Penalising the voiceless is cheaper than doing the right thing

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.

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. 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.