Alternative Healthcare Economic Policies

Singapore continues to spend less than 4% of its annual GDP on healthcare. This is unrealistic. Even the Health Minister admits as much. Speaking at a dialogue session organized by the Singapore Health Services on 10 September 2008, the Health Minister implies that the health spending needs to go up but should be “kept below 10% of GDP”.

The Budget allocated 3,705 million to the Health Ministry this year. The Ministry of Health has identified the following desired health outcomes in line with their mission:

* Healthy Singaporeans
* Affordable & Good Quality healthcare for all Singaporeans appropriate to needs
* Pursue Medical Excellence

In outlining the initiatives in line with these mission statements, the Ministry besides highlighting Eldercare, fails to address the issue of the aging population adequately in this budget.

The population of Singapore is aging rapidly. The proportion of population who are 60 years old and older has risen from 4.1% in 1961 to 11% in 2001; and is expected to reach 27% in 2030. The elderly people in a country spend more on medical care than the young, and it is therefore, intuitively correct to assume that the aggregate healthcare rises with higher percentage of elderly population in Singapore.

One of the five components in the 20.5 Billion ‘Resilience Package’ unveiled in Budget 2009, states “building a home for the future. We will spend $4.4 billion on developing first class infrastructure for the island and on expanded provisions for education and healthcare.”

“Building a future…building first class infrastructure…for healthcare.” No doubt is a noble statement. But after the Finance Minister have made this statement, the Health Minister makes a suggestion that Singaporeans might want to consider staying at a nursing home across the causeway in Johor where it is much cheaper. Then he goes on to qualify his suggestion by saying how much cheaper the nursing homes are in JB and also by justifying that “a significant number visit only during the weekends, so what is the difference in putting them in Johor Baru?”

When he realised that this was a suggestion that would not go down well with many people, he tried to point out that this was only an option that he wanted to highlight; and that it was not an option for the poor, who are heavily subsidized but for the middle-income families, who may need to pay more for the care themselves. He said that this was part of globalization and compares it with Singaporeans going to Bangkok for Lasik treatment and with Americans and Russians coming here for treatment.

How different is short-term treatments like lasik and longer term treatment and care provided by Nursing Homes? Has the Minister tried to cross the causeway to JB on weekends? Is this a true option for the middle-incomed or another added burden for them?

Was this merely a suggestion? In 2006 in an interview with Mediacorp’s Channel 8 the same Minister said, ““My personal view is, our land is expensive. But we have nearby neighbours in Johor, Batam and Bintan. The elderly want to reach their doctors within half to one hour. So retirement villages in neighbouring countries is possible…”

Even if it was a mere suggestion should the Minister have even alluded to such an ‘option’ in parliament, when he knew that a similar suggestion made in 2006 created so much misunderstanding and accusation at the same Minister; when entitlement of healthcare is one of the basic rights of every citizen, and even mentioning it as an option may imply that Singaporeans are only as good as they could contribute to the economy; who could be discarded once they are old or cannot contribute to the ‘grow at all cost’ economy?

The Health Minister said in his dialogue with the Singapore Health Services if the Healthcare spending were to go up and be capped to 10% of the GDP, then it would mean that an individual would need to use 15 percent of his own income on medical expenses, including health insurance premiums and co-payments. Besides medical advances making treatments and drugs costlier, the government policy of capping the medical intakes at local universities has contributed to the escalating healthcare costs in Singapore.

The government should refrain from setting a quota for the local universities for their medical intakes. This quota system has not only contributed to the escalating healthcare costs, but it has also discriminated the women who are assigned only a maximum of 41% of the available medical seats in the local universities. Is meritocracy only given lip-service to; when it comes to medical seat allocation in Singapore?

Studies shows that two-thirds of seniors over the age of 65, who receive long-term care rely exclusively on family, friends and other informal caregivers for helps including everything from shopping, to cleaning to taking medication, to getting to doctors’ appointments and even financial helps. A proper alternative and a true option especially for the middle-incomed, would have made the following suggestion in reducing individual healthcare expenditure, especially in eldercare:

1. Remove the Domestic Foreign Worker levy for qualified foreign workers who are brought in to care for the elderly, so that the elderly could be provided appropriate care at home (where possible) without the need step-down care at nursing home.

2. Provide Elder Care Tax Credit for qualified elder care expenses. As caregivers make heavy financial sacrifices in spending a large amount of money each year on expenses for aging relatives, including cost of providing food and transportation and paying for medical expenses, such a tax credit would be an added incentive and encouragement for caregivers to provide appropriate care for the elderly in their own homes.

