Wan Soon Bee
Singapore
“I would like to thank the Minister of State for the answer, although I am not satisfied with what he has said because these are standard answers which have been given to us year after year. However, I still beg leave to withdraw the amendment. Amendment, by leave, withdrawn.”
“Sir, since 1992, selected old HDB flats have been undergoing upgrading through the Main Upgrading and the Interim Upgrading programmes. These programmes are highly popular with the residents since they have brought about new facilities and amenities in the precinct as well as an enhancement in the value of the flat in this resale market.”
“Hence, I would like to ask the Minister whether the foods introduced into the Singapore market are safe and for large-scale consumption, and whether tests have been carried out to ensure that these GM foods would not bring ill health or allergy or even trigger long-term side effects as a result of prolonged continuous consumption.”
“Sir, with the Government actively pursuing its policy to attract more foreign talents and workers, I would like to ask the Minister if there are any plans in place to accommodate this influx of foreigners. Will there be a surge in demand for housing that will distort the housing market?”
“Features which may have high aesthetic value but are hardly used when completed are really unnecessary. Such duplication and under usage is not cost effective. Besides they have a serious impact on the long term maintenance cost.”
“This has significant advantage over the options of downgrading to a smaller flat or queuing for a rental flat after selling off the existing flat or buying a studio apartment as all these three options require a re-location. Currently, reverse mortgages exist only for private properties but not for HDB flats.”
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“If the children are condemned with the cost of the proceeding, then after paying for all the expensive fees and charges, do you think the children will have any money left to maintain their parents? So, having heard the arguments put forward by the Members who are against the Bill, I tend to agree with them. If you go by the recent survey conducted by the Lianhe Zaobao and the Straits Times, we can see that more than 80% of Singaporeans are faithfully maintaining their parents. Only some 10% to 20% of our Singaporeans are not doing so. Of the 10% to 20%, some are unable to provide for maintenance of their parents because of genuine financial difficulties, and not because they do not want to. What is the percentage of those unfortunate parents who are being neglected by their children? We do not know. But, I believe, we all know that the number is very, very small. From the economic point of view, legislation for maintenance of parents is a matter of course, something that ought to be done. But now, in Singapore, with all communities having their own self-help facilities and funds, do we not have the means to help this group of unfortunate parents who, after all, constitute only a very small proportion of our population? Maybe over time, when the bond between parents and children in our country becomes so weak and brittle, then we may consider having such a legislation. But, considering the situation in our society today, it may well be too premature for us to pass such a Bill at this stage. To me, passing a legislation now is like using a sledgehammer on a gnat. It may appear to be too early.”
“Mr Choo Wee Khiang (Jalan Besar GRC)( In Mandarin): Mr Speaker, Sir, first of all, I would like to declare my stand. I do not support the Bill introduced by Nominated MP, Prof. Walter Woon. Yesterday, Mr Goh Choon Kang quoted the Chinese saying: "Even an upright magistrate finds it difficult to settle other people's family disputes". That is to say, every family has its own fundamental problems. There used to be a very popular Chinese song entitled: "Every Family Has A Difficult Scripture to Recite". So, even if we have the legislation in place, every family still has this difficult scripture to recite. In every family, there is this very delicate relationship between parents and children. It is not something which can be decided by a judge in just one sitting in court. In my constituency there is an old person who is over 80 years old. He collects wastepaper for a living. One night, he came to see me at my meet-the-people session and asked me to help him in renting a flat from HDB. I asked him why his children did not help him. He said, "Do not talk about it. I am self-reliant." He is well over 80 years of age and he wants to be self-supporting. It shows that in an oriental society like ours, when a person's children fail to maintain him, he would just resign himself to fate, and forget about it. I think this may have something to do with "face saving" or with tradition. In reality, if the court were to summon the children to court over such matters, it does not seem to be possible. You would not know where the children are. How do you call up the children to support the parents? Secondly, if you have to go to court nowadays, the court fees are extremely high. Who is going to pay for it?”
“Mr Speaker, Sir, I rise in support of the Maintenance of Parents Bill not because I am a parent myself. Over the last couple of days we have heard many Members' views on the pros and cons of this Bill. While some Members' complete confidence in the sense of responsibility and filial piety of every citizen is touching, it is, I think, a little unrealistic. It is a sad fact of life that no matter how educated, traditional or moral society is, there will always be a small minority of misfits who will insist on neglecting their duties and obligations. This has happened in the past, it is happening now, and I think it will happen in future. It has happened in the West, it has also happened in the East. This is certainly not a modern phenomenon. I am certain that Members are familiar with the stories from ancient Chinese history about young men who, through the hard work and sacrifice of their parents, were able to perform well in the imperial examination and possibly ended up marrying the Prime Minister's daughter and promptly abandoned their parents. Two salient points should be noted from such tales. Firstly, no matter how traditional society is, misfits will always exist. Secondly, even educated persons who fully understand their duties and obligations towards their parents who made their success possible may behave in an immoral way. Therefore, while it is crucial that moral values be taught, it is nonetheless important to ensure that where filial piety ends the law will step in. In these unfortunate cases, at least we shall be able to ensure that if the parents of these undeserving children do not get the love and care their morality demands, they will at least not be allowed to suffer or die of hunger.”
“By doing so, the traffic police from the ROV can easily carry the equipment in their motorcycles and they can test and check vehicles which fail the emission requirement. I believe that by doing so, we should be able to control the emission of soot on the road more effectively.”
“I would like to ask the Minister whether in the near future there is any plan, working in conjunction with the Ministry of the Environment, to require all petrol stations to have different dispenser nozzle sizes, so that the leaded petrol and unleaded petrol will be clearly differentiated, and the car user will not be mistakenly pumping leaded petrol into a car which is supposed to use only unleaded petrol. Sir, the next issue I would like to touch on is the exhaust emission from diesel vehicles. Despite the regular inspections required for diesel vehicles in Singapore and also the tightening of the diesel soot emission standard by the ROV, we still can see from time to time vehicles emitting excessive amounts of diesel soot. I travel quite often along Woodlands Road, Choa Chu Kang Road, which is in my constituency, and also the Jurong areas. Almost every day, I could spot diesel vehicles emitting excessive amounts of diesel soot. Some of these vehicles are foreign registered. I would like to ask the Minister whether we apply different emission standards of soot emission for the local and foreign registered vehicles. Sir, at the present moment, the ROV is using a bulky soot meter to check diesel vehicles at different check-points. This method is actually not very effective because the drivers could communicate among themselves in advance. They can easily spot the check-point and they will avoid the check-point, thus avoiding the vehicle from being checked. May I ask the Minister whether he would, taking into consideration the advancement in technology, adopt smaller portable and equally effective soot detecting meters to check on diesel vehicles?”
