients do not have enough Medisave savings, or they do not know the system well enough to maximise its full benefits. And this is where I will try to give some advice to some of these patients, and I will explain this later. The above patient is my taxi driver's wife and he knows the healthcare delivery system well and, thus, avoided the many pitfalls that many unknowing Singaporeans get into. Sir, there are two categories of patients seeking hospital treatment. One, the acute, ie, the very sick patients, and the less acute, or the cold cases. In the acute cases, the patient goes to the A&E Unit.”
“Mr Speaker, Sir, can I ask the Parliamentary Secretary to clarify a point? He said that he would leave it to the employers to decide whether or not they recognise the TCM medical certificate. Can I ask whether the Government recognises the TCM medical certificate? The second point is that there must be a minimum standard of entry. At the moment, having heard what he said, it seems that you take in anyone who has some qualifications. But I feel that there must be a certain minimum standard.”
“Is it just recognition that they can practise or recognition at the same level as medical practitioners?”
“Mr Speaker, Sir, I support this Bill. As my name was mentioned, I thought I had better say a few words on this Bill too. The Bill is welcome. As a Western-trained doctor, I still feel that we should register these practitioners. The main thing that we must consider is a good standard and training for all TCM practitioners. Medical students training to become doctors have to go through six years of rigorous training, including one year of medical housemanship before they can come out and practise. That is important because we are dealing with lives. For students who want to take up medicine, they have to achieve very good grades at 'O' and 'A' levels. So we are picking the top of the 'A' level cohort to become doctors. That should be so because the training to be a doctor is very tough and we are putting all these people out to treat patients eventually. Rightly so, we should maintain this very high standard in the medical schools. I am hoping that with the registration of TCM practitioners, all these TCM practitioners should also be trained very rigorously so that when they come out to practise they will also be of a very high standard. If we expect the entry for Singaporeans to become TCM practitioners, let us say at 'O' level or just very poor 'A' level results, we might be getting poor quality graduates from the TCM school. It would be good to maintain a very high standard of entry for these Singaporeans who want to be TCM practitioners. Mr Ang Mong Seng brought up the point whether, having registered the TCM practitioners, we would recognise them or not. It is a question of registration and recognition. If recognition is accorded to them, we must also be prepared to recognise the medical certificate. I am not sure what level of recognition he is talking about.”
“To accept the full amount of stock option gains without any discount is unfair and will skew the benchmark upwards." Therefore, my suggestion for a cap is reasonable. Finally, Singaporeans are not aware that the Minister's salary is a total package. Many Singaporeans do not realise this. There are no perks, like car, driver, house, maid, medical benefits, etc, and that the bonuses form part of the pay package. Mr Speaker, Sir, I have made a few suggestions which I hope DPM will consider. I support this revision in salaries.”
“This has been brought up a couple of times by other Members of Parliament. The question some are asking is, as long as the pay of the 48 top earners in the private sector keeps changing, Ministers' pay will always receive an upward revision of their pay, as experienced in the recession years. To many, this is a win-win situation. Is there a reason for not changing? Perhaps, DPM would want to consider keeping half of the 48, that is, 24 top earners permanent and rotate the rest. This could be a compromised move to reflect the truer comparison as the same cohort of 24 is used for every year. The ideal of course is to use the same cohort of 48 each year. It is only a suggestion. With the new economy, the salaries of top CEOs will continue to go up as the salaries are based on the individual's worth and not on good or bad years. If we take the cue from the US again, in 1994, the US CEOs made US$2.8 million. Last year, the average CEO of large corporations earned US$12.4 million. As Singapore is 12 to 18 months behind the US, we can expect next year's salary of our CEOs to follow suit and a corresponding increase of our top civil servants and political appointees. A large portion of pay package could come from stock options. Thus, halving the amount of the stock option portion, as suggested in the new formula, may be very high in the coming years. I therefore suggest that we consider putting a cap on this. One suggestion is to use the present stock option portion of this revised formula as a benchmark to work out a figure on this. In yesterday's DPM's speech, he said, and I quote: "Executives may exercise in a single year stock options which they have accumulated over several years, especially in a bull market.”
