Author: Gerald Giam

This is my speech during the debate on the Online Safety Bill in Parliament on 8 November 2022.

The Online Safety Bill before us seeks to tackle harmful content on online services like Facebook, YouTube and TikTok, which are accessible to users in Singapore. I support the Bill, given the online harms that people in Singapore have been subject to on social media and on the internet, and the growing need to protect our people, especially the young, from these harms.

However, I have some clarifications to seek on the Bill which I hope the Minister will address before we vote on the Bill.

Protecting young persons

Access to digital communication devices is not optional in this day and age, even for younger children. For example, if a 10-year old child takes public transport on his own to and from school, his parents would want him to be able to contact them in case of an emergency or to track his location. In most cases, this can only be done using a mobile phone or smart watch. However, it would not be wise to give that same 10-year old unfiltered access to the internet on his phone.

Currently, parents can install a parental control app on their child’s phone. This app will allow parents to restrict content, approve apps, set screen times and filter harmful content. It can also locate the child using GPS.

I set this up for my son some time back. However, even with all my professional technical knowledge, it took me quite a bit of time and research to figure out which was the most suitable software to use and how to configure it. I wonder how many parents have tried to set up parental control software for their children. For those who haven’t, they should be aware that their children and teens have essentially unfiltered access to the internet, and all the harms that come with it. These parents can only regulate their children’s internet access by looking over their shoulders. This is a suboptimal solution given the asymmetry of technical knowledge between most parents and their children. Most children nowadays can run rings around their parents when it comes to configuring settings on their mobile phones.

Also, for such content filtering to work for young people, age verification is needed. The Code of Practice for Online Safety for Designated Social Media Services proposed by the Ministry states that social media services must have additional measures to protect children, including minimising children’s exposure to inappropriate content and ensuring that their account settings are age-appropriate by default.

However, the Code of Practice does not prescribe how this age verification should be implemented. Indeed, attempts at imposing age verification have previously failed in the United Kingdom’s implementation of the Digital Economy Act of 2017, in part because of privacy concerns — online age verification providers could collect excessive personally identifiable information and process it for other purposes in violation of privacy laws.

Separately, a young user can circumvent age restrictions by declaring his age to be 18 when in fact he is only 12.

Can I ask the Minister: How will content providers be required to perform age verification checks in practice?

Some internet service providers do provide parental control tools which block harmful content before they come through the fibre. However, they require a separate subscription that entails an additional cost every month. Many parents aren’t even aware of this service. They will have to take the effort to login to their broadband provider’s website and subscribe to this service. This is additional friction which will deter many parents from signing up, leaving young children vulnerable to accessing harmful content without their parents’ knowledge.

It would be better for internet service providers to block harmful content at the network level by default, rather than expect parents to set up complicated filtering software on their children’s devices. This remote filtering should be activated by default for all new mobile and broadband subscriptions, and offered for free for all subscribers. This will ensure that even children of less tech savvy parents will be protected by default. Adults who need full access to the internet should be able to opt out of the filtering service without any charge.

I am glad to note that under the Code of Practice, content that may encourage young users to engage in dangerous acts will be considered harmful content and be subject to additional safeguards for young users. Examples of these include the skull-breaker challenge where two people trick a friend standing in between them to take a vertical jump, then kick her legs from under her as she is in the air, making her fall backwards and potentially injure her head and back. People sometimes do not properly assess the risk associated with an activity. They may have seen others perform it without incident in a YouTube video, and may be tempted to experiment themselves.

Ultimately we cannot completely insulate young people from all dangerous, harmful and silly content online. The best protection is for parents and teachers to educate their children and students of the potential harmful content that may be accessed online and the consequences of indulging in them. The Media Literacy Council could also directly push out educational materials on the platforms that young people access like TikTok and Telegram. This should be an ongoing process, not a one-time effort, because harmful content is constantly evolving, and new trends are always emerging.

Under this Bill, failure to comply with the directions from IMDA could be an offence punishable by a fine on conviction. Can the Minister clarify if this fine will apply to only the company or also individual officers within the company responsible for ensuring compliance? Given the financial might of social media companies, they might have no problem paying even a huge fine.

The Code of Practice will require social media services to submit annual reports to IMDA to reflect Singapore users’ experience on the services, including the actions that they have taken on user reports.

I would like to propose that social media services be required to also submit quarterly reports listing the type of content that has been flagged by users. This is so that IMDA can keep apprised of trends in harmful online content and behaviours.

