Hougang By Election Rally – Parliamentary Process

So the PAP MPs can say they opposed the casino, and make grand speeches against it, but when it comes to a vote, they have no choice but to vote according to the party line, even if they disagree.

My fellow Singaporeans and residents of Hougang, good evening!

On Sunday night during the PAP election rally, Ms Denise Phua, the MP for Moulmein-Kallang GRC, tried very hard to persuade the people of Hougang that it is possible to have a check on the government without voting any more opposition MPs into Parliament.

First, she said the PAP MPs can be an effective check on the Government. She said that some PAP MPs are ‘more opposition than the opposition’ and they express their views ‘independently’.

Then she went on to say that we don’t even need opposition MPs. She said that we can go check out the Internet to see the views of ex-Nominated MPs and bloggers like mr brown. She said that they do not have allegiance to any specific political party and have minds of their own. She said that they are the real check on the PAP.

Wow! Really? Bloggers are the real check on the PAP? I was an active political blogger several years ago. If I had heard this her speech back then, I wouldn’t have bothered going through all this trouble to join the Workers’ Party and contest in elections. I would have just stayed at home and blogged away to bring about real change to Singapore!

By her logic, we can just all go into Facebook to debate and make laws there. Why bother with Parliament?

In fact, even blogger mr brown, whom Ms Phua mentioned, was tickled. Here is what he wrote on his blog in response:

“I am honoured. Does that mean I get to vote on bills and speak in Parliament from now on?”

I think Ms Phua has a fundamental misunderstanding of the Parliamentary process.

Since there has been so much talk about “independent voices” and “checks and balances”, I would like to share with you a few things about the Parliamentary process, which they probably didn’t teach in school.

Most people know that MPs look after town councils. They conduct meet-the-people sessions every week to hear their constituents’ concerns and petition the government to help them.

An MP is also expected to play an equally important role as a legislator. What does a legislator do in Parliament?

Firstly, he or she talks. Yes, both WP and PAP MPs talk. Is anyone doing anything but talking in Parliament? That’s our job. It is the quality of the talk that matters.

I hope Ms Denise Phua and Mr Teo Chee Hean are not expecting us to do more than that. Do they expect us to throw shoes at each other and fight in front of the cameras, like they do in some other countries?

We talk. We ask Ministers questions. The Ministers reply. We debate. We make speeches to state our opinions on draft laws presented to Parliament. These are called Bills.

But after the debates are over, the real action is when we vote on the Bill. This is a central part of the Parliamentary system we are in. By voting on a Bill, we are collectively deciding on whether the Bill will become a new law.

This is where many so-called “independent voices” have to shut down. All major political parties have a party whip, who is usually one of the senior party leaders.

What does the party whip do? Firstly he makes sure that the MPs from his party are present in the Parliament chamber when the vote is taken. Then he ensures that all his MPs vote according to what the party leadership wants them to vote—this is called the “party line”.

So the PAP MPs can say they opposed the casino, and make grand speeches against it, but when it comes to a vote, they have no choice but to vote according to the party line, even if they disagree.

This is where opposition MPs differ. Workers’ Party MPs also have to vote according to our own party whip. But they do not have to vote according to the PAP party whip.

You may say, chey, then Workers’ Party MPs are also not independent. We are not independent MPs, but we are independent from the PAP. Can you imagine if we go into Parliament, just seven of us, and each of us votes a different way for a Bill? We’ll never be able to effect change like that.

So we work as a disciplined team. We discuss the issue beforehand, debate it and agree internally on what is in the best interest of Singaporeans, and then come to Parliament with a common position.

All Bills need more than 50% of the votes in Parliament to become law. For amendments to the Constitution, a two-thirds majority is needed.

With just seven MPs in Parliament, obviously we cannot affect the voting outcome. But a journey of a thousand miles begins with a single step. We have to start somewhere. We started in 1981 when Mr JB Jeyaretnam won the by-election in Anson. Then in 1991 when Mr Low Thia Khiang won Hougang. And most recently in 2011 when we had a breakthrough in Aljunied GRC.

We will need 29 opposition MPs in order to block Constitutional amendments that we believe are harmful to Singapore’s development. One example of this was the introduction of the GRC system in 1988, which stifled Singapore’s political development.

We are still a long way from that number, 29. However, the PAP will do everything in its power to prevent the Workers’ Party from reaching that number, or even getting close. This is because they fear the day that the cannot ram through policies unhindered in Parliament.

PAP MPs, no matter how vocal, present no threat, because they are controlled by the party whip. Nominated MPs, or Non-constituency MPs also are no threat to them, because they have limited voting rights, and they cannot vote on Constitutional amendments, the Budget and other measures.

This is why it is necessary to vote in elected opposition MPs, if you want a real check on the Government. This is why this by-election is so important to move Singapore towards a First World Parliament where you have a credible but responsible opposition to keep the Government on their toes, working for the people.

Voters of Hougang, you have been through six consecutive General Elections, and voted for the Workers’ Party for the last five. You have been the vanguard of multiparty democracy for the past 21 years.

You have earned the respect and admiration of Singaporeans all over the island.

You have put up with so many disadvantages thrown at you by the PAP. Yet your faith remained strong, because you believed in the need for an opposition voice in Parliament.

But you did not just vote for any opposition. You voted for a credible and responsible opposition party to represent you in Parliament.

It is for this reason that I think it is a huge insult for anyone to imply that Hougang voters vote blindly.

Residents of Hougang, have you been voting blindly?

No, definitely not!

Don’t just vote for anyone who has been here for a year or so and claims that he is always here for you.

Png Eng Huat has a track record of work here in Hougang. He did not just parachute into Hougang before the election last year. He has been here, helping needy residents since 2006.

He did this out of his own care and concern for needy residents, long before he was picked as a candidate for Hougang.

Yes, you should choose the best candidate who can represent you well and work best for you.

Png Eng Huat will be able to represent Hougang residents very well in Parliament. He is from the Workers’ Party and not the PAP, so he will not have any fear in speaking out and voting against PAP government policies that hurt Singaporeans and hurt Hougang residents.