“I remember SM said that once we agreed on the formula, we need not come back to this House again to discuss this politically emotive issue. But we could not achieve this because of two changes taking place in the world. One is the new economy companies, including dot.coms and life sciences. Their remunerations do not follow the norm. Second, stock option is becoming an accepted way of rewarding the top executives. This portion of reward far exceeds their basic salary. How we address these two will be a challenge for us. 15P32 apparently is working well. But I am not so sure how long it needs another review, seeing the big numbers coming from the United States corporate remunerations. For example, let me give you some idea. Last year, US CEOs, on average, earned an incredible 475 times more than what the workers did. If you compare this to 84 times in the year 1990, it is a very big jump. We may not see such figures in Singapore yet. But we tend to follow the US trend. Today, the average Singapore CEO earns 44 times more than the average worker. DPM has proposed three changes. The first one is to put more numbers in the basket of top earners, that is, increase to eight, instead of the present four top earners in the six categories - banking, accountancy, law, engineering, local manufacturing and multinational companies. The second change is to rank these 48 top earners in these categories and take the median. And third, stock options, a portion of the 48th top earners be divided by two, that is, accept only 50%. The two points of increasing the pool of top earners to 48 and taking the median as a reference base definitely improves the formula. But, again as before, it fails to address the point that these 48 top earners change every year.”
“Mr Speaker, Sir, I rise to support this pay rise. The prevailing local conditions of CPF cuts, widening wage gap between the top income earners and the lower income earners, higher transport and utilities costs make the upward pay revision debate of all political appointees and top civil servants very embarrassing. Yet, globalisation and fast changing technology require us to move quickly to meet the new challenges. Thus, the urgent need to retain talented people in the civil service and the political arena to take our country into the very competitive world markets. We are in Government to provide the ambience for the private sector to create wealth and jobs for Singaporeans. We must pay them well. Yesterday, many in the House were revisiting many old arguments on why politicians must put service before self, and I agree. But the discussion should be centred, in my opinion, on whether the changes made to the two benchmark formulae will be able to meet the changing wage pattern in the years to come. We will debate on these equally important issues at a later date, or we may lose sight of the topic under review. I know it is difficult to de-link, but we must try. So with this as the background, we have to ask whether we are comfortable with the revision in the remuneration package and can we avoid the situation we are facing now. I think today's debate is not why top civil servants and political appointees should be paid well. This issue was argued in this House during the last debate on the subject. We agreed and we discussed how best we could pay them. And it was in that debate that the current two benchmarks, 15P32 and 2/3 average 24, were thoroughly discussed and agreed upon, some grudgingly.”
“Did you have a proactive scheme to make sure that when these bank charges were imposed, you would have other schemes, apart from having to uproot the CPF system? An hon. Member: Liberalising the CPF. BG Lee Hsien Loong: Liberalising the CPF. I understand now. Liberalising CPF does not arise from DBS. Liberalising CPF arises from Mr Mah Bow Tan's Inter-Ministerial Committee on the Ageing Population, which had many discussions and published a report, which I am sure Dr Tan Cheng Bock has read, and which explained that it was necessary for us to liberalise the CPF accounts, so that members would be able to invest them for better returns, and also to have savings above the CPF. As a result, the Government accepted that report and so the Finance Minister, in the Budget Statement this year, introduced the Supplementary Retirement Scheme. And as Dr Lee Boon Yang has said and as I have confirmed, we have also been studying ways to liberalise the CPF accounts itself to remove the requirement to keep the minimum balance in cash in the CPF to allow the whole of the Ordinary Account to be invested, and even to allow the Special Account to be invested, although the Special Account probably will have to be invested in safer assets and instruments. That is point number one. Point number 2 is, out of the 341,000 people, how many of them cannot afford to have $500? As I have said, out of 341,000 people, only 35,000 have less than $1,000 net balance, and one-third of these are below 30 years old. So if you ask how many have less than $500 net balance, I think it will be even less than that.”
“I just want to know whether it was a reactive response? BG Lee Hsien Loong: By whom?”
“Did you anticipate these bank charges? And if so, did you make preparations? BG Lee Hsien Loong: We anticipated that it would need to be done. We explained it and we made the statement here. Dr Tan understood this, and we also had a full discussion here.”
