Debated in Parliament on 27 May 2014.
Order read for Resumption of Debate on Question [26 May 2014].
"That the following Address in reply to the Speech of the President be agreed to:
‘We, the Parliament of the Republic of Singapore, express our thanks to the President for the Speech which he delivered on behalf of the Government at the Opening of the Second Session of this Parliament.'." – [Mr Zaqy Mohamad].
Question again proposed.
Before I proceed to call the first Member, I would like to remind Members that if, in the course your speech or in the course of your clarification, you need to make a reference to another Member, you would need to refer to that Member by the name of the Member – Ms, Madam or Mr – or by the constituency which the Member comes from, instead of referring to the hon Member as "he" or "she". This is just a reminder to Members, to upkeep the decorum in this House. Dr Chia Shi-Lu.
Thank you, Mdm Speaker. The President, in his speech to Parliament, spoke from his heart about his vision for how Singaporeans can build a better life for themselves and their children amidst a challenging and changing environment. Just over two years previously, when he spoke during the Opening of this Parliament during its First Session, he likewise called on all Singaporeans to be as one, to build an inclusive and inspired society.
I rise today to speak to thank him for his wise words, as I did then during the Opening of the First Session of Parliament. Singapore has not stood still since that day in October, and, likewise, this Government has been hard at work all this time listening to the people, working with the people and working for the people.
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Back then, one of the measures several of my colleagues and I pushed for was to give our seniors greater peace of mind where healthcare was concerned. I asked for greater subsidies to be given to senior citizens and that this should be calibrated to their age: the older a Singaporean is, then the more healthcare financial support he or she gets. The announcement of the Pioneer Generation Package and also MediShield Life which will provide universal healthcare insurance to all Singaporeans regardless of pre-existing illnesses, have exceeded all my expectations and then some, and have been warmly welcomed by all. These are the sort of bold moves by the Government which make me truly proud to be part of this governing party and to be a Singaporean.
There was a time that whenever we spoke of the Singaporean Dream, there was the inevitable mention of the dreaded 5Cs: cash, credit card, condo, car, country club. Even then, I found it difficult not to feel a little bit sheepish when I was talking about this, because it seemed as though this was all that Singaporeans aspired to. Certainly, these are things that many of us would still like to have, but I am happy that the younger generation seems to have started to move beyond these material aims.
Is there a new definition of the Singaporean Dream? I suppose there are many viewpoints about this but why not let us try Happiness, Health and Hope, and a respect and appreciation of Home and living with Heart?
A central pillar of this new Dream is Health. The landscape of healthcare in developed societies is transforming from that of disease treatment to that of health maintenance and wellness. All of us are aware that each of us is personally responsible for our own health, but this does not mean that the Government should not act to nudge us towards being better keepers of our own health. Freedom of choice is important but, sometimes, it may not be a bad idea to save us from making less than wise decision where our well-being is concerned.
Tobacco and smoking legislation is a widely accepted form of governmental oversight which has had far-reaching positive public health effects over the past few decades. Let me here take the opportunity to laud the Health Promotion Board's recent efforts to raise the legal age for buying tobacco products.
The other clear and present health risk facing modern societies lies in the food we eat. There have been many calls in recent years for the Government to act more decisively in making the food we eat more healthy. There are many rules and regulations which safeguard food safety in terms of freedom from toxins and harmful biological agents like bacteria, but what about unsafe nutritional choices? In developed countries, diseases related to poor diet, such as excessive sugar, salt and fat, present a far greater public health burden than that
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posed by food poisoning and related problems.
Let us look at a few examples. Britain's Food Standards Agency, between 2001 and 2011, set targets for the reduction of salt in various food categories and got food companies to achieve these targets over time. Over this period, sodium consumption in the UK fell by 15%. But what was more important was that this was accompanied by a significant decrease in the average blood pressure of the British. This was also accompanied by a 40% drop in deaths from heart attacks and a 42% drop in stroke deaths. Reducing the salt content in our food gradually over several years means that it is less likely consumers will taste the difference and also helps to shift our preference away from salty foods.
The work by the British Food Standards Agency mirrors the success seen by other countries, like Finland and Japan, which have managed to reduce sodium consumption through various government-led measures and consequently enjoyed substantial reductions in heart attacks and strokes.
Admittedly, some similar measures have met with less success. For example, Denmark's fat tax and New York City's scuppered attempt to outlaw oversized sodas, but that should not deter us from continuing to push for healthy eating choices. Continue to highlight healthy hawker cooking, or perhaps have advisory health notices on unhealthy foods, like we now do on cigarette packaging. These are critical moves we have to make as a nation. The crisis is not so much that we have an ageing population but whether we are an ageing and also unhealthy nation.
The Government Parliamentary Committee on Health last year delivered a position paper on Healthcare Affordability to MOH based on numerous dialogues with the public and healthcare professionals. Since then, many of the concerns and proposals contained in that paper have been addressed by MOH, for which we are, indeed, grateful. But as we move to an era of even more affordable and accessible healthcare, we will also have to learn as a nation to utilise healthcare appropriately. This is not just about dollars and cents, but using healthcare in an unwarranted and excessive manner may do us more harm than good.
Let me share one cautionary tale. In one state in the United States, they conducted an experiment where certain of the citizens were given expanded health insurance coverage through a lottery system. The hope was that if the citizens did not have to worry about healthcare expenditure, then, they would actually try to stay healthier by going to see the doctors more regularly. However, the researchers found the converse. They actually found that these "lucky" people – so to speak – who won the lottery, ended up making even more visits to Emergency Rooms at hospitals, and often for simple conditions that could be treated by their general practitioner or GP. In fact, their self-reported health scores were worse than
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before they won the lottery.
More and newer is not always better. Many health supplements and even some forms of health screening have little if any health benefits, and overuse of certain medications have risks. There are countries where, because of the pattern of reimbursement for antibiotics, they saw a high incidence of resistant strains of bacteria because of the change in the pattern of prescription.
These are some things that we have to be mindful of even as we make our healthcare more affordable and more accessible.
But universal, state-backed health insurance, such as that which is to be offered through MediShield Life, is, nonetheless, vitally important to plug certain healthcare financing gaps. There are certain conditions which incur significant costs to the patient and the family which require better coverage than what is offered today, such as cancer treatment and kidney dialysis. I hope that these needs will be met through MediShield Life or other supplementary programmes.
Let me now turn my attention to how we prepare for an older Singapore. However much attention we place on our health, we will grow old. Singapore is growing old, and her people are growing old even more quickly. But as I have said on many occasions, growing old is not something to be feared but to be embraced. Going back to the 5Hs I mentioned earlier, we hope to grow old not only Healthily, but also Happily and with Hope in our own Homes. Mdm Speaker, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] Though I do feel that retirement homes and villages are useful and serve specific needs, I hope that Singapore will not develop into a country where there are enclaves for the young and for the old. The elderly should age gracefully and actively within the community, and the community should provide an environment which allows this to happen.
I am glad that an Inter-Ministerial Committee has been set up to strategise a whole-of-Government approach towards preparing Singapore for an ageing society.
The President, in his speech, noted that our seniors did much to build today's Singapore and deserve our full support, and we have a duty to help the elderly remain active and healthy. Progress is inevitable.
As we become an increasingly connected and "smart" city, we will expect to see fewer traditional bank branches, post offices or, indeed, coin- or card-operated phones in the
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community.
We will have to help our seniors navigate these unsettling paths of change, leveraging on the very same technological advances that have caused these disturbances. Redesign automated cash machines and tellers to be more senior-friendly, and create simplified technological solutions within neighbourhoods so that seniors can access information services.
Perhaps, provide staff during certain hours of the day at these otherwise self-service, automated facilities to guide seniors to utilise this new-fangled technology.
(In English): I have just described how we can perhaps adapt the community to make it more senior-friendly. The other problem we will face is that we can expect to see more seniors growing old alone. While we can do many things to keep seniors engaged within the community, the Government should look into using technology also to monitor the well-being of such seniors, in as unobtrusive and respectful a manner as possible.
I am thankful to MOH for disbursing the City for All Ages grant to allow communities to promote Ageing-in-Place. In my ward in Queenstown, we have been using this grant to understand the needs of seniors, provide services, such as shuttle buses to the nearby polyclinic and, later, to embark on a small pilot programme to provide personal or home monitoring for seniors who live by themselves. Presently, we have alarm systems in some homes which can be activated in case of emergency, but there may arise situations when the resident is unable to activate this system. There are now simple, cost-effective monitoring systems which require no deliberate actions from the resident. For instance, many of us now use wearable technology, such as these little armbands that help our activities during the day. There are sensors that detect movement and appliance use, or the usage of electricity and water within a given home. These smart systems may be used to alert the community when something of concern might have occurred to a resident who lives in that home but, at the same time, these systems are relatively private and relatively unobtrusive.
A final point I wish to make is that, aside from the hardware and the software that are needed to make our society senior-friendly, the Government has to maintain its effort to engage and communicate with seniors. The Pioneer Generation Package is a wonderful programme and it is heartening that the relevant Ministries have really gone all out to reach out to these seniors to explain what it means to them.
However, judging from recent feedback from the ground, some seniors are still unsure of other Government policies, such as the periodic raising of the Minimum Sum
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requirements for CPF. I would submit that, perhaps, it would be worthwhile to turn these stories on their head and to focus on the fact that the key reason why we are doing this is because, as a nation, we are more healthy and the average life expectancy has risen. So, if we focus on this good piece of news, then it will be easier for us to understand that because we are all living longer, we may then need more in our CPF accounts to prepare for this longer period of life.