Section B of the Code of Practice requires that users of online communication services must be able to report harmful content or unwanted interactions to the platform providers through an “effective, transparent and easy to use mechanism” and social media services are expected to take action on these user reports in a “timely manner”.

This leaves open lots of room for interpretation. In contrast, Australia’s Online Safety Act requires platforms to provide a clear and easily accessible complaints system for end-users to submit complaints or requests to remove certain material, and the platforms must respond to the complaint within 48 hours, failing which the end-user may contact the eSafety Commissioner, who has the power to investigate the complaint. I would like to propose that Singapore’s Code of Practice include these specific requirements and timelines.

Another potential area of harm to young people is online gaming, which can be both addictive and cause social problems. Can the Minister share to what extent this Bill and the Code of Practice will regulate online gaming?

I note that the Bill covers cyberbullying content that is likely to cause harassment, alarm or distress to the target person. Will the non-consensual sharing of intimate images be covered in this Bill? There have been recent cases of disgruntled ex-lovers sharing such images, which most certainly cause alarm and distress to the victim.

Protecting our democratic rights

Next, I would like to seek clarifications from the Minister regarding the protection of Singaporeans’ democratic rights in this Bill. Some respondents to the public consultation sought assurance that the proposed measures would not affect user privacy or freedom of expression.

The Bill gives wide ranging powers to IMDA to issue directions to social media companies to remove content it deems harmful. Can the Minister elaborate on what safeguards will be in place to ensure that such powers are not abused? Will there be any channels for independent appeal or judicial review?

The United Kingdom’s Online Safety Bill specifically includes protections to safeguard pluralism and ensure internet users can continue to engage in robust debate online. For example, Section 29 of the latest draft of the UK’s Online Safety Bill requires content providers to “have regard to the importance of protecting the rights of users and interested persons to freedom of expression within the law” when deciding on safety measures and policies.

Section 15 of the UK Bill also requires social media services to put in place clear policies to protect “content of democratic importance” such as user-submitted comments supporting or opposing particular political parties or policies, and to enforce this consistently across all content moderation. The UK Bill also requires that platforms must not discriminate against different political viewpoints.

The UK’s draft legislation has also been designed to safeguard access to journalistic content. News publishers’ content will be exempted from social media platforms’ new online safety obligations. Because of this, social media platforms will not be incentivised to remove news publishers’ content as a result of a fear of sanction from the regulator.

Are there such provisions in Singapore’s Online Safety Bill? If not, will the Government study the online safety bills in other countries like the UK and Australia, and include democratic protections in the Code of Practice and subsidiary legislation?

Will Singapore have the equivalent of an eSafety Commissioner like Australia does? Who will this eSafety Commissioner be and will he or she be empowered to make directions independent of the Government?

Australia’s Online Safety Act itself was controversial in part because of the huge amount of discretion and power it puts in the hands of the Minister for Communications and the eSafety commissioner to determine what are community expectations. How will Singapore’s Bill safeguard democratic freedoms while protecting the young from online harms?

I note that some electronic services are excluded from this Bill. Examples of these are SMS and MMS services. Can I confirm with the Minister that other private messaging platforms like WhatsApp, Telegram and Signal are also excluded from this Bill? For the avoidance of doubt, I am not advocating for these services to be included in this Bill, as they are primarily used for private communication between individuals. Much of the communication is end-to-end encrypted, which means even the platforms do not have access to data exchanged by their users. I would have strong privacy concerns if this encryption were to be broken for the purpose of enhancing online safety.

This was my speech in Parliament on 4 Oct 2022 during the debate on the Healthier SG white paper.

Healthier SG is a welcome new initiative, even though focusing more on preventive healthcare is something that has been advocated for over the years.

In February this year, the Member for Aljunied GRC, Mr Leon Perera, made a very comprehensive adjournment motion speech on rethinking preventive health to generate better outcomes. Among his policy recommendations were for the Government to set short- and medium-term targets for reducing the incidence of chronic diseases; encouraging more people to go for health screening by providing additional subsidies for MediShield Life premiums; and nudging people to buy healthier food products by providing a digital currency earmarked for their purchases.

To its credit, the Ministry of Health is now bringing preventive healthcare to the forefront of healthcare policy, through the Healthier SG programme.

My speech today will focus on managing the cost of healthcare under Healthier SG and measuring and improving the desired health outcomes of the programme.

Out-of-pocket payments

Under Healthier SG, MOH will waive the requirement for residents to co-pay part of their bills in cash when using MediSave for chronic care management at their family doctor under the Chronic Disease Management Programme (CDMP).

