Penalising the voiceless is cheaper than doing the right thing

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It is early days yet, but it may be possible to glean a gradual, reluctant retreat from dogma on the part of the Singapore government. This pattern is hardly discernible across the board; we only see these small changes in what might be termed the ‘bread and butter’ issues.

Notable straight away is Minister of National Development Khaw Boon Wan’s pledge that about 2,500 two-room flats will be launched for sale this year, and another 5,000 in 2014. Khaw revealed that the launch of 519 two-room flats July 2013, which for the first time allowed purchases by singles — i.e. unmarried, divorced or widowed persons without a “family nucleus” (based on the Housing Development Board’s definition) — attracted applications from 8,800 interested singles. “We expect to see such huge oversubscription for many more [Build-to-Order] exercises,” he said.

Today newspaper reported:

There are more than 220,000 single Singaporeans aged 35 and above. Starting from July’s BTO exercise, first-timer singles aged 35 and up, with a monthly income of S$5,000 or below, can apply for a new two-room flat in non-mature estates. Singles can also receive up to S$30,000 in extra subsidies if they apply on their own, with the grant doubling to S$60,000 if two or more singles apply together. Previously, singles could only buy resale flats.

– Today, 24 Sept 2013, More BTO flats for singles in non-mature estates

Pricing is too complex to discuss here, but you can take a look at this page on the HDB website. Moreover, the above numbers may be misleading. So far, only about 30 percent of 2-room flats have been set aside for singles; the rest, I think, are for retired couples and less well-off “families”. Khaw’s 5,000-figure for 2014 therefore means rather less than it should.

For decades, the unmarried portion of our population has been penalised by our housing policy. The HDB insisted that persons buying directly from them must constitute a “family nucleus”. If you’re single, at best you can purchase a second-hand flat on the resale market, enabling the first owner to make a profit out of you.

The ideological foundation for such a policy is not hard to guess at: the ruling party’s Scrooge-worthy abhorrence at the very idea of social spending. To cover its tracks, it promoted the hard-to-oppose mantra of “family” as the bedrock of society (and needless to say, its very conception of “family” is an old-fashioned one). Waving the banner of this policy, the government has been able to keep arguing that people should look to family members for social support, and not expect the state to chip in very much.  Thus, the extremely thin social safety net, from healthcare to unemployment and retirement support, and even child-care — promotion of birthrate notwithstanding.

The policy of only providing new homes for “families” — and I use quotation marks because I find the government’s definition of “family” far too narrow — is rooted in the same ideological ground, with the argument going more or less like this: Since “family” is the bedrock of society, therefore the government should support “families” and discourage entropy. Which is well and good except that “support” can be costly, so in housing, as in so many other areas, the preference has been to do more “discourage” than “support”. Imposing punitive costs on disfavoured sections of the population — and at the same time, making these folks out to be morally inferior to justify the neglect — is far cheaper on the public purse than providing meaningful assistance. This explains the cold-shoulder towards anyone — such as single parents and their children — who don’t fit the dogma model of society. This explains why, despite a steadily growing segment of the population who never get married, the HDB has not seen it as its responsibility to provide them equal access to housing.

Until now. So perhaps kudos are in order to Khaw for taking his ministry in this bolder direction.

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Healthcare

Healthcare is the other area where popular expectations and demographic change have outpaced the government’s response. Leashed by the same dogma — reliance on family — the state has been extremely slow to rework the system. Even now, tweaks to Medishield (including a renaming it to Medishield Life — renaming is quite pointless, if you ask me) still look like minor, ridiculously necessary catch-ups, however much the government wants to blow its trumpet. I mean, the old policy actually withdrew support for anyone over 90 years old. How heartless could we get? Fixing this is hardly progress, more like realising our error after twenty years.

Did the ideological framework see elderly people over ninety as burdens on society to be got rid of as fast as possible? Did the state want to send the signal that we should discourage people from getting so old by punitive action?

Long waiting times at hospital emergency rooms

Every now and then, we see complaints about long waiting times at hospital emergency rooms. I myself have personally experienced it. I think it gets particularly bad in the evenings.