“Unfortunately, on 28th February this year, the Minister announced that the deregulation of the taxi trade would not take place until the Electronic Road Pricing (ERP) system is in place. This was a disappointing turn of event. Sir, the ERP system is scheduled to be effective only in 1997, which means that the economic disequilibrium in relation to the taxi trade and the disadvantaged position of the taxi drivers will not be corrected at least for another three years. Perhaps the Minister could explain the reason for linking the deregulation of the taxi trade to the ERP system. Further, I should like to ask the Minister what plans the Government has to improve the situation in the interim period. Assoc. Prof. Low Seow Chay (Chua Chu Kang): Sir, from 1992 onwards, the ROV requires all new petrol cars to be installed with a catalytic converter and at the fuel tank a restrictor has also to be installed. These measures have made significant contributions towards the control of air pollution from the mobile sources. The installation of a restrictor at the inlet of the petrol tank is to prevent any leaded petrol from accidentally getting into the petrol tank which could cause a serious damage to the catalytic converter. By implementing this measure, it implies that, in future, all the petrol stations must be installed with different nozzle sizes for the petrol dispensers, ie, a bigger diameter nozzle for the leaded petrol so that it will not get into cars with catalytic converters, and a smaller diameter nozzle will be used for cars specifically using unleaded petrol. So far, until today, even in the newly-renovated petrol stations, we still do not see dispensers of different nozzle sizes so as to differentiate between the leaded petrol and unleaded petrol.”
“During these 3 1/2 years, our Singapore workers have received good salary increase every year: in 1991, 9.8%; 1992, 8.1%; and 1993, 8.1%, a total of 26%. It would not be fair to deny our taxi drivers a fair increase in wages as well. Taxi drivers are also workers and I think taxi drivers, like all Singaporeans, deserve to improve their standard of living as the country prospers. In short, Sir, given the two points I have made, namely, the present low taxi fare and the plight of the taxi drivers, I urge the Government to be more sympathetic when taxi drivers ask for a revision to the existing taxi fares. Maybe the Minister should instruct the PTC to be a little bit more sympathetic and would ask the public to be understanding enough to accept a moderate increase in taxi fares. Perhaps, Sir, the solution to most of the problems which I have highlighted above is to permit market forces to operate freely and, therefore, to determine the number of taxis in Singapore as well as the taxi fares. This will also indirectly have the effect of adjusting the incomes of the taxi drivers. In other words, I am asking the Minister to consider deregulating the taxi trade. By deregulating the taxi trade, the artificially high demand which exists in Singapore will undoubtedly be lessened. Further, in addition to the benefit of enabling the taxi trade to find an equilibrium between supply and demand, deregulation will also increase competition among taxi companies and, indirectly, improve the quality of services rendered by taxi drivers. Sir, the Minister for Communications declared last year in this House that he favoured the deregulation of the taxi trade.”
“For instance, Thailand's GNP per capita is much lower than Singapore's, about one-eighth, but the taxi fare in Bangkok is about the same as ours, and not, as would be expected, about one-eighth of ours. Sir, these taxi fare comparisons point to one conclusion: that taxi fares in Singapore are relatively low compared to those in other cities, and, I would say, very affordable to our commuting public. This, I believe, is the main reason for the excessive demand for taxi services which sometimes causes long queues of commuters for taxis. The solution, however, should not be simply to put more and more taxis on the road while maintaining present taxi fares. This is because taxis, being users of roads, also contribute to traffic congestion. I do not want to choke the road with taxis. In spite of what I have said, I would like to inform the House that during the last three years, NTUC Comfort has put a total of 2,235 taxis (brand new taxis, excluding replacement taxis) on the road - 804 for 1991, 896 for 1992 and 535 for 1993. Sir, at this juncture, it would be pertinent for me to touch on a related topic, that is, the income of taxi drivers. At present, the average net income of a taxi driver is about $1,500 per month. In order to earn this income, a taxi driver must work 8 to 10 hours a day, 30 days a month, 365 days a year. Unlike other workers in Singapore, in addition to working very long hours every day, they enjoy no annual leave, no medical leave, no off-days, no extra pay on public holidays and no CPF. And when they are sick or have an accident, they are on their own and receive no income. Sir, the last taxi fare revision was carried out in October 1990, that is, about 3 1/2 years ago.”
“This will ensure that they have sufficient COEs when their taxis are delivered by the suppliers in Singapore. Further, since these taxi COEs are non-transferable, there is no need to impose a tight schedule on their validity. I would, therefore, suggest that the Minister for Communications consider favourably extending the validity period of the taxi COEs to, say, nine months or even one year. This would make it operationally much easier for both taxi companies and the taxi suppliers. Sir, I now wish to speak on the taxi fares and taxi drivers' earnings. In a table which I have already distributed to the House, which is a comparison of taxi fares in selected countries, I have compared taxi fares in Singapore with other major cities like Tokyo, London, New York and, closer to home, Bangkok and Kuala Lumpur. For a more meaningful and fairer comparison, I have also looked at the country's per capita GNP of these cities. The GNP per capita figures roughly reflect the relative standard of living in these countries. Sir, the table gives us an interesting picture. Japan has a per capita GNP which is 80% more than Singapore's, but the taxi fare in Tokyo is 7 1/2 times the taxi fare in Singapore for a 6.9 km trip. Similarly, the United States' GNP per capita is only 50% higher than Singapore's, but taxi fare in New York is three times that of Singapore. The taxi fare in London is also three times higher than Singapore's, although the per capita GNP of United Kingdom is only 13% more. Hong Kong's GNP per capita is comparable to Singapore's, but their taxi fare is 1 1/2 times more than ours. Taxi fares in Bangkok and Kuala Lumpur, at first sight, may appear to be cheaper than in Singapore. But, taking into consideration each country's per capita GNP, it is not so.”
“Sir, I would like to speak on the validity period of the COEs for taxis. But first I would like to declare my interest as the Chairman of NTUC Comfort (Pte) Ltd which runs a fleet of 8,500 taxis in Singapore. 5.15 pm At present, taxi COEs, which are not transferable, are valid only for six months. However, it takes about five months from the point an order for a taxi is made to the time it can be put on the road. Should there be any delay due to production, shipment or administrative problems, the entire process may take more than six months, by which time the validity of the COE would have lapsed. Taxi suppliers generally do not find it economical to keep an inventory of taxis, unlike private passenger cars, because, firstly, the taxi market is much smaller and, secondly, the taxis are "custom-made" in that a blue taxi can only be sold to Comfort, a red and white one to SBS, a yellow taxi to Singapore Commuter, and so on. This is very much unlike private cars, which can be sold to any buyer, and for which there is also a much wider demand. Given the short taxi COE validity period and the fact that taxi companies do not find it economical to keep an excess taxi inventory, the taxi companies sometimes find themselves in a situation where taxi licences issued by Government are not translated into actual taxis on the road. To exacerbate matters, there are also times when taxi companies have taxis available but no COEs to register these taxis. I come to know that some companies have more than 100 taxis but there are no COEs for them to put the taxis on the road. With a longer validity period for these taxi COEs, this problem might not arise as taxi companies might be prepared to take a longer term view when they bid for COEs.”
