Debated in Parliament on 1 Sep 2020.
Debate resumed.
6.49 pm
Mr Speaker, I stand in support of the Motion of Thanks to the President. In my maiden speech in this House in 2016, I spoke of imagining a Perfect Storm, "… a global downturn lasting many years; divisions of race, language, religion; social class, inequality and culture; a fractured national consensus, divisive politics. And then having to face a major crisis – a terrorist attack on Singapore soil, a pandemic, or a regional conflict where old friends ask us to choose between them."
It has been nearly five years and a storm has gathered all around the world. Not quite a Perfect Storm, but still a hurricane. COVID-19 pandemic – worldwide. US-China relations – full of uncertainty. Economic crisis – all around the world, the worst in the history of independent Singapore. Some say it will be as deep as the Great Depression of a hundred years ago, or even worse.
Sir, in crisis, all the more important that we look after our people at home – our fellow Singaporeans. We must be clear-eyed about where policy and implementation can be improved. As I said in this House in March 2016 during an Adjournment Motion, it is about "seeing through the eyes of our people". This includes looking after our people in sickness and in health.
I will speak on five areas, on health – our elderly; our workers; access to insurance; access to new treatments; and our nurses and our allied health staff.
Supporting our elderly. Sir, we know of many elderly in our estates who are less mobile. Some in older flats that cannot easily have ramps installed through the EASE programme and these elderly cannot afford to pay for transport assistance to get to the clinic. In our community outreach, we do our best to help. But I ask, has MOH systematically studied seniors in such a situation? Are such seniors less likely to keep up with primary care appointments and necessary follow-ups? Are they more likely to be admitted to hospital? And when they are hospitalised, do they stay longer when they are admitted?
On mobility and medical assessments. Sir, some Government programmes require a doctor to assess an elderly resident. I have met elderly seniors who tell me that when they apply for a personal mobility device, they were told part of the process involves a doctor signing off on the paperwork. But some seniors, Mr Speaker, are confined to the home because they are not mobile, to begin with. Some have a care-giver who also has mobility needs and is home-bound. Some do not have family to bring them to the doctor. So, it becomes a difficult situation – have to go out to see the doctor as part of the process to get the mobility assistance, but they need that assistance to more easily go out.
Again, in the community, many of us in our constituencies are trying our best, but we must continue looking at improving the implementation. We must make sure that residents do not fall between the cracks of policy implementation and we must continue to try and improve.
Digital access. I have older residents who have mixed feelings. Every time there is a new Smart Nation app or digitalisation programme, some are excited, the more techno-savvy uncles and aunties. They are excited that Singapore is innovating with new technology, new platforms. But there are some older seniors who are less IT-literate.
Sir, digital access must not become a digital divide. Otherwise, digital progression broadly will have regressive impact on the less well-off, the less IT-savvy, and all those elderly who are less literate. So, again, we must continue pushing, to inculcate IT skills in our elderly, but we must also continue to keep the face-to-face and telephone option open for interacting with Government services. And the telephone option must be meaningfully available, which means not a half-hour wait on the line before there is a human voice. It maintains the human touch to have that face-to-face, that human telephone option. And in an economic downturn, it is an opportunity to hire many more Singaporeans with people skills and life experience to help fellow Singaporeans.
Sir, my second point – supporting workers. There are low-wage workers and those without flexible working arrangements, who cannot get time-off for a polyclinic consult during the day. If they go to a GP after hours, the cost is higher. Sir, I call upon MOH to work with MOM, to look even deeper into the health situation of low-wage workers, including gig economy workers who are especially vulnerable.
Sir, for low-wage workers going to a CHAS GP after hours, can we identify them, subsidise them better, so that the out-of-pocket cost can be comparable to polyclinics, or even equivalent to a polyclinic consult?
Sir, in the COVID-19 crisis, I have also met residents, workers, brothers and sisters who have lost their jobs. Some have lost their employee healthcare benefits. Just because their workplace had healthcare benefits, does not mean the workers were rich to begin with. Our residents, especially in the COVID-19 crisis, should not face unnecessary challenges to means testing when trying to return to subsidised healthcare. I have filed a Parliamentary Question on this, so that we can look at this issue further.
Thirdly, access to health insurance. Mr Speaker, in a Straits Times Forum letter published on 29 August this year, the Singapore Medical Association shared that some insurers are no longer allowing claims for diagnostic endoscopy, even when medically necessary. This is a serious development, implications for patient care and patient safety. It is also a very visible sign that individual patients and customers do not have bargaining power to stop insurance companies from such practices. When an insurance company moves the goal posts for an integrated shield plan, it is not so easy for a patient to switch provider because existing conditions become pre-existing conditions under the new policy.