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I have recently noticed that polyclinic operating hours are 8am to 12noon (last registration) and 2pm to 4pm (last registration), weekdays only. They are not open on Saturdays or Sundays.

Why such short operating hours? Is it any wonder that people pack into emergency rooms?

Emergency rooms are more expensive to run than polyclinics. For many less severe treatments, including stitching up a bad cut, or getting an X-ray done, a polyclinic should be able to do it. The rational response should be to keep polyclinics open through the evenings and weekends, in order to take the load off emergency rooms, which can then provide more prompt attention to really serious cases.

Why has the Health Minister not done this? Is he sleeping on the job?

Compared to Khaw Boon Wan’s move to provide housing for singles, Health Minister Gan Kim Yong’s moves are too tentative, and still too straitjacketed by cost-recovery calculations as can be seen from threats to increase premium payments.

In this connection, do check out Jeremy Lim’s new book Myth or Magic — Singapore’s healthcare system. It’s a landmark critique of healthcare services from someone who has an insider’s knowledge of all that goes on.

Public transport

A third area where we can see retreat from the old ideological framework is in the subsidy to bus companies, to enable them to buy more buses, increasing capacity. At last, there is a bit of flexibility from the long-sacred demand that public transport must be a profit-making business.

 . . . . LTA embarked on the Bus Service Enhancement Programme (BSEP) to improve overall bus service provision.

Under the BSEP, the Government will partner bus operators to significantly ramp up bus capacity and current bus service levels by providing funding for 550 buses, while the Public Transport Operators (PTOs) will add another 250 buses at their own cost. With the progressive addition of these 800 new buses, commuters can expect more frequent and less crowded buses.

Over the next five years, about 300 of the 550 buses funded with Government assistance will be deployed to reduce crowding and improve the frequency of the existing basic bus services. The increased capacity of buses means that PTOs will be required to deliver higher service levels than those currently set by the Public Transport Council’s (PTC) existing Quality of Service standards. The remaining 250 buses will be used to run some 40 new bus routes to improve connectivity.

– Land Transport Authority, Annual Report 2011/2012. page 28.

But like tweaks to healthcare, I am not convinced we are doing enough. The whole provisioning model needs to be overhauled.

I think it was Prof Tommy Koh [Correction, 5 Oct 2013: it was Kishore Mahbubani] who, at a recent conference, quoted Enrique Penalosa, for­mer Mayor of Bogotá, in saying:  “A devel­oped coun­try is not a place where the poor have cars. It’s where the rich use pub­lic trans­port.” Indeed, that’s the way we should go, but we’ll never get there unless we are prepared to let go of old biases and mental fences and rethink how we should run our public services.

Instead, to control motor vehicle growth, tight caps on total numbers of vehicles on the road are imposed, causing auction prices of Certificates of Entitlement — pieces of paper that entitles one to own a car for ten years — to skyrocket. I don’t disagree with the tight caps; I am horrified by the way we go about destroying a human- and nature-friendly environment through building more and more roads and carparks. But what we see here in transport policy as a whole is the same logic at work: Do the minimum necessary to “support” public services — but a long way from making public transport sufficiently attractive to induce car-owners to switch — while focussing on imposing penalties. It’s not only cheaper, but actually brings in tax revenue!

(That said, this example may depart from my thesis:  car owners aren’t exactly voiceless.)

Electoral mathematics

Flats for singles, universal health insurance, subsidies for bus companies — what prompted these slight softenings of the cold heart? Demographic reality and electoral mathematics come quickly to mind. Recent elections have shown that voters may be more and more of a mind to punish the ruling party.

Doubtless, the party will protest that it has always had the people’s interests at heart and that this new provision of housing for singles and greater attention to healthcare and transport is no more than a continuation of a deeply-felt leadership responsibility. I doubt that people will be so easily hoodwinked; the government’s past policies have been too much carved in stone for us not to forget.

In any case, we can still see cold calculation at work.