Can I ask the Minister if there will still be an annual MediSave withdrawal limit for chronic disease management?

According to an answer to my PQ, in 2019, some 15% of patients reached the $500 withdrawal limit, most of whom had complex conditions.

Fifteen percent of patients in 2019 translates to about 20,000 patients in absolute numbers.

These patients were restricted in the use of their own medical savings for chronic disease treatment. It could discourage them from seeking treatment for their conditions and lead to a further deterioration of their health.

This could necessitate more expensive interventions down the road like hospitalisations or amputations, which will drastically reduce their quality of life.

Given the direction of Healthier SG towards waiving cash co-payment requirements for chronic care management, I would like to call for the annual MediSave withdrawal limits for chronic disease management to be completely lifted, especially for those over 60. This will encourage residents with chronic diseases to see their doctor early and stay on their disease management plan.

In an answer to another PQ I filed, in 2018 about 563,500 local patients were seen at polyclinics for non-CDMP conditions. These patients were not eligible for the full subsidies and MediSave withdrawal allowances under the CDMP.

Moving forward, under Healthier SG, can the CDMP be expanded to all chronic conditions so that more patients can benefit from it?

The Future of Polyclinics

Next, on polyclinics.

Polyclinic attendance has increased from under 410,000 ten years ago to more than 550,000 in July 2022. The White Paper acknowledged that many residents, especially retirees who no longer have company health plans, have been switching away from private family doctor clinics to polyclinics for their medical treatment. Cost is a factor in these decisions, with drug prices a key reason why medical treatment is often more expensive at GP clinics.

Under Healthier SG, drug prices at participating private family doctor clinics will be made “more comparable” to those at polyclinics through a combination of enhanced drug subsidies and drug price limits. I also note that a new subsidy tier to CHAS for common chronic drugs will be introduced. Singapore Citizens who are CHAS, Pioneer Generation or Merdeka Generation cardholders can opt to obtain these drugs at the private family doctor clinic which they have enrolled with.

These are welcome changes. However, the words “more comparable” suggest that CHAS, PG and MG cardholders will not necessarily enjoy the same low prices for drugs and medical consultations at private family doctor clinics as they do at polyclinics, let alone the other patients who are not eligible for these additional subsidies. The Minister mentioned just now in his speech that the basis for computing subsidies for polyclinics and GPs is different, so the prices cannot be equalised to the last cent. However, can the Minister confirm that the differences will only be in cents, and not dollars or tens of dollars for each prescription?

I’m asking for these details because any price differentials will be a disincentive for Singaporeans from switching from polyclinics to family doctors.

I note that Healthier SG aims to encourage residents to enrol with a family doctor by “narrowing the difference” in drug subsidies across polyclinics and private clinics.

Can the Minister confirm that the “narrowing” of the difference will be brought about only by lowering the price of drugs for patients of family doctors, and not by increasing polyclinic prices to achieve parity?

Furthermore, how much can drug costs be brought down, without subsidising private GPs’ profits, given that GPs also make a margin from the sale of prescription medication?

With all this in mind, it is my recommendation that residents who currently prefer seeking outpatient medical treatment at polyclinics should not be compelled to enrol with a private family doctor.

They should, however, remain with a polyclinic in the same healthcare cluster, so that their medical records can be shared with whichever doctor is attending to them.

If eventually most residents enrol with private family doctors, can the Minister elaborate on what will be the role of polyclinics under Healthier SG? Will the Government continue to build more polyclinics or will there be a reduction in polyclinic capacity as Healthier SG gets implemented?

Maternal and child health

Another area that can potentially reduce healthcare costs in the long term but was given relatively less attention in the White Paper is maternal and child preventive healthcare.

A research study on childhood obesity published in the International Journal of Obesity found that early-life risk factors increased childhood obesity. These risk factors included the father’s obesity at 24 months after the child was born, the mother’s pre-pregnancy obesity and excessive weight gain during pregnancy, short duration of breastfeeding and early introduction of solid foods.

The study found that early-life and preconception intervention programmes may be more effective in preventing obesity if they concurrently address these risk factors.

Another study by local researchers published in BMC Pregnancy and Childbirth found that women interviewed had poor knowledge of the child health consequences of maternal obesity and were often unaware of reliable sources for health information.

Is MOH looking to take a more preventive approach to maternal and child health? For example, family doctors could take a more proactive approach in advising expectant mothers and young parents on healthy dietary habits for themselves and children. The Healthy 365 app could also be used to provide more continuous guidance from healthcare professionals to women who are planning, undergoing and recovering from pregnancy.