We have also seen from the SMA letter that even individual healthcare practitioners, despite assessing a diagnostic procedure to be medically necessary, in some cases cannot move the insurance companies.
Mr Speaker, the invisible hand of the market appears to have become unbalanced. I call upon MOH and MAS to look at this, and to see if the visible hand of the regulators needs to come in to level the playing field for patients and our people.
Fourthly, access to new treatments. Sir, as a small country with a small market, we cannot negotiate based on market size alone. We must find new ways to ensure affordable access to the newest treatments, not just for today but for tomorrow. For new and emerging treatments, such as cell-based therapy, which are capital intensive and where very few firms currently have the capability, we should invest in our own domestic capability, so that we can shape the local and regional market, and not be held ransom by overseas manufacturers who will charge what the market can bear or what the wealthiest segments of the market can bear, as we have seen in some other jurisdictions.
Are there also ways to relook our patent system so that cheaper but equally effective medications can more easily enter the market, while still allowing our pharmaceutical industry to create jobs and opportunities for Singaporeans and maintaining our forward position as an intellectual property hub and intellectual property thought leader? I am sure that MTI and MOH can explore this further.
Sir, fifth, and importantly, our healthcare workers. Many residents in this COVID-19 crisis have shared how COVID-19 has been a reminder of the contributions and good work of our healthcare workers, especially our nurses, our allied health workers, our healthcare frontliners. In a pandemic, our frontline healthcare workers are part of our national defence. If the pandemic frontline cannot hold, Singapore will be overrun.
Some residents have asked if we are paying our nurses enough and if we can have more Singaporean nurses and staff in our public hospitals. I have met older uncles and aunties, pakciks and makciks. They say there is something comforting about having a fellow Singaporean looking after them in the hospital wards, even just having someone bringing them between the ward and the clinic an assistant who understands them, with whom they can connect instantly, someone who can connect in our seniors' languages, in their dialect, it is that much closer. As one auntie said in Mandarin, "有这个亲密感, 有这个亲切感" – someone who can be a familiar-sounding voice in difficult times for our seniors.
So, I would like to ask the Government: how often does MOH compare the pay of our nurses and allied healthcare workers across the public and private sector? Can we pay our nurses and allied health workers more? The Minister for Finance has spoken about fiscal prudence but, in a deep recession, we should also be willing to spend counter-cyclically, to invest further in our fellow Singaporeans and further build up capabilities within Singapore and in our public sector healthcare, especially in areas where the market alone may not generate the most optimal outcome straightaway.
In conclusion, Mr Speaker, outside Singapore, it is a world of troubles. But to survive and surmount these challenges, our domestic policies at home must also be ready for the future – looking after our people, making sure no one is left behind or falls between the cracks.
Mr Speaker, health is key, because it touches all our lives. When a grandparent falls ill, it affects the grown up children and their own households. Is Ah Kong, is Ah Mah going to get better? Would Ah Kong be there when "didi" finishes his PSLE? When a breadwinner is struck down, the whole family worries. When a child is unwell, the hopes and dreams of an entire family are at stake.
Mr Speaker, healthcare is about our people’s lives – your life and mine, the lives of our loved ones, the lives of every Singaporean, regardless of background. Sir, I support the Motion. [Applause.]
Ms Rahayu Mahzam.
Mr Speaker, the President gave a very solemn and meaningful message that touched on key issues affecting Singaporeans. We are facing tough times but it is during times like these that our mettle is tested and we are given an opportunity to shape our norms as a nation. We decide how we respond and the path we take. Singapore, as always, has to evolve. She needs to adapt and change to adjust to the changing global environment. She needs to evolve economically, politically and socially. But she can choose to be different from everyone else and do things the Singaporean way.
Politically, we are maturing. For some time now, there has been a call for alternative voices to represent the diverse interests in the community. I am encouraged to see our electorate maturing and many people from different backgrounds stepping up to contest during the last General Election, offering different perspectives, aspiring for a better Singapore.
What we have in Singapore is an adversarial process. This process, when carried out in the best traditions of democracy, brings out the best in all of us as we seek to continually improve. Healthy competition is good, as we challenge each other to do better and, in the end, the nation benefits.