I was just surfing around and chanced upon the charges levied by polyclinics. For a consultation, those run by the National Healthcare Group charge citizens $11.45 (including Goods and Services Tax); polyclinics run by Singhealth Group charge citizens $10.50 (not stated whether GST is included). By contrast, foreigners, even those living and working in Singapore, have to pay $54.57 and $39.40 respectively. This difference in fees is too great. It discourages foreigners here from seeking medical treatment, besides the ethics of price gouging. To the extent that communicable diseases are not treated promptly, they affect us all, citizens and non-citizens alike.

Of course, I am aware what the rationale for the price differential is: citizens enjoy state subsidies, foreigners pay full cost — though you might notice that no one has actually published the accounts demonstrating that these charges are coherent with the claim (for example, “full cost” can mean a myriad of things depending on definitions and cost allocations).

I am also aware that this fee policy came out of the government’s panicked reaction to rising complaints against our open-door immigration policy and a perceived devaluation of citizenship. But seriously, this is not the right response. The right response should be to control the gates, but after people have been selectively allowed in, to treat them decently, including providing some form of social safety net. The bottom line is that the government doesn’t want to control the gates. Instead, they use these punitive price measures to signal to citizens that the government is listening.

However, as I have argued, there are downsides to such short-sighted policies that create social problems (untreated illnesses among foreigners working here, or homelessness among low-wage foreigners). More to the point of this article, this example once again demonstrates the tendency to use punitive measures on electorally-unimportant sections of the population as smokescreen to hide the government’s reluctance to do the right thing.

21 Responses to “Penalising the voiceless is cheaper than doing the right thing”


  1. 1 Sasha 28 September 2013 at 17:52

    In China, they have 吳三桂 who opened the gates of the Great Wall of China at Shanhai Pass to let Qing forces into China proper. In Singapore, we have someone by the same surname, who opened the flood gates to let foreigners to come in and take away our jobs.

    The right solution and only solution is to limit the people coming in. But no, PAP will not want to do this as their way of doing business relies on having cheap labour, like an opium addict. They cannot innovate. They cannot growth the economy without putting more people on this already crowded island. This government has zero ideas and total group think.

    The population is still growing rapidly. It is very clear that PAP is not listening. At 1.6% growth, they are still aiming for a population of 7 million by 2030. Every Singaporean has the responsibility to vote against the PAP to prevent this from happening.

  2. 2 alan tan 29 September 2013 at 03:52

    interesting that he seems to be talking about the same problems we are having here

    http://inequalityforall.com/#see-the-film

  3. 3 yuen 29 September 2013 at 06:18

    in public affairs “the right thing” is often hard to define; for example, when the government announced that it will spend money to buy new buses for the transport companies, some citizens complained on the web “it is wrong for taxpayer’s money to be used to subsidize private companies”, though I assume the silent majority approved of the move

    since the government is elected, it is generally speaking “right” to follow majority will; if the majority think foreigners should pay more for this and that than citizens, why should the government say this is not the right thing? (BTW, I am a foreigner)

    • 4 yawningbread 29 September 2013 at 10:29

      I don’t know where you get the idea that the majority wanted the foreigners to pay more. From what I can see, many people (whether or not majority is unknown because pollsters haven’t polled the issue) want control on immigration numbers-wise, not punitive charging.

      • 5 yuen 29 September 2013 at 11:47

        why not have a poll of your readers? I assumed that (a) the majority approve of using taxpayer money to buy buses to be operated by the listed transport companies (b) they think charging foreigners higher prices for government medical service (and probably, also for property) is OK; it is simple enough to find out whether this is true right here

      • 6 gentleaura 1 October 2013 at 12:59

        The correct question to ask in the first place is whether the public transport system should be nationalised and not pte ltd, then in that context we can better frame the answer if the majority approve of using taxpayer money to buy buses to be operated by the listed transport companies.

