Hansard, 1994-01-17

Mr Speaker, Sir, MediShield was introduced on 1st July 1990 to help Medisave members and their dependants meet hospitalisation and medical costs of serious illnesses. The scheme now covers more than 1.5 million people or 88% of eligible Medisave members. The White Paper on Affordable Health Care recommends that the Government improve and extend the coverage of MediShield to help meet the increasing medical costs so as to reduce the need to significantly increase Medisave contribution rates in the future. MediShield will be extended in two ways: by improving the present Basic MediShield benefits package and introducing a second tier optional scheme called MediShield Plus to cover hospitalisation expenses in higher class wards. The White Paper also recommends that employers should build their medical benefits system on Medisave. They are encouraged to make voluntary additional Medisave contribution for their employees, over and above the statutory contribution, in lieu of part of their traditional benefits in kind. The Civil Service has taken the lead by introducing a new medical benefits scheme, called the Medisave-cum-Subsidised Outpatient (MSO) scheme, for new employees along these lines. New recruits from 1st January 1994 will receive additional 1% Medisave contribution over and above the statutory Medisave contribution, in lieu of hospitalisation benefits and retain the traditional outpatient benefits subject to an annual cap. Existing civil servants can also opt into the MSO scheme. MediShield Plus is introduced by the Government so as to facilitate conversion of the traditional medical benefits in kind offered by employers towards the MSO-type of schemes. MediShield Plus Ministry of Health together with the Central Provident Fund Board has worked out the MediShield Plus Scheme. MediShield Plus will offer a two-tier plan to extend adequate coverage for those using Class A and B1 wards on a voluntary opt-in basis. We are not changing the basic MediShield package in this exercise which already provides adequate coverage for B2 and C wards. However, we are currently studying various improvements to this basic package, but to be implemented separately later. The structure of MediShield Plus benefits is similar to the basic MediShield package, with co-payments on deductibles, and with specified coverage rates for room and board, including medications and investigations, ICU, surgical operations, etc. MediShield Plus Plan A is designed to provide coverage for those using the Class A wards and, to a lesser extent, the private hospitals, while Plan B is for Class B1 wards. The deductible limits are higher than for Basic MediShield, because the new schemes are designed for middle (50th percentile) and upper-middle (70th percentile) households, who are the major users of Class A and B1 wards, and who should be able to absorb a larger amount of medical charges themselves before needing help from MediShield. Lowering the deductibles would have meant raising the premiums further. MediShield Plan A will have a claim limit of $500 per day of hospitalisation with a deductible of $4,000 per policy. Plan B will have a claim limit of $300 per day of hospitalisation with a lower deductible of $2,500. Both Plan A and Plan B will have a co-payment of 20%, as in the case of the Basic MediShield scheme. MediShield Plus will pay 80% of the amount in excess of the deductible. MediShield Plus also caters for certain outpatient medical treatment such as radiotherapy, chemotherapy and renal dialysis. There will be no deductible for such treatment and MediShield Plus will pay for 80% of the medical bills incurred subject to the claim limits. The detailed MediShield Plus benefits package for Plan A and Plan B are given in Annex 1 (Cols. 249 - 250). Some examples of reimbursement computation for Plan A and Plan B are given in Annex 2 (Cols. 251 - 254). Annex 1 - MEDISHIELD BENEFITS AND CLAIMABLE LIMITS (Cols. 249 - 250) Annex 2 - Reimbursement Computation for MediShield Plus Plan A (Class A), Reimbursement Computation for MediShield Plus Plan B (Class B1) (Cols. 251 - 254) Premium Structure The annual premiums are between $60 and $660 for Plan A and $36 and $396 for Plan B, depending on the age group. The detailed premium rates are given in Annex 3 (Cols. 255 - 256). As in the Basic MediShield Scheme, the age limit for MediShield Plus coverage is 70 years. Annex 3 - ANNUAL MEDISHIELD PREMIUMS (Cols. 255 - 256) Medisave members can use their Medisave for the MediShield Plus premiums for themselves and their dependants. They can also use Medisave to pay for the deductible and co-payment. In general, the premiums for Plan A are five times those for the basic package, and for Plan B three times the basic package. This is roughly the ratio of charges between Class A and the average B2/C wards, and between B1 and B2/C wards. A 70th percentile upper-middle income household, with an income of $4,000 per month, can afford the Plan A premiums for a family of two adults and two children on 1% of its income, while a 50th percentile middle income household, with an income of $2,700 per month, can afford Plan B premiums on 1% of its income. The premiums are therefore comfortably affordable. Implementation Ministry of Health and the CPF Board will work out the implementation details including media publicity and the promotional materials to explain the MediShield Plus scheme before the official launch in March this year. MediShield Plus applications will be accepted from 1st April 1994 onwards and the coverage will commence from 1st July 1994, after a two-month waiting period for approved applicants. Medisave members and their dependants who are now covered by Basic MediShield can also apply to join the MediShield Plus. On the commencement of MediShield Plus coverage, their Basic MediShield coverage will cease automatically. Private Insurance Companies We intend to allow private insurance companies to offer competing MediShield Plus-type schemes, offering similar benefit structures, drawing on members' Medisave accounts. As a first step, we are discussing with NTUC Income, which should be ready to launch its scheme soon. We will review our experience with NTUC Income's scheme after six to 12 months and then decide how to extend it to other insurance companies. Revised Medical Benefits for Civil Servants Mr Speaker, Sir, MediShield Plus is designed as primary insurance coverage, ie, for people with no medical benefits in