The President called on us to keep Singapore Special and Unique, by being "united in engaging our hearts and minds". I am confident that Singaporeans will work together to make this so and grow from strength to strength, staying Happy, Healthy and with Hope in the Home we love and with all our Heart. With this, I support my colleagues in this Motion of thanks to the President.
Mdm Speaker, I support the Motion to thank the President for his Address. Before the local media reported that Singapore was named the best place in Asia for mothers, there is already a group of residents in Woodlands who believed that it is true that Singapore is the best place for them and their families and for women and girls as well. This group included many women grassroots leaders, women residents who regularly took part in our community activities with their family members, foreign wives and new citizens, all of whom acknowledged that their children benefit from being born and raised in Singapore.
Singapore's top spot is due to the Government's efforts to improve services for mothers and children: maternal mortality has been cut by 80%, child mortality decreased by 25%, gross national income per capita doubled and the percentage of women in Parliament increased six-fold over the past 15 years.
I attend international parliamentary conferences regularly and have also hosted foreign parliamentarians in Singapore. The high percentage of our women parliamentarians and the safety for our women and girls generally are widely admired by even the most advanced countries in Europe, Australia and New Zealand.
From feedback I have gathered on the ground, what is important to many mothers is not the affluence our children would inherit, but the care and concern they would receive as they grow up and the amount of care and concern they would show others when they become adults.
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The President's Address has also touched on the Government's proactive approach to improve the nation, including how we would continue to make Singapore a Caring Society. There is a great deal that our Government can deliver in terms of affordable housing, good healthcare, equal educational opportunities and secure employment, which are close to Singaporeans' hearts. When it comes to building a caring society, Singaporeans need to be convinced that they, too, must play their part and that they cannot rely on the Government to make it happen or expect a change equivalent to our remarkable achievement in making our nation the best place for mothers and women.
What the Government has done and should continue to do is to promote courteous and considerate behaviour at all fronts – the workplace, in schools and in neighbourhoods. In recent years, customer service standards across many Government agencies rose significantly. Singaporeans have become more aware of the extensive social services we provide for the less fortunate in our midst. In addition, the National Service (NS) Review Committee has recommended more benefits in recognition of NSmen's contributions to the country. The proposed changes show more than due consideration towards Singaporeans who defend us and our homes. They are proof that the nation places great priority on furthering options that will increase their well-being as well as their family's well-being which, in turn, strengthens their sense of belonging to our nation.
Anecdotally, since last week's announcements on the proposed increased benefits for NSmen, some mothers have begun telling their sons – and wives, their husbands – to work harder at staying fit so that the families will benefit overall.
While I am heartened by the NS Review Committee's recommendations to strengthen National Service, I would like to urge the Government to help develop more ground-up initiatives to deepen the sense of belonging to our nation. Allow the community to play a greater part by giving them more resources to pursue the cause of promoting care and concern for one another.
We can further enhance existing activities and programmes to emphasise kind thoughts, kind words and kind actions every day. Membership could be as varied as possible; it could be based on age groups, common interests, life phase, alumni or adopted charitable organisations. The key to success is consistency so that such groups are given sufficient resources to interact regularly. The promotion of care and concern among Singaporeans should also be enlarged to include caring for the environment and animals.
There is among some of our youths a certain cynicism that showing care and concern towards others works against their own interests. They argue that they may end up as victims of their own altruism. This pessimistic view of others often drives able young people to focus solely on what matters most to their future – excellent academic qualifications. There is a
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need for us to address this dreadful pessimism.
School pastoral programmes have to pay greater attention to this aspect of character development. Our children must be imbued with a strong sense of confidence about their future. They must believe that their future is co-created with their friends and how good their future is depends on how much they can complement and support each other. It is no doubt a difficult balance to strike when we subscribe to meritocracy as a society and have an entrenched belief in the value of individual diligence. But it is a balance we have to achieve, and the sooner we begin on this tough job, the better the outcome will be for all of us.
Mdm Speaker, I shall speak in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] The President delivered the policy speech on behalf of the Government at the Opening of the Second Session of the Twelve Parliament. His speech, to many Singaporeans, including myself, was very inspiring. Indeed, the Government must work hand-in-hand with the people to build a better and more caring home. While the Government works towards attaining economic achievements, we must also unite as one people, young and old, to live happily and confidently together.
The President also reminded us that although Singapore has been independent for nearly 50 years, we are still a young nation. Singaporeans of today must uphold the same spirit as our pioneers, namely, resilience and hard work, to overcome the challenges we are facing today, just like what our pioneers had done in the past.
Amidst the transformation of the global economy and the rapid change of the Singapore society, the Government has made major policy changes in the past 10 years, such as introducing ComCare and WIS, to better look after the vulnerable and the low-wage workers.
In recent years, the Government has continued to improve its policies, ramping up the supply of public housing, improving the public transport system and introducing the Marriage and Parenthood Package. These schemes reflect the Government's commitment to stay relevant.
Singapore is a small nation. It is a fact we cannot change. Hence, we cannot take our nation's defence for granted. To recognise the contributions of our NSmen, the Committee to Strengthen National Service has proposed a series of measures. Some residents feel that the benefits currently provided under the NS Recognition Scheme are a very powerful way of showing recognition. For many parents, their children need to have financial ability before they can marry and have children. An additional amount in their bank accounts after National
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Service means that they can get an apartment earlier.
Occasionally, I will hear young men saying jokingly that girls enjoy many advantages over boys because she graduates two years earlier and will have more savings after graduation. To be honest, it is not difficult to understand their sentiments. Our children are brought up in a culture of fierce competition and they believe that hard work leads to success. When they encounter seemingly unfair situations in education and work, they cannot help but feel a bit unhappy. The proposal of the Committee is the right one. Six thousand dollars is not a small amount. However, what matters is not the number, but the message that is being conveyed, which is recognition of our NSmen and their families' contributions. It is with the support of their families that they can complete their National Service successfully, a noble duty of a male citizen towards the country.
Another piece of good news for our residents is the additional $100 reward for passing the Individual Physical Proficiency Test (IPPT). Those who achieve Gold will receive $500; Silver $300; and those with a pass will be awarded $200. This must be a rare reward system in the world. Interestingly, I have heard of some Singaporeans who tell their sons or husbands to work harder, so that the whole family can benefit if they get the cash reward.
Therefore, I would like to urge teachers to discuss the Committee's proposals with their students during Civic Education classes. By doing so, not only can we get to know the views of the students but, more importantly, we can instil in them the right values. This is not to trivialise the spirit of National Service, as the contributions of our NSmen cannot be measured by money. We must all remember that it is each and everyone's duty to defend the nation.
Mdm Speaker, I support the Motion and I thank the President for his Address. As we celebrate our Jubilee next year, I believe that Singapore is at a critical inflection point in our nationhood.
In ancient Judaic tradition, the Jubilee was not just a year of joyful celebration, but also a year of rest, during which slaves were set free, alienated property restored to their former owners, and lands left untilled.
This tradition appears to be of no relevance to us. But there is something worthwhile about resting, in the sense of taking a step back to reflect and ponder: what do we wish to become? How do we want to get there?
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Yes, we have gone through an entire exercise of a National Conversation to talk about the future we want. That was a useful exercise, distilling core aspirations of Singaporeans. I regard the 12 perspectives presented as foundational pieces for the future.
But I believe we need something extra. Something more aspirational – to excite the imagination, to enliven the spirit and to energise the mind and body into action. Hence, we should not just have diverse definitions of success in terms of outcomes, but also welcome purpose and passion in the journey itself, whatever the outcome.
We should not just want a more fulfilling pace of life, but also a high level of meaning and engagement in both work and life, so that they become a false dichotomy. We should not just be a society that takes care of the disadvantaged, but also one that partners the disadvantaged so that they use their own strengths to transcend their current state. We should not just be a society with a greater sense of togetherness, but also one where every citizen has ownership of his or her community and acts to improve the common good.
And we should not just have a competent and trustworthy Government, but also a trusting Government that believes in its own people, whose abilities and desires can be harnessed.
For my speech today, I will focus just on this last social compact challenge – the need to improve the relationship between the Government and the people. I think this is a critical issue to address because there seems to be some breakdown in mutual trust – not just between the Government and the people, but also among the populace ourselves. How does the Government lead, given the current realities?
Madam, today we face complex economic and social opportunities and challenges, which the Government, competent as it is, cannot work on alone. We all know that global realities are changing. Globalisation and technological advancement – and their impact on job obsolescence and income inequality – mean that we have to continually adapt our economic interventions.
At the same time, the domestic environment is rapidly evolving, too. Citizens have widening interests and heightened expectations. They are also much more expressive of their opinions and desires. It is an illusion, in this dynamic environment, that mere technical fixes, developed by the Government alone, can resolve the messy and interconnected problems we face today and in the future.
Leadership then is not just about intelligent and committed national leaders having good answers and good policies. Because half the time, we may not even be clear what the
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real problem is, beneath all the layers of presenting symptoms. And the other half of the time, we may not be sure which proposed solution works best.
Instead, leadership is often about mobilising people to confront and deal with problematic realities for the purpose of making progress. It requires people to be part of the solution and to be part of doing the work that generates progress.
For example, in healthcare, we cannot just build great hospitals and institutions, we need to get people to re-examine the diets and lifestyles. Another example is working with vulnerable families – it is not mere financial assistance schemes that we need, as these may end up undermining the dignity of the human person and lay the seeds for long-term dependency. We must also address the social structure, systems and policies that are likely to make these people vulnerable in the first place.