For all these reasons, I say to you that Png Eng Huat is the best man for Hougang and I ask you to vote for him.

Every vote is important. Please contact your friends and family members who live in Hougang, and ask them to vote for the Workers’ Party, and vote for Png Eng Huat!

Hougang By Election Rally – Transport

This market-oriented, “leave it to the private sector” approach to governing has been the hallmark of today’s PAP, whether it is in the area of public transport, healthcare, housing, or immigration policy.

Good evening residents of Hougang and my fellow Singaporeans! Thank you for coming to the Workers’ Party rally this evening.

A year ago, I stood on this stage during the General Election campaign as a candidate for East Coast GRC. I am now here as a friend, a supporter and a fellow party member of the Workers’ Party’s candidate for Hougang, Mr Png Eng Huat.

National issues

The PAP has said that this is a local election, and national issues are less of a factor. I find this very odd. I can understand if we are in a much larger country, where what happens in one small town of 37,000 people does not really affect the entire country. But Singapore is such a small city-state.

Does the affordability of HDB flats affect Hougang residents? Are Hougang residents concerned about the stress their children have to go through in our education system? Do Hougang residents get caught in MRT train breakdowns?

These are all national issues, which affect all Singaporeans, including Hougang residents.

So why is the PAP so reluctant to talk about national issues at this by-election? Is it because they are concerned that many Singaporeans are not happy with their performance over the past one year?

Since the PAP does not want to talk about national issues at this election, we will. Let’s talk about a national issue that touches the lives of many, many Singaporeans—the state of our public transport system.

Transport

The Workers’ Party is very concerned about the quality and affordability of our bus and MRT system.

I am definitely concerned about it because, like many of you, I depend on the MRT to take me to and from work every day. Like many of you, I know what it’s like to squeeze into crowded trains and stand all the way from home to work.

I know what it is like to be stuck in a stationary train with air conditioning that is not working, and then hear the dreaded announcement, “This train will be delayed because of a track fault. We apologise for the inconvenience caused.”

Or when we are on a packed station platform, and the announcement goes, “For easier boarding, please move to a less crowded area on the platform.”

Hello? Where to find a less crowded area?

Our problems with overcrowding on buses and trains are a result of years of poor planning and lack of investment by the PAP government. They allowed in hundreds of thousands of foreigners over the past 10 years, but without first upgrading the transport infrastructure to accommodate the surge in commuters.

Thanks to the message that voters sent them in the last General Election, they “woke up their ideas” a bit, and started accelerating their purchases of trains and buses, and doing system upgrades.

Then before we started enjoying more comfortable train rides, something even worse emerged—MRT breakdowns!

In the last year, we have seen major MRT breakdowns on almost all the train lines—the North-South line, the East-West line, the Northeast line, the Circle line and even the Bukit Panjang LRT.

On April 9th, Transport Minister Lui Tuck Yew told Parliament that train disruptions are “unavoidable”. Then the very next week, we had five MRT disruptions, all of them affecting rush-hour commuters on various lines .

There are always excuses for the breakdowns: For the NSEW lines, we are told it is because of “ageing infrastructure” . For the new Circle line, we are told it is due to “teething problems”. For the not-so-new Northeast line, we are told the reason is “collapsed cables”.

One frustrated commuter wrote to the Straits Times forum earlier this month . She said, “It is odd how a system which was apparently fine and held up as a role model of First World efficiency for 25 years turned suddenly into a plague of breakdowns and disruptions. What commuters like me want to know is why it happened virtually overnight late last year?”

Before, we used to believe the SMRT slogan, “Always there for you”. This sounds very similar to the slogan of the other candidate in this by-election, doesn’t it?

Sad to say, now we cannot assume that the MRT will “always be there” to take us from point A to point B.

Because of the increasingly frequent train breakdowns, we now have to factor in possible delays when making travel plans, especially when we have important appointments like exams or job interviews.

Some of you have had to spend more money to take taxis when the trains breakdown—and taxi fares have recently increased too!

Is this something we should start to accept as normal in Singapore, because it is “unavoidable”?

During the current Committee of Inquiry into the massive December train breakdowns, we have seen LTA blaming SMRT, SMRT blaming their predecessor MRTC, and everyone else blaming the former CEO.

Frankly we are less interested in who is to blame, but more interested to ensure that Singaporeans enjoy affordable, efficient and reliable public transport.

We hold the Government ultimately responsible for the performance and reliability of the MRT system. This is after all an essential public service, and all the more so when car ownership has become more unaffordable because of sky-high COE prices.

Some of you will remember that there was a time when the Government took full responsibility for providing affordable, efficient and reliable public transport.

But subsequent generations of PAP governments have since chosen to transfer much of this responsibility to profit-oriented companies which operate in virtual monopolies,

These companies enjoy the profits derived from the fares you pay, but do not have to worry about competing for ridership. So that gives them little incentive to improve service levels or invest in maintenance, except to meet the minimum standards specified by LTA.

This market-oriented, “leave it to the private sector” approach to governing has been the hallmark of today’s PAP, whether it is in the area of public transport, healthcare, housing, or immigration policy.

The Workers’ Party has voiced your concerns, both in and out of Parliament, on the affordability, reliability and structure of our transport system.

We will continue to do so, but we need your support so that we have more MPs in Parliament to speak out for you with a louder voice.

About Png Eng Huat

Voters of Hougang, the Workers’ Party has chosen Mr Png Eng Huat to be our candidate for the Hougang by-election.

Allow me to say a few words about Png Eng Huat.

We contested together in East Coast GRC in the 2011 General Election. We worked the ground together in East Coast GRC. We did house visits together, served residents together, we planned our election campaign together, and we fought the election together.

Png Eng Huat is a humble and caring man. He always thinks of others’ welfare ahead of his own. I have no doubt that he will put the interests of Hougang residents as a top priority if you elect him as your MP.

But more than just being a good man, Png is able to analyse policies, and identify the issues that affect the lives of Singaporeans. I have seen this in the Parliamentary speeches that he has helped our MPs to write. So I have no doubt that he will have ability to clearly voice the concerns of Hougang residents in Parliament, if you elect him as your MP.