kind from employers, and no insurance coverage, eg, civil servants on the Medisave-cum-Subsidised Outpatient scheme. However, the scheme will also be open to people who do receive employer medical benefits in kind, eg, civil servants opting for the revised Comprehensive Co-payment Scheme (CCS) of medical benefits who want additional protection for themselves or their families. In fact, with the Government paying 85% of the hospitalisation bills of civil servants under the Comprehensive Co-payment Scheme, and 60% of their dependants' bills, this group probably does not need MediShield Plus. The coverage of MediShield Plus will overlap with the coverage provided by the employer's medical benefits. Civil servants who have both will, in fact, be over-insured, and will pay unnecessarily high premiums. The needs of civil servants and their dependants who are on the Comprehensive Co-payment Scheme will be better met by a medical insurance scheme specially tailored for them. The Public Service Division has discussed with NTUC Income about offering supplementary medical insurance to civil servants to cover the additional co-payment they now have to bear. NTUC Income has proposed a scheme, called Co-pay Assist, to cover half the hospitalisation expenses which civil servants and their dependants who are on the Comprehensive Co-payment Scheme have to pay. With this scheme, civil servants will pay 7.5% of their medical costs, while their dependants will pay 20%, with an equal share borne by NTUC Income. Since civil servants on the new medical benefits scheme will have to co-pay approximately twice as much of their hospitalisation costs as under the old medical benefits, Co-pay Assist will restore the civil servants to the level of co-payments which prevailed under the old medical benefits scheme. The difference is that they now have a choice whether to take the supplementary insurance and pay the premium, or to save the money and bear the additional medical costs themselves. The Co-pay Assist scheme will be available to civil servants on a voluntary basis. The premiums are shown in Annex 4 (Cols. 257 - 258), and will be paid in cash. They are modest, much less than the salary increases received by civil servants. Whether or not individual civil servants choose to take up this supplementary insurance from NTUC Income, it is for them to decide, but the availability of the scheme proves clearly that civil servants are better off with the new salaries and medical benefits than before. In other words, civil servants can have their cake and eat it too under the Comprehensive Co-payment Scheme, but they have to decide how many calories they want. Annex 4 - ANNUAL PREMIUMS FOR CO-PAY ASSIST (Cols. 257 - 258)

Mr Speaker, Sir, in order that Members may have the opportunity to discuss my statement, I beg to move, That Parliament do now adjourn. Question proposed.

Sir, I am very happy to hear the final statement made by the Minister that civil servants will indeed be better off and this will allay the apprehension that they have with regard to the revised medical benefits scheme. The MediShield Plus scheme has allowed CPF members to pool their resources together for additional coverage in the higher class wards, ie, A and B1 wards. As MediShield Plus has been in place, and the Minister has told us that there will be improvements made to the Basic MediShield, I hope that the Ministry will not take too long to make the necessary improvements. Otherwise, you have one category of CPF members who are not benefiting from the improved MediShield scheme. The civil servants now have a complete picture as to the options available and how they can make the choice for themselves. I hope with this announcement by the Minister all uncertainties will be removed by the civil servants. I have got a few questions for the Minister to clarify. I am concerned, as he said, 12% of the eligible Medisave members have opted out of Basic MediShield. May I know what are the reasons for these people opting out? Because he said that 88% did not opt out. So 12% have opted out. Is it because of ignorance or is it because of misinformation with regard to the Basic MediShield? What will be the implication for these people, the 12%, who have opted out in the first instance? Will they then not be given the opportunity to move on to MediShield Plus? Sir, with MediShield Plus, will the patient be allowed to choose private hospitals? Will it be restricted to the Government and restructured hospitals' B1 and A class wards? Does it mean that the patients can choose a private hospital as an option now? If, indeed they can, then in fact they are better off, especially for the civil servants. I hear that NTUC Income will give supplementary insurance. Does it mean that now insurance could be provided for co-payment and deductibles? I am not so sure. Can the Minister clarify that? What does it mean when NTUC Income come in with the supplementary Co-pay Assist? Does it mean that you can allow co-payment and deductibles to be insured? Can the Minister clarify that, please? What about the other insurance companies? We know that arrangements have been made with NTUC Income. Will there be provisions for the other private insurance companies? The Minister also said something about over-insurance. Is there really a possibility of a person over-insuring himself? What will be the implication? In the Medisave account, we have a limit on how much can go into the Medisave account. Will there also be a similar limit on the MediShield Plus insurance. So that (1) we save people the money; (2) we do not want to create a situation whereby a person who has insurance will make full use of the insurance that he has already paid for. I think that will end up with a negative effect on insurance that we want to avoid. The last question, Sir, the age limit for MediShield Plus has remained at 70. There is no 70-plus for MediShield Plus.

Sir, could I ask the Minister a few questions on the new MediShield Plus? Firstly, whether we need to go through a medical check before entering into this new MediShield Plus. Secondly, what happens to those people who are now suffering from major diseases and whether they will be allowed to join in the scheme. Thirdly, whether the Minister could say what is the maximum number of dependants allowed. Is it only for the wife and two children? What happens if there are more than two children? Can three or four children come under this co-payment insurance scheme?