“I wonder how many other examples there are of excessive or unnecessary acquisitions of high-tech equipment. The MRI example certainly seems to suggest a lack of coordination between the private and public sectors of the health care industry. A pooling of resources in this case would have better served the country. This example also calls into question the effectiveness of our controls on high-tech medicine. Certainly, we can and should better control and coordinate the introduction and use of such high-tech medicine. What is the Government's position on this point? I hope the Minister will give his comments.”
“Sir, high-tech medicine has raised the standard of medical care to new heights. It has helped improve and prolong the lives of many by permitting the early detection of diseases. It has also provided better and more effective cures. However, high-tech medicine is not without its disadvantages. The disadvantage of high-tech medicine is that it tends to cause medical costs to escalate dramatically. Studies have shown that, in many instances, unnecessary demand is created because of the availability of high-tech medicine. Sometimes, unnecessary demand is also created to recover the high costs of high-tech medicine. I, therefore, feel that the acquisition of high-tech equipment should be more strictly controlled and better coordinated. As an example, I cite the case of the Magnetic Resonance Imaging system, more commonly referred to as MRI. I have been informed that the MRI is a very advanced and sophisticated machine for diagnostic purposes. It is also a very expensive piece of equipment. Each MRI system costs between $6-$8 million. In the United States, the recommendation is for one MRI system per million people. Scotland, with a population of over 5 million people, has only two such machines. Singapore, with a much smaller population of 2.7 million people, has five MRI systems; two in our private hospitals and three in the restructured hospitals. This not only appears excessive but also uncoordinated. In such a situation, it is likely that unnecessary demand will be generated in order to recover the cost of these machines. The cost of each MRI scan ranges between $500 and $800. This House will, no doubt, appreciate that this is a very expensive procedure. The MRI system is but a single example.”
“Given the added needs of a greying population, what plans does the Government have to meet these new challenges?”
“By the year 2030, approximately 250,000 Singaporeans will be over the age of 75. This group of citizens will need much more medical care. The health care system will be facing major geriatric medical needs for the first time. Is it prepared for this new situation? The elderly will have smaller Medisave accounts than younger citizens while their medical needs will be greater. Will their accounts be sufficient, bearing in mind that they are not protected by MediShield and MediShield Plus? These are important questions which we must consider now and they call for a more creative approach to meeting the medical needs of our country in the 21st century. Finally, while I support the Government's position on discouraging an abuse of the health care system, I should nonetheless like to point out that there are some instances where the question of abuse is irrelevant. This is in cases where the patient is chronically or terminally ill. Patients who are suffering, eg, from cancer, heart disease, kidney disease or stroke, to name but a few, in these cases, I would strongly urge the Government to reduce to a minimum the deductibles under MediShield and MediShield Plus or, better still, to eliminate them entirely. Sir, I have highlighted but a few of the challenges which are likely to face us in the future. I am afraid that an aging population will see more and more people not being able to pay their medical bills despite all the present safety nets. More claims are likely to be made against the $200 million Medifund. The Medifund may not even be able to meet the growing demand. Sir, while the health care system in place now is excellent, will it be able to grow and change in order to meet the future challenges that I have spoken of?”
“Sir, while it is true that we have schemes like Medisave, MediShield and now Medifund to ensure that Singaporeans are able to afford what they consume in the unfortunate event of a prolonged illness, we must nevertheless face the fact that there will always be a significant group of Singaporeans who will find basic health care to be not affordable. Over the years, the Government has gradually shifted more of the financial responsibility to individual citizen. I worry whether we have gone a bit too far. Would the Minister tell the House what the Government's future plans are in this area? Is the Government planning to shift a greater proportion of the financial burden to the people? If that is the case, then I ask the Government to show compassion and give special consideration to the old, the chronically ill and the poor. Please ensure that whatever policies are implemented in the future will not make their lives more difficult than they already are. On a different note, I should like to point out that while I agree that the provision of health care is vital, we should not under-estimate the importance of preventive medicine. Our policies on health care would not be complete without the correct policy to encourage Singaporeans to be a healthy nation. I would strenuously urge the Government to give utmost importance to this area and to do even more to promote a healthy nation. Sir, I should like to point out that we are on the threshold of the 21st century and that the problems which the health care system will face in the future are likely to be different from those faced by it in the past. For one thing, Singapore's demographic profile is changing, with the population aging at a greater speed than in other countries.”
“Sir, we have in place an excellent and efficient system of health care for all Singaporeans. Our restructured and Government hospital services are among the finest in the world. Health care costs have been kept low and, therefore, affordable for most Singaporeans, because we have adopted a co-payment system. The co-payment system helps to eliminate the wastage and abuses which are endemic in systems where health care is provided free to citizens. Therefore, the concept of shared responsibility for health care between the citizen and the state is a good one, and I fully support it. At the same time, however, we must be vigilant and ensure that the individual citizen is never asked to carry an unnecessarily large financial burden for essential health care. I am gravely concerned that our people may be asked to bear too much of the responsibility for health care in our zeal to contain costs. Many citizens may find the burden too great to bear. The young, the healthy and those in the higher income bracket will probably face few problems. The old, the sick and the poor, on the other hand, may be tremendously disadvantaged if the burden on them is excessive, thus causing them severe financial difficulties. It is not just a question of added expenses for these latter groups. The unfortunate truth is that they would probably have to sacrifice many things in life in order to pay for health care, things which the rest of us take for granted.”
“I feel that medical students, doctors and other health care givers must make it their top priority to inculcate in our citizens an awareness of the need to practise preventive medicine. Doctors and other health care givers should not simply be concerned with healing the sick, they are not simply dispensers of medicines. They should also be teachers. They must concern themselves with teaching patients how to stay healthy and prevent illnesses. In this connection, I welcome the recent efforts of the Ministry in vigorously promoting a healthy lifestyle for Singaporeans as well as in advocating the beneficial effects of exercises. Here, perhaps some incentives would be useful to encourage more people to participate. Finally, let me sum up by saying that the guiding principle in providing affordable health care must always be to ensure that all the basic health care needs of even the poorest citizen are met at a cost which both the nation and the individual citizen can comfortably afford. It is undoubtedly a difficult task to balance the need to contain health care costs against the need to provide all the basic health care needs of our citizens. However, I am confident that the Government, together with the guidance of the Ministry of Health, will find a way to meet this challenge. I support the motion, Sir.”
