Are Singaporeans being set up for disappointment?

More help for pioneer generation soon: Tharman”, “A new social compact between the people and the government will also have to be forged”… The traditional build up to the National Day Rally (scheduled this year for 18 Aug 2013) seems to be in overdrive this year.

I am worried. Looking at a couple of letters published today in TODAY’s Voices section asking for free public transport and medical care, and means testing to be at the individual rather than the household or family level, I fear that whatever PM Lee unveils, it will disappoint. This would be a real pity- in conversations with policy makers and politicians and reading of the newspapers I get a very strong sense that this year’s National Day Rally will signal a radical departure from previously held beliefs about ‘moral hazard’ and ‘welfarism’.

My guess is that the social safety net will be strengthened considerably. Especially in healthcare, I think the government has heard the concerns about escalating costs, the fears of bankruptcy due to major illnesses and the consequent large bills and will announce schemes this Sunday to mitigate these. But it won’t be a ‘free for all’ fracas…

It has been said that “Satisfaction = Experience – Expectation”. If ‘Expectations’ are built up to such a crescendo these few days, then PM Lee despite his and his Cabinet’s best intentions, can only disappoint. To those who may be disappointed after Sunday’s rally, it is worthwhile to take a few steps back in time to see how profound the shifts in thinking actually are.

Two old quotes from Mr. Lee Kuan Yew to highlight how much we have changed our thinking:

Subsidies on consumption are wrong and ruinous … for however wealthy a nation, it cannot carry health, unemployment and pension benefits without massive taxation and overloading the system, reducing the incentives to work and to save and care for one’s family – when all can look to the state for welfare. Social and health benefits are like opium or heroin. People get addicted and the withdrawal of welfare benefits is very painful.

Lee KY. Cited in Barr, Michael Dominic. 2008. Singapore: the limits of a technocratic approach to health care. Journal of Contemporary Asia

My major objective in the early days was to make sure that nobody derails the idea of having individual accounts for CPF and Medisave. Whatever you earn, it’s yours. Because once you have that individual account, any suggestion that you put it into a common pool and everybody takes out from it (as with other welfare systems) is bound to lose you votes.

So if Low Thia Khiang says now, let’s set up a common pool, I think he’ll lose votes in the next election. Are you prepared to put your money into a common pool, having slogged and built up your CPF nest egg? It’s yours and if you don’t use it, you can leave it to your children or your relatives or whoever you like. Why should you put it into a common pool and everybody draws out at your expense, which is what’s happening in some Western countries? The system has collapsed.

From Lee Kuan Yew : Hard truths to keep Singapore going. (Eds Han FK, Z Ibrahim, Chua MH, L Lim, I Low, R Lin, R Chan) Straits Times Press 2011

Are we becoming a more caring, more inclusive society? Are Singaporeans more ready to look out for each other and contribute to each other’s well being? Yes, I think so. Are these changes going to happen overnight? No, highly unlikely. What then can we do to keep the process in the right direction? Perhaps some encouragement together with the exhortations for faster, bolder transformation of Singapore society.

All that said, what announcements can we expect in the healthcare space?

Mr. Goh’s speech over the weekend are suggestive

The government is trying to lessen our anxiety over medical costs as we grow old. Medical costs are indeed a burden, not just for the old but for their children as well.

Many Singaporeans dread the prospect of being stricken by serious, chronic illnesses, even if they lead healthy lifestyles. While the future old will have more Medisave and insurance to help pay for their medical needs, the current old – the pioneer generation that built the country – are less able to cope.

Mr. Heng Swee Keat’s speech to the Economics Society of Singapore on healthcare was in a similar vein stressing the unique circumstances of the ‘pioneer generation’.

My guess is that some previously unthinkable measures will be rolled out for the ‘pioneer generation’ however this is defined (perhaps those born before 1945 or some agreed upon year of birth) recognizing as both ministers have mentioned that the ‘pioneer generation’ have been less able to cope with the increased costs of living and have not benefitted fully from the social support systems like Medisave and MediShield. However, their words also suggest that the existing subsidies and 3M framework will be preserved for the “future old”. Perhaps MediShield will be enhanced and expanded to be more inclusive, i.e. cover more Singaporeans and more comprehensive, i.e. cover more diseases or treatments but I do not think we will dismantle the fundamentals of our healthcare financing model which in fairness has served reasonably well these last three-odd decades. Let’s not also throw out the baby with the bathwater. Family support and responsibility are important; call me old-fashioned but I still believe that ‘family’ should be the first layer of social support albeit with government being much more ready to step in and help. As we shift “left-of-center”, let’s not overcompensate and lose everything that made Singapore what it is today.



  1. […] – Insights Health Associates : Are Singaporeans being set up for disappointment? […]

  2. […] healthcare announced are a major shift away from the previously dominant ideology. Recall that in a previous post, I had highlighted the elder Mr. Lee’s strong views on subsidies on consumption as […]

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