It is for this reason that I am happy to give my full endorsement to Png Eng Huat to be MP for Hougang!

Residents of Hougang, the Workers’ Party represents your hope for change in our beloved Singapore. We want to make our country a more compassionate, caring and fairer society, where everyone, whether rich or poor, has an equal opportunity to achieve success in life.

Last year, Hougang voters gave the Workers’ Party a ringing endorsement of almost 65% of the votes. Next Saturday, you have another opportunity to decide if you want the Workers’ Party to continue serving you like we have done for the past 21 years. Will you give us your support?

Every vote is precious. Please call, SMS, Facebook and ask your friends and family members who live in Hougang to vote for the Workers’ Party, and vote for Png Eng Huat as MP for Hougang.

Energy Conservation Act

I support the introduction of the energy management framework in the Energy Conservation Act. This could be complemented by tax incentives for companies which meet their energy efficiency improvement targets, a higher tariff for large users, an Energy Efficiency Certification scheme that extends to all companies, energy labelling of business equipment, and aligning energy labelling with companies’ energy management systems.

Energy Conservation Act

My speech on the Energy Conservation Act on 9 April 2012 in Parliament.

———-

As an industrialised economy which consumes its fair share of energy, Singapore must play its part to reduce its carbon footprint and combat climate change. One way of doing this is to be more efficient in the use of our limited energy resources. Doing so is not only environmentally friendly, but is also economically beneficial to our companies.

The introduction of the Energy Conservation Bill (or EC) is a welcome development to signal our nation’s commitment to improving energy efficiency.

The key objectives of the Bill are to give the practice of energy management greater focus within companies that are large energy consumers, and to build industry capability in energy management. This is expected to help reduce Singapore’s energy intensity by 35% by 2030, from 2005 levels. Improving the energy performance of companies will make them more competitive in the global economy. The Bill is also expected to complement existing schemes and capability building programmes which provide support for companies that invest in improving their energy efficiency.

Energy intensity targets

I would like to ask the Minister how the Government arrived at its 35% target for reduction in energy intensity. Is this meant to be a stretch target that will need measures like the EC in order to achieve, or is this likely to be achievable with the improvements in technology expected over the next 20 years, even without an EC?

South Korea aims to cut its energy intensity by 46% between 2007 and 2030. Both our countries are highly industrialised economies, that are dependent on external sources of energy. Both are large energy consumers. Why are we not being as ambitious as the South Koreans?

Energy labelling

The Bill establishes the framework for the energy labelling of certain “registrable” goods. Energy labelling is currently targeted at only household electrical appliances. Only refrigerators, air-conditioners and clothes dryers now require energy labels to be affixed on them.

I would like to suggest that energy labelling would be a more effective tool to achieve energy conservation, if it were expanded beyond household appliances to equipment used by industry and businesses. This is because the industrial, commerce and services sectors consume 71.9% of all electricity in Singapore, while households consume only 16.7% .

Common business machines such as computers, monitors, printers and photocopiers should be gazetted as registrable goods. The energy efficiency rating of these machines could then be better integrated into the energy management systems of companies.

For example, as part of its energy efficiency improvement plan, a company could aim to increase its proportion of energy efficient computers by, say, 25% within 5 years.

Energy Efficiency Certification

The proposed regulations will require companies that consume more than 15 gigawatt hours (GWh) of energy annually to maintain an energy management system. These include keeping records and reporting on their energy use, submitting energy efficiency improvement plans to the Government, and appointing a qualified energy manager.

However, the vast majority of companies will not come under the radar of the EC, and hence will not be required to implement these energy management systems.

Could the Government consider drawing up an “Energy Efficiency Certification” scheme under which all Singapore companies can voluntarily apply to be assessed on their energy efficiency practices?

The Energy Efficiency Certification could complement the existing Energy Efficiency Improvement Assistance Scheme (or EASe) by providing an incentive for companies to follow through the energy services company’s suggestions for improvement. They will also have an added incentive to apply for EASe, as they can get rewarded if the appraisal is positive. I will explain more about possible tax incentives later.

This Energy Efficiency Certification scheme would be similar in structure to the People Developer (PD) Certification scheme, which is used to assess a company’s training management practices. Like the PD Certification, companies attaining the Energy Efficiency Certification could be given public recognition of their excellent energy management practices.

This could help create a culture of good energy management practices throughout companies in Singapore, and not just a few large energy consumers. Would the Minister agree that the more companies that implement programmes to improve their energy efficiency, the greater the cumulative benefits to the nation’s economy?

Tax incentives and tiered tariffs

Since improving energy efficiency will reduce companies’ electricity bills and hence improve their profitability, it should be in their business interest to improve energy efficiency. We need to make it even greater business sense for them to do so.

I would like to build on the Hon. Member Mr Yee Jenn Jong’s suggestion for tax incentives to be extended to companies which adopt good energy management practices.

The EC requires registrable corporations to submit their energy efficiency improvement plans and targets, but makes no requirement for them to achieve their targets.

Firstly, I would like to propose that tax rebates be extended to companies which achieve their energy efficiency improvement targets.

Secondly, if the Energy Efficiency Certification scheme, which I suggested earlier, is introduced, then companies which attain the Certification could also be given tax rebates as an incentive.

Thirdly, disincentives could be introduced for companies which use electricity inefficiently and hence consume more.
Currently, large energy consumers already enjoy several benefits which smaller consumers and households do not. These include contestability of their electricity suppliers, lower electricity tariffs and much lower off-peak period tariffs. In short, there are currently limited financial disincentives for them to reduce their electricity use.

I would like to add to a suggestion made in this House in 2008 by the Hon. Member, Ms Sylvia Lim, to introduce tiered electricity tariffs, such that those who consume more electricity pay for additional units at a higher rate. Ms Lim’s suggestion is even more relevant today, given the push for energy conservation.

Introducing tiered tariffs could result in large energy consumers paying a higher bill, and smaller consumers paying less, while remaining revenue-neutral overall.

This price mechanism will impact large energy consumers the most. It will therefore force them to innovate and improve their energy efficiency, in ways that an energy management framework alone cannot.