“I also feel that the Government must make adequate provision so that citizens who, through no fault of their own, are stricken with serious and chronic illnesses will not be financially debilitated by the costs of getting necessary treatment. For example, patients who require regular kidney dialysis face, together with their families, serious financial burdens. Many kidney patients are constrained to forgo necessary treatment, or to undergo dialysis less often than recommended, because they simply cannot afford the treatment. In such cases, I urge the Government to be compassionate and to provide greater financial assistance. I feel that these cases need to be treated as exceptions and, therefore, subsidised more generously. A further point I should like to make is in connection with the private sector patients using Medisave. I understand that there will be a cap on charges above Medisave limits for such patients. While this is necessary, measures must be taken by the Government to ensure that such patients are not given second best treatment as a result of the control on the charges which may be imposed by the private hospitals. As far as encouraging competitiveness and efficiency amongst hospitals is concerned, I think we should be circumspect. While some competition is necessary, hospitals must be monitored to make sure that they do not cut corners just to maintain maximum returns on their investments or that health care is sacrificed for economic efficiency. I feel that more emphasis needs to be placed on the importance of preventive medicine. The best way to ensure that the nation's health care bill does not escalate is to teach our citizens to be as healthy as possible.”
“However, in trying to curb the demand for health care and to cap health care costs, we must vigilantly guard against taking things to such an extreme that citizens with genuine health problems are prejudiced. We must ensure that the basic package, which is being proposed in the White Paper, must be as comprehensive as possible. It must provide for all the basic health care needs of even the poorest Singaporean. I believe that, on the whole, the White Paper has adequately addressed many of the concerns expressed both in Parliament and by the man-in-the-street. It is now up to the Government to implement the proposal in such a way that we achieve the stated aim of a good and affordable health care for all Singaporeans. We must present the proposed basic package in as positive a manner as possible so that the basic package will not be misconstrued as being second rate and providing only the bare minimum. Further, while I feel that the White Paper has addressed most problems, I am, nonetheless, concerned and feel that there are certain areas which will require more careful study. For example, while I agree that it is not always possible or wise to keep a terminally ill patient alive via high-tech and expensive machines regardless of his quality of life, I, nonetheless, feel it vital to provide proper safeguards and guidelines to ensure that a decision of such monumental proportions as deciding whether a human being is to be kept alive, or allowed to die, should be made only after the most careful consideration. In making decisions of this nature, our guiding principle cannot be the issue of costs.”
“Mr Speaker, Sir, let me begin by congratulating the Government on the publication of the White Paper on Affordable Health Care. The question of affordable health care has been one with which I have been most concerned for the past few years. In my constant interaction with the ordinary man-in-the-street, I understand how concerned our citizens are with the rapidly rising health care costs. The perception of many lower and middle-income families is that in time to come, they may not be able to afford the medical charges in our hospitals. I have often spoken in the past on the need to contain health care costs in Singapore. And I am glad that the Government has set up a Ministerial Committee to study the issue. I fully support the basic philosophy of dual responsibility which underpins the White Paper. Experience has also shown that pure market forces cannot be permitted to work freely in an area as vital as health care. Health care is a basic human need and it is the Government's responsibility to ensure that each and every Singaporean can afford it. If market forces were permitted to work without some intervention from the Government, very soon a large proportion of Singaporeans would find even the most basic health care beyond their reach. This would be totally unacceptable. On the other hand, I feel it is correct that the citizen should also bear a portion of the health care costs. First, we do not wish to foster a welfare state mentality in our citizens. Second, by making the citizen bear some of the costs, it will help discourage unnecessary consumption and wastage of precious resources. We have seen that countries where health care is free now face a problem of excessive and uncontrollable demand.”
“Otherwise, the rising cost of supplying medical services will push the employers' cost of providing health care benefits beyond the 2% cap. Maybe the Minister would like to enlighten us with a breakdown of the causes for the increase in health care cost, how much of it is caused by the system itself, the inherent cost increases in the system, and what percentage of the increase is caused by excessive demand or rising demand. The primary responsibility of providing quality health care at an affordable cost must remain the Government's responsibility. After all, the Government is a major provider of health care services and the Government is also a major employer who provides very generous medical benefits to its employees and their dependants. The 2% cap is placed on tax deductible expenses of the private sector employers to dampen demand. But the Government itself is not affected by such a cap. What actions, therefore, are being planned or looked at by the Government to reduce health care cost and, at the same time, dampen the demand for more health care services, particularly by Government employees? The private sector would like to see the Government set the example by showing us how, as employers, you could work with employees in the public sector to cooperate to keep the demand down and, ultimately, contain health care cost as a proportion of operational cost for business.”
“Is this what the Government meant by its promise to provide good medical services? It is indeed worrying that the hospital authority may even delay the necessary operations for some Class C patients for fear that they may not have the means to pay for the surgical bill! I would be obliged if the Minister would kindly clarify the doubts that I have mentioned above. In addition, will the Minister consider making all the necessary medical treatment and surgical operations available to Class C patients who will pay for such medical treatment and surgical operations according to the Government's standard of subsidy for Class C patients? Finally, I would like to know whether there are any undisclosed administrative instructions given by the Ministry of Health or the Health Corporation of Singapore (Private) Limited to avoid having too many patients going to the Class C wards. Mr Robert Chua Teck Chew: Sir, one of the main issues in addressing the rising health cost in Singapore is its impact on business cost and business competitiveness. Most employers would like to continue to provide quality medical benefits if they can afford it. I therefore agree with the Minister for Finance in his Budget Statement that the 2% capping of tax deductible health care expenditure as a percentage of payroll is a move in the right direction to discourage over-consumption of health care. This should force employers, unions and employees to look at ways of containing medical cost. The capping will also help to lower the rate of increase in demand for health care in Singapore. However, we must tackle both the demand side and the supply side of the health care problem. The Government must ensure that the cost of providing medical benefits should not rise faster than the rate of wage increases.”
“Sir, the Consultancy Fee Scheme probably is one of the most important reasons why C class patients in hospitals feel that they do not get the necessary medical care they need. Last year, several Members expressed the view that the Consultancy Fee Scheme was unsatisfactory. The Scheme permits specialists to earn consultancy fees only for A and B1 class patients. Not surprisingly, the specialists prefer to look after the A and B1 class patients. The Minister promised that an alternative scheme would be implemented. And I understand a new scheme has been devised. I should like to ask the Minister to explain the new Consultancy Fee Scheme to the House and also to inform the House when the scheme will be fully implemented. Mr Low Thia Khiang( In Mandarin): Sir, the Minister for Health has promised in Parliament that all Singaporeans, irrespective of their family background, will receive good medical care in Singapore. I think if this promise is to be fulfilled, then we should have to improve our medical services in the C class wards. From what I understand, there are some major surgical operations such as heart surgery and paediatric surgery that are not available to Class C patients. These operations are provided only to patients of B2 class and above. This problem was briefly touched on by Encik Othman a moment ago. So, C class patients who have to undergo such surgical operations but cannot afford the cost will have to apply for complete or partial waiver of fees, and whether such application will be approved will depend on the family background of the patients concerned. Sir, if this is the way medical services are being provided in Singapore, do you not think it will make our Singaporeans lose confidence with the services in Class C wards?”