Sir, I would like to ask the Minister two questions. First, under this Co-Pay Assist Scheme, I understand you can only pay in cash. Would the Minister consider allowing Medisave to be used for this purpose? My second question is actually related to the one which has been raised by Mr Loh Meng See. This is in regard to the 70 years age limit. Could this age limit be raised, say, to 75 years since the average lifespan is about 75 years old?

Sir, may I ask the Minister some questions regarding the Co-Pay Assist Scheme. Firstly, since this is run by a private organisation, whether there are exclusion clauses. Medical insurance is normally on a year-to-year basis. If something happens to a person who is on the scheme, can the policy be made invalid? Secondly, since this is a new scheme, are the present or existing ailments or diseases excluded from the scheme if the civil servants want to join the scheme?

Mr Speaker, Sir, since the new MediShield Plus and also NTUC Income's Co-Pay Assist Schemes are going to be intertwined with the medical benefits scheme and since several MPs have already raised questions about the medical benefits scheme and what can be done for the civil servants, I wish to take this opportunity to lead Members through these various schemes. I think this would address the point raised by Mr Loh Meng See that the Government should provide assurances to the civil servants. To understand the new medical benefits scheme, we have to go back a little bit to the first principles in our health care financing policy. We have always said that we uphold the importance of personal responsibility. And this means that we should save for our medical expenses. That is why we have Medisave. Medisave is for that purpose. The person's savings for medical expenses are supplemented by Government subsidies for outpatient treatment as well as for stays in subsidised wards in Government and restructured hospitals. For those who incur serious illness and have to stay in hospital for lengthy periods, there is MediShield. Finally, there is Medifund, if you cannot afford to pay the bill after these resources have been exhausted. There is a safety net. So this is the existing situation. In accordance with the principle of self-responsibility through Medisave, ie, people should save for their medical expenses and build up their Medisave account, the White Paper recommends that employers should make voluntary additional Medisave contributions for their employees over and above the existing statutory contribution rate. And this is in lieu of part of whatever they have been giving out as medical benefits in kind. So there is an additional 1% Medisave in place of, partially, whatever they have been giving out as benefits in kind. There are several advantages to this and this explains why we are moving towards the MSO scheme in the civil service. The advantage of giving Medisave instead of medical benefits in kind is that it encourages the employees to use medical services responsibly. The employees would have the maximum freedom to choose and decide how they want to use their Medisave. If they use their Medisave sparingly, then whatever is in excess will go back to their Ordinary Account. This scheme also does not tie the employee to any particular job. So this is why we encourage employers to give the 1% additional Medisave in lieu of what they are providing for. The civil service is leading the way in this transition by instituting a new medical benefits scheme, called the Medisave-cum-Subsidised Outpatient Scheme (MSO), for new officers. Under this scheme, the civil servants receive 1% additional Medisave in lieu of hospitalisation benefits, and also an outpatient subsidy of up to $350 per year. For existing officers, those who are already serving in the civil service, they have three choices. Option A is to stay on the old system, ie, the Co-payment on Ward Charges Scheme. Under the old system, they co-pay 20% of ward charges for themselves, but 50% for their eligible dependants. Outpatient treatments are free. This old medical benefits scheme has been there, I think, for many years, maybe since the 1950s. And we started charging a bit of co-payment back in 1972 or so. If civil servants opt to stay on this old scheme, they have to stick to their old salary scale as at 31st December 1993. Any future salary revisions will be different from those who opt into the other two schemes, because in future the people who stay on the old scheme will receive medical benefits whose value will increase over time. Option B, called the Comprehensive Co-payment Scheme (CCS), is a modification of this. The co-payment level is 15% of the total hospital bill and outpatient bill for the officer himself and 40% for the dependants. If civil servants opt for Option B, they will enjoy the 1994 salary revision. The third option, Option C, is what I have described earlier. It is the Medisave-cum-Subsidised Outpatient Scheme (MSO). I have already gone through the features of this scheme. Officers who opt for MSO will enjoy the 1994 salary revision. Since the announcement of the new medical benefits scheme, we have received quite a lot of feedback about an upsurge of anxiety among the civil servants. Members of this House have brought it up during the last two days' debate also. Many of the civil servants do not understand what are the options open to them. Existing civil servants have three options. Some of them do not even know that. There is also confusion over how each option works for them - methods of payment, what levels of co-payment, how to pay, etc. I think their anxiety is understandable. Health care is a very emotional subject. When you are in good health, you do not worry very much about medical expenses. But once you fall ill, the expenses come in. And if you have a serious illness, your medical bills can come to considerable amounts. Now, under the new medical benefits scheme, the civil servants only hear about having to pay more. Many think that they would be worse off. As I said, they have expressed their sentiments to us. There is a sense of being let down, even a sense of betrayal, to put it very strongly. This is in their own words. But this is not justified. Actually, the Government has every good intention to take care of the medical needs of the civil servants. The salary increases will fully cover any additional outlays they incur. We have made careful calculations on such incremental expenses, ie, additional expenses, and have made sure that the salary increases will more than cover such additional expenses. I think much of the anxiety and confusion can be allayed if the officers can see some actual calculations on what are their additional