Much leadership work is hard because it invariably involves people confronting losses – losses from modifying habits which give stability, values which give identity and meaning, and lifestyles which give comfort. The danger of placing all the burden on the Government to solve all problems is the Government eventually breeding over-reliance, promising too much and not being able to deliver to satisfy escalating demands from citizens. Inevitably, certain promises by the Government would be perceived to have been broken.
The President's Address shows the seriousness and commitment on the Government's part to deal with the current challenges, for example, to keeping pathways open to all, strengthening social safety nets and enhancing retirement adequacy.
I am encouraged by the Government's full and active policy agenda. Yet, there continues to be an unhealthy dynamic in the Government-people relationship. Scepticism persists as to whether the Government really empathises with the plight of the average person. The dependency on the Government to fix every problem, big and small, real and imagined, is also coupled with some degree of learnt hopelessness amongst citizens that prevents them from having the confidence to contribute to the solutions.
The crux of the matter is that it is not just about doing things for the people, but also about doing things with the people. Citizens need to be stirred to take greater responsibility for the problem-solving work in the community. The Government needs to involve and entrust citizens more proactively in the hard and messy but creative and opportunity-enhancing work that produces societal progress. Apart from developing a sense of agency, this ensures increased commitment to the implementation of the solutions and policies adopted.
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The good news is that there are hopeful signs that citizens want to step forward to act and to contribute. These passionate citizens can be seen volunteering, donating, mobilising, initiating and advocating.
Last year, I was involved in a poverty awareness initiative in Singapore. The intent of the campaign was not to highlight policy adequacies. Rather, it was to get Singaporeans to understand the plight of struggling families. By this measure, it was a successful campaign because it elicited a broad range of responses from big-hearted Singaporeans which showed that many cared deeply about the disadvantaged amongst us and are, indeed, acting to do something about it through numerous ground-up initiatives.
Nevertheless, it is inevitable that when committed Singaporeans care passionately about an issue, they may sometimes disagree with the authorities, or with one another. Sometimes, authority figures are too quick to judge these people who passionately espouse differing views as being against the interests of Singapore and having their own agendas. When threatened by a person or a group, the official response may be to act decisively to neutralise the perceived threat.
Madam, I strongly suggest that the Government re-evaluate its stand on how it engages and empowers citizens. In this regard, I believe that strengthening our civil society is in our long-term national interest. We need all our engines, not just the Government‘s and private sectors' engines, firing.
There is a misconception that civil society is about anti-Government bashing and about navel-gazing. We must get rid of such thinking. Civil society should just be about citizenship – ordinary citizens doing their part to help with the social and economic progress of our nation. I have faith in the capacity of citizens to cater to the needs of fellow citizens in ways that the Government may not be able to be involved. I believe in the ability of citizens to innovate if they are allowed to and given the support.
What must change? Let me just highlight a few proposals. First, I think the Government needs to acknowledge the potential contributions of civil society and show willingness to co-own social issues. I am afraid that, sometimes, the Government may end up disfranchising the very people who can be their best partners because they bring the peace of complexity of the problem to the table and care deeply about the problem and are willing to act to make things happen.
Secondly, civil society groups can be engaged to think about the national interest. It is understandably natural for citizens to first think and advocate for their own narrow interest first. But this is only because they have never been engaged properly to think about the
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larger good. People respond in self-fulfilling ways. We must trust that citizens – when facilitated well – can be empowered to come up with appropriate solutions for the broader community.
Thirdly, there need to be concrete actions on the part of the Government to allow citizens to grow and become fully contributing members of our society. For sure, civil society also has to improve the way that they engage the Government. But the Government has more to do because the power equation is unequal since the Government holds substantial legal, regulatory, financial and information powers. Specifically, the Government needs to involve civil society and non-public leaders as valid partners and co-creators. There should be regular strategic dialogues to discuss critical social problems.
Co-ownership also means more transparency in sharing data and research, greater willingness to accommodate diverse viewpoints. Some academics, like Harvard Prof Cass Sunstein, have written how nations are far more likely to prosper if they welcome dissent and promote a culture of candour and disclosure.
I also believe we can embrace a more deliberative form of democracy, with authentic deliberations among representatives, meeting as equals, who propose and justify decisions that are generally acceptable and accessible. Deliberative democracy requires safe environments to speak and debate, mutual respect for each other's positions and freedom for participants to deviate from original positions held.
The Government sometimes speaks of co-creation. Co-creation must involve a real meeting of equals coming together to create new inventions. To facilitate this, there must also be more support for social entrepreneurs and intrapreneurs within existing institutions, whether in terms of funding, capability building or infrastructural support.
Civil society members also critically need to play their part by stepping up to the plate. They need to demonstrate that they can be worthy co-equal partners at the table. There needs to be a stronger appreciation of the common good; there needs to be a deeper desire to move upstream to tackle root causes, to be impact-driven, not programme-driven, to take risks to experiment with new models and to mobilise community resources. Discourse needs to be civil and the focus should be on the issue on the table and not on persons.
Mdm Speaker, what I am arguing is that constructive politics is not just about debating, deciding on specific policies and then moving ahead as one united people to implement the programmes. Increasingly, politics is also about engendering co-ownership so that the creative energies of people are harnessed, even if they have a few sharp edges. It is about encouraging that passion of leadership at all levels of society so that we can more swiftly,
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adapt and respond to the demanding and fast-changing challenges confronting us. It is about nurturing mutually-trusting relationships so that everyone has a stake in creating a home that they love and continually care for.
What is critical is, hence, not only what we do, but how we do it. We are not part of different teams, we are all part of Team Singapore seeking to build the only home we have.
Mdm Speaker, thank you for allowing me to join this debate on the President's Address and I fully support the motion to thank the President.
To me, the President's speech amplified the values of Courage, Commitment and Confidence. Courage and grit of the pioneers in laying the foundation and building this country. Commitment of the present generation to a progressive, inclusive, compassionate nation. Confidence that Singapore and Singaporeans will do well in a future of opportunities amid a rising Asia.
The Government has recently brought about the Pioneer Generation Package to give our pioneers peace of mind in healthcare.
In his speech, the President also touched on the wider subject of retirement adequacy. This goes beyond the Pioneer Generation. Citizens of all ages must prepare for their eventual retirement. Every person hopes to be able to enjoy a good standard of living in retirement, preferably not too different from that before retirement.
When Singapore became independent in 1965, life expectancy then was around 65 years. If a person starts work at age 20 and retires at, say, age 55, he would have worked 35 years and then must provide for an average of the remaining 10 years in retirement. So, if you divide one by the other, 35 by 10, then the ratio of working years to retirement years is 3.5.
Today, life expectancy is around 82 years. If a person starts work at age 22, say, after National Service, and works till he retires at today's statutory retirement age of 62, then he would have worked 40 years to provide for the remaining 20 years in retirement. And once again, if you divide the working years by the retirement years, then the ratio would have changed to something that is already less. So, it would have been three. And then if he is re-employed till age 65, then it would have been 43 years of working for 17 years of retirement,
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that giving a ratio of 2.5. This is the reality that we must together face.
There are two main ways one can save more for longer retirement years: first, by earning more during working life. This increases the chance for savings being accumulated, for a given level of consumption expectations and choices. Second, by maximising the pool of savings meant for retirement.
For the more one can do that individually and for the population as a whole, the more adequate would retirement funding be.
What is Retirement Adequacy? One way of looking at it is – it is the relationship between available funds and the level of expenditure for a given level of standard of living.
If you look at the money side of things, on the funds side, one source of money would be CPF savings. It is not the only source. For example, there could be other sources, like private savings outside the CPF, contributions from family members as well as the ability to monetise assets like renting out rooms or right-sizing to a smaller flat. These are the other avenues.
But, for today, I wish to discuss ways to strengthen the pool of CPF savings for workers, so as to help as many workers as possible build the means to an adequately provided retirement. And for this, I have divided the measures into two buckets: one, the measures that maximise the flow of money into a worker's CPF savings; two, how to make the CPF savings work harder for the worker's retirement.
So, the first bucket, that is, of maximising the flow of money into the worker's CPF savings. There are different ways.
The first way would be to increase the base pay. As CPF is a percentage of a person's base pay, an increase in base pay will increase one's CPF savings. So, in this regard, the Labour Movement's push for the Progressive Wage Model, a call which is now supported by the Government, will help enable sustainable improvements in wages through skills, productivity and career enhancements. It would also help to improve CPF savings on a long-term basis.
Second, minimising episodes and duration of unemployment. There is no CPF to be earned during periods of unemployment. Hence, efforts to minimise unemployment, for example, through skills upgrading and employability capacity-building, and enabling more economically-inactive citizens to return to work, will help workers derive more CPF savings.
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Next, more working years. If we can lengthen the working runway for our older workers, there will be additional years of salary to increase overall earnings and overall savings. Not only that, but the additional savings would also themselves earn additional CPF. This would certainly also improve the working years to retirement years ratio. So, again, using the earlier example of starting work at age 22 and continuing to age 67, instead of 65, and with a life expectancy of 82 years, then the support ratio will improve from 2.5 to three.
This is why I have been pushing hard to raise the re-employment age ceiling from 65 to 67. This will give older workers, who wish to do so, such a choice.