“341,000 earning less than $1,500. How many of these account holders with less than $1,500 income have $500 to invest in a fixed deposit, after deducting all their CPF commitments? I just want to know how many would have been left out of this scheme. BG Lee Hsien Loong: Mr Speaker, Sir, I do not understand Dr Tan Cheng Bock's first question. Is it whether we privatised POSBank in order to charge people $2? No, we did not.”
“Sir, I just want to ask the Deputy Prime Minister whether the Government anticipated the implication of an increase in bank charges when POSBank was merged with DBS Bank. If so, why is it that you have to uproot the CPF system to accommodate the $2 service charge? Was this a reactive decision? Second, the DPM mentioned 351,000. BG Lee Hsien Loong: 341,000.”
“Sir, I just want to clarify with the Minister about the funding of outliers. He said that they would be funded. I agree that they would be funded but at what level. Is it below the level of the running cost of the hospital?”
“You can see this sudden jump of almost two times. Home care visits per home care patient per year grew from 34 to 69, again, almost double. The number of home healthcare businesses grew 5,718 to 9,147 and, again, almost double. Nursing home and home care expenditures under Medicare have been expanding more rapidly than any other category of personal health expenditure, including hospital and physician services. Home healthcare, in particular, has been growing at incredible rates of 20% to 25% per year. You will observe that there is emphasis on home care services. We do not have such services but this should be looked into in the future. However, looking at the present position of our community care institutions, I wonder if we can manage if most of our acute hospitals go casemix. Bearing in mind that our nursing homes are always at full capacity, and there is usually a long waiting list in the Government-supported institutions and VWO homes ---”
“Thus, the Ministry must, in the next Budget, make provisions for the establishment of these institutions and encourage more voluntary welfare organisations to come along by giving better subvention grants to them. We will need to move to high-end nursing care institutions and rehabilitation centres, apart from the community hospitals, as the United States' finding is quite clear that recuperation is occurring outside the hospital setting, and patients and families have more responsibility in the recovery process. There must not only be an increase in the number of such institutions, but also in the quality of such institutions. Let me explain why quality and special care will be expected. One of the downsides of casemix funding is the hospital may discharge patients earlier than needed. This is what we call "quicker and sicker", that is, patients are not too well, but they are discharged because of the funding method. Let me explain in very simple terms. You see, Sir, if a case of appendix requires a four-day hospital stay, you get full funding if you discharge the patient in four days. If you exceed the four days, you will become what the system calls an outlier, and an outlier is not funded fully. Therefore, it is the duty of the hospital unit to discharge the patient within four days. Thus, when patients are discharged quicker and sicker, the need for post-acute institutions to manage these community hospitals and special nursing and rehabilitation institutions must surely be the order of the day. Let me give you some statistics from the United States to prove my point. Between 1990 and 1997, the number of Medicare (this is the United States Government funded health institution) beneficiaries using home care services jumped from 1.9 million to 3.4 million.”
“" Sir, the above observations are significant. Not only has hospital care changed, but outside hospital care has also changed. There is need to upgrade and improve community healthcare institutions to meet the new hospital development. All these have political implications as the community is thrust upon to play a greater role of care giving. Why is this so? I think this is because the clinical management of patients has changed dramatically. Even for the elderly in the United States, conditions that had been diagnosed and treated in hospitals are now being handled outside hospitalisation, and patients treated in hospital leave sooner. Thus, patients admitted to the hospital today in the US are more severely ill and more complicated to treat. Thus, one of the startling results of casemix based funding of hospital payment was the expansion of post-acute long-term care and home care business. Are we prepared for this development? If the Ministry of Health wants all public sector hospitals to be funded through casemix by the year 2000, then the numbers of post acute long-term care institutions must also expand. And I do not see the Ministry emphasising on this aspect, except a $37.2 million subvention grant to voluntary welfare organisations. This is out of a total of $629.38 million subvention grants to restructured hospitals. Invariably, the voluntary welfare organisations and community hospitals are going to bear the brunt of all those post-acute long-term care. My point is, we must quickly learn from the experiences of the other countries who have used casemix findings and not reinvent the wheel. 1.30 pm The Ministry of Health must move in this area fast.”