Conclusion

In summary Sir, I support the introduction of the energy management framework in the EC. I have proposed that this could be complemented by:

Firstly, tax incentives for companies which meet their energy efficiency improvement targets;

Secondly, disincentives for high usage of electricity, like a higher tariff for large users;

Thirdly, an Energy Efficiency Certification scheme that extends to all companies, not just the biggest energy consumers;

Fourthly, energy labelling of business equipment; and

Lastly, aligning energy labelling with companies’ energy management systems.

If these complementary measures are in place, I believe Singapore can aim for a more aggressive reduction in our energy intensity over the next 20 years.

More importantly, these measures will contribute towards creating a stronger culture of energy efficiency in Singapore and encourage companies large and small to innovate and invest in this area. This will improve these companies’ economic competitiveness, while at the same time preserving our environment for generations to come.

Committee of Supply debate with Health Minister

During the Committee of Supply debate in Parliament on 6 and 7 March 2012, I presented a number of proposals on improving affordability and service quality in our healthcare system. These are a summary of my points, the Health Minister’s responses and my follow up clarifications.

Ministry of Health

During the Committee of Supply debate in Parliament on 6 and 7 March 2012, I presented a number of proposals on improving affordability and service quality in our healthcare system. Here is a summary of my points:

Managing hospital resource constraints
1. With the current high bed occupancy rates, can we be sure our hospital system will be able to cope in the event of a major outbreak or a national disaster, without resulting in preventable deaths?
2. If restructured hospitals converted some of their private wards to subsidised wards, can more bed space be created?
3. Regarding the Fee Scheme component of doctors’ remuneration, under which a doctor who sees non-subsidised patients earns more under this scheme than one who treats more subsidised patients, would it have an effect of incentivising doctors to see private and foreign patients, over subsidised local patients?
4. Is it possible that some senior doctors are seeing a higher proportion of private patients and leaving the subsidised patients to the more junior doctors?
5. If so, would the subsidised patients be losing out because the more senior doctors spend less time seeing them, or will the junior doctors get burnt out by the high patient load, contributing to their departure for private practice?
6. May I suggest adjustments to the Fee Scheme, to reward doctors based on the number of patients they see and the complexity of the cases, regardless of whether these are subsidised or non-subsidised patients?
Increasing MediShield coverage
1. What is the Ministry’s targeted level of coverage of MediShield, and what is the Ministry is doing to achieve this target?
2. Will the Ministry consider providing pregnant women an option to buy a MediShield rider to cover for any congenital problems or prematurity-related complications? This should naturally be done before any problems are diagnosed. It would be a one-off payment for the rider, and it could be actuarially adjusted upwards for older women, as they are at a higher risk of having babies with congenital problems or prematurity-related complications. This will provide the insurance coverage if the baby is later diagnosed with a problem, yet it would ensure a large enough risk pool to cover the potential pay outs. Overall, this change should not require any increases in premiums.
3. Will the the Ministry consider doing away with the age cap of 90 years old for MediShield altogether? There are only about 9,000 Singaporeans aged above 90. Some of them may have outlived their own children or siblings, and have no direct relatives to support them.
4. I note that some enhancements to MediShield coverage may require premium increases. However, based on the Minister’s reply to my Parliamentary Question last November, each year between 2006 and 2010, MediShield collected an average of $131 million more in premiums than it paid out in claims. While I appreciate the need to set aside a portion of the premiums as reserves, can the Ministry re-look at whether the premiums collected can be used to cover at least part of the increased coverage, instead of passing the additional cost entirely to policy holders?
5. Currently, MediShield premiums vary widely according to members age, from $30 per year for those aged below 30, to $1,123 for those in their 80s. This imposes a heavy burden on older members, many of whom may be retired or have exhausted their Medisave. If premiums need to be increased to cover the additional claims, can they be increased for working adults instead of for the elderly?

Managing hospital resource constraints

1. Bed crunch. With the current high bed occupancy rates, can we be sure our hospital system will be able to cope in the event of a major outbreak or a national disaster, without resulting in preventable deaths?

2. Suggested that restructured hospitals could convert some of their private wards to subsidised wards, so that more bed space can be created.

3. Doctors’ Professional Fee Scheme. Regarding the Fee Scheme component of doctors’ remuneration, under which a doctor who sees non-subsidised patients earns more under this scheme than one who treats more subsidised patients, I asked if it would have an effect of incentivising doctors to see private and foreign patients, over subsidised local patients? Is it possible that some senior doctors are seeing a higher proportion of private patients and leaving the subsidised patients to the more junior doctors? If so, would the subsidised patients be losing out because the more senior doctors spend less time seeing them, or will the junior doctors get burnt out by the high patient load, contributing to their departure for private practice?

4. Suggested adjustments to the Fee Scheme, to reward doctors based on the number of patients they see and the complexity of the cases, regardless of whether these are subsidised or non-subsidised patients.

Increasing MediShield coverage

1. Babies with congenital problems. Suggested providing pregnant women an option to buy a MediShield rider to cover for any congenital problems or prematurity-related complications. This should be done before any problems are diagnosed. It would be a one-off payment for the rider, and it could be actuarially adjusted upwards for older women, as they are at a higher risk of having babies with congenital problems or prematurity-related complications. This will provide the insurance coverage if the baby is later diagnosed with a problem, yet it would ensure a large enough risk pool to cover the potential pay outs. Overall, this change should not require any increases in premiums.

2. Age cap. Suggested doing away with the age cap of 90 years old for MediShield altogether. There are only about 11,000 Singaporeans aged above 90. Some of them may have outlived their own children or siblings, and have no direct relatives to support them.

4. Premium increases. I noted that some enhancements to MediShield coverage may require premium increases. However, based on the Minister’s reply to my Parliamentary Question last November, each year between 2006 and 2010, MediShield collected an average of $131 million more in premiums than it paid out in claims. While I appreciate the need to set aside a portion of the premiums as reserves, suggested the Ministry re-look at whether the premiums collected can be used to cover at least part of the increased coverage, instead of passing the additional cost entirely to policy holders.