Even as the Tripartite Committee continues in earnest to reach a consensus on when and how to raise the re-employment age ceiling, I am very encouraged by a survey that NTUC's ULive@Work department is conducting. The ULive@Work department, which is the NTUC's department championing older workers' issues and interests, had asked affiliated unions to categorise their partner companies with regard to employing workers beyond age 65, according to a five-point scale. This survey is ongoing but I would just like to share some preliminary results. So far, out of 313 companies rated, 75% of them are employing workers beyond age 65. Some do it on an ad hoc basis whilst others are systematic, and the best ones have policies to back up their intent. Sixty percent of the rated companies re-employ older workers as a matter of norm, that is, better than ad hoc. So, whilst the survey is ongoing, I can see that such a strong labour market result goes to show the recognition by both workers and companies of the value-at-work that our older workers create. I am optimistic and convinced that a calibrated move from 65 to 67 is doable. And as I explained earlier, doing so would certainly also benefit earnings and CPF savings.
Next, MediShield Life, employer health insurance, Medisave contribution. Many employers provide some form of health insurance for their employees and pay a premium for that. MediShield Life will be a national, universal health insurance programme for all our citizens. It will cover pre-existing illnesses as well. When the details of MediShield Life are released, I think there is an important opportunity for employers, workers, unions and insurers to work together to minimise duplication of coverage, if any. More importantly, where savings can therefore be derived from the cut-down of duplication, then these savings must go into additional Medisave contributions for the workers, thereby helping to strengthen this part of a worker's CPF savings.
Next, CPF contribution rates. Of course, higher rates mean more CPF savings for the worker. At the same time, it would mean a higher unit manpower cost to employers. So, a win-win sustainable set of rates would have to be determined from time to time. The current structure of rates was set in 2003, that is, 11 years ago. The rates have either been reached or surpassed – I think that is a point that the Labour Movement has made before – and we
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remain committed to our call to the tripartite partners to work together to update this.
Next, CPF contribution ceiling. The current ceiling is $5,000 per month, up from the previous $4,500 per month set, and this change came about in September 2011. The review of such a ceiling periodically will help those earning just above the current ceiling save more in their CPF. And, for this, because we are talking about the higher end of the salaries, it would particularly help PMEs.
There is another source and, that is, ad hoc top-ups. The Government grants top-ups to individual CPF accounts from time to time from its Budget surpluses, and for the low-wage workers through the Workfare Income Supplement payouts, which are 60% CPF and 40% cash. Individuals and companies also have avenues to do their own top-ups and some have done so. These top-ups will also help increase their CPF savings. We should continue to encourage this, especially by the Government, for lower-income workers and by the more financially able for family members who are not working.
The next bucket is that of making the CPF savings work harder for a worker's retirement, and, on this, the interest rates on CPF savings. The current Ordinary Account interest rate is 2.5% per annum and the interest rate for the Special Account is 4% per annum, both of which are significantly higher than what CPF account holders will get if the money is placed in low-risk bank fixed deposits. In addition, there is a one percentage point mark-up on the first $60,000 saved within CPF. The Government has maintained these rates against a very low interest rate environment for quite a number of years. These preferential interest rates and the compounding effect of interest rates will help boost CPF savings over time. The Government should keep a keen eye on the rates and ensure that the best possible preferential rates are used to aid workers' retirement adequacy.
The next measure would be the payout rates for CPF LIFE annuities. If the payouts from CPF LIFE can be enhanced in sustainable ways, then the retired persons would have more funds each month at their disposal. There are different ways of doing this. I am no expert but perhaps one suggestion is for the Government to consider future CPF top-ups, as discussed earlier, and increases in contribution rates if these would come about, to prioritise the Special Account, because that would then eventually convert into the Retirement Account. An increased flow into and extra preferential interest rates for Special Account savings will then best enable the compounded growth of such savings.
Allocation among the different sub-accounts of the CPF is another area where the individual can have more for retirement. Today, we know that there are three sub-accounts – the Ordinary Account, the Special Account and the Medisave Account. Savings in the Special Account will eventually become the core Retirement Account savings for CPF LIFE. The current CPF rate structure already has differentiation by age bands. The periodic review
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to determine the optimal allocation among these sub-accounts, taking into account factors like the different needs of different life stages, will help determine what is optimal in the entire portfolio and help to ensure that what is put aside as one goes through life, saving up for retirement, would, in fact, be adequate, which was the core purpose of CPF in the first place.
Aside from the apportionments and changes to the apportionments across time, it is also important to remind CPF account holders of impending changes, for example, as they cross from one age band to another and the arrangements change. For instance, many people may have forgotten or may not be aware that they can pledge their property, subject to conditions, for up to 50% of the Minimum Sum at age 55. And if they do so, then it lessens the need to transfer Ordinary Account savings into their Retirement Account. If the communication and administration aspects within the CPF system like these could be further enhanced, then it will certainly help to smoothen the process for many and also reduce the confusion.
Mdm Speaker, with an ageing population, retirement adequacy is an important matter to take care of. Adequate retirement is certainly contingent upon the money being found for it, and it does not happen on its own. Accumulating and growing the CPF part of that retirement nest egg require the clear-headed and determined joint efforts of workers, employers and the Government. We must make every effort and seize every opportunity to do so. Mdm Speaker, I support the Motion.
Mdm Speaker, like many in this House, I found the speech by His Excellency President Tony Tan to be a timely reminder of the task that lies ahead of us in making life better for all Singaporeans. Please allow me to thank His Excellency the President for his thoughtful words.
Madam, we are mid-way through the Twelfth Parliament. We have debated issues close to the hearts of Singaporeans and many of us urged the Government to address the people's unhappiness over housing, transportation and cost of living. I am happy to note that the Government has taken decisive action. The Government ramped up its HDB building programme and, at the same time, took steps to control rising speculation in the private property market. Many young couples today have greater certainty about when they can get their HDB flat of their choice. Those aspiring to buy private property are also better placed to assess whether they can afford to do so.
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Our transport woes will take longer to address, but I am glad that the Government has not shied away from taking bold steps. It has increased its speed of transport infrastructure development, added new buses and, most recently, applied a new model to managing our bus services. These are proof that the Government is willing to do everything it reasonably can.
Much has been done, but much more needs to be done in the next half of this Parliament. Mdm Speaker, with your permission, I would like to cover some areas that we could work together to focus on in the coming months.
Opportunities for all. One of the factors that had underpinned Singapore's rapid progress as a nation is the fact that our meritocratic system allowed anyone who puts in effort to rise up. There are innumerable stories of people from humble backgrounds rising up to lead our nation – in public service, in industry and in academia. Our education system is open to all, and there are many pathways where people can take time to discover their strengths, learn to maximise their strengths, and use them to build a good livelihood for themselves. But to make opportunities open to all, we have to go beyond formal education. We have to recognise that no matter how fair and open a system is, there will always be some who do better and some who are left behind.
But Singapore did not rise to where it is today by accepting the status quo. We have always been fighters, working against the odds, to turn the improbable into reality. That is the same spirit that we will need to apply to address some of the inequalities that exist today. The best of these opportunities that we work so hard to create – in our schools, at our workplaces – must be accessible to Singaporeans. At the same time, Singaporeans must have the fighting spirit to challenge themselves, in the face of competition from other Singaporeans, and also from foreigners. This is a fact of life, but this fact of competition should be managed such that it is a competition among those who each has a fighting chance of making it. So, I urge the Government to continually focus on providing opportunities and resources to Singaporeans, so that we can build ourselves up – through world-class education and training and continuing training – and so that we are able to stand tall among any worker anywhere in the world.
The Government must play its part, but, as workers, Singaporeans must also realise that we have responsibilities, too. We came this far because we worked hard. And the journey ahead is not going to be easier, but, in fact, much harder. Harder because education and training become redundant more quickly because of rapid changing technologies and industries. Harder because there are cheaper and faster options elsewhere. And harder because the motivation for hard work, in an era of plenty, is lower. So, it is not time for us to rest on our laurels and think that we have arrived. Far from it. In fact, it is probably a fact that we Singaporeans will always have to work hard, to continually improve ourselves, to
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fight competition and to do better than others.
Nevertheless, Madam, employers, too, must play their part. The Government has offered many schemes to help businesses improve themselves and stay competitive. But businesses also have the responsibility to their workers, by offering their Singaporean employees every opportunity to improve themselves through training and rising up through the ranks.
There will always be someone out there who can do the work more cheaply, but if Singaporean workers and employers strive for quality – in manufacturing, in services, and in productivity – then we will stand out from our cheaper competitors, and enter into the high-value, high-return markets. But this means that our attitude as workers and as employers cannot be to admit defeat at the first sign of a challenge, but, rather, to rise up to the challenge, overcome it and make a better life for ourselves and for our family. This was the spirit of our pioneers and this must continue to be the spirit of Singaporeans today.
Madam, in Malay, about seizing opportunities.
(In Malay): [Please refer to Vernacular Speech.] Madam, it is heartening to note that since the early days of our nation, there were pioneer leaders of the past that contributed with commitment and passion to the Malay/Muslim community and our country. With dedication, they contributed as community and youth leaders, and left their mark on the community until today. Therefore, as the present generation of Malay/Muslims, we have to continue to strive and work hard as our Pioneer Generation did.
Due to the strong foundation laid by these pioneer leaders and the ongoing efforts from one generation to the next until today, Malay/Muslim students now perform better academically. More of our Malay/Muslim workers are pursuing tertiary education and working as PMETs. This continued progress over the years has resulted in the improved quality of life for our community and we should continue putting in the effort just like before.
Madam, the Malay/Muslim leaders in the VWOs and self-help groups have contributed greatly to the progress of the community. Nevertheless, we must realise that their resources are limited even though there are many Malay/Muslim youths who still require assistance.