Many habits are developed from a very young age and persist for the rest of our lives. The benefits in terms of cost savings and health outcomes of preventive health initiatives for expectant mothers and children could thus be tremendous in the long term.

KPIs and Targets

I would now like to discuss more about the health outcomes under Healthier SG.

What gets measured gets done. Both performance metrics and targets should be set before embarking on Healthier SG.

I am glad to see that the White Paper has listed some short term and long term metrics. However, it does not provide their targets. Without targets, these metrics hold much less meaning.

I have filed PQs to be answered by the Minister tomorrow on the targets for various short and long term preventive health metrics. These include the target screening rates for chronic diseases, the proportion of residents actively using the Healthy 365 app, the obesity rate and the avoidable emergency department attendance rate.

I look forward to the Minister’s reply to these questions. The achievement of these targets should be closely monitored, so that adjustments can be made to better achieve them.

Given the huge investment in Healthier SG, the public should expect an improvement in both the short and long term metrics.

Family doctors that accept enrolment should also be held to a high standard of quality and transparency. They should publish their prices, bill sizes and clinical outcomes. This will allow residents to make informed decisions when choosing or switching their enrolled family doctor.

Other non-clinical metrics should also be used to gauge them. These include the adoption of IT systems that make it easier for patients to make and change appointments, reducing waiting time and sharing of clinical data with other healthcare institutions.

Good service quality would encourage patients to more regularly seek preventive health services.

Conclusion

Last week, I received a phone call from a market research firm doing a survey on behalf of the Government. The pollster asked me to state the extent of my agreement — strongly agree to strongly disagree — to statements like “Singapore is heading in the right direction”, “the Government is managing Singapore well” and “I approve the way the Prime Minister is running the country”.

This was not the first time I was surveyed this way. But this time I was also asked a series of questions about healthcare financing, which was an uncanny coincidence given that it was only a week before today’s Parliament debate on healthcare.

The questions revolved around whether I was worried about being able to pay for my family’s healthcare needs currently and in the future.

I must admit that the questions made me ponder about my own family’s healthcare expenses. Individual healthcare expenses are unpredictable and a large chunk of the costs are likely to come in the final years of life as a result of chronic conditions, many of which are preventable.

Given that this survey was funded by taxpayers, the Government should release the survey results, so as to better inform the public on issues regarding future healthcare spending, and prompt them — as is the objective of Healthier SG — to make the necessary adjustments to their lifestyles and preparations to avert preventable chronic illnesses in the future.

Aljunied GRC MP Sylvia Lim and I raised questions to the Minister for Manpower in Parliament today (4 Oct 2022) on senior citizen re-employment:

Mr Gerald Giam Yean Song: Asked the Minister for Manpower (a) from 2016 to date, how many appeals on re-employment disputes has the Ministry received annually; (b) how many of these appeals are successful; and (c) what are the main reasons for unsuccessful appeals. 

Ms Sylvia Lim: Asked the Minister for Manpower regarding re-employment disputes reported in 2016 to 2020 (a) how many notifications have been received by the Commissioner for Labour under section 8A of the Retirement and Re-employment Act (RRA); (b) of these cases, how many and what proportion are subsequently referred to the Minister for decision under section 8B of the RRA after conciliation failed; and (c) what proportion of cases are found to be substantiated. 

Ms Sylvia Lim: Asked the Minister for Manpower regarding re-employment disputes reported in 2016 to 2020, of the cases where the employee succeeded in obtaining compensation under sections 8A and 8B of the Retirement and Re-employment Act, in how many cases was the errant employer a public sector employer. 

Some of my elderly residents have shared with me their experiences of being passed over for jobs for younger candidates, or not getting re-employed after reaching retirement age. Many are reluctant to even try looking for work, because of their bad experiences with age discrimination. 

I made some suggestions on how to counter age discrimination at the workplace:

First, that MOM embark on an extensive and sustained public education and engagement campaign to ingrain in the mindsets of everyone in Singapore that age discrimination is morally, socially and legally unacceptable, and ultimately hurts the ability of companies to attract and retain good workers.

Second, to look into improving the reporting and appeals process to better assist older workers who have experienced age discrimination.

I filed several questions for the Minister for Health regarding the overdose of Covid-19 vaccines administered to two patients at a clinic in September. The clinic is located in my ward of Bedok Reservoir-Punggol in Aljunied GRC, so that naturally got me concerned.