5. Cross subsidy across ages. Currently, MediShield premiums vary widely according to members age, from $30 per year for those aged below 30, to $1,123 for those in their 80s. This imposes a heavy burden on older members, many of whom may be retired or have exhausted their Medisave. If premiums need to be increased to cover the additional claims, can they be increased for working adults instead of for the elderly?

[My full speeches can be found here and here.]

—————————-

These are segments of Health Minister Gan Kim Yong’s responses on 6 and 7 March 2012:

6 March 2012

Assoc Prof Muhammad Faishal, Ms. Lina Chiam and Mr Gerald Giam highlighted the shortage of hospital beds and asked how we are going to address it.

Let me share with this House our long- and short-term plans to expand capacity across our healthcare sector. To tackle the short term demand, our hospitals have over the years improved their processes to reduce admissions and facilitate discharges. Mrs Lina Chiam would be glad to know that innovative initiatives such as discharge lounges have been introduced for discharged patients to wait for their family members to pick them up, enabling beds to be turned over more quickly for incoming patients. Where possible, our hospitals have also added more beds in an incremental way, by optimising space and converting administrative areas into medical facilities and bed space. For example, the Singapore General Hospital (SGH) moved more than 800 non-frontline staff offsite to commercial buildings over the years, and converted the administrative and office space to add over 50 beds and 20 outpatient consultation rooms. We will continue to explore ways to optimise the available bed capacity and space wherever possible. We also make use of private wards for subsidised patients when necessary, as suggested by Mr Gerald Giam.

*    *    *    *    *

Mr Patrick Tay, Assoc Prof Dr Muhammad Faishal Ibrahim and Mr Gerald Giam asked how we were going to address our healthcare manpower needs. First, we will train more healthcare professionals locally by expanding the intake of our schools. The Lee Kong Chian School of Medicine will open next year with an initial intake of 50 students and this will grow to 150 eventually. With the third medical school, we expect to boost our locally-trained doctors to 500 a year, across the three medical schools. We will also be expanding the dentistry intake from 48 to 80. To train more nurses and pharmacists, we intend to expand the annual intakes for nursing from 1,700 to 2,700 as well as for pharmacy from 160 to 240.

Second, even with the increase in local training pipelines, we will still need to supplement our workforce with foreign-trained professionals, both Singaporeans and foreigners. We have stepped up efforts to attract back overseas-trained Singaporeans through the pre-employment grant for medical students studying overseas. The response has been encouraging thus far, with 89 grants given out since 2010.

*    *    *    *    *

As we build greater capabilities, we have to ensure that the recognition and rewards are commensurate. While pay is not everything, it is still an important factor to retain and attract high calibre individuals to pursue careers in the public healthcare sector. For this reason, my Ministry embarked on a review of the healthcare professionals’ pay.

Over the past year, we gathered feedback from public sector doctors on how we could improve recognition and rewards. Besides more competitive pay, many of them told us that they wanted a pay system that reinforced a greater sense of public sector ethos and values and that recognised and rewarded doctors for looking after all patients, regardless of whether they are subsidised or full-paying. Individual doctors also wanted greater clarity around their diverse roles – in clinical service, education, leadership and research – and wanted recognition for excellence in these areas.

We will therefore introduce a new and more competitive pay framework for doctors that is aligned with our public healthcare ethos and values. The framework will better recognise public sector doctors for the complexity of their clinical work, quality outcomes and workload regardless of patient class – a point made by Mr Gerald Giam earlier. We will also strengthen the recognition for doctors who play crucial roles in education, administration, leadership and research.

*    *    *    *    *

7 March 2012

Mr Gerald Giam asked if some of the MediShield reserves can help to offset these premium increases. Sir, these reserves are crucial in ensuring the long-term sustainability and viability of the MediShield Fund. Their main purpose is to provide an adequate capital buffer in accordance with MAS’s guidelines, and to fund other liabilities, such as future treatment costs and premium rebates for policyholders when they age. I will talk about the premium rebates shortly. Ultimately, MediShield operates on a not-for-profit basis, with premiums actuarially are calculated to cover expected payouts and meet the MAS risk and reserve requirements. The reserves ensure that MediShield will be able to honour policyholders’ future claims. We have instead addressed potential affordability concerns through targeted Medisave top-ups.

Several Members highlighted the challenges faced by the elderly and vulnerable in particular in paying for their healthcare expenses. We have paid special attention to ensuring that the elderly can afford healthcare services. First, to strengthen protection for the elderly, we will be extending MediShield coverage from 85 to 90, given the longer life expectancy today. This will ensure that Singaporeans will be covered by MediShield for most, if not all, of their lives.

Some MPs have asked whether we can extend beyond 90 and maybe provide lifetime coverage. Sir, it is something that is very attractive, but we must be very cautious about doing so, as there is really limited risk-pooling at ages far beyond the life expectancy, which currently stands at 82. Although Prof Lateef mentioned that she had met quite a number of elderly above 90 in her clinics but the total number in Singapore remains rather small. With the small number of people with a higher risk profile, the premiums can be very expensive and they may become unaffordable for some and they will drop out of the scheme. Nonetheless, we will study how we can help those above 90 in other ways.

Mr. Gerald Giam asked if MediShield premiums can be increased for working adults to offset the increases for the elderly. I hope I understand what he meant. I presume that he is talking about, as a person when you are younger, you accumulate more, you pay more and when you get older you pay less. In fact, MediShield was designed to have an element of this, where policyholders “pre-pay” a bit more when they are young, and this amount is then held within the MediShield Fund to support premium rebates in their old-age. This is the premium rebate that I talked about earlier. This forms part of the reserves. By paying more today, younger policyholders will pay less in premiums when they are no longer working, when they are older.

If Mr Giam is suggesting that we ask the younger generation to support the older generation, I think that could be problematic. Increasing premiums for the younger generation to cross-subsidise claims by the elderly, if this is what Mr Giam suggests, may not be viable in the long-term. With an ageing population, each young policyholder will face increasingly higher premiums in order to support the growing number of elderly policyholders. This may not be acceptable to the younger generation and the younger people may choose to opt out, affecting not only the older generation but also their own insurance. With the GST Voucher for Medisave and the one-off top up just announced in this Budget, the Government is stepping in in a big way to help older Singaporeans afford healthcare costs, without adversely affecting the younger ones.