Our Malay/Muslim community has a large youth base. There is so much potential in them, we must help them discover and maximise it. Their progress over the years is due to the fact that they can be trained for excellence. They have much potential. We must continue trying and have faith in them. Our youths are talented, and if we can instil and provide the relevant skills, our youths can get good jobs and do well in the industries. I would like to urge
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that we should try to achieve the best we can.
We should also find effective methods to increase the employability and productivity of our Malay youths. In the context of a competitive job market, soft skills, including technical and academic skills, will ensure that our youths will be more competitive and more able to get the available jobs and opportunities. It is hoped that the Government will continue to work with self-help bodies to help our youths, so that, one day, they will also be able to help the community, as leaders, just like the Pioneer Generation before them.
(In English): Mdm Speaker, I would like to turn to some developments which I have observed and which are a cause for concern to me. Over a couple of years, I have observed that there has been a change in the attitudes and behaviour of some Singaporeans. By and large, we are still a gracious Asian society – respectful of our elders, welcoming of our visitors, adapting to change as best as we can. But there is also a segment of our society that is louder, more demanding and less willing to accommodate changes, especially online. These people make arguments against foreigners. But they not only make arguments, they are also stoking distrust and hatred by making allegations about foreigners, their contributions and their motives here.
In other instances, some people have gone about questioning Government policies by running so-called exposes and articles. There are other more bizarre allegations that are made online. It all makes for very interesting reading, but, if you ask me, it belongs in the realm of pulp fiction novel, rather than for any serious consideration. But bizarre or not, to me, the fact that so many people, even those well-educated and well-established in their careers, are willing to believe what are clearly untruths and fabrications is cause for worry. I worry that they believe this untruth because they do not believe the truth that is presented. It is time that the Government made efforts in explaining its policies and mount a robust challenge to dispel these insidious untruths.
Even as we strive to meet personal aspirations and achievements, we must not ignore the well-being of the people around us. As the US film-maker Peter Guber says, and I quote him, "Without social cohesion, the human race wouldn't be here. We're not formidable enough to survive without the tactics, rules and strategies that allow for people to work together."
Since pre-historic times, humans have been working and living in tribes to survive. We know that the world is changing and we are constantly changing. But the fact that can never change is we are all connected, dependent on one another and are easily influenced by one another. As such, social issues these days have never become more complicated. Singaporeans' mindsets and behaviours are visibly transforming. Singaporeans are more educated, more vocal, and, with the access to more arenas for expressions, human
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interactions and communications have become more messy and thorny. While it is good to be able to debate, offer constructive opinions and call for actions through more platforms, when these debates get out of hand, there is a real risk of our society falling apart if we are not careful.
The recent incidents of reactions to foreigners' activities in our country online show the fragility of our social construct. Madam, it is not just about how others perceive us as a people, society or country, but the real values that we live by and aspire for all Singaporeans. Furthermore, it is not right to use social media to fan the flames of hatred and goad others into ripping persons or even groups apart.
Values of respect and caring for our fellow mankind must be the order of the day. Ideally, we should not need to have rules or law hanging over us to intimidate us into categorising what is good. Kindness and empathy should come from within the heart. We need to stand up against what is wrong. We need to speak up against racism. Bigotry has no place in our society. We need to be united against it. Perhaps, it is time to review our education system and programmes to incorporate these values in our youngsters when they are at an impressionable age and are exposed to frequent usage of social media.
Above all, we must encourage a caring society where we help and look after one another in good and bad times, regardless of race, religion, social status and background. It is all very well to excel individually in academics and careers, but this does no benefit to the nation if everyone is defensive and selfish with their achievements.
As a nation, we are still very young. We will undoubtedly go through many more complex challenges that could tear through the fragile net that connects and supports us as a nation. We must prepare ourselves and focus on building our inner strength and resilience. We need to strengthen our roots and sense of rootedness for our beloved country, and I quote, "To be rooted is perhaps the most important and least recognised need of a human soul." Those are the wise words of a French philosopher, Simone Weil, and I think it is good for us to be reminded of this.
Madam, economic progression remains one of our greatest concerns and, certainly, it is important in maintaining our status quo. But many Singaporeans have expressed unhappiness with the perceived obsession with the GDP. Materialism scarcely goes hand-in-hand with happiness. In our pursuit of a more prosperous future, we must not sacrifice the real needs of our society that allow our people to lead fuller lives, the pursuit of aspirations, family, social bonding and compassion for the less fortunate.
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I am thankful to the President for his heartening speech. His words have certainly painted an encouraging view of the future amidst a time fraught with worries and uncertainties. I share the President's confidence in our ability to tackle challenges together. If we remain steadfast and united in the pursuit of our goals, I believe we will be able to help Singaporeans achieve their aspirations. Madam, I support the Motion to thank the President for his speech.
Mdm Speaker, I would like to focus on three areas in my response to the President's Address – managing risks, incentivising hard work and constructive politics.
First, on managing risks. We face numerous risks in the course of our lives, or what the President called "the vicissitudes of life". We could lose our job, suffer a drastic drop in income; we could fall seriously ill or get into an accident and have difficulty affording the medical treatment. Or we may retire but find we do not have enough to live our golden years with peace of mind.
This Government has been an excellent risk manager. It has been very good at managing its own risks but less so the risks faced by our citizens. It pegs the CPF Minimum Sum amount to inflation but does not do the same for CPF Life Annuity payouts to the elderly. It raises the CPF drawdown age which helps preserve the value of CPF balances but leaves many retirees struggling to make ends meet despite decades of contributions to CPF. Even a risk-sharing scheme like MediShield, which is supposed to be a form of social health insurance, is run more on commercial and social principles. The MediShield Fund had a capital adequacy ratio of 161% in 2012, which is more than 40% higher than what the MAS expects commercial insurance funds to hold. The loss ratio of MediShield averaged just 63% from 2001 to 2012. This means that it is collecting a lot more in premiums than it is paying out in claims.
In the last two decades, this Government has marketised many public services like transport and healthcare, transferring risks from the Government to service providers, which can easily pass them on to customers because of their near monopoly positions. There are negative consequences for transferring too much risk to citizens. If Singaporeans face very high uncertainties in their lives, they will be less willing to start a business or volunteer their time to serve others. Their minds will be so preoccupied with survival that they find it hard to engage in innovative, creative or compassionate thinking. Instead, they will be under tremendous stress, worrying about how to cope with the rising cost of living and the increasing responsibilities of work and family.
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In my maiden speech at the Opening of the First Session of Parliament in October 2011, I criticised the regressive transfer of risks from Government to citizens over the previous decade. I am glad that in the last two-and-a-half years, there has been a shift in mindset and policy and the Government is starting to bear a larger share of the risks. The HDB says that it has delinked BTO flat prices from resale market valuations. The LTA has just announced that public bus services will undergo a nationalisation of their infrastructure and operating assets, with operations contracted out to private operators under stricter service standards. Changes are underway in healthcare to distribute more risks through universal insurance.
These are moves in the right direction. However, it is not time to declare victory yet. While flat prices have moderated, they come from a very high base and the prices are still high relative to the incomes of young home buyers. We have yet to see whether service quality will improve under the new bus contracting model and whether fares will continue to rise at the same rate as now.
While everyone will soon have health insurance, is the risk simply being distributed among all Singaporeans? Will the Government take on some of the risks by subsidising premiums and removing claim limits, as I proposed in my Adjournment Motion on healthcare financing last November? I look forward to some good news in this respect when the MediShield Life Committee announces its recommendations.
There are other related issues, like the increasing cost of living, the adequacy of CPF for retirement, healthcare affordability and job security, that continue to cause Singaporeans a great deal of worry. The Government will do well to pay closer attention to these issues this remaining term.
Next, on incentivising hard work and productive activity. In Singapore, almost all Government assistance is strictly means-tested and time-bound. Most Members would have seen cases at their Meet-the-People Sessions where a struggling resident with a family to support is given a small amount in financial assistance, sometimes as little as $50 a month by the Community Development Council and has to repeatedly appeal through the Member of Parliament for it to be renewed every few months. I presume the purpose of this is to motivate such residents to work harder and reduce their reliance on Government handouts. However, in many of these cases, the resident is already working as hard as she can but her income is simply not enough to maintain her children and elderly parents while paying off utility bills, service and conservancy charges and medical expenses, just to name a few. The Government cannot expect that by making them jump through hoops to receive financial assistance, they will suddenly be able to pull themselves up by their bootstraps, especially when incomes at the lower end are not rising at a fast enough rate. Some struggling families need to be given financial assistance on a longer term basis until their circumstances change, for example, when their siblings graduate or their children graduate from school and start
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working.
We must always incentivise hard work and productive activity, productive contributions to our economy and society. However, these incentives should not only be focused on welfare recipients. We must be on guard against rent-seeking behaviour in our society, especially in major industries that have an impact on our economy. The Economist magazine defines rent-seeking as cutting oneself a bigger slice of the cake rather than working to make the cake bigger. In other words, trying to make more money without producing more for customers. Rent-seeking may or may not be illegal. Some examples of rent-seeking include forming cartels or lobbying for changes in regulations that benefit one's own company at the expense of customers. Rent-seeking can impose large costs on our economy without creating any value.
It insults our sense of what is fair and goes against the values of meritocracy and hard work that we expect our people to put in before getting rewarded. The Economist has developed what it calls a "crony capitalism index", which ranks countries according to billionaire wealth earned as a proportion of the overall economy in sectors that are vulnerable to monopoly. All that involves licensing or heavy stake involvement.