I noted that the incident occurred on Sept 15, but MOH was alerted only on Sept 19 —  a four-day delay. I was concerned that a crucial window of time, where emergency actions need to be taken, may be lost if there is a delay in reporting such incidents.

I also asked the Senior Minister for State for Health how soon clinics must notify the affected patients and extend emergency assistance to them.

Finally, I asked if there are any penalties for non-reporting or late reporting.

These were the questions I filed:

*3541: To ask the Minister for Health (a) how many overdoses and underdoses of COVID-19 vaccines have been administered to patients respectively since the start of the vaccination programme; (b) whether clinics are required to immediately report each incident as they occur to (i) the Ministry and (ii) the affected patients; (c) how many patients have been affected by these incidents; and (d) of these, how many were children.

*3522: To ask the Minister for Health (a) when will the result of the investigation into the overdose of the COVID-19 vaccines administered at the ProHealth Medical Group’s Hougang clinic be made public; (b) what is the maximum duration of hospitalisation for any patient that has been hospitalised in Singapore as a result of an overdose of a COVID-19 vaccine; and (c) what further safeguards will be put in place to avoid a further repetition of such incidents.

I asked these supplementary questions in Parliament:

Mr Speaker, these incidents occurred in a clinic in the Bedok Reservoir-Punggol ward of Aljunied GRC, so I am naturally quite concerned about this.

The incident occurred on Sept 15, but MOH was alerted only on Sept 19 — a four-day delay.

I am concerned that a crucial window of time, where emergency actions need to be taken, may be lost if there is a delay in reporting such incidents.

The SMS (Senior Minister of State) said just now that they must report no more than 3 hours after the incidents happen. So clearly this is something the MOH will be investigating.

Can I ask the SMS how soon must clinics notify the affected patients and extend emergency assistance to them?

Are there any penalties for non-reporting or late reporting?

Today I asked the Minister for Manpower whether there are plans to review the Employment Pass (EP) scheme to introduce a new dependency ratio ceiling for the bottom half of income earners among EP holders to encourage employers to enhance their Singaporean workforce by hiring and training more Singaporean talent and transferring skills from their foreign employees to the local workforce.

In short, the Minister said no. 

I asked two follow-up questions:

“Since the Ministry is not imposing any quotas for Employment Pass (EP) holders, will the Ministry consider having fixed term EPs, which cannot be renewed after they expire? 

This way, employers will be incentivised to hire and train Singaporeans to fill those positions when the EP expires, and there would be more knowledge and skills transferred to Singaporeans. This is a proposal that the Member for Aljunied GRC, Mr Leon Perera, raised in Oct 2020.

Second, even with the Compass Framework, a candidate can attain the passing score even with zero points from the Diversity criteria, which in any case is quite a low bar because it only looks at the share of candidate’s own nationality among the firm’s PMETs. 

Can MOM tighten the Compass Framework to require the candidate to obtain at least 10 points from each of the four Foundational criteria and a minimum of 50 points overall? 

This will ensure that companies give consideration to all the criteria to ensure a more level playing field for Singaporean PMETs during the hiring process.”

The Ministry of Manpower has introduced a new work pass for foreign talent, called the ONE Pass. During today’s sitting of Parliament, I asked a Parliamentary Question (PQ) and two Supplementary Questions (SQs) on this work pass. 

This was my PQ:

*3317. Mr Gerald Giam Yean Song: To ask the Minister for Manpower regarding the new Overseas Networks and Expertise (ONE) Pass (a) what is the maximum number of companies that a ONE Pass holder may work for; (b) whether the minimum monthly salary of $30,000 is an aggregate of the salaries from the multiple companies that the pass holder is employed in; and (c) if so, what is the minimum salary that the pass holder must receive from each company.

The Minister said that those applying for the One Pass who draw a monthly fixed salary of $30,000 or more should “generally” receive this amount from one employer. I followed-up with these SQs:

“Will MOM allow ONE Pass holders to earn $30,000 a month from one company and smaller amounts from several others? Since they will be exempted from job advertising requirements, minimum salary thresholds and local PMET shares in those other companies, will Singaporean PMETs in those companies lose out in any way if this happens?

Second, I note that ONE Pass holders do not need to reapply for a new pass if they change jobs. How will the Ministry prevent ONE Pass holders from switching jobs and joining another company at a lower salary soon after getting their pass?”

The full exchange in Parliament will be published in the Hansard within two weeks.