However, when people take the adversarial process to its extreme and assert their opinions in a very vicious manner, there is a danger of the society being divided and polarised. During the campaign, in the online space, we saw some constructive discourse but also some malicious comments being passed, vitriolic remarks being expressed and personal attacks being made which strayed from the substance of the debate and became an attempt to bring people down instead.
An election, is an emotive exercise, I appreciate that. However, all of us must continue to push for decorum and constructive debates always. As we evolve and mature as a nation, we have to find a better way to have discourse and for each of us to express our views and challenge opposing ones.
We have been seeing some negative conduct on the Internet for some time now. There is increasing cognisance of the "cancel culture" which is causing some concern. "Cancellation", basically, refers to an attack on someone’s reputation by a determined group of critics because of an opinion or action of that individual that is deemed to be unacceptable. It is a targeted effort to destroy the individual, to get them de-platformed or put out of business.
Conceptually, the "cancel culture" is not new. Society had always rallied against what it deems wrong and groups of people have campaigned against individuals to censure them. However, the Internet and social media have amplified and caused an evolution of this phenomenon and its repercussions. For one, online, a certain issue or matter can get viral very quickly and a mob mentality can form long before facts can be verified or discussed. Secondly, the distraction from all the attacks takes attention away from the substance of the matter which is often then lost in the flood of comments and criticism. Thirdly, people are quickly pushed to take sides and the very person or groups that need to be edified about the error of their ways, or to be shown different perspectives, are then disengaged. A more serious side effect is that those with genuine views become muted as they fear being judged or lynched by the angry mob.
The cancel culture can manifest itself in many different ways. Several months back, there was an issue that arose within the Malay/Muslim community. A popular podcast channel was criticised when it was found to have certain episodes where comments which were misogynistic and degrading to women were made. Many women and men, called out the hosts. Misogyny is unacceptable and has no place in a progressive society. However, what was actually an opportunity to address an important issue, turned out to be a highly polarising exercise for the community. Online, people were pushed to take sides – you are either on the camp asking for the hosts to be de-platformed or are seen as their supporters and, by affiliation, accept misogyny. Some people I spoke to about the matter felt that there was so much negativity and people missed the point about the need for the community to address misogyny.
We must take a stand against things which are morally unacceptable. However, we need to learn to do so constructively so that the community can learn, have discourse and shape new and better norms.
Another trend that we have been seeing is the online movements that have been waged in other countries to change norms and push back against years of repression. Power has shifted to the people, with the Internet and social media platforms as accessible battlefields. We have seen the #MeToo and #BlackLivesMatter movements in the US. There is value in rallying people to call out injustice and shift norms to be a more just and fair society. We should encourage people to be conscious of social issues and do their part to bring about positive developments as a society evolves and matures. However, we must be conscious of the impact to the community. Inevitably, there will be different opinions and we need to ensure the expression of opposing views does not cause polarisation. The movements in the US have had their fair share of criticisms, even among liberals. So, even as we may be inspired by some of these developments abroad, we should not follow them blindly but, instead, find the Singapore way to evolve.
We have much to learn from the experiences of other countries. However, as we look to others for lessons to develop norms in our nation, we must pause to appreciate the impact of the same in our context. We should be cautious not to jump on the bandwagon and copy and paste the playbook in other countries without adjusting the same for our needs.
In particular, we must be keenly aware of our special demographics as a multiracial, multi-religious society. Multiracialism is a value we hold dear. We must, therefore, ensure that in our debates and discussions, we are mindful of the impact of our comments and the danger of fraying our social fabric if we pit one group against the other.
We must, therefore, take the necessary action to ensure that we shape the norms of discourse in our nation. What can we do?
We all need to play a part in creating a safe space online that encourages meaningful debates and curbs vitriolic discourse. I sit on the Management Committee of OnePeople.Sg (OPSG) and have been involved in a few discussions with our youth volunteers and participants of our programmes recently. We were discussing what were acceptable boundaries when discussing race and religious issues and whether current laws or frameworks need to be adjusted to changing times. The youths shared that it was not so much the laws they were afraid of. They feel afraid of expressing their views online because they fear backlash from others who have different views. So, while the Government can do its part by putting in place laws and regulations to set the necessary boundaries that circumscribe our discourse, as individuals, we all have a personal responsibility to behave fairly and call out any action that threatens healthy discussions.