      • 7 yuen 1 October 2013 at 17:11

        since you want a poll about nationalizing transport companies, we might as well poll (a) whether senior citizens should enjoy free travel on government owned public transport service (b) whether everyone should enjoy free travel; some cities (e.g. HK) have (a), others (I remember Austin Texas in 1989) implement (b)

    • 8 ape@kinjioleaf 29 September 2013 at 22:45

      I believe the silent majority are silent because they thought they have no say. Sadly, in contrast, the vocal minority (I don’t mean all of them. Yawningbread is one of the exceptions that gives thorough analysis and focus) went the other extreme and berate the government for every little problem.

  4. 9 Rick 29 September 2013 at 11:59

    The difference in price between foreigners and Singaporeans at the polyclinic arose because in certain clinics foreigners comprise a large percentage of the patients seen.

    Unfortunately, some employers continue to insist that only MCs from the Polyclinics will be accepted. Instead of mandating that MCs issued by GPs be accepted by their employers, the MOM took the easy way out by increasing fees exorbitantly. It was an attempt to ‘right-site’ without having to do the right thing.

    Private GP clinics don’t have different citizen and foreigner rates and provide equally good management. Somebody needs to man up and do the right thing.

  5. 10 Eugene Tham 29 September 2013 at 14:18

    Polyclinic operating hours indicate when they’re receiving new patients, not the times when they’re working. So, you get staff coming in at an hour earlier to prep the place, they stop registering new patients at 12 so that they can clear the patient load so that the staff can go for lunch and so forth. Closing registration at 4 allows for them to finish up the patient load and then complete adminstrative work before 6pm.

    • 11 yawningbread 30 September 2013 at 01:32

      But 6pm is not good enough. I am suggesting that they should open to maybe 12 midnight. And weekends. If McDonalds can operate 24 hours, why can’t an essential service like healthcare?

      • 12 yuen 30 September 2013 at 08:36

        mcdonalds can hire large numbers of foreign workers making management decisions easier to implement; not all organizations, especially government units, are in the same position

      • 13 yawningbread 30 September 2013 at 10:24

        Have you been to a public hospital lately? They hire jumbo-loads of foreigners too.

        Additionally, are you postulating that one reason why McDonalds is more service-oriented is because they have foreigners making management decisions, but in an organisation helmed by Singapore citizens, decision-making is of poorer quality?

        I’m not saying you’re wrong — this question can only be settled empirically — but you’ve certainly raised an interesting (and perhaps to some, an unwelcome) point.

      • 14 yuen 30 September 2013 at 11:15

        I have been to both private and government hospitals numerous times since April 2012, and noticed that most of the ward nurses in the former, large portion in the latter, are Filipinos and Mainland Chinese; however, receptionists, clerical staff and nurses on consultant doctors’ personal staff are local; obviously, someone in the labour ministry decided that local nurse supply is insufficient to meet the need in the less popular categories; I guess a similar decision has been made regarding fast food counter staff

      • 15 Innocuous 6 October 2013 at 22:34

        YB, big fan, been following your blog since the early days. I’d just like to chime in here on some of your comments about the healthcare sector, particularly the one in the blog post regarding long waiting times at the EDs.You also ask why outpatient clinics/polys can’t run for longer hours and you have noted the large numbers of foreigners in the ranks of hospital staff.

        It all boils down to the lack of manpower, the system suffers from an acute lack of trained manpower where it is needed most. ie. by the bedside. The ancillary healthcare providers like radiographers and physiotherapists suffer to a lesser extent as they tend to be concentrated into departments and parceled out as needed. I’m going to focus on the nurses cos I reckon they are the ones who make the hospitals tick as they are by far the single largest occupation in any given healthcare setting.

        So, why aren’t there more local nurses? The pay has become much more attractive than a decade ago and the job is about as secure as a job can be in this day and age. Why then are there so many foreign nurses?