“I, therefore, would like to appeal to the Minister to put a cap on the charges and make a commitment to keep the charges at the present level at least for the next five years. Similarly, I ask the Minister to consider keeping the B2 and C class hospital charges at the present level for the next five years. This will be a tremendous relief for the lower income patients and will allow them time to adjust to the higher costs and higher standard of health care services. Finally, I applaud the Ministry on its effort to encourage Singaporeans to learn to live healthily and hope that the effort will continue with even greater vigour. Clearly, if Singaporeans learn to live healthy lives by eating well, exercising, and learning to cope effectively with the stresses of modern life, then the need for health care will decrease. This is a method of cutting health care costs which should not be overlooked.”
“We must also make sure that such equipment is properly and optimally used. There is the perception among people today that doctors order many unnecessary procedures and investigations simply because high-tech equipment is readily available. This perception may well be without merit and unfair to the medical profession, but it exists nonetheless. With the frequent publicity of the availability of high-tech equipment, new techniques and high-tech medicines, the demand for such services will no doubt increase. We have in a way helped to create higher demands and greater expectations. I should therefore like to ask the Minister what action has or is being taken to control any unnecessary purchase of expensive high-tech equipment. I should also like to ask whether there is any control on the use of the equipment. More and more of our doctors are trained to use high-tech equipment. They become more familiar with and dependent on the equipment. Perhaps, the Ministry should reconsider the training of our doctors to ensure that it suits the needs of our society. I now turn to our polyclinics. These provide an important and comprehensive health care service and are conveniently located around Singapore. Currently, the polyclinics cater for about 25% of the health care needs of the populace. The people who patronise polyclinics are mainly the middle and lower income groups. Many of them also suffer chronic conditions like hypertension and diabetes, which require repeated treatment. The consultation fee of $6 and the prescription fee of $1 per item per week would appear to be quite reasonable; but I am informed by my constituents and grassroots leaders that it is nevertheless a very heavy burden for many of the lower income patients, especially for those with chronic diseases.”
“Sir, rising medical costs is one of the greatest concerns of Singaporeans. Ways must be found to control the rapidly inflating costs. In the last few years, our medical costs have spiralled alarmingly. I fear that if we do not take positive action now to control them, we may reach a state where neither the Government nor the patients can afford medical care. This would be calamitous. The Government has upgraded and restructured our hospitals. The hospitals are now modern, efficient and well equipped. The restructuring of hospitals has brought us many benefits. At the same time, however, it has also contributed to the inflation in medical costs. Let me elaborate. The restructured hospitals are now run more independently. This has inevitably created a certain degree of competition among the hospitals. Because of this, there is the tendency of each hospital going into medical and surgical sub-specialities. There is, therefore, a duplication of effort and, consequently, a waste of the scarce resources we have in Singapore. I believe that there is a need to coordinate these activities in hospitals to ensure that duplication and waste are minimised. Further, the competition has led to a proliferation of high-tech equipment in the hospitals. I do not question the necessity of having modern equipment in our hospitals. It is, of course, necessary and good. However, I refer to the extremely expensive and very specialised equipment. I feel that any unnecessary or excessive acquisition of such equipment will, without a doubt, cause the cost of medical care to spiral to heights which may rise beyond the means of the ordinary Singaporeans. It is our duty, as the representatives of the ordinary citizens, to ensure that there is no unnecessary duplication of this equipment.”
“Would it come a time when the cost is so expensive that Singaporeans cannot even afford the 20% of the medical charges that they have to pay? So if the Government hospitals are still being completely controlled by the Government after privatization, then why are the hospitals known as private limited companies? By so doing, is the Government trying to confuse the public? Sir, to provide medical care to the people is a duty which the Government should never shirk. The Government should ensure that medical charges are affordable by all the people in Singapore. For those who cannot afford, their medical charges should be borne by the Government. I think nobody would want to deliberately get sick and get himself admitted to hospital just to be subsidized by the Government. By naming the Government hospitals "Hospitals Private Limited", it loses the spirit of "succouring the poor and saving the distressed" which a hospital should possess. Is this yet another ill-trend of a modern prosperous society that the Government is taking the lead in promoting?”
“Finally, I would like to ask the Minister when will the Ang Mo Kio Community Hospital be officially opened and how many such hospitals are planned and what time-frame is envisaged for their completion. I urge the Minister to proceed with speed in building these community hospitals as I am convinced that they will provide a valuable service to the country. Mr Low Thia Khiang (Hougang)( In Mandarin): Sir, the original Government hospitals are now known as the Singapore General Hospital Pte Ltd, Tan Tock Seng Hospital Pte Ltd and Toa Payoh Hospital Pte Ltd. We all know that private limited companies operate on a fixed amount of capital and strive to make the maximum amount of profit from it, yet they are limited in liability. Even if they run into a loss, their liability is only limited to their registered capital. So when we call our hospitals "private limited", does it mean that the private limited hospitals will henceforth be responsible for their own profit or loss, and relieve the Government of its burden on medical costs? Does it also mean that the hospitals will have a free hand in fixing their charges in order to make the maximum profit? On the other hand, will the Government reduce its subsidy, causing the hospitals to increase their charges, thereby transferring the burden of increased operational cost of the hospital to the people? Moreover, once these hospitals are privatised, and if they were to increase their charges resulting in an increase in medical cost, then how is the Government going to curb this increase? The Government is presently subsidising 80% of the hospital bills for C class beds, and the patients are paying 20%.”
“Mr Speaker, Sir, I also would like to fully support the decision of the Ministry of Health to set up community hospitals around Singapore in the next few years. There is definitely a need for community hospitals that complement existing hospitals by catering to the needs of patients with minor ailments, those who are convalescing or the aged sick. There are those patients who still need some medical supervision and care but who do not require the specialised care provided by the existing hospitals. But I hope community hospitals would really present a much cheaper alternative to existing hospitals. For many, it is often too expensive to remain in hospital while recuperating from an illness. On the other hand, it may not be wise to send them home especially since they may not have anyone to take care of them. Community hospitals are the ideal solution in that they will provide basic medical care at a much lower cost. This way, patients can convalesce under the care of properly trained staff without constantly worrying about the hole that is being made in their pockets. Families of patients can also feel secure in the knowledge that their loved ones are receiving the care that they require. I should like to point out that the aim of the community hospitals is to provide good, though less sophisticated, hospital care at affordable prices. Therefore, I hope that such community hospitals will be built with the minimum of frills to ensure that costs are kept to a minimum. We must make community hospitals within the reach of all Singaporeans, even for those who require long periods of hospitalisation.”