costs. They can then see how MediShield helps and can also consider whether they need additional insurance under MediShield Plus or under the NTUC Co-pay Assist scheme. With your indulgence, Mr Speaker, Sir, I would like to go over some calculations and examples with Members of the House. Can I ask the Clerk of Parliament to distribute a set of tables (Cols. 259 - 276)? [Copies of tables distributed to Members]. tables - ANNUAL OUTPATIENT CO-PAYMENT UNDER OPTION B, INCREMENTAL CO-PAYMENT ON HOSPITAL BILL FOR OFFICER ON OPTION B, ANNUALISED INCREMENTAL COST OF HOSPITAL BILL UNDER OPTION B, ANNUALISED INCREMENTAL OUTPATIENT AND HOSPITALISATION EXPENSES UNDER OPTION B COMPARED WITH ANNUAL SALARY GAIN, REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS, ANNUAL INCREMENTAL MEDICAL COST OF OPTION B WITHOUT AND WITH CO-PAY ASSIST PLAN (Cols. 259 - 276) Just now, we were talking about how civil servants may want to choose between the different options. We think that most civil servants would choose between Option A and Option B. To reiterate, Option A is the old scheme. Option B is the new Comprehensive Co-payment Scheme. This is the option that I would be talking mainly about. We think that most civil servants will opt eventually for Option B, the Comprehensive Co-payment Scheme. Why? Because for most officers, they will enjoy, first, the full benefits of the 1994 salary revision and future salary revisions. Second, the pay increase will exceed the additional co-payment. Third, they can afford additional insurance coverage if they want to cover the additional co-payment. This is where the Tables would be of help. Under Option B, the officer co-pays 15% for himself and 40% for his eligible dependants. Table 1 is about the amount of outpatient co-payment expenses he has to come up with. How do we arrive at those figures? Based on a PSD survey of 10 departments in 1992, only 70% of civil servants used outpatient services at the polyclinics, specialists' outpatient clinics and private clinics; 30% did not. The average bill for an officer himself for outpatient expenses is $180 per year. So under Option B, the Government will subsidize 85% of the bill. The officer only pays 15% and this 15% comes to $30 per year. Similarly, we found out the figures for the officer's dependants. Average expenditure is $120 per year per dependant. Because the civil service subsidizes 60% under Option B, the dependant pays only 40% of that and this comes to $50 per year. Row 2 of the Table adds up the outpatient co-payment for the officer and his wife. In the third row, it is the officer, his wife and two children. For each dependant, it is $50 per year, so the total for the family adds up to $180. I think most people are not worried about the outpatient expenses. They are more worried about hospitalisation. Under the old scheme, the officer co-pays 20% of the ward charges for in-patient bills. But ward charges only cover the bed and the meals. Total hospital bill covers a lot of other things, such as investigations, X-rays, and sometimes operation fees. This 20% co-payment under the old scheme works out to be around 7% of the total hospital bill. Under Option B, the officer will co-pay 15%. This represents only an additional 8% as compared to the amount he used to have to pay, and the Government pays the rest. Likewise, under the old scheme, the dependant co-pays 50% of the ward charges, but this 50% works out to be only around 17.5% of the total hospital bill. So the incremental cost to the dependant is 22.5% (i.e. 40% - 17.5%). Table 2 (Cols. 259 - 260) gives you an idea of what is the incremental, that is, the additional co-payment on a hospital bill for an officer under Option B, based on what he has to pay as an additional outlay, that is, the extra 8%. This Table gives you not just the average but also the percentiles. Table 2 - INCREMENTAL CO-PAYMENT ON HOSPITAL BILL FOR OFFICER ON OPTION B (Cols. 259 - 260) But Table 2 is on hospital bills. You have to also remember that people are not hospitalised every year. You can work out the probability of hospitalisation in a person's life-time and according to age groups. There is also differentiation by gender. I would not bother you with the details, but a very simple rough guideline is that, on the average, men below 60 are hospitalised once every 10 years. For women, it is slightly higher at 1.5 times in 10 years because this is related to child birth and so on. If we spread out the extra co-payment, that is what is presented in Table 2, over every year, i.e. annualize the incremental cost of a hospital bill for the different divisions of officers (Divisions I, II, III and IV), the annual extra costs are shown in Table 3. To read Table 3 (Cols. 261 - 262), you should just concentrate on the "Average" column because it is very near the 75th percentile already. This Table gives you the figures of the annual incremental cost of the hospital bill under Option B. If you compare this Table with the salary increases the civil servants are receiving, you will see that under Option B, the salary increases for all Division I to IV officers are several times the additional amounts of medical costs they would incur, even though they pay a higher co-payment now. Table 3 - ANNUALISED INCREMENTAL COST OF HOSPITAL BILL UNDER OPTION B (Cols. 261 - 262) Table 4 (Cols. 263 - 264) shows the average incremental cost per year for outpatient plus hospitalisation expenses, ie, everything combined, annualized, and compared to the minimum annual salary gain for officers from Divisions I to IV and their families. There is a clear indication from Table 4 that under Option B, the salary increases are more than sufficient to cover the annual incremental cost of medical expenses, both outpatient and hospitalisation. Table 4 - ANNUALISED INCREMENTAL OUTPATIENT AND HOSPITALISATION EXPENSES UNDER OPTION B COMPARED WITH ANNUAL SALARY GAIN (Cols. 263 - 264) With some more examples, I will show you how, under the existing Basic MediShield, all the officers will benefit and will get some help from this insurance scheme. Members have brought out the point that a lot of people do not understand how MediShield works. In the Ministerial Statement we have worked out examples for MediShield Plus. The same principal structures apply to Basic MediShield. I want to show you how, even under Basic MediShield, people can receive quite a bit of help. If I may refer you to Table 5 (Cols. 265 - 266). This is a case of a very serious illness, 21 days of hospitalisation in Class C ward. I choose the removal of breast cancer with reconstruction as an example. It is one of those things that women are vulnerable to, and it is a major operation. Actually