Through the MediShield review, we hope to address the needs of a few vulnerable groups, be it the elderly, those with congenital conditions, or those who require inpatient psychiatric care.

*    *    *    *    *

Mr Gerald Giam also asked us how we intend to be more efficient and better optimise our existing manpower resources. Underlying all these questions is this – how do we make sure that we make the best use of the resources that we have, and that whatever we spend now is sustainable in the long term?

A key driver for the increase in healthcare costs is improvements in medical care – technology, new and improved drugs, better treatments, breakthroughs in surgical techniques – that improve quality of life and extend life. This is good for patients and their families. However, as a society, we cannot afford to support and subsidise all new treatments “at all costs”. New does not necessarily mean better. We need to consider what appropriate and cost-effective treatment is.

As a system, we need to do our best to bend the cost curve – to reduce inefficiencies and discourage over-consumption. Let me share two key fundamental principles that will serve us well. First, we must always strive to innovate, increase productivity and develop new and more cost-effective models of care. Wherever we can, do more with less. One of the ways we achieve this is through technology. Take tele-ophthalmology, for example, which allows ophthalmologists, located in the hospitals, to “look into” the eyes and the retina of patients in the polyclinics. The optometrists in the polyclinic prepare the images which are transmitted to the hospital ophthalmologists for assessment. Those with minor conditions such as dry eyes can receive the medication that they need at the polyclinic, and only those with more serious conditions will need to be referred to the eye specialist clinic for further assessment. This brings care to the community level, and cuts down unnecessary visits to specialists, saving costs for patients and freeing up resources of the hospitals.

To improve efficiency and productivity in our healthcare system, we will set aside $20 million for a fund called Healthcare Productivity in Acute Services Scheme (Health-PASS). The hospitals can make use of this fund to pilot and implement projects that improve productivity and efficiency. A similar scheme will be introduced in the ILTC sector.

Co-payment by patients is another fundamental principle to prevent unnecessary over-consumption of healthcare services which will drive up costs. Through co-payment, the patient shares part of the responsibility of spending his healthcare dollar smartly. He is more likely to weigh the treatment options or choices of drugs and choose a more cost-effective option. It will also ensure that healthcare providers are more cautious in prescribing treatment to ensure patients can afford the co-payment. We want to avoid the pitfall of countries where healthcare is virtually free, resulting in an insatiable demand from patients for healthcare services, runaway healthcare spending and an increased fiscal burden that is eventually borne by all taxpayers.

—————————

Following these Minister’s responses, I sought further clarifications from Minister:

Mr Gerald Giam Yean Song: I thank the Minister for his responses and I look forward to working with him to make this Healthcare 2020 Plan work. I have two clarifications, Sir.

I was not asking to draw down from MediShield reserves as I know that would not be sustainable. Instead, what I suggested was that given the very healthy financial position of MediShield, perhaps not all the annual costs increases from the enhanced coverage for the elderly have to be automatically passed to policy holders through premium increases.

My second clarification is the point about the cross-subsidy of MediShield premiums across ages. My main concern is actually the high premiums payable by the elderly who have no other source of income. I am not saying that premiums must be equal across all ages but that the enhanced coverage that I proposed in my cut could come from small premium increases for the many working adults. I do not think many working adults will begrudge paying a bit higher premiums to cover the 11,000 seniors above age 90.

And, Sir, I have three questions: is the Minister saying that MediShield currently has no cross-subsidy across ages? Is this a key principle of our healthcare financing approach, or is it only for MediShield? And, thirdly, how does this gel with the expectation for adult children to use their Medisave to pay for their parents’ medical treatment before Medifund assistance is provided? Is this not a subsidy across generations of an even worse kind since many of these are low-income children paying for retired parents who have exhausted their Medisave accounts.?

Mr Gan Kim Yong: Sir, I have explained the need for MediShield reserves. And even as we look into the future when we review the MediShield this year, we also need to look at the adequacy of the reserves. As we enhance the benefits and look at the claim experiences of previous years, we will have to decide how much of reserves need to be put aside for the coming five-year period. And therefore for every revision to the premium, we will have to take into account what proportion of it needs to be put aside for reserves, partly for the capital adequacy required by MAS and also partly for the loyalty rebate in future which I explained.

As an individual when you are younger, when you are able to earn a regular income, there is a loading on your premium. This loading is not for other people but for yourself, so that when you are older, your premium would be lower than what it would have been. As you get older, you would appreciate that the number of people shrinks and the claims go up. And so as you get older, for the older cohorts, their premiums are going to be very high and that is why we have this arrangement for pre-funding. So, as an individual you pre-fund yourself; when you get older, you then draw on this rebate which comes from the reserves. And so in the design of the scheme, as we move forward, you will not want to put aside more than what is necessary; but we need to be advised by the actuaries on what is adequate. So I would assure Mr Giam that we will be very careful because we do not really want to increase premium unnecessarily. But if it is necessary for reasons of prudence, then I think we ought to do so.

Your second question on premiums across ages: for MediShield, the design of the scheme is such that each cohort will be risk-pooled together, so there is very little cross-subsidy between younger generation and older generation.

But if we start to do that, and as the younger generation begin to shrink, you will have a bigger problem in future for the younger generation to shoulder the insurance premium for the older generation, if it is built into the structure of the MediShield. Because once you go on that structure, that means the older generation is not paying their own premium. And you will find that as the younger generation grows older, they are already not paying their own premium and they are relying on the next generation to pay for them. And this inter-generation subsidy is between people who are unrelated. So I think it is a lot more difficult to persuade the younger generation to accept this. The risk of that is that some of the younger generation may opt out of the MediShield scheme and join other schemes that do not have this cross subsidy. Therefore, we have to be very mindful. Even the loyalty rebate I talked about, we also have to be very careful not to overload a person when he is younger. Because when he compares his own insurance premium versus premiums that are available in the private sector, they may ask, “why is my premium so expensive today?” Because he may or may not be aware that there is a loyalty rebate that will benefit him in future. So some of them may actually decide to drop out, and once they drop out, there will be problem, because they may not be able to rejoin due to pre-existing conditions. So, as we adjust some of these parameters, we have to be mindful and be very careful.