“I am going to finish. Rising health costs, if not adequately contained, will in the long run have a tremendous negative impact on our nation. I believe that this is going to be one of the most critical issues confronting Singaporeans. It is important that we put in resources now to study how best we can manage our health care system and contain costs. In this regard, I must point out that as many of our hospitals have undergone restructuring, their management is quite independent, I fear there is a danger that each hospital may go its own way and, therefore, there is need to ensure that their activities and management are coordinated. I note that the philosophy of the Ministry of Health is to emphasise prevention rather than cure, and I fully agree with that. I do hope that maximum effort and resources will be put in, as has been said by other Members in this House, and that it is very important that we pay attention to this particular area.”
“Secondly, some patients who opt for better wards such as B2 or even B1 do not fully realise the tremendous difference in charges, for example, operating fees and others vary tremendously from one class to another. Hospitals should provide clearer and more comprehensive estimates of the total charges involved so that patients and their families can make more informed choices. Thirdly, and most worrying, is the belief among most Singaporeans that the quality of care and attention received in C class wards is far below that of other classes. Should this belief be justified, then I hope that the Minister will do all in his power to remedy the situation. Obviously, patients in C class wards cannot expect the same level of comfort, but there should be no difference whatsoever in the quality or quantity of medical care and attention that they receive. We would not be fulfilling our duty towards our citizens if we allowed such discrimination to take place in our hospitals. In this respect, I should like to point out that specialists in the hospitals now earn consultancy fees only from A and B1 patients. Such a system is unsatisfactory in that it discourages specialists from caring for B2 and C class patients. I am happy to learn that a new system is being proposed which will encourage specialists to give equal attention to all patients, whether they are paying or subsidised. With an ageing population, the need for health care will increase rapidly.”
“The question we should ask ourselves is whether we really need all these luxuries in order to provide good health care for our citizens. Are we providing a standard of health care that is too high for many to cope with? The problem of escalating costs has been compounded by the fact that the restructuring of many Government hospitals coincided with the reduction in subsidies. It is true that B2 and C class wards are available for the lower income groups, and that these remain highly subsidised. However, we must not forget that even patients in C class wards have to pay between 20-25% of the cost of hospital care. Clearly, the higher the total cost the more they have to pay. 20-25% may not seem like much to those of us here, but believe me, it can be crippling for many Singapore families. Patients can also seek a waiver of medical costs if they cannot afford to pay but, unfortunately, this is not well known, and hospitals are not doing enough to inform lower income patients that they have this option. Sir, many may be sceptical that health care is unaffordable to lower income groups when they hear that C class wards, though highly subsidised, are also highly under utilised. This is ironic. Why are Singaporeans not going to C class wards if they cannot afford the charges in other classes? Many reasons have been offered. First, some say that it is because of Medisave. Many believe that the money in their Medisave accounts is not really theirs and so they might as well spend it. Perhaps more intensive effort is needed in order to convince people that such is not the case and to make them aware of the dangers of spending their Medisave funds indiscriminately.”
“Sir, I think there has been a lot of concern about rising cost of medical care, but Singaporeans today are in general quite happy with the standard of health care services provided. They are proud of the many achievements made in this area by both doctors, specialists and institutions in Singapore. Singaporeans are now much healthier. Our life expectancy is one of the highest in the world while the infant mortality rate is among the lowest. We compare very favourably with the developed countries in most areas of health care. We have rid ourselves of many of the diseases that used to afflict large portions of our population in the 50s and 60s. However, affluence has brought us a new set of diseases and the need for health care continues. Nowadays, many Singaporeans suffer from degenerative diseases such as cardiovascular diseases and cancer. Obesity among our young is another major area of concern. The task ahead in combatting these health problems is different but no easier than in the past. Fortunately, we now have an abundance of well qualified and highly competent medical professionals to look after the patients when they are ill. We have ultra-modern hospitals, in particular the restructured hospitals such as NUH and SGH. These are fully equipped with the latest in high-tech equipment. Most hospitals now are air-conditioned and some are even carpeted and beautifully decorated with paintings. All these, however, cost a lot of money and, of course, the money has to be recovered. So, medical care and hospital charges keep increasing. No wonder Singaporeans are worried about these rising costs of health care. Sir, this is an issue which worries many Singaporeans.”
“What they do see are the tangible effects which have the greatest impact on them, and that is increased cost. Sir, I would like to reiterate that we must subsidize medical care at the level which is affordable to the lower income families. Sir, there is no fear that we would be become a welfare state by answering to the needs of this lower income group. We would merely become a more caring, concerned society. People do not go into hospitals for the sheer pleasure of it. So there is no fear of abuse.”
“It is also wrong to assume that medical services are affordable just because the number of waivers of hospital bills per annum is small. There could be many reasons why people do not apply for waivers. First of all, the criteria may be too stringent. Secondly, people may feel embarrassed to apply for waivers. Thirdly, they may be too ignorant and scared to apply for it. We must not allow those Singaporean households on the borderline of poverty, if one of their families falls sick, to either neglect their health or to sink into poverty if they do seek medical services. We must ensure that should the need arise these families will be able to receive our excellent medical care without fear of sinking into abject poverty. I am happy to note that the Ministry has responded positively to the request for re-implementation of C class wards at SGH. This is indeed welcome news and I should like to add further that I hope C class beds will be retained at all restructured hospitals. On the question of restructuring Government hospitals, one issue still crops up, ie, the belief of many people that restructuring is in effect privatisation. The aim of restructuring is to enable hospitals to be autonomous, freeing them from the constraints and bureaucracy of civil service. It is hoped that this will enable hospitals to be run more efficiently and thus lower cost in the long run. The people must be made fully aware of this objective. The notion that restructuring means privatisation must be dispelled once and for all. People must also be made aware that the benefits of restructuring will be reaped in the long run. Greater efficiency and lower cost in the long run are intangible benefits which the people do not see at present.”
“The people believe that the cost has escalated further with the restructuring of the Government hospitals and the removal of an income ceiling for senior doctors. The people are now very concerned. This continuous rise in the cost of medical services and the process of restructuring the Government hospitals have drawn adverse reactions among both the members of the public and the medical profession. Perhaps it is time we reviewed our medical care programmes to see whether some of the costs are necessary and justifiable. Perhaps we should ask ourselves whether we have been spending unnecessarily on expensive equipment, and whether our doctors have been too liberal in performing medical tests and whether we are now running our hospitals in a most cost effective manner. If the cost has to go up, I do agree that it is unfair and unwise to expect the Government to shoulder the entire burden. Some of the burden has to be shifted to the consumer. But I want to appeal to the Minister to give special consideration to lower income families. Sir, I think it is not correct to concentrate merely on the level of subsidies. The question of affordability must be carefully looked at. It is important to review the question of affordability because health care is not a choice. It is a necessity. The only way a poor person can avoid spending the enormous amount of expenses when he falls sick is to neglect his health and this is not acceptable. It will be futile to point out that the subsidy for C class beds is at 82%, if even at this level there is a significant proportion of the population who cannot afford or find it difficult to afford health services. In such a scenario, health care would not be affordable to the lower income group despite the high level of subsidy.”