Singapore ranks poorly in this index. We are ranked fifth among 23 countries that are surveyed in 2007 and 2014. The Economist identified several industrial sectors that are prone to rent-seeking behaviour, including casinos, real estate and construction. We should be on higher guard against the risk of rent-seeking in these sectors.
Madam, as social spending increases, the Government has said that it will need to develop other revenue streams to make up for future Budget shortfalls. We should continue to keep taxes low for income derived from engaging in value-adding activities which bring technological advancement and create good jobs for Singaporeans. This rewards hard work and incentivises productive activity and entrepreneurship. However, if there is a need to raise more revenue to make up for future Budget shortfalls, the Government should look first to increasing the Net Investment Return contributions or taxes on profits derived from economically non-productive activities. This should be done before considering raising GST or personal income taxes for middle-income earners.
Madam, on my last point, I want to respond to what the President said in his Address about constructive politics. He said that "it is crucial to maintain constructive politics that puts our nation and our people first". He acknowledged that politics lives off robust debate and passionate argument and that we should continue to have vigorous debates on the challenges facing our nation and this is important so as to have the best ideas and the best leadership for Singapore. I agree with the President on these points. My reason for entering politics was to contribute towards shaping better public policies that benefit my fellow
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citizens and help Singapore progress. I trust that this was also what motivated all Members of this House to enter the political arena.
Robust debates which focus on the issues and the problems at hand and where alternative solutions are proposed and properly considered can help shape better policies which will benefit Singaporeans. But when debates start getting personal and descend into unnecessary political attacks, they risk losing focus on the bread-and-butter issues that citizens are concerned about. This sort of politics can cause our people to become cynical about the political process and erode their respect for politicians of all parties. We must not let our politics descend to this level because that weakens Singapore.
Having said that, we must not presume that vigorous and passionate debates will lead to gridlock and paralysis. We should not sacrifice quality for efficiency. As the wise adage goes, "Legislate in haste, repent at leisure." It is unproductive to rush through new policies only to have it cause pain and unhappiness for the people and have to reverse it later. It would be much better to have a proper and informed debate, both inside and outside this House, make adjustments and respond to feedback from Members and the public, then roll out better schemes for Singaporeans.
I will continue to join my Workers' Party colleagues to contribute constructively to debates on issues that matter to Singaporeans. If we assess that a policy will go against Singaporeans' interests, we will oppose it and, where possible, propose alternatives. If the policy is good for our country, we will support the Government for the benefit of the people. This is how we play the role of a constructive opposition. Madam, I support the Motion to thank the President.
Mdm Speaker, thank you for the opportunity to speak in this very important debate over the direction and commitment for Singapore's next lap.
The President in his address articulated the key thrusts and underpinning values of the Government and he painted a picture of what I would describe as our Singapore Dream. He clearly described the six areas that the Government has pledged to focus on to offer better opportunities and enhance the quality of life for Singaporeans. Clearly, the address is about building a Singaporeans' Singapore.
The President's address is timely, as we approach a significant juncture of our history – Singapore's 50th National Day next year. It is an important debate for the Twelve Parliament and the Government to address the concerns and aspirations of Singaporeans and chart the
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way forward to create the Singapore of Tomorrow. In other words, we are here to discuss what our Singapore Dream is and what we must do to achieve it.
I would like to make my modest contributions in three areas: how we should take care of our elderly; how we can inspire our young; and how we will advance as a community.
A successful society is not simply defined by the strength of its economy, the height of its skyscrapers or the achievements of its most capable members. It is not one in which its citizens focused solely on pushing ahead, with a winner-takes-all attitude.
No, a successful society is one that takes care of its elderly and vulnerable, and one that draws strength from solidarity. It is about bringing everyone along, moving ahead together and sharing in the fruits of our success. A successful society is inclusive and compassionate in its policies and in its spirit.
I am pleased that the Government's policies demonstrate that Singapore is moving towards building such a successful society.
MOH has made successive significant moves in improving the care of our old and vulnerable. It has enhanced healthcare affordability through, for example, enhanced Senior's Mobility and Enabling Fund, Community Health Assist Scheme and enhanced outpatient subsidies, on top of the 3M framework. MediShield Life, which will come on line next year, is also something that is on the horizon and that is here to help Singaporeans better afford large bills. The Government has pledged to keep it affordable and certainly, through this pledge, the Government is sharing the risk with its citizens in managing healthcare affordability.
MOH has also pledged to increase healthcare capacity and manpower to address the increasing healthcare demands resulting from an ageing population. It has and it should also pay attention to ensuring the mental well-being of our elderly through efforts to heighten awareness of age-related conditions, such as dementia, and to build social infrastructures and networks to provide high-touch care and support. All these moves will go a long way in assuring Singaporeans that ageing is not gloom and doom.
While the Government has moved to provide quality healthcare and strong safety nets for Singaporeans, especially our elderly, it is extremely important that the implementation and communication, the very last mile, are done well. The majority of our elderly and pioneers today belong to a generation who had limited education as Singapore went through tough times. Many may also have lost their family members for various reasons and are now living alone fending for themselves. Hence, it is imperative that we help our elderly to
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navigate our complex and seemingly daunting healthcare system, so that they can seek the treatment they need without fear. What is the point of having these wonderful measures and packages if these beneficiaries do not know of them and, therefore, cannot benefit from them?
In this regard, I must applaud the Government for the Pioneer Generation Package, which is highly focused on healthcare – a top concern amongst elderly Singaporeans. The generous package honours a generation who has given so much for Singapore, but who has gotten back so little in comparison. The Pioneer Generation, despite their selfless contributions to Singapore, does not have a legal claim over the benefits offered in this package. But we have a moral duty to thank them, honour them and take care of them. The package does this and signals our desire for Singapore to be a better society.
But more has to be done to communicate the Pioneer Generation Package. Many inside and outside this Chamber have spoken about this. I trust that MOH will step up its communications, as promised. We, politicians, community leaders or just ordinary Singaporeans, should also do what we can to reach out and help the elderly and vulnerable Singaporeans, some of whom may be tucked away in their homes or simply too preoccupied with their immediate needs.
I would also like to repeat my call to introduce more flexibility for the Medisave payout of the package, specifically that it can be converted into cash in some years to give our pioneers more autonomy to decide whether the money is better used for healthcare or other pressing living needs. To encourage prudence, this option can be capped at, say, five times. Fiscally, the Budget should remain pretty much the same but, practically, our elderly pioneers will have an additional help resource to use in times of need.
Many people are worried about growing old. Apart from concerns over losing physical and mental strength, there is a real concern over retirement adequacy. The CPF is our main device to ensure retirement adequacy in Singapore; it has served us well and it should continue to stay. Recent media coverage and the Minister for Manpower's blog post have explained how CPF works and why certain restrictions are necessary. I am grateful for the explanation that the Minimum Sum is necessary to ensure that Singaporeans will have enough when they retire. Many Members had also spoken on this yesterday and I will not belabour this point.
Nonetheless, I would like to echo my support for the review of the CPF system. I urge the Government to evaluate the feasibility of guaranteeing a higher rate of return on our CPF monies, so that it can better withstand inflation and ensure Singaporeans' CPF monies will be well above the Minimum Sum. I also urge the Government to make the rules governing the use of CPF money more flexible, so as to allow mature Singaporeans genuinely
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in dire straits to take care of their immediate needs, such as HDB mortgages and their children's education.
Such a move is in line with a more compassionate society. Does it mean that there will be a higher risk that some Singaporeans will not have enough in their old age? Maybe, but I believe that such cases are in the minority and the reality is that some Singaporeans are in desperate need for help and we need to help them reach the life buoys as they try so hard to paddle ashore on their own.
The Pioneer Generation laid the foundation for modern Singapore. The young will pave the way for the Singapore of tomorrow. As such, I am glad that the President focused so much on our young in his Address and I strongly agree with his statement that, "We will enable young Singaporeans to fulfil their potential, pursue their dreams and follow their interests in diverse fields."
It will be extremely challenging to fulfil this promise. Already, today, there are concerns about providing enough job opportunities for PMETs and equipping Singaporeans with the right skills to fill such jobs.
The future world that the young will operate in will be even more competitive. It will be full of smart, well-educated, very ambitious and driven young men and women, many of them in Asia, and they will do whatever it takes to succeed. The future world will also be characterised by rapid change, as new technological developments push corporations to innovate or die and propel societies to adapt or wither.
Our education system must prepare our young for such a competitive, fast-changing world. Our system, therefore, has to teach our young to have multi-disciplinary skills, to be versatile and adaptable. We must equip our young with skills of the future, in a world where work will be transformed and enabled by technology.
To date, our education system has done well. It has evolved over the past decades – from a one-size-fits all in the colonial days to post-World War II's "10-year programme" to the "survival-driven education" in the 1950s and 1960s, to quality education in the 1980s and to the "Thinking Schools, Learning Nation" in the 1990s, which continues to be relevant today. Because of our rigorously well-designed education system, Singapore has been able to nurture generations of knowledgeable and skilled Singaporeans. Singapore has also been able to capitalise on our talented human resource to transform our nation from a Third World to First World within one lifetime. We must now evolve our education system once more to keep it relevant to the economy and to the future.
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The April edition of The Economist carried an article titled "Coding in Schools, A is for Algorithm". It discussed how computer coding – a fundamental in understanding and designing technology – is proliferating in schools in many countries. For instance, computer science is slated to become part of England's primary school curriculum this September. The article further noted that, "Many other places are beefing up computer-science teaching, too. Israel was an early adopter, updating its high-school syllabus a decade ago; New Zealand and some German states recently did the same. Australia and Denmark are now following suit."