this kind of bill can be applied to other equally serious conditions, for example, bone cancer, liver cancer, open heart surgery. For Class C ward, 21 days, major operation, the hospital bill comes to $1,607. MediShield, if you remember, has a deductible. For Class C, it is $500. And for each category of expenditure, there is an upper claim limit. For room and board for 19 days, the limit is $100 per day times 19. So $1,900 should be the claimable limit. The actual bill is only $1,235; so it is under the limit, and you can claim for the entire item. Intensive care, two days. For Class C, the limit is $200 a day. So, the upper limit is $400. Your bill is $142, again, you can claim for the entire item. Surgical procedure - this is a Table 7, major operation - the upper claim limit under Class C ward is $600. All the limits to claims are in the Annexes to the Ministerial Statement. So if you want to study further, you can refer to them. Table 5 - REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD (Cols. 265 - 266) For this person, the total claimable amount under MediShield is $1,607. This does not mean that he does not have to pay anything at all at this point. You must minus the deductible of $500. So the actual claimable amount is $1,107. But there is also the feature of 20% co-insurance. So 20% of $1,107 is $221, which the patient has to bear. In the end, MediShield pays $885, the patient pays the deductible of $500 and co-insurance of $221, altogether $721. So 55% of the total hospital bill is borne by MediShield and 45% by the officer. This case applies to anyone who comes under MediShield in Class C ward. The civil servant is much better off because the Government pays 85%. So if the civil servant is not covered by MediShield, the Government already pays 85% for him, and he himself pays $241. For the dependant, because Government pays 60% of the total bill, he pays only 40% for the dependant - $642. Under MediShield, it would have paid a total of $885. So it covers entirely his 15% co-payment as well as his dependant's 40% co-payment. I go over these Tables carefully with you because a lot of people say that they have not seen how MediShield works. I think with these Tables, Members of the House may be able to show their constituents how these computations are worked out. The same principle applies to a Class B2 bill, Table 6 (Cols. 267 - 268). For outpatient renal dialysis, Table 7 (Cols. 269 - 270) - a lot of people are very worried about chronic illness and their bills - for class B2 and C, the hospital bill is $480 per month. MediShield pays 80% of the hospital bill, subject to the limit of $600 per month. So it comes to $384. The patient pays $96. For the civil servant, without MediShield, he pays only 15%, which is $72; his dependant pays 40% or $192. With MediShield, the civil servant pays $0, and his dependant also pays $0. So MediShield really helps a lot. Table 6 & 7 - REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS (CLASS B2/C) (Cols. 267 - 270) The next Tables 8 (Cols. 271 - 272) and 9 (Cols. 273 - 274) show that even for Division 1 and II officers, Basic MediShield helps. For the same kind of operation and the same length of stay - if you choose to stay in class A, you incur a bill of $14,120 - how does MediShield help you? Here you have to note that because MediShield is pegged at B2 rates, so the room and board claims limit is pegged at B2 rate, which is $100 per day. So the maximum claimable limit for 19 days is $1,900 only, and this principle goes down the line. The maximum claimable amount under MediShield is $2,900 for the whole bill, but for class B2, your deductible is $1,000. After that, you have to co-pay 20% ($380). In the end, MediShield pays $1,520 and you pay $12,600 which represents 89% of the bill. But civil servants are again covered by the Government's 85% subsidy and their dependants by the Government's 60% subsidy. So if you look down the Table, you will see how MediShield also helps Division I and II officers who stay in class A ward. With these examples, it should be quite clear that Basic MediShield helps everybody. Tables 8 & 9 - REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS (Cols. 271 - 274) Table 9 on renal dialysis at Class A/B1 charges shows the same principles at work. I think you can study Table 9 at your own leisure. The above examples show that if the officers are covered by MediShield, they pay either nothing or a very small fraction when they incur large hospital bills. If you look at Table 8 again, with Basic MediShield, a civil servant pays only 4% of the bill because the Government pays 85% already, and MediShield pays 11%. However, for dependants who stay in class A and B1 wards, they are not fully covered by MediShield and the 60% subsidy from the Government. The dependants end up having to pay about 29% of the total bill. So this is where NTUC Income's Co-pay Assist comes in. If people feel that, even with Basic MediShield, the amount they have to co-pay for their dependants is something that they do not want to bear, they can pay a premium and go on the NTUC Income's Co-pay Assist scheme. This scheme will result in the officers and their dependants co-paying at approximately the same level as before. Instead of 40%, they now pay 20%. Instead of 15%, they now pay 7.5%. There are some advantages to NTUC Income's Co-pay Assist insurance scheme. If I can bring you to Table 10 (Cols. 275 - 276) - this is the last of the tables I will refer to - please look at the column on the left-hand side on the "average incremental costs per year". This column is actually transferred from Table 4; it refers to the additional annual medical cost for officers who opt for Option B. And this covers both outpatient and hospital expenses. For Division I (Ward A), female officer pays $65 extra; male officer with no dependant, $55 extra, etc. Compare this column with the last column on the right-hand side, the annual salary gain, you will see that for all officers (Divisions 1, II, III, IV), the minimal annual salary gain of $400 - this is calculated on per month increment times 15 months - is more than sufficient to offset your average incremental cost per year (the first column compared with the minimum annual salary gain in the last column). Many officers have gained much more than the minimum sum, as the median income gain column indicates. They are much, much more comfortably off. If the officer takes up NTUC Income's Co-pay Assist scheme, it only pays for hospitalisation, so he still has to pay something for outpatient treatment. This is what the middle part of the Table is about - NTUC Assist premiums plus your own outpatient outlay. Of course, the premium varies