Mr Giam talked about Medisave sharing between generations. I think I have answered that question in a previous parliamentary Question. The answer – and I also mentioned it in my speech – is that family support remains an important component. But I also said in my speech that we have to recognise that the older generation has a lot more burden and we want to make sure that they too have a sufficient amount to meet their healthcare needs. And that is why, in this Budget, we have provided top-ups for the older generation, and the one-time top-up is specifically to help members pay for the increases in the MediShield premium when we adjust it. We want to strengthen family support for our Singaporeans but, at the same time, we recognise that we have to be very mindful that the older generation would have a higher burden, and we find different ways to help them. So our top-up is one way.

—————

[Source: Parliamentary Hansard]

Parliament speech on the ‘Lemon Law’

I welcome the amendments to the Consumer Protection (Fair Trading) Act and the Hire Purchase Act to include so-called ‘Lemon Law’ provisions. This is a progressive step to bring Singapore’s consumer protection regime up to speed with other developed countries like Japan, the US, Canada, Australia, and the EU.

Parliament

Speech during the debate on the amendments to the Consumer Protection (Fair Trading) Act and Hire Purchase Act, on 9 March 2012.

————

Mr Speaker,

I welcome the amendments to the Consumer Protection (Fair Trading) Act and the Hire Purchase Act to include so-called ‘Lemon Law’ provisions. This is a progressive step to bring Singapore’s consumer protection regime up to speed with other developed countries like Japan, the US, Canada, Australia, and the EU.

If executed well, the Lemon Law could help weed out poor practices by a minority of retailers in Singapore, and reward those with good practices. This could lead to improved customer service and greater customer satisfaction.

In addition, as poor retail practices are weeded out, it will inspire more confidence among both local consumers and the millions of tourists who arrive at our shores each year to shop. They will be more at ease to buy goods here, without worrying about having limited recourse should the goods turn out to be defective. In turn, we could see fewer tourists leaving Singapore with a bad taste in their mouth because of unpleasant shopping experiences.

Sir, I have a few questions about the proposed amendments, as well as some suggestions on how the execution of the Lemon Law could better achieve its objective of protecting consumers.

Continue reading “Parliament speech on the ‘Lemon Law’”

COS 2012: Vehicle Quota System improvements

Many working families with young children or elderly parents seek to own a car, not for a status symbol, but as a utility to help them cope with their busy schedules and multiple responsibilities. There have been concerns expressed by Singaporeans in newspapers and online that the inclusion of taxis in COE Category A could have an effect of pushing up the Quota Premiums for this category. This is because the private car owners have to compete with taxi companies for a limited number of COEs. In addition, buyers of these smaller cars are often less well-off than large car buyers.

Parliament

Committee of Supply Debate (Ministry of Transport), 7 March 2012

————-

Mr Chairman,

The Vehicle Quota System (VQS) exists to limit Singapore’s vehicle population growth rate. This is necessary because of Singapore’s limited land area and growing population.

The VQS is managed through the issuance of a limited number of COEs each year.

There are currently 5 categories of COEs—of which Categories A and B are for private cars. Category A is for taxis and small cars below 1,600cc; and Category B is for larger cars above 1,600cc.

Sir, many working families with young children or elderly parents seek to own a car, not for a status symbol, but as a utility to help them cope with their busy schedules and multiple responsibilities.

There have been concerns expressed by Singaporeans in newspapers and online that the inclusion of taxis in COE Category A could have an effect of pushing up the Quota Premiums for this category. This is because the private car owners have to compete with taxi companies for a limited number of COEs. In addition, buyers of these smaller cars are often less well-off than large car buyers.

The Ministry of Transport has said previously that taxis bid for COEs in Category A in recognition of the fact that they are part of the public transport spectrum albeit at the high-end.

Could the Minister explain why taxis are in Category A (smaller cars) and not Category B (larger cars), even though many taxis, like the Hyundai Sonata, in fact have an engines larger than 1,600cc?

Sir, in 2002 there were 378,706 private cars, distributed among 35% of local households. By 2008, the vehicle population had risen by 26% to 476,634, but the proportion of households which owned cars only grew by only 3%.

Does this suggest that the private car population is becoming more concentrated in a certain segment of the population?

Could the Ministry look into ways to adjust the way COEs are allocated, so that families with children are not competing directly with individuals and companies who are able to afford to place higher bids for their COEs?

COS 2012: Increasing MediShield coverage and benefits

MediShield is a government-administered insurance scheme that is meant to help cover the costs of major hospital bills. Unfortunately, some of those who need MediShield coverage the most, like babies with congenital problems and the very old, are often denied coverage.

Parliament

Committee of Supply Debate, 7 March 2012 (Ministry of Health)

———–

Mr Chairman,

MediShield is a government-administered insurance scheme that is meant to help cover the costs of major hospital bills. Unfortunately, some of those who need MediShield coverage the most, like babies with congenital problems and the very old, are often denied coverage.

MediShield currently covers 92% of Singaporeans . Those who are not covered include some of the elderly, homemakers, and others who have voluntarily opted out of MediShield. Some are not able to obtain MediShield coverage due to pre-existing conditions.

I would like to ask what the Ministry is doing to achieve a higher level of coverage for all Singaporeans? What is the Ministry’s targeted level of coverage of MediShield?

Currently new-borns with congenital conditions are either denied MediShield coverage completely, or have their conditions excluded from coverage. This does nothing to relieve the financial hardship that parents of these children may face.

In order to ensure that these children are adequately covered under MediShield, will the Ministry consider providing pregnant women an option to buy a MediShield rider to cover for any congenital problems or prematurity-related complications? This should naturally be done before any problems are diagnosed. It would be a one-off payment for the rider, and it could be actuarially adjusted upwards for older women, as they are at a higher risk of having babies with congenital problems or prematurity-related complications.

This will provide the insurance coverage if the baby is later diagnosed with a problem, yet it would ensure a large enough risk pool to cover the potential pay outs. Overall, this change should not require any increases in premiums.