These countries are taking steps to prepare their children and youths for the future. We must do the same. I am not saying that teaching coding is definitely the way to go; but it is important that our education planners adopt a future-oriented attitude in curriculum development. The consequences are dire for our young if our education does not match the needs of the economy. The case of Europe is perhaps a grim warning for all of us.
Last year, I had the chance to discuss this subject with some European officials who are deeply concerned about the Continent's high youth unemployment. About one in four young people in Europe cannot find a job. That is about 5.5 million young people in Europe out of work. In some EU member countries, the youth unemployment rate can reach more than 50%.
However, at the same time, there are about 2.5 million job vacancies with no one to fill them. Why is that so? Because there is a mismatch of skills and lack of practical hands-on experience. There is a demand for labour in jobs requiring STEM knowledge, that is, Scientific, Technical, Engineering and Mathematical knowledge. However, many young Europeans are not educated enough in these areas and, despite having a degree, they are finding it difficult to secure a proper job. Many end up in temporary jobs.
The officials I met were concerned not only with the immediate impact on the young people's well-being but also with the risks of long-term scarring. They worry about an entire generation of young European people unable to find work for months or maybe years at a time, watching their contemporaries in other countries move far ahead while they stay static, feeling lost and depressed, losing drive and hope during the prime years of their lives. We must not allow Singapore to get into such a situation.
We must enable our young people to have meaningful employment and to be empowered to support themselves and their families. We need to prepare our youths for diverse job opportunities, avoid ever letting them experience the despair of wasted youth, of losing hope in the prime years of their lives.
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Of course, it is not enough to have an education system that only equips the most capable students to succeed. Our system must ensure that all young Singaporeans, with their different aptitudes and starting points, can have the best chance of succeeding in life. In this vein, I feel very heartened by the President's statement that "we will keep pathways upwards open to all Singaporeans, regardless of background or family circumstances" and that "Singapore must remain a nation of opportunities for all. Those who do not succeed at first should have a second chance, indeed must always have the chance to try again."
I look forward to MOE's new initiatives to do this. It is not enough also for education to be solely about preparing students for the future economy. Clearly, it must also nurture in our young critical thinking skills, resilience and adaptability, lifelong learning habits and values that will stand them well throughout their lives. Most importantly, it must inspire them to greatness – to want to do better; to want to do more for our community, for the nation and perhaps even for the world; to be inspired to take Singapore to ever greater heights. We must support and nurture our youths, for it is young Singaporeans who will carry forward and fulfil the hopes and dreams of Singapore.
We must never allow young Singaporeans to ever share the pessimism that youths in other developed countries have, which is a finding that a recent Ipsos Mori study has shown. We must create a Singapore that not only provides many opportunities but also more comprehensive safety nets which enable Singaporeans to explore the world and succeed in different ventures and also provide a safe and comfortable home for all Singaporeans.
As we approach our 50th year of Independence, I dream of a Singapore that is both compassionate and competitive, successful yet inclusive. That means meritocracy must stay. Without meritocracy, we risk making way for cronyism, favouritism and discrimination – all of which we, as Singaporeans, have clearly rejected. We can invest more in those who start off further behind, and we can create more pathways and entry points for them. But we must also not hold back talented Singaporeans, to fulfil some misguided sense of social fairness. Instead, we have to allow Singaporeans with talent and grit to get ahead and to help pull our nation ahead.
However, our meritocracy must be tempered with compassion and a sense of community. We cannot be a careless and care-less meritocracy. We cannot be careless in the way we implement meritocracy such that our system ends up exacerbating inequality and breeding politics of envy or, worse, class warfare between the haves and have-nots. We cannot be care-less and end up with a Singapore society that is cold, fragmented and brittle. We must be a society where there is mutual respect and camaraderie among all Singaporeans, where the more successful Singaporeans feel for and will help those who are less successful and where all of us share a common cause to build Singapore together.
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Our Government policies must shift to put in place the framework for this better Singapore. I am glad that the President's Address has articulated a strong message of making policy changes to improve Singapore for Singaporeans. But true changes require also a change in the spirit of our nation. It requires all Singaporeans to believe in our Singapore Dream and commit to creating the miracle again and again.
Although Singapore is now passing or almost passing the half-century mark, ours is still a young nation full of promise. As we approach our 50th year next year, let us give our wholehearted support to the President's call to take pride in what we have achieved and pledge ourselves anew to build a better, brighter Singapore. With that, I support the Motion.
Mdm Speaker, I rise in support of the Motion to thank the President for his Address. Healthcare is a topic that has generated much discussion, debate and anxiety. Recently, we have seen a number of significant policy announcements.
The centrality of health to our personal happiness and satisfaction with life is often only appreciated in disease or, hopefully, recovery. Health, like many truly important things like family and friends, safety and security, good governance and clean government, is only deeply appreciated when lost or at risk. Health is a topic where much anxiety is the result of us grappling with the unknown. On a personal level, we do not know when, how or if we will get sick. As a family, we are unsure of who will do the caring and who will need support until the situation presents itself. As a society, we do not know what will happen in the next five to 10 years in terms of disease, new treatments and costs.
In the healthcare profession, we often have to balance the choices in deciding between a risk-tolerant path and a risk-averse path. We have to weigh the potential benefits of a decision, a new medicine, a surgical approach: what will happen if everything works well, as I planned against the risks that everything will go horribly wrong? What is the worst case scenario?
On a society-wide basis, given the uncertainties, it is only right and proper that the policy approach has to be one that is risk-averse. This prudent, conservative approach can be seen in the recent policy announcements and the ensuing discussions. Even as we strive to ensure that excellent healthcare is delivered in as timely a manner as possible, to as many people as possible, at as low a cost as possible, we have had to pay special attention to ensuring the long-term sustainability and financial viability of our healthcare service.
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Madam, MediShield Life and the recent announcements are timely, wide-reaching and address many important concerns about our current model as we project forward on the basis of our changing demography, earning power, life span and quality of life. But I hope today to look even further ahead and ask: where might we go next after we have put our system on a more solid foundation of financial viability and outreach, what next for our healthcare service, and how might we get there?
One of the first questions to ask is: do we yet have an advanced healthcare system in Singapore? Many other nations think so. We have many regular visits by healthcare professionals and policymakers hoping to learn from us and about us. We rank highly on many lists. The local news very regularly has stories of the latest and greatest new technology or technique that is being implemented in one of our public institutions.
An analytic approach would ask that an advanced public healthcare service be accessible, affordable, safe, comprehensive, provide high quality care which is cost-effective and, finally, is one which invests significantly in strategies to prevent disease. In each of these domains, we can always do better, we can always do more, but, in general, we are doing pretty well. The facts are out there, together with a whole host of hysterical, irresponsible and inaccurate claims about a catastrophically dysfunctional system. The facts are out there. We need to keep calm, check the facts, look at the reality and not the hyperbole.
As a sidebar, as a digression and as an example of that hyperbole, I am going to choose one example of what I believe is sound-bite politics: "CDC expects a family of four to live on $50 a month." We know this is not the case. The CDC does not expect a family of four to live on $50 a month. But someone has chosen to highlight that one fact, that one number, and make an implication that this is so. Real politics is spending time with this family.
I have several families in similar circumstances – low-income, two kids, one or more parents out of work and, yes, they get $50 from CDC a month. But they get a lot of other things as well. They get help from the temple, they get help from us. They get help from members of our civil society, our grassroots leaders, our welfare team. This is civil society in action. That family is not surviving on $50 a month.
We mentor them, the volunteers make sure that the kids get some free tuition. When there are toys and books available, they are passed to these families. And most importantly, wherever possible, we look to find ways to upskill and upgrade the work that the parents do so that they maintain the dignity of their family so that they can provide for themselves and that they can go on to look after themselves. This is real politics – understanding all that that family gets and all that that family needs, and not going for the hyperbole of one fact and
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one number to score points.
Let me return to healthcare. The key factor in answering the question is the health of Singaporeans, the outcome. In the hyperbole example I gave, the outcome is: how does the family fare over time? Let me return to healthcare. I will stop digressing.
The key factor in answering the question is the health of Singaporeans. We are living longer, living healthier and we are having a better quality of life, one that is the envy of the world. If we check the facts, we come to the conclusion that, on the whole, we have the privilege and the luxury of living in a healthy nation, with one of the best healthcare systems on the planet.
That is where we are now. Where are we going? How should our system evolve? How should we decide on the balance between preventive strategies and acute interventions? Which aspects should be centrally controlled and directly delivered by the Government agencies? Which aspects should be decentralised, deregulated, exposed to market forces to drive multiple innovative solutions and be allowed to find a true pricing?
Before we tackle these issues, allow me another digression. I have in front of me here the secrets of a long, happy and healthy life. It turns out the secrets were hiding in plain sight all this time and I propose to share them with this House. I have a list of eight steps which, if followed, will guarantee a better life. Confirmed. This sounds like a dubious link on your Facebook feed, but I promise you there are no adverts.
Number one – eat in moderation, do not get fooled by fads or special diets. Just eat sensibly and not too much. It turns out that every single proposed special diet has been demonstrated to be ineffective, but having some common sense about what you eat can work wonders – more fruits, more vegetables, less cake. Eat in moderation.
Number two – cut your sugar intake, drastically. However much you are adding to your diet, reduce it. Add as little sugar as possible to your food and drinks. Drink water rather than sweet drinks.
Number three – this may be painful for some – if you are going to drink alcohol, make sure it is less than one glass of wine a day, on average.