“Sir, in Singapore we have a good health care system. The programme is comprehensive and the standard is high. It is comparable to the best in the world. Singaporeans are aware of this tremendous progress we have made in the area of public health care over the last 25 years. They are proud of our achievements. Sir, we are continuously pushing for excellence in medical care and greater efficiency in our medical services. There is absolutely nothing wrong in the pursuit of excellence and efficiency. But we must not forget that the ultimate aim of a good health care programme is to serve the needs of the people. No matter what we do, whether it is the restructuring of the Government hospitals to achieve greater efficiency or the new incentive schemes for the senior doctors in order to retain them in the Government hospitals, the Government must make sure that every Singaporean, no matter how poor, can take advantage of this excellent medical care. We would have failed in our duty towards the people if a significant portion of our population finds that this excellent medical care is beyond their reach. This is why the Government must ensure that medical cost never becomes so prohibitive as to prevent or discourage people from seeking medical care or so high as to plunge lower income families into chronic poverty if they do seek medical care. Sir, over the last few years the cost of medical care has been going up. This could be due to inflation, higher wage cost, better equipment and facilities, better ambience and comfort. Whatever the reasons are, the people are feeling the pinch, especially those in the lower income group.”
“I just want to clarify regarding the quota premium. I am not against reducing the ARF. What I mean is that if this is reduced and the taxi has to pay for the quota premiums, that means taxis are going to pay more and more and, in the longer term, the taxi will be so expensive that I do not think they will be able to afford it.”
“The extension of the no-smoking law in public places from 1st November is a step in the right direction. It may appear harsh, but I think it is necessary in order to safeguard the health of many non-smokers who for years have had to put up with smoky environments in many public places. The effectiveness of the ban, however, cannot be maximised unless non-smokers learn to assert their right to breathe unpolluted air. It is time that non-smokers stood up for their rights. 4.47 pm”
“One has only to follow the fads of the young to see how easily they are swayed by advertising. This was the main reason behind the enactment of the Smoking (Prohibition on Advertising) Act of 1970. It was not so much aimed at reducing smoking amongst those who were already smokers but to try and eliminate the persuasive impact that smoking advertisements had. The aim was to protect our population, especially the young from the constant bombardment of cigarette advertisements that invariably glorified smoking. These would inevitably arouse the curiosity of people to try out smoking. A recent survey among school students aged 9 to 20 years old showed that 20% of the boys had experimented with smoking. 36% of them became regular smokers. This shows how dangerous experimenting with smoking can be. The urge to experiment must surely be greater when one is constantly being told in advertisements that smoking is refreshing and is associated with success and prestige. I believe the 1970 Act has achieved its objective to a great extent. It has successfully eliminated most forms of cigarette advertising in Singapore. However, its effectiveness has been reduced by certain loopholes which allow the tobacco companies to circumvent the 1970 Act. Some of the examples are giving away free samples of tobacco products, giving away cigarettes as prizes in competitions, a common practice at the moment. In addition, the Amendment Bill also seeks to increase the effectiveness by providing for stiffer penalties. I believe these stiffer penalties are a more realistic deterrent and hopefully would persuade would-be offenders to think twice. I hope that this Bill will be able to achieve its intended objective.”
“The costs associated with smoking are too high for us, as a responsible Government, to ignore. Every year, many of our fellow countrymen are dying tragically and painfully because of this addiction-forming habit. Their families and friends share in this traumatic experience, all the more so when the victim is at the prime of his life. In addition to this pain and suffering, there is the economic cost of smoking. It is generally accepted that smokers are less healthy and fit as compared to non-smokers and are thus prone to infections like colds and flus. This causes a higher rate of absenteeism among smoking workers, leading to thousands and thousands of lost man-hours every year. Their overall lack of fitness also means that they are not as productive as they could have been. Add to this, the economically active workers who die from heart disease, cancer, etc. are all citizens who would otherwise have contributed to our nation. Then there is the financial burden associated with hospital and medical expenses. The irony is that people actually spend money every day for years to do harm to themselves. Perhaps it is not easy for us to convince those who are already hooked on the habit to give it up. But we must at least try to prevent those who have not started from doing so. We must actively discourage smoking by making our population aware of the risks inherent in smoking and by disallowing any form of advertising which might encourage smoking. All of us have been subjected to subtle persuasiveness of advertising. Advertisements are very effective, especially in this technological age, in creating markets for its products. The young are especially vulnerable to the impact of advertising.”
“Mr Speaker, Sir, I rise to give my fullest support to this Bill. Sir, the impact of smoking on health is not a mystery to any of us. Time after time, research has shown that many health hazards are directly linked to habitual smoking. This addictive habit is a major contributory factor to some of the deadliest diseases known to man. Smoking is the leading cause of lung cancer, an often fatal and extremely painful disease. Statistics from the Ministry of Health show that 80% to 90% of lung cancer deaths are attributable to smoking. This is frightening indeed. But what is less well known is that smoking causes other forms of cancer as well. For example, cancer of the oesophagus, cancer of the bladder, mouth, throat, pancreas, kidneys and cervix. In short, smoking is an important causal factor associated with most forms of cancer. Smoking is also notorious for its role in cardio-vascular diseases. People who smoke are three to four times more likely to develop heart attacks as compared to non-smokers. Four out of 10 deaths caused by heart attacks are attributable to smoking, as well as half of all stroke cases. Each year, 2.5 million people around the world die from diseases related to smoking. What is amazing is that in spite of these morbid statistics, there are still so many people who continue to smoke. Perhaps the worst thing about smoking is that it not only hurts those who have consciously chosen to smoke, it also harms those who by no choice of their own are forced to continually inhale polluted air filled with cigarette smoke. For too long this is the problem faced by the passive smoker. The smoker not only puts himself at risk, he is also putting his spouse, children, friends and colleagues at peril. Even unborn children are not spared.”
“They must be reminded not to squander this money while they are young because the need for it will be greater in their old age. People must be discouraged from being extravagant with their Medisave money on the basis of these two erroneous beliefs. I think it is a very serious problem and the Government should put in the effort to really correct the belief of the population.”
“Will lower income Singaporeans still be able to afford medical care if the level is reduced further? Perhaps the Ministry can reconsider its policy on subsidies and reduce the level where subsidies are unnecessary while maintaining the present level for C class and maybe B class beds. Lastly, I should like to talk about Medisave. As a consequence of Medisave people have tended to spend more liberally on hospital bills firstly because they believe that the money in the Medisave account is not really their money and they can never get it back; and, secondly, because they want better medical services for their families by upgrading the class of beds used. This is because some patients believe, and maybe justly so, that the quality of medical care is differentiated according to class. Therefore, they prefer to spend more money on a higher class of bed - whether or not they can afford it in the long term - in the mistaken belief that they will be getting better medical care. In effect, all they are getting may be just greater comfort. I hope that is the case. Clearly, if a person wants and can afford greater comfort he is free to spend his money as he chooses. But if the only reason for choosing a more expensive bed is the erroneous belief that he will be getting better care, then clearly it is a waste of precious funds which will be more urgently required in old age. It is up to our Government to assure the people that in effect all classes of patients receive the same care and I hope the Minister will assure this House that this is the case and that the only difference is the comfort factor. Further, our Governnment must constantly remind the people that the money in their Medisave accounts belongs to them entirely.”