3. Create a Programme and Registry of Certified Geriatric Caregivers. There is a need to create a programme to train Certified Geriatric Caregivers, who are not full-fledged nurses, as there is no need for all the caregivers for the elderly to be registered nurses. Creating such a programme and a registry for properly certified and licensed caregivers, will ensure the availability of qualified caregivers for the elderly and it will also reduce the high manpower costs involved with hiring registered nurses.

4. Create Retirement Communities which is a community-based model for aging in place which experts say is an alternative to nursing homes and assisted living centers run by large service providers. Such a community of subscribed members, allows the elderly to stay in their own community as they age, by organizing and delivering programs and services that allow them to lead safe, healthy productive lives in their own homes. Beacon Hill Village of Boston, USA is a good model to study and adopt in creating such retirement communities.

Such alternatives in healthcare, especially in aging and eldercare would make significant difference in a graying society like Singapore. Such initiatives would promote successful aging as well as be pioneer new approaches to aging and eldercare throughout Singapore.

Scolari and the Dark Train Tunnel

Ministers and unionists said during the Singapore Tripartism Forum on 22 February 2009 that fighting the recession is like playing a football match against a stronger team and that Singaporeans will have to go on the offensive and play to win.

Struggling Chelsea sacks manager Scolari.

In the same forum, Mr. Lim Swee Say Minister in the Prime Minister's Office and the Secretary General of the National Trades Union Congress says, "When you try to find the easy way out, try to look for early lights coming, chances are these lights aren't daylight, but the headlights of an oncoming train."

Is this where we have been led? Unto the path of an oncoming train?

'Marxist Conspiracy' Revisited

On the 21st of May 1987, the Singapore Press announced on its front page the discovery of a Marxist plot aimed at overthrowing the State, that 16 persons had been arrested, among whom 10 were directly engaged in Christian-inspired movements.

New York Times in an article dated June 21, 1987 and titled, "Singapore Is Holding 12 in 'Marxist Conspiracy' ", says these arrests prove the "intent on keeping its People's Action Party in power into a new generation, perhaps under Mr. Lee's son, Lee Hsein Loong."

The International Commission of Jurists in a report dated 12 October 1987 concludes (among other conclusions):

1. The detention without charge or trial, 'brainwashing' interrogation techniques and other physical and psychological maltreatment by the Internal Security Department amount to clear and grave violations of the human rights of those detained and an abrogation of the rule of law. With only one hour's interval, detainees were interrogated continuously by relays of interrogators for 5 days and nights, with complete sleep deprivation. (This is a well-known torture practice).

2. The activities of the detainees were a legitimate exercise of their civil rights, which should be defended and applauded in a healthy democracy. There is no evidence which justifies their being labelled 'Marxists' or 'communists'.

3. There is no evidence of a Marxist conspiracy or that this informal network of community development groups and workers posed any imminent threat to the security of Singapore.

Some held in the so-called 'Marxist Plot' are having a private book launch. The book which is a collection of poetry is titled, "Our Thoughts are Free". This book launch will be on 28 February 2009 (Saturday) at 3pm in Geylang East Library. Admission is by invitation only. For RSVP to the event, please email your particulars to events@ethosbooks.com.sg or Adeleena@pagesetters.com.sg by 25 Feb 2009.

The Alternative Green Economic Policy

The Ministry of Environment and Water Resources saw its budget for the next fiscal year increased from $1 billion to $1.09 billion. Despite the increased budget, there is a imperative need to develop Green Energy and the Green Workforce. Budget 2009 could have done more to provide incentives and create a market that will encourage more companies to embark on green renewable energy projects.

Green Job Initiatives

Susan Hockfield, the president of the Massachusetts Institute of Technology and one of the United States’ leading brains says, “I am convinced that the next economic growth will come from innovation and the most powerful promise for innovation lies in the renewable energy sector.” A study by Roland Berger Strategy Consultants on the current global green-tech market indicates that the market which was worth more than $1.3 trillion in 2005, is set to grow in value to more than double to some $3 trillion until the year 2020. “This (the green sector) will become one of the biggest markets in the world, bigger than the automotive sector”, says Matthias Machnig, a state secretary at the German Environment Ministry.