Number four – this should not be painful to anybody – do not smoke. Ever. Do not let anyone around you expose you to second-hand smoke. And stop your friends from smoking, because you need them to live long enough to help you with point number 8 which is coming
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up soon. Do not smoke, ever.
Number five – get some exercise. This can be divided into three types of exercise and you need to think about all three. Get some continual low-level, low-intensity exercise, equivalent to taking about 10,000 steps a day. This keeps everything ticking over, ensuring an optimal metabolic rate – walk, get off the bus early, maybe get off the bus two stops early, take the stairs. Find little ways to walk as part of a daily routine.
Next, you also need to play a sport, or do something which is an occasional high-intensity effort so that you build up your reserve capacity which allows you to cope with the surprises that life will throw at you.
Thirdly, as we get older, we need to pay attention to maintaining strength, particularly in the upper body. This helps you to cope with falls, helps you to keep mobile and what was taken for granted in terms of strength in our youth needs work and attention as we work past 40. Get some exercise.
Number six – this may be difficult for all of us in this House to fix at this point in time – have a healthy mother and, especially, make sure she was healthy before she thought of having you. Jokes aside, if we take this seriously and introduce this into our healthcare planning, we can significantly improve the health of the next generation, the yet-to-be-born, by helping young women ensure they are in optimal health prior to starting a family. The health of the mother before and during pregnancy has been shown to affect the health of the child throughout their life. Have a healthy mother.
Number seven – have a purpose and a mission in life. Not a problem for all my colleagues in this House, clearly. This is rarely an issue in our childhood, teens and while we are in education or building our careers. But there is good research to show that as we age, those of us that continue to see ourselves as having a purpose in the world cope better, live longer, live healthier. Have a purpose in life.
Number eight – and this is why you need your friends to stop smoking. Maintain your friendships, social networks, family ties and relationships. These need nurturing and attention. We know that seniors that are part of an extended network of social relationships live longer, healthier lives. Isolation is bad for your health. Stay close to your friends and family.
Eight key points and such simple ideas. Many do not require any expense – I would not go so far as to say "free". All will result in a better, healthier life. Taken together, these eight points could completely change the health outlook of an individual, let alone a nation. We
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have the answers, but are we asking the right questions? These are not flights of fancy. These are not fads. These are proven through science, research and experience to be extremely effective at driving important health outcomes and are all very cost-effective.
Yet, if we look at our healthcare system and that of any advanced economy, what do we see? We see that these key ideas are dealt with by a public health authority, by a Government agency. These key drivers of health are centrally addressed, or left entirely to individual choice, to the individual to make the behavioural change.
If we look to the typical interventions of medicine on the other hand, clinics, hospitals, pills, surgery, chemotherapy, MRI scans; if we look at what we do as reactive medicine, rather than preventive medicine, we see a market-based, competition-driven ecosystem, centred around large academic hospitals that support technology-intensive, expensive interventions, some of which will only result in marginal improvements in key health outcomes.
Why? Because for these complex, difficult, expensive treatments, we want to drive competition to manage costs. We want to use the market and competition to drive innovation and novel solutions, we reduce central control in the hope that it results in better health. But there is a problem. In order for an efficient market to drive the right outcomes, we need two key factors. First, the ability of citizens to make a choice by choosing their healthcare provider. This is happening. Singaporeans are not tied to a provider by location, where they live, or by a primary care gatekeeper, like in some advanced economies. The public health insurance is truly portable across a variety of providers and, in addition, the citizen can choose to access private healthcare. This comprehensive access and mobility are a strong and important part of our system. But the second factor is based on information. In order for a market to function efficiently, the consumer, the patient, must have enough information in order to make valid comparisons.
In healthcare, this is missing. This is not a local problem. It extends across healthcare systems throughout the world. The information asymmetry is huge. The outcomes that a patient can know about, that the Ministry can collate, analyse and publish, such as length of stay, bed occupancy, infection rates, complication rates, mortality rates and so on rarely address the true value of healthcare quality. We all know this intrinsically. This is why a personal referral to a healthcare provider is so much appreciated, especially for complex and difficult problems.
Simplistically put, only another cardiologist can truly assess if a cardiologist is any good. This is the basis for the self-regulating, self-governing nature of the medical profession. Regulatory authorities and agencies have difficulty in assessing the professional performance of healthcare providers. Not for lack of trying, not because they are not
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collecting, analysing and publishing large amounts of data. It is just that this information does not truly reflect the underlying quality of the provider. Could it be that one of the reasons that healthcare costs continue to rise is because of this very significant information asymmetry, leading to inefficient market mechanisms?
So, we have a market-driven, competitive environment for expensive, inefficient healthcare interventions, without the true information flow needed for market-driven choices. And we have a centrally controlled Government agency-driven approach for simple, effective cheap preventive interventions that are proven to have deep positive impacts on the healthcare outcomes that matter. Why?
There are many reasons why this is the situation we find ourselves in. Some are reasons of history and development; some are reasons of science as we did not know then what we know now. We did what we did with the best intentions on the basis of what was known at the time.
But, mostly, we are in this situation because, like democracy, for all its faults, we have not found a better solution. It is the least bad solution to the problem of public healthcare services. Yet, should we invert the situation? Should we move to have a diffused, market-based competitive environment to drive the key human behaviours around things like diet and exercise that result in better health, and a centralised command approach to the complex acute expensive care so that inefficiencies are removed and the information asymmetry is no longer a problem? This would be a radical change from the current situation, but what if this were the ideal solution for our nation?
I offer this idea not as a solution, but as an idea, as a thought experiment, if you will. I do not know what the future of our healthcare landscape should look like ideally, but this is the kind of outcome-driven, evidence-based, restructuring that we will have to think about if we want to plan ahead. The actual ideal destination may be quite different from what I have described and it will take a lot more work to develop a vision of where we want to go. But getting there from here, from where we are now, will be no less challenging. No less challenging than changing our system to match the ideas I have just described.
There are many complex pieces of the puzzle, there are counter-intuitive scientific findings, there are competing ideas and there are vested interests. How would we get there, how would we navigate the difficulties and uncertainties?
We will need a long-sighted, clear-headed approach. We will need the ability to make rational choices that may not be immediately popular and we will need the ability to balance
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between the risks and benefits.
One of the key challenges in the practice of medicine is to persuade a patient to take some medicine to prevent a problem in the future. You are asking a patient to take a substance with side effects, sometimes unpleasant side effects, in order to prevent a problem that they have not yet suffered. Right now, sitting in front of you, they feel fine. One example is hypertension, high blood pressure. Usually picked up on a health check, the patient feels completely normal. Untreated, this can lead to serious problems, perhaps even to death. You have to persuade the patients that they have to change their lifestyle, get some exercise, watch their diet, take this pill, suffer the side effects now. All to deal with something that they have not yet experienced. "But, doc, I feel fine." It is not easy to make those changes, to accept those trade-offs. No wonder there is a thriving industry making money persuading people that everything will be okay, just take this herb, this "koyok". All natural, organic even, no side effects, cures everything. People want to believe it is that easy for everything to be okay. Some folks want to believe that just by having more choices and everything will be okay, do not worry.
And how do we deal with this misconception? How do we persuade the patient to do the right thing? You can explain, you can reason, you can discuss but, at the end of the day, it comes down to trust. Trust is the key issue in choosing a healthcare provider because, at heart, we know about the information asymmetry. We know that there has to be a leap of trust in taking a recommendation from our physician. There are risks and, therefore, there needs to be trust.
Do we have this trust? Do we have the long-sighted, clear-headed approach needed to address the vision of what our public healthcare landscape needs to look like in 20 years' time? Do we have the institutional ability to do the right thing, in anticipation of unknowns, in dealing with the anxiety of an uncertain future?
Doing the right thing seems so obvious, just like the eight steps to lifelong health and happiness I laid out. Will we do the right thing? Or will we go down the route laid out for us by many other advanced economies, where the key issues of healthcare financing, structure and delivery are increasingly polarised and politicised?
Looking around at the world outside our borders, it is clear that the more politicians play with healthcare, the worse the health of the nation, because short-term popular political interests overthrow the long-term outcome and the true deep issues. What would the increasing politicisation of healthcare look like?
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It would start with sound-bite politics, like making comments about active ageing as joke about corridor beds when these are not reflective of the health outcomes. It may progress to attacking spending on healthcare instead of addressing the success we have had in terms of healthcare outcomes.
Dr Janil Puthucheary, you have only got one minute left to convince us of your theories.
I will try my best. How might we recognise playing politics with healthcare? It can be recognised by politicians taking pot-shots at easy targets, not discussing outcomes or consequences. The more politicians use healthcare as a tool for advantage, the more the health of the nation suffers.
Madam, I am not for one minute suggesting that debate and a diversity of opinions are not necessary, merely that they are not in themselves sufficient to help us navigate difficult choices in the future.
In medicine, we are often asked to provide a second opinion. Sometimes, there are many different teams looking after one patient with many opinions. When I consult for a second opinion, usually, there will be many points of agreement with the primary team.
Please wind up your speech, Dr Puthucheary.
Maybe, out of 10 decisions, I might agree with nine, and have a different perspective on the tenth. What you do with that difference is critical. You can spend time explaining how you agree on most of the plan; you can spend time explaining that the physician is someone you trust and is it not good that you have an opportunity to discuss and agree on the best way forward. Or you can focus your energy on that one point of disagreement and suggest, imply or even outright say that you are better and the other person is bad, and the patient will be far better off with you.
Mdm Speaker :Dr Puthucheary, I have to stop you there. Your time is up.
Mdm Speaker, thank you for the opportunity. I support the Motion.
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