        Simple, for years, people have seen and continue to see nursing as a last resort when it comes to deciding what to do after O levels. It is seen as decidedly inferior in so many ways to its sexier counterpart, medicine. In the 23 July 2012 edition of ST, a youth was quoted in an article as saying, “If I flunk my O Levels, i have other options to choose from without a formal education. For example, i could be a swimming instructor, or go into nursing.” Also, anyone remember the footnote which was in the Population White Paper this year which labelled nursing as a low-skilled job? The fact remains deep down despite what they may say or do most people wouldn’t want to have anything to do with nursing if they can help it.

        You also might be interested to know cutoff points for the 2013 intake for Nursing in NP is a staggering 28 points. Chew on that for a moment. They’re practically inviting anyone who can spell their name legibly to undergo training to do a job which requires you to memorise words I can’t pronounce much less spell. A job which requires you to work in a place where there are protocols by the ream.and where the difference between life and death is whether you do your job correctly.

        And another thing, the foreign nurses that come to our shores to care for the sick and elderly among us might not all be angels but they are a damn sight better human beings than a general sampling of the population might give. I’ve had by far more good experiences than I have bad ones when it comes to dealing with foreign workers in our healthcare system. Sure, some of them are using the work experience here to step up to better opportunities elsewhere but the only reason they’re here in the first place is cos Singaporeans don’t want to do the jobs they do.

        Nursing can definitely pay the bills. It has shitty hours and a hostile environment but what frontline customer service doesn’t? The system is practically taking anyone who even looks remotely interested in it as a career and offers mid-career options for those who want to switch so this definitely isn’t a sector where the foreigners have an advantage. Who then is left to take the blame for this predicament we’re in? I get the impression you don’t like the fact that there are so many foreigners in the healthcare system but have you ever thought about why it is so in the first place?

      • 16 Eugene Tham 10 February 2014 at 08:39

        Polyclinics don’t work on the same shift rota systems as other healthcare services in Singapore. Working until 6pm ALREADY entails a 10 hour workshift(longer if one remembers that lunch is a ‘luxury’), and ignores the additional hours on management and supporting staff. This even as the organisations are trying to promote a more ‘family friendly’ work environment.

        Manpower wise, they don’t have it. As for McDonalds, you can hire anyone off the street to supply said manpower. Where are you going to find the doctors to do that for healthcare?

  6. 17 Duh 29 September 2013 at 15:35

    Also, why are govt subsidies to foreigners and PRs the same as that for Singaporeans for people attending undergraduate courses in NUS and NTU?

    I know of no state-funded universities that have the audacity to do so and still employ academic staff as if they were private universities. Clearly, our universities are doing so with the the support of our PAP govt.

  7. 18 patriot 29 September 2013 at 22:16

    The Rulers are bend on enriching themselves. And in order to be richer, the People must be the Ones to supply them the Dollars.
    Since their appetites are never satisfied and their consciences are fed to the dingos, what can we expect from them?

    patriot

  8. 19 GE 29 September 2013 at 23:27

    I agree we shouldn’t levy exorbitant charges on foreigners after letting them in. Let’s be humane. A foreign laborer will have to suffer in silence instead of seeking treatment. As you point out. How does that help us ?

  9. 20 Daniel 1 October 2013 at 02:10

    LKYSPP Dean Kishore Mahbubani wrote an article published 2 weeks ago in the Straits Times titled “Fewer cars, fewer roads”. In it, he mentioned that quote attributed to Mayor Penalosa. Not sure if Tommy Koh quoted Penalosa recently as well, but I think it’s likely you read Mahbubani’s article.

    I must say, it was the first of Mahbubani’s articles I’ve ever read without instinctively feeling angry. I actually… agreed with him. I know you’ve sworn off ST but… well I thought it was worth a read! http://www.straitstimes.com/breaking-news/singapore/story/the-end-the-roads-singapore-20130914

  10. 21 Catherine 4 October 2013 at 14:06

    Hi,
    Just a clarification on the quote”The former mayor of Colombian capital Bogota, Mr Enrique Penalosa, put it very well when he said: “A developed country is not a place where the poor have cars. It’s where the rich use public transportation.” It was Kishore Mahbubani

    http://www.straitstimes.com/breaking-news/singapore/story/the-end-the-roads-singapore-20130914


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