A quickly growing global green market could mitigate the effects of the recession that is pulling many other industries to their knees. We must be made aware of the vast potential the Green Sector offers. The Green Sector may very well be the savior of the ailing economy of Singapore; which is why the Budget should have given the impetus to create Green Jobs Initiatives, which include:

* Increasing the number of industry sectors and businesses that have or are creating green jobs; * Supporting creation of green jobs for a diverse mix of people with various educational backgrounds;
* Establishing job-readiness training programs for unskilled workers so they can get jobs in green industries;
* Aligning and increase the resources and expertise needed to grow the workforce capacity for these emerging and changing jobs;
* Investing in diverse worker education and training to prepare for green jobs; and
* Increasing education and training capacity to support green job growth.

The Budget should have made provisions for the government to create jobs in the sector of Alternative Energy Production and Efficiency, which includes jobs in wind energy; bio-fuels and bio-materials; solar and energy storage; energy efficiency; and advanced technology vehicles.

Green Building Construction and Retrofitting, which includes jobs in energy efficient building, construction, and retrofits; energy efficiency assessment serving the residential, commercial, or industrial sectors; materials recycling and reuse; architecture and design; land use/site analysis; building materials; and construction/rehab, is another Green Sector where new jobs can be created.

To support the Green Sector growth, the Budget should have placed key investments and stimulate activities in this sector through:

* Working with Business and Industry to Create Green Sector Skills Alliances;
* Investing in Worker Education and Training to Prepare for Green Jobs;
* Increasing Education and Training Capacity to Support Green Job Growth; and
* Supporting Green Jobs Related Research, Information Sharing, and Learning.

Capital Market Development Taskforce

Many Green stocks have lost their market value in this global economic crisis. But experts from the renewable energy markets, like Vivienne Cox, the chief executive officer of BP Alternative Energy, believe that as long as the incentives are provided, “money will flow” into renewable energy and “green stocks will recover”.

As this is an opportune time to invest in such low Price-to-Earnings ratio (PE) and Price-to-Book ratio (PB) stocks in the Green Sector, the Budget should have created a Capital Market Development Taskforce, which will develop blueprints and action plans to create investment funds to foster the creation and grow new businesses and new industries in the Green Sector through investments in private equity, venture capital mezzanine funds and co-investments in individual companies alongside these funds. A balance between saving money and spending money in such investments will create a healthy economic climate for Singapore.

A Holistic Approach

A more integrative, holistic approach should be adopted in embracing the Green Sector; where not just the Ministry of Environment, but the whole of government including the Ministry of Education, Ministry of Trade and Industry, Ministry of National Development and even Land Transport Authority should look at the environment as part of growing the Green Sector.

The current government of Singapore recognises the need to have an integrated approach in dealing with Green issues and have created the Energy Policy Group (EGP). The EGP consists of representatives from:

* Ministry of Trade and Industry (MTI);
* Ministry of Finance (MOF);
* Ministry of Foreign Affairs (MFA);
* Ministry of the Environment and Water Resources (MEWR);
* Ministry of Transport (MOT);
* Agency for Science, Technology and Research (A*STAR);
* Building and Construction Authority (BCA);
* Economic Development Board (EDB);
* Energy Market Authority (EMA);
* Land Transport Authority (LTA); and
* National Environment Agency (NEA)

The EPG has four working groups on Economic Competitiveness, Energy Security Climate Change and the Environment, and Energy Industry Development, headed by the different agencies:


However, the administrative difficulties and layers of bureaucratic red tape accumulated across 11 ministries and agencies in the EPG will pose a problem in developing effective, timely and appropriate green policies.

If effective and appropriate Green policies have to be developed to boost the Green Sector, the creation of a new ministry is important; the Ministry of New and Renewable Energy. The creation of this new ministry will create accountability for the government to be focused on energy security, in tackling the threat of climate change and also to develop the Green Sector further to the benefit of the economy of Singapore.

The Reform Party Forum

The Reform Party has organised a forum: Singapore Budget 2009 - The Alternative Policies. I have been invited to participate as a panelist in this forum. This public forum purposes to discuss, debate and put forth alternatives to the Singapore Budget 2009. The forum is scheduled on 28 February 2009 (Saturday) @ 2pm in Allson Hotel (Victoria Room). More details can be found in their event advertiser here:

Candlelight Vigil for Peace

The civil war in Sri Lanka is one of the world's deadliest ongoing armed conflicts, causing significant harm to civilian population, environment and severe damage to the economy of the country. Now 25 years running, it has claimed at least 215,000 lives and displaced more than 1.5 million people. The possibility of a lasting peace was raised when a cease-fire agreement was signed with international mediation in 2002. However on January 2, 2008 the Government of Sri Lanka formally announced unilateral withdrawal from the ceasefire agreement and since the conflict has escalated to critical levels in the recent months.