“Sir, I move this amendment not to highlight the problem of casemix implementation which the Ministry of Health must surely know, but to share with you, Sir, and Members of this House the implications on the community when hospitals are funded using the casemix model. The Ministry of Health has announced that, by the year 2000, that is this year, all public sector hospitals will be funded by case mix for acute inpatient and day surgery. Casemix funding is supposed to - (1) control increase in healthcare costs; and (2) ensure healthcare is of a high quality and remains affordable. I learn that the Ministry of Health had started two pilot projects at the National Heart Centre and the Changi General Hospital in May 1998. The Minister may like to share these two centres' experiences as to how casemix information has promoted better management of health services. Has it improved health care? That is an important question. Perhaps, the Minister would like to respond to these questions later. But let me draw this House's attention to a US report on casemix. It was titled "Casemix information in the United States: 15 years of management and clinical experience" by Rosanna M. Coffey. This article is dated 31st March 1999. It is from a magazine called Quarterly Casemix, a US medical publication. This report made certain pertinent observations after 15 years of casemix experience. I would like to quote from the report: "Hospitals are treating only the most seriously ill patients. Simple surgeries are performed outside the hospital. Nursing care has been moved to intermediate-care facilities or is given during home visits. Recuperation is occurring outside the hospital, where patients and families have more responsibility in the recovery process.”
“The Minister's argument is that if the general practitioners are very well trained, there is no need for us to refer patients to specialists. That is the impression I get. Is that correct?”
“Sir, is the Minister aware that referral to a specialist is different from what he is trying to tell us that if a general practitioner is very well equipped, then there is less chance of him referring patients to the specialist? Yes, I agree with that. But there are certain situations ---”
“I think the family physicians themselves must also upgrade and do continuing medicare education, so that the level of expertise, the level of skills and the confidence can also be raised. Then I think we will reach a situation where people want to see their family physicians and not be forced to see their family physicians.”
“Mr Speaker, Sir, the Minister may not be aware that the practice of referral to see a specialist in the past was actually by way of a referral system through the general practitioner. My question is: is this change from the previous type of practice, where referral is through a general practitioner, a way for the restructured hospital doctors to get more income? That is one thing. The other thing is this. Is the Minister aware that it is not affordability that should allow people to go and see a specialist on their own? I think it is the proper approach to the whole healthcare delivery system that the Ministry of Health is trying to put out. This means that patients should actually get the correct information, the correct direction from his general practitioner before seeing the appropriate specialist. They might see the wrong specialist. Mr Lim Hng Kiang: I agree entirely with Dr Tan Cheng Bock. That is the ideal practice. We are actively encouraging it. But we have not made it compulsory that if a patient does not come with a referral, we will turn him away. So we are still flexible. If people do not come with a referral, we will, of course, counsel them and say, "Next time, please see your family physician." But we do not turn them away if they do not come with a referral. I think it is a multi-faceted problem. At the same time, we must get our GPs and our family physicians to upgrade themselves, so that they offer such a good level of service that Singaporeans have a very high level of confidence that their overall medical needs can be looked after effectively by their family physicians. So it is not just making it compulsory for the patient to see the family physician.”
“He goes to the HDB, buys a new flat and gets a second market subsidy of $41,000, no doubt a reduced one. I do not know how Mr Chiam See Tong has come to the conclusion that the resale levy penalises Singaporeans. It reduces the market subsidy for the upgrader but it in no way takes away his second subsidy. I hope he is convinced. Mr Chiam See Tong claims that HDB provides PAP MPs with free meet-the-people session office. This is factually incorrect. PAP MPs run their meet-the-people sessions from the PCF education centres. The HDB rents the void deck space to the PCF at a concession rate because PCF is doing a community service. Mr Chiam can also set up his own PCF if he forms his own educational foundation under section 29 of the Companies Act, and HDB will similarly rent him a void deck space and his political party can rent a room from his education centre, provided the education foundation has a paid-up capital of $5 million.”