with the age group, because hospitalisation rates differ between age groups. So there are different outlays. Table 10 - ANNUAL INCREMENTAL MEDICAL COST OF OPTION B WITHOUT AND WITH CO-PAY ASSIST PLAN (Cols. 275 - 276) You can see that for all Division officers, the younger ones are going to be all right if they opt into NTUC Income's Co-pay Assist scheme. They can both pay for the premium plus the outpatient charges and have something left over. It is only among the older age groups (50 and above) that those people who receive only a minimum salary increase may not want to spend that amount on NTUC Income's Co-pay Assist. In fact, only the last row of Division I and the last row of Division II officers show that a male officer in the 50 and above age groups with a wife and two children would probably find that their sums do not break even. But it is very unlikely that at age 50 to 60, or 60 above, an officer will still have two dependent children. So these are not really realistic figures. Finally, let me go to the post-retirement benefits. There is a lot of concern about officers who will be retiring. For those who have retired on pensions, there would be no change to their medical benefits. For serving officers on pensionable services, upon retirement, the Government will continue to bear the bulk of the pensioners' and their wives' medical costs at 85% and 60% respectively. This refers to those who opt for CCS. Upon retirement, the Government will still continue to pay 85% of the hospitalisation cost and 60% for the wife. In addition, the Government will contribute 1% to Medisave based on the last drawn salary for the lifetime of the pensioner. In any case, the incremental cost of post-retirement benefits is relatively low. Some Tables have been worked out, again based on the idea of annualised incremental cost versus 1% additional Medisave the Government will pay into these pensioners' Medisave accounts. The PSD has done calculations and found that the 1% Medisave contribution is enough to cover the average yearly incremental medical cost for all officers and their wives in all the Divisions. Together with the salary gain during their service, pensions and their accumulated Medisave and, if necessary, they can draw on MediShield, a pensioner is very well covered, even for exceptionally high bills. If a pensioner wants to have additional psychological assurance, he may want to take up some insurance scheme. In the Ministerial statement, the Minister has already given an indication that PSD has consulted insurance companies and their advice is that for civil servants, because the Government pays 85% and 60%, most civil servants will be adequately covered, especially if they also have MediShield. It would be wasteful for civil servants to have additional insurance coverage. The examples that I have given you show that only for dependants in class A and B1 wards, MediShield may not be enough to cover large hospitalisation bills. For these cases, civil servants with dependants who are eligible for A and B1 wards and who wish to co-pay no more than before, they may wish to buy the Co-pay Assist plan, because that will help them to half the co-payment rate. CPF Board will soon implement the MediShield Plus scheme and I should add that the MediShield Plus scheme is mainly designed for those with no medical benefits. It is for everybody, not just for civil servants. There are some people who work in the private sector with no medical benefits. MediShield Plus is designed for them as well as for those civil servants who opt for the MSO scheme, or for the new recruits into the civil service who must go on the MSO scheme. If serving civil servants choose Option B and if they also choose MediShield Plus, then they will be over-insured. PSD will be issuing a booklet soon. In fact, it is done in this form [indicating]. I hope they will be improving on its format, and not just come out with this. And for the Members' information, I have asked for copies to be distributed to you. There will be more examples. So if Members want, they can study all these examples at their own leisure. I understand the PSD will be briefing the individual Ministries and Departments and, in turn, they will brief their officers and explain to them the examples contained in the booklet. And if labour MPs and union leaders would also like to be briefed, I think arrangements can also be made for them. A final assurance for those people who already have chronic illness, which is one of the points raised. My explanation has shown that civil servants generally will be better off. They will be fully covered, they have salary increase and they should opt for Option B. However, if any of them face financial hardship due to serious pre-existing illness, for example, if they are already on renal dialysis or if they already have cancer, PSD is willing to consider helping them on a case-by-case basis. A few short answers to the points raised by Members. What happens to the 12% of CPF members who have not opted for MediShield? What can we do to help them now that they can see the benefit of MediShield much clearer? We will have more publicity to persuade them to opt in. They can come in. They can come into MediShield Plus also if they want, but they can only opt for either Basic MediShield or MediShield Plus. Since NTUC Income is coming out with a supplementary insurance scheme to cover the co-payment, does it mean that we will allow other insurance schemes to cover co-payments and deductibles? I think you must be very clear in your mind that NTUC Income's Co-pay Assist scheme is designed only for civil servants on Option B who want to pay no more than what they have been paying before as co-payment. In the Ministerial Statement, it is already said that NTUC Income may come up soon with some scheme similar to MediShield, with a structure that will ensure there is no excessive demand for health services, which means deductibles, co-insurance, and such features should be built in. After NTUC Income's scheme has come into operation for a certain period of time, we will think about whether other insurance companies will be allowed to follow. The age limit for both MediShield and MediShield Plus is 70 years. The NTUC Income insurance scheme covers beyond age 70. MediShield and MediShield Plus, at the moment, do not go beyond 70 years. As Government schemes, we have to be very careful. We have already raised the age limit once. MediShield was introduced in 1990, and in 1992, we raised the age limit from 65 years to 70 years already. We better proceed more cautiously. For commercial schemes, it is up to them. They have to do their sums. Thank you for your indulgence. [Applause].