Donor countries such as the United States, Canada, Norway and Japan have shown deep regrets on this decision by the Government of Sri Lanka. On September 9, 2008, the Government of Sri Lanka ordered all international and local aid agencies to leave the northern areas of conflict and take their equipment with them. UN agencies and international relief organizations including Oxfam, "Save The Children" and the Danish Refugee Council that have been delivering food and medical aid to nearly 200,000 refugees in the affected region started to pull out.

History tells us that such wars can never be won. The international community must take decisive steps to pressure the Government of Sri Lanka to abandon the path of militarism and opt for a negotiated political settlement. The early intervention by the international community will avert the loss of many more precious lives.

Join me at the Tamil Methodist Church Ang Mo Kio St.21, Singapore on Friday from 8pm onwards to light a candle vigil (prayers for people affected by the war in Sri Lanka) and show your support for peace in Sri Lanka.

Event Details:
DATE: Friday, 13.02.2009
TIME: 8:00 p.m.
VENUE: Tamil Methodist Church, Ang Mo Kio St. 21

ALL ARE INVITED TO ATTEND

The Myth of the 'Welfare State'

"...however wealthy a nation, it cannot carry health, unemployment and pension benefits without massive taxation and overloading the system, reducing the incentive to work and to save and care for one's family - when all look to the state for welfare...Social and health welfare are like opium or heroin. People get addicted, and withdrawal of welfare benefits is very painful." (Quote: Mr. Lee Kuan Yew)


MYTH: Welfare rewards people for doing nothing, destroying their dignity and character. The `Welfare State' is a threat to liberty. Welfare threatens to make all citizens dependent on a central government. The Welfare system gives government too much power. People who work for their own income are more independent. People who are not taxed to support others are more independent. Therefore doing away with the welfare system will promote independence and liberty.

FACT: This argument is not subject to factual analysis. It is basically a matter of philosophy.

The Truth Shall Set You Free: Read Can't? Or won't?

The Improbabilities

The study team led by Mr. Lim Swee Say upon returning from Europe in 2007, created the Skills Redevelopment Programme to pre-empt structural unemployment and to provide those at risk with training to upgrade themselves, better equip themselves for higher-value jobs. Mr. John De Payva speaking at the Singapore Manual Mercentile Workers' Union Delegates Conference on 12 April 2007, commented on these initiatives to upskill and re-skill workers and said, "Our vision was for every worker to possess better skills so that he could do a better job, enjoy better pay and enjoy better life."

In an impromptu speech at the parliamentary sitting to debate the Singapore Budget 2009, Mr. Lim Swee Say told a tale of a kingdom of mice. He said the mice in the kingdom 'lived very peacefully' until a cat appeared. The mice Parliament convened to discuss how to overcome their new fear.

One mice MP proposed a very simple solution: hang a big bell on the cat's neck so that it can be heard wherever it goes. Another suggested that it be big and heavy 'so that by the time the cat sees us, it will be so heavy, it cannot keep up with us'.

But there was a snag in implementing it. Who will bell the cat? 'There was no volunteer,' said Mr Lim. The idea failed and the cat continued to move around freely while the mice lived in fear.

One day, a mother mouse and her baby were hunting for food when the cat cornered them.
Trapped, the mother did the unexpected: she stared at the cat and barked, sending the feline fleeing.

To laughter from the MPs, Mr Lim said: 'The mother mouse turned and told the baby mouse: 'See, now you understand the importance of upskilling and re-skilling'.'

Now, who has ever heard a mouse bark like a dog? Is that how improbable it is for a upskilled and re-skilled worker to enjoy better pay and better quality of life?

No-Frills Housing Please!

Dr Lim Wee Kiak and Ms. Lee Bee Wah made unusual calls in parliament for 'no-frills' housing to be made available as another option of providing affordable housing for Singaporeans. Dr. Lim gave the example of flat prices in the 1970s: S$15,000 and S$20,000 for a three-room and four-room flat respectively. A graduate with a starting salary of S$1,000 could pay off his apartment with 15 to 25 months of his pay, he said. But today, though their starting salaries are three to five times higher, the prices of new flats have shot up “10 to 30 times”, he added.

Changing Profile of the Homeless in Singapore

Why a 2-Party System?

Mr Ravi Philemon proposed a multi-party democracy in place of a two-party system which some speakers appeared to favor.



As Reported in the Wayang Party Club article: Full House at SDP's Forum

Pre-School Education is not Compulsory?