“Mr Chiam quoted the example of a 3-room flat which was sold by the HDB to the owner a long time ago at a low price. For this owner, the resale levy is reasonable. If I read him correctly, Mr Chiam pointed out that for a person who bought a 3-room flat or a 4-room flat in the 1980s or even 1990s, he or she may not find the resale levy acceptable because in the 1980s and 1990s, HDB sold these flats at much higher prices than the flats sold in the 1960s and 1970s. I have an example of a 4-room flat owner. The HDB sold this flat to a 4-room flat owner in 1992 in Toa Payoh. At that time, the selling price was $160,000. Today, the resale price for this 4-room flat or its equivalent in Toa Payoh is something like $375,000. If you factor in the resale levy of 22.5% for a 4-room flat, that comes to $84,000. If you take $375,000, which is the price of a resale flat today, minus the resale levy of $84,000, this resident has a profit of $290,000. The original selling price by HDB to this owner was $160,000, so he has a capital gain of $130,000 which is tax-free. On this count, even if he pays the resale levy upfront, he has a capital gain of $130,000. Suppose now he wants to upgrade and go for a direct purchase of a HDB flat in the same locality in Toa Payoh, the selling price of a new 5-room flat now is something like $347,000. The resale price of a 5-room equivalent in Toa Payoh is today half a million dollars. The market subsidy, which this owner will get if he were to go to HDB to get a new flat, is something like $125,000. If he pays the resale levy of $84,000, he still gets a second subsidy of $41,000 which is substantial. Either way is a win-win for this owner. When he sells, he gets a capital gain, tax-free of $130,000.”
“Koo Tsai Kee: Sir, Mr Chiam has come back on the HDB resale levy a bit late because my colleague, Dr Vasoo, raised it some time ago, and I have convinced Dr Vasoo to look at the right picture and he agreed with me that the resale levy was necessary. But, nevertheless, I will reiterate the main points. In the mid-90s, many upgraders took advantage of the bouyant property market to cash in on the existing HDB flats and apply to buy another subsidised flat from the HDB, in other words, a second flat. As a result, HDB's waiting list ballooned to something like 150,000 at the peak in 1997. With upgraders making up 52% of the applicants, what this means is that upgraders are depriving first-timers of an opportunity for a first flat. Is this fair? The answer must be "no". 6.45 pm In order to address this problem, HDB implemented this resale levy. But in doing so, HDB was mindful of the fact that families that live in smaller flats, ie, 3-room flats and 4-room flats should not be unduly disadvantaged. Therefore, we pitched the resale levy such that for smaller flats, the resale levy is smaller. For example, for a 2-room flat, the resale levy is 15%; a 3-room flat, 20%; a 4-room flat, 22.5%, and a 5-room flat, we pitched it at 25%. One does not need to pay the resale levy unless one goes back to the HDB for a second subsidised flat. This is fair because the upgrader already has his first flat. He has lived in the first flat for some years. He has enjoyed the benefits. He has now cashed in his capital gains, and he must decide whether he wants to pay the resale levy and get a second subsidised flat, or he can buy a resale flat with the capital gains and still have some money in the pocket.”
“Sir, I move this amendment to highlight a problem that we encounter at our meet-the people sessions. A majority of our HDB dwellers get along with each other pretty well. However, occasionally, we do come across some HDB residents who are inconsiderate and they cause problems to others. I am sure you must have many instances of residents coming to your meet-the-people session to complain how some residents just throw the rubbish along the corridor right in front of somebody's flat, or making a big nuisance in the evening when they come back at 11 pm and blast the radio very loud. There are so many instances, and I do not want to quote all of them. When such complaints are received, usually the MPs, the Residents' Committees and even the police are all involved. They will try to settle the dispute. Very few times, we succeed; most times, we fail. I think it is not fair that we should allow these inconsiderate residents to even stay there. I am sure HDB has a lot of rules to protect the interest of the majority. I wonder whether HDB has ever evicted any resident who has been found guilty by a court, if he is caught for misconduct. I want to find out whether HDB has ever evicted such a resident. If there are no such rules, is it not time for such a ruling to be imposed to ensure harmony in the neighbourhood? I know it is a very, very serious thing. Perhaps, HDB could buy back the flat from the offender and bar him from buying or renting a HDB flat for perhaps five years. I think we should not allow all these inconsiderate residents to make a nuisance of themselves and make life very difficult for the residents of HDB dwellers. Assoc. Prof.”