Mr Speaker, Sir, before I withdraw the motion, can I beg Members' indulgence for swamping them with so many details. But it is impossible to address many of the concerns raised without going into details and, in fact, after this, we are going to hold a press conference to answer more specific questions, including some of those raised by Members earlier. PSD, Health officials, and NTUC Income officers will be there. Let me clarify that the Ministry of Health is not, I repeat, is not the insurance agent for NTUC Income. But we have to address the concerns that the Comprehensive Co-payment Scheme somehow short-changes civil servants of the medical benefits they are used to. So our point is that if they wish, if they want to be spared the pain of having to make the choice, they can always go back to status quo ante by opting for this Co-pay Assist plan. But if they do not wish to, if they want to structure something more for their own needs, they are free to do so for as many dependants as they wish. So on that note, Mr Speaker, Sir, I like to withdraw the motion. Motion, by leave, withdrawn.

"to repeal the Judicial Committee Act (Chapter 148 of the 1985 Revised Edition) and to make consequential amendments to certain other Acts", presented by the Parliamentary Secretary to the Minister for Law (Assoc. Prof. Ho Peng Kee) (on behalf of the Minister for Law); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

Order read for Resumption of Debate on Question [13th January, 1994], '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 Loh Meng See]. Question again proposed. 1.35 pm

Mr Speaker, Sir, I rise in support of the motion standing in the name of Mr Loh Meng See. We in Singapore have another good year, a vintage year of growth and prosperity. This came about not by accident, but by the hard work of the people, by the entrepreneurship of our businessmen and the far-sighted leadership of our Government, all pulling together in the same direction for the betterment of Singaporeans. This internal cohesion and unity of purpose are essential ingredients of success, and even more so of continued success. But success brings about a host of other issues and problems. The Roman Empire in the West, for example, had to grapple with the problems of success. At the dizzy heights of its success, it was overwhelmed by new issues. Rome became too soft. Romans indulged in luxurious living and society generally was lulled into complacency by years of Roman successes. This ultimately contributed to the decline of Rome. We can learn from this, and do not do what the Romans did. Singapore, after years of prosperity, is also facing the problems of success, or the management of success. If we manage these issues well and are not carried away by success, or lulled into complacency, we will, I believe, continue to enjoy the prosperity well beyond the 21st century. One of the issues in the midst of success is the accumulation of surpluses. As the reserves grow, some will ask what we are going to do about it, and there will be demands to spend and spend. The Government has wisely put in place the system of checks on spending of past surpluses under the Elected Presidency. The ultimate checks, however, reside with the people. The man-in-the-street must understand and appreciate the rationale and purposes of reserves. Like a family, we have to prepare for a rainy day, or an unexpected catastrophe. The reserves should be built up to see us through a recession, like that of 1985, an oil crisis, or a world-wide prolonged economic downturn, or a protracted conflict in our region. As pointed out by Dr Albert Winsemius, former Economic Adviser to the Government, we need abundant resources to deal with the unexpected. Further, with good reserves, we will have the resources to upgrade our infrastructure and services, keeping a few steps ahead of our competitors, as well as invest wisely in overseas projects and enterprises. And this will give us the cutting edge and generate additional revenues for all Singaporeans. The point here is that the unexpected does happen often in history. Few predicted, for example, the collapse of the Berlin Wall, or the Soviet Union, or the outbreak of the Gulf War. We must therefore, as a nation, prepare ourselves for the worst turn of events, while hoping for the best. The Government should be commended for consistently avoiding the pitfalls of the welfare states of the West. The European nations, for example, are finding out painfully that the work ethic is undermined, there is no incentive to work hard and their competitiveness is down the drain. Instead of spending endlessly, the Government has rightly invested wisely and increased our reserves, while taking care of the needy and embarking on an asset enhancement programme for our citizens. This twin strategy allows Singaporeans to share in the fruits of our success, to strengthen their stakes in our future. The HDB Home Ownership Scheme, the major and interim Upgrading Programmes, as well as the sale of shophouses and hawker stalls, all add enormously to the assets of Singaporeans. The Government went one step further and floated Singapore Telecom, thereby allowing 1.4 million Singapore citizens to be Group A shareholders of Singapore Telecom. With success and prosperity, there is the problem of rising expectations. In the past, most were quite happy to move from 1- or 2-room apartments in Bukit Ho Swee, for example, to 4- or 5-room apartments in HDB new towns. Now, there is a growing trend for upgrading to private condominiums and landed properties. I remember in my time, we were quite happy to have Bata shoes. Remember first to Bata, then to school. Now, it is either Nike or Reebok and nothing less. This is well and good in that it motivates the people to work hard for the good life. But prices will go up. The Government can help more in this regard by releasing more land for private development, or accelerating the HDB building programme. With the prosperity that we have and the advent of the age of telecommunications, there are changes in lifestyle. Changes are part of life of course, but we must be watchful that our time-tested values built around the family, thrift and self-reliance are not eroded over time. The schools, together with the parents, can help to explain and promote our Asian values. Our youth should learn more about history and our cultures, how Singapore became a nation in 1965, and the blood, sweat and tears of our pioneering generation. Few know about the Hock Lee Bus riots, the battle for merger, the battle for Malaysian Malaysia and how we had to start from scratch after separation. I am afraid