“The increase in costs and the reduction of subsidies may mean that in the near future even C class beds will be unaffordable by a portion of the lower income group. I would like to suggest to the Government that in deciding the question of subsidies for C class beds, our Government should not be too concerned about the level of subsidies. Instead the decision should be based upon the affordability of the lower income group. It is true that patients can request a waiver or remission of hospital fees. However, a waiver is only available to those who really cannot afford to pay. What about the greater number of people who could afford to pay but only at the cost of immense sacrifice to the family? Who are these people to turn to? Will they be forced to neglect their medical problems or avoid necessary hospitalization because they cannot afford to pay the fees for a C class bed? Surely we cannot allow this to happen. It is my opinion that the waiver is not an effective aid to the poor. The fact that every year the number of waivers is so small may be an indication that it is difficult to qualify for a waiver and not necessarily that health care is affordable. The issue which our Government must concern itself with is affordability. The level of subsidies for C class beds may be high but the crux of the issue is not the level. The vital consideration is whether or not the lower income group can afford medical services at the present level of subsidy. In other words, it is pointless to say that our Government subsidizes C class beds at the level of 85% of the running cost if the lower income group cannot even afford to pay the 15%. 85% is a high level of subsidy but is it an affordable level?”
“The people are indeed very worried that the high cost of medical care will be shifted from the Government to the individual consumer, making the cost of health care prohibitive and inaccessible to the lower income group. Another fear is that these hospitals, in fact, as what Dr Tan has also mentioned, will become too profit-oriented. If they do not make money, the doctors will be chopped. If this happens it will lead to a loss of compassion and the human touch. These are two vital elements in the provision of health care for our population. Yet another problem is that foreigners will start to compete for the medical services that we are providing in these restructured hospitals. I urge the Minister to reassure the people that the restructured government hospitals will continue to provide excellent medical care to all Singaporeans and not just those who can afford to pay. Secondly, I hope the Minister can assure the House that the cost of medical care, particularly that of C class patients will remain affordable. The cost of medical care has escalated over the years, not only because of inflation but, more importantly, because the quality of medical services has improved tremendously. New equipment, new facilities and better equipment and better facilities cost money and therefore the cost has actually gone up substantially. The Government's medical bill therefore has correspondingly risen at an increasing rate. This has led to the necessity of shifting some of the burden of the cost to the individual consumer. The reduced level of subsidies coupled with the higher cost of medical care has dealt a double blow to the people, the hardest hit being the lower income group who can least afford it. Therefore, my particular concern is for C class patients.”
“Mr Chairman, Sir, medical care is one of the basic necessities of life which every modern government has a duty to provide. Let me first begin by applauding our Government of its diligent efforts in providing and constantly striving to improve the medical services which all Singaporeans utilize. In the past two decades, our medical services have improved by leaps and bounds, providing Singaporeans with health care that is comparable to the finest in the world. This amazing achievement has resulted in a healthier population, with an increased life expectancy and a very low mortality rate. There are currently, however, three issues which are of concern to the people. Firstly, there is the issue of the restructuring of Government hospitals. Secondly, the question of the level of subsidies for the different classes of beds in these hospitals. Lastly, there is the issue of Medisave. The aim of restructuring Government hospitals is to give them greater autonomy so that they can develop greater efficiency and flexibility by freeing them from the constraints and regulations of the Civil Service and therefore to allow them to improve the quality of services that they provide. I personally support the restructuring of the Government hospitals. Sir, but the fear of the public is that this restructuring in effect means privatization of Government hospitals. We have also heard from Dr Tan Cheng Bock just now, that the restructuring in effect means privatization of the government hospitals. If the hospitals are going to be profit-oriented and they are not going to look after patients who are not able to pay, then I think the objective in restructuring the government hospitals and make them efficient and flexible will be defeated.”
“I would also like to highlight the hardship that would be suffered by the taxi driver and his family should he fall ill or his vehicle meets with an accident. The taxi driver would not be able to have earnings for a period of time, and yet somehow he must find additional money to pay for the hefty increase in diesel tax. For all these reasons, I therefore appeal to the Minister for Communications and Information for greater compassion and understanding on the diesel tax issue. I would urge the Minister to defer the decision to impose the second increase of tax in November and review the situation in consultation with the GPC for Communications and Information and the various taxi organizations. I would also like to ask the Minister to consider exempting the taxi operators from paying diesel tax during the period when the taxis are in the workshop for repairs and when they scrap their cars in the beginning of the month. The monthly diesel tax works out to be $500-$600 and it is a substantial amount which the taxi drivers have to pay although they may not be using the cars during that period. But if the Minister cannot agree to my requests, perhaps it is time that the Minister consider allowing the taxi organizations to determine their own taxi fares and let market forces determine the supply and demand of taxi transport.”
“Mr Speaker, Sir, before the House adjourned yesterday afternoon, I was talking about the hefty diesel tax increase and that the Public Transport Council had only approved a 20-cent taxi fare increase. Therefore, the total burden of this tax increase was borne by the taxi drivers. As such, their income has been drastically reduced and 20,000 taxi drivers and their families are adversely affected. I was also talking about the importance of taxis as a public mode of transport and that it was the second largest public transport to serve Singaporeans and tourists. Although taxis do provide the comfort and convenience not unlike that of private cars, but taxis are not private transport and therefore they should not be treated like private cars in terms of social cost. Therefore, the question of normalizing the differential treatment of the private cars and the taxis does not arise. I agree with what the Member for Fengshan said during the debate on the Presidential Address - that the diesel tax was introduced mainly for private diesel cars; and therefore it has nothing to do with the taxis which are serving the public as such. The Government has announced its intention to increase the diesel tax further in November this year and the total amount will be $6,600. After this increase, the operating cost of the taxi drivers will be increased by about $15 a day compared to the pre-November 1988 days. I would also like to point out that come end of this year, the eastern line of the MRT will be operational. With a full MRT system running, this is expected to impact considerably on the demand for taxis. Taxi drivers will therefore be dealt, a double blow. Are we fair to these cabbies who also contribute to our economy and form a valuable segment of our workforce?”
“Sir, the Minister has said that the forecast is not accurate and I do agree that a variance of 10-15% is acceptable. But in this case, I think the variance has been very big, from 6-7% to about 10.9%. This will make the forecast quite valueless and meaningless.”