Beyond having safe spaces for discussions online and even offline, to truly shape norms, we need to translate our discussions into real action. We need to walk our talk. For this, too, we all must play a part. Some policies or legislation may need to shift to shape behaviours. There have been concerns by some in this House about the issues of discriminatory conduct on the part of employers and we need to review and look at the frameworks in place and improve them. However, we must also take individual responsibility. We must ensure that we ourselves do not discriminate, especially in our conduct with others who are different from us and that we teach the right values to our children. Mr Speaker, in Malay.
(In Malay): [Please refer to Vernacular Speech.] We are increasingly seeing various views expressed on current issues affecting Singaporeans, especially online. What is good is that it shows the maturity of the community in discussing important issues such as Government policies or community norms. What is bad is that sometimes the discussions that we see online are very negative, leading to personal attacks on someone and running away from the original topic of discussion. This is worrying because we can see how online campaigns and cultures that spread in other countries, can divide society and lead to violence.
Therefore, it is very important for us to ensure that, in Singapore, we develop our own norms and ways to conduct online discussions, especially when touching on hot and sensitive issues. Issues related to religion and racism, or discrimination issues, for example, are important issues that we should face in a plural society. We must be bold enough to speak out and be firm in calling something out if it goes against our societal values. We should also want to continue contributing suggestions that can improve the lives of our people. But we must always rely on facts, and not just accept all the stories that we hear; and when we are faced with different views, we need to discuss with wisdom and have a constructive attitude.
We are indeed facing challenging times. But in times of difficulty, our character and integrity as a society are tested. We have the opportunity to shape the norms in our country. I hope, we can choose our own way, the Singapore way, in debating important issues in our country.
Hopefully, with constructive contributions, Singapore will continue to grow and become an inclusive society, where we all have the opportunity to work, build families and achieve our aspirations.
(In English): How we treat each other will determine how we evolve as a nation. Our individual actions accumulate to create the culture of our society. I hope to do my part to make this world kinder, more compassionate, more accepting of differences. I hope to make this place a better place for my son, Ayden. Ayden, as many of you know, has Down Syndrome. As a parent, I worry about how he will be treated when he grows up. I wonder if people will be patient with him, whether they will be kind and whether he will have the support he needs to live well.
I am happy to hear that there will be stronger support for special needs students by training educators, opening new special education schools and upgrading current ones. The efforts in improving the support and infrastructure has been a work-in-progress. We have made many big strides and Ms Denise Phua deserves special mention for all the efforts that she has done in this House as well as outside to champion the needs of the special needs community. We can and should continue to build on these efforts.
I do hope that when we look at reviewing some of the support given, we go beyond lip service and truly work towards changing attitudes and norms. I hope that we truly learn what empathy is. We should not tick boxes and be content to just address one feedback at a time.
When we talk about improving infrastructure, it is not enough to just build ramps and a few inclusive playgrounds. We must really nudge behaviours to facilitate and make it convenient for those who have disabilities to join in all the activities that others are involved in. When we talk about creating awareness and being inclusive in workplaces, it is not enough to just incentivise employers to employ people with disabilities. We must encourage understanding and conversations amongst employers and co-workers. We must learn to see the value and contributions of people who may be differently-abled. When we talk about building the capacity and capability of educators, it may not be enough to just train a select group of teachers or provide basic training for all teachers. We must provide the skills to all educators to identify needs, teach the right values and attitudes and inculcate a culture of pervasive inclusivity within our education system. We need to also look at enhancing the career pathway of educators in the special needs sector.
The reality is that embracing and supporting this community bring great value to Singapore as a whole. There is great economic value in empowering this group with the necessary skills to take care of themselves and be as independent as possible. If we deal with this issue upstream, we will spend less in providing support for them in the future. When we enable people with disabilities, we enable the whole community. More importantly, they are differently-abled and should be seen an equally valued member of the community. People with special needs are conduits through which we all learn to be kinder and more compassionate. This I have learnt from you, Mr Speaker. A kind and compassionate society is one that can brave through difficult challenges and emerge stronger.
It is so important that in the midst of all the turbulence, we remain steadfast in preserving and shaping our values as a nation and remain a fair and just society, a society that is truly embracing of diversity.
It is a great honour and privilege to be able to debate in this august House. As I have said in my maiden speech, in this House, we may not always agree with each other, but we debate respectfully. I believe this decorum can extend beyond this House and I hope, as a nation, we always seek consensus, not conflict. I hope, as a nation, we embrace our differences and be kind and compassionate always. Mr Speaker, I support the Motion. [Applause.]
PAPERCUTS