that History has been somewhat neglected in our schools, much to our detriment in terms of nation-building. Sciences should rightly be emphasized in the schools, but we should not forget that history is the soul of the nation. When our youth do not know where we came from, or what we had been through as a nation, there is no sense of history. It is that much more difficult to build an identity, or a sense of belonging to our country. It is time, therefore, for us to change gear and address this problem. The Ministry of Education should set up a committee to review the teaching of History in schools, and make History come alive in the classrooms and let our youth know what is the meaning of history and nationhood. In dealing with the problems of success, Singapore can also learn from Athens. Athens, a small city state, was then the centre of excellence in the Greek world. It was the leader in philosophy, architecture, culture, trade and commerce. It was a great trading city state, with the Mediterranean Sea as its commercial lake. Like a dragon fly, Athens had its second, third and fourth wings in trade. However, despite its affluence and excellence, Athens lost to Sparta in the Peloponnesian War. A democratic and mercantile Athens was vanquished by authoritarian and militaristic Sparta. Athens fell because of its internal problems, fractious democracy, the unbridled pursuit of wealth and affluence, and the lack of military preparation. We, in Singapore, should therefore learn and draw a lesson from Athens. We should avoid being driven by materialism, or by the blind pursuit of affluence and consumption, particularly conspicuous consumption. There should be internal cohesion and democratic consensus, and we should always remain strong and never neglect defence. I believe that if we do it right, we can be the reformed Athens of Asia Pacific, using the Pacific Basin as our commercial lake and developing not only a second wing, but also a third and fourth wing, like the dragon fly. And we will thrive and prosper into the 21st century. Small though we may be, we will be counted and Singaporeans will be proud to carry our Singapore passports, not only in the Asia Pacific, but throughout the world. Sir, I support the motion standing in the name of Mr Loh Meng See, and thank the President for his Address.

( In Malay): Mr Speaker, Sir, I rise to support the motion of thanks to the President moved by Mr Loh Meng See. The issue of neglect of the old is indeed a heart-breaking one. The rise in the number of residents in welfare homes is an indication of the further erosion of Eastern values among our young people and is also a sign of the weakening of family bonds among our citizens. There is no truth in the notion that the richer we are, the more we will necessarily shed these noble values. Something can be done to preserve them. We need to act on the lack of concern among our young people for their parents. Young people who show such irresponsibility must face stronger laws or be made to bear the cost of maintaining and looking after the homes, to the maximum possible, if they send their parents to welfare homes. Besides upholding responsibility and fostering a sense of caring and love among our young people towards the elders through the school curriculum, we can also have more and more varied activities in conjunction with Family Days and other similar events. The benefits granted to those who are prepared to look after their parents should be reviewed in accordance with the current situation. Considering the increasingly higher cost of medical care and standard of living, the tax relief for maintaining one's parents should be increased. The cost of looking after and caring for dependent parents, especially sick parents, is much higher than the relief of $3,500 now allowed for each parent. The CPF Top-Up Scheme for parents should also be reviewed. The sum of $230 a month allowed for each parent is not sufficient, especially to cover the cost of looking after sick parents who need medical care. The Housing and Development Board should continue to grant priority to applicants who want to preserve an extended family or who want their parents to live with them. The Government should also look into specific cases where there are valid grounds to allow children-in-law or stepchildren to receive the same benefits. This will help to reduce the number of neglected parents. It is unfair to place the burden of looking after and caring for our elders on their children-in-law or step-children without giving them equal benefits. Indeed, there are cases of step-children and children-in-law having to maintain the family after the death of the main breadwinner or where the breadwinner's income is insufficient for the family. In this connection, CPF should allow members to withdraw their savings to pay for the tertiary education of their step-siblings or siblings-in-law. Mr Speaker, loneliness haunts an elderly person each time his children or grandchildren go out to work or to school. But the aged will not be lonely especially if they are members of the Senior Citizens' Clubs that have been set up in every constituency. It is necessary for the Government to set up clubs like this in every zone so that activities that would benefit our senior citizens can be organised. These clubs can be set up under the auspices of the Residents' Committees. And in order to cover the cost of providing the services and activities, the Government can allow the senior citizens to manage and run provision shops or void deck kiosks as partners or as a cooperative. Mr Speaker, the problem of dropouts among primary school students has been revealed last year. The revelation of a high percentage of dropouts reflects our concern. The new education system allows our pupils to undergo at least 10 years of education. But is this system capable of preventing parents from stopping their children's education voluntarily? Or to deter students from withdrawing from school at a young age? No system can do that. However, the schools can play a role by constantly ensuring that the school atmosphere is attractive and beneficial to our students. Schools and the Government, in particular, can continue to play a major role for our students in order that they can continue to be educated without being troubled by financial difficulties or squabbles between their parents, by drug or crime problems, and so on. Our adolescents should be given a fair opportunity to continue to remain in school. We might not all have the same talents or social backgrounds, but all of us must have a fair opportunity to develop our talents and move up the social