As proposed during my Budget debate speech, will the the Ministry consider doing away with the age cap of 90 years old for MediShield altogether? There are only about 11,000 Singaporeans aged above 90 , we should be doing all we can to help this small group of seniors who have made it this far, instead of denying them the insurance coverage when they need it the most. Beyond age 90, many of them may have outlived their own children or siblings, and have no direct relatives to support them.

I note that some enhancements to MediShield coverage may require premium increases. However, based on the Minister’s reply to my Parliamentary Question, between 2006 and 2010, MediShield collected an average of $131 million more in premiums each year than it paid out in claims .

While I appreciate the need to set aside a portion of the premiums as reserves, can the Ministry re-look at whether the premiums collected can be used to cover at least part of the increased coverage, instead of passing the additional cost entirely to policy holders?

Currently, MediShield premiums vary widely according to members age, from $30 per year for those aged below 30, to $1,123 for those in their 80s. This imposes a heavy burden on older members, many of whom may be retired or have exhausted their Medisave. If premiums need to be increased to cover the additional claims, can they be increased for working adults instead the elderly?

COS 2012: Managing hospital resource constraints

For some time now, our government restructured hospitals have been facing a bed crunch, as several Members before me have mentioned. With the current high bed occupancy rates, can we be sure our hospital system will be able to cope in the event of a major outbreak or a national disaster, without resulting in preventable deaths?

Parliament

Speech on 6 March 2012 in Parliament during the Committee of Supply Debate on the Ministry of Health’s budget.

————

Mr Chairman,

For some time now, our government restructured hospitals have been facing a bed crunch, as several Members before me have mentioned. With the current high bed occupancy rates, can we be sure our hospital system will be able to cope in the event of a major outbreak or a national disaster, without resulting in preventable deaths?

I appreciate that hospital staff and administrators are doing their best to manage these space constraints, but perhaps we need to explore other ways to free up bed space.

Currently about 22% of all beds in acute care government hospitals are non-subsidised beds. In our largest hospital, SGH, non-subsidised beds make up 28% of its beds . This is according to a reply from the Minister to my Parliamentary Question last month.

If these hospitals convert some of their private wards to subsidised wards, can more bed space be created?

Sir, another concern I have is the doctor shortage in our public hospitals. I recognise that this is a long-standing and multi-faceted issue, which has no simple solutions. Apart from recruiting more doctors, I believe more can be done to make the most of existing resources.

According to a Straits Times report on March 1st, the pay structure in public hospitals includes three components:

First, a basic salary, which is the same across doctors of the same grade.

Second, an allowance pegged to the medical speciality, with doctors doing surgery getting more.

And third, a fee scheme determined by the type of patients a doctor treats. A doctor who sees non-subsidised patients will earn more under this scheme than one who treats more subsidised patients. A doctor who sees non-subsidised patients who are foreigners earns even more.

Sir, does the third component—the fee scheme—have an effect of incentivising doctors to see private and foreign patients, over subsidised local patients?

Is it possible that some senior doctors are seeing a higher proportion of private patients and leaving the subsidised patients to the more junior doctors?

If so, would the subsidised patients be losing out because the more senior doctors spend less time seeing them, or will the junior doctors get burnt out by the high patient load, contributing to their departure for private practice?

May I suggest adjustments to the fee scheme component, to reward doctors based on the number of patients they see and the complexity of the cases, regardless of whether these are subsidised or non-subsidised patients.

I believe this will more fairly compensate doctors who shoulder a higher patient load, and at the same time better ensure that the experienced doctors are available where they are most needed.

This could help reduce patient waiting time as well as improve the quality of care, especially for subsidised patients.

COS 2012 Debate: Growing alternative city centres

Sir, having a large proportion of commuters travelling to and from the city centre at the same time puts huge stress on the transportation network. This necessitates the building of more roads and MRT lines to serve the city centre, and puts pressure on public transport operators to add more bus and train capacity to cater to very high peak loads heading in the same direction.

Parliament

My speech in Parliament on 5 March 2012 during the Committee of Supply Debate on the Ministry of National Development’s budget.

——-

Mr Chairman,

URA’s Master Plan 2008 envisioned more regional commercial centres being developed outside the city centre to offer alternatives for businesses and provide jobs closer to homes. One of the objectives of the Master Plan is to achieve better job distribution island-wide, and reduce congestion and commuting to the city .

Sir, having a large proportion of commuters travelling to and from the city centre at the same time puts huge stress on the transportation network. This necessitates the building of more roads and MRT lines to serve the city centre, and puts pressure on public transport operators to add more bus and train capacity to cater to very high peak loads heading in the same direction.

I understand that development of Jurong Lake District and Paya Lebar Central are currently underway.

May I ask the Ministry for an update on progress of these developments and any other decentralised commercial centres?

To what extent will these reduce the crowding in the city centre, and manage the stress on the transportation network?

Does the Ministry have plans to develop more such commercial centres, and if so where will they be located?

COS 2012 Debate: Increasing rental flat options

Many families with housing difficulties are ineligible for HDB rental flats because they may not meet all the requirements under the Public Rental Flat scheme. Yet many are unable to buy a BTO flat because they cannot afford the resale levy on the sale of their previous flat, as Ms Sylvia Lim has just mentioned, and renting a room from the open market is prohibitively expensive for them.

Parliament

My speech during the Committee of Supply debate in Parliament on 2 March 2012.

—————-

Mr Chairman,

Many families with housing difficulties are ineligible for HDB rental flats because they may not meet all the requirements under the Public Rental Flat scheme. Yet many are unable to buy a BTO flat because they cannot afford the resale levy on the sale of their previous flat, as Ms Sylvia Lim has just mentioned, and renting a room from the open market is prohibitively expensive for them.

On November 21st last year, the Minister told the House that MND may be looking into a higher rental tier to help these families. With a higher rental tier, tenants will pay rents that are higher than current HDB rental rates, but lower than the open market rate. This will enable these families to afford a roof over their head, but without enjoying the full benefits of the usual HDB rental rate.

May I ask the Minister for an update on this initiative, and if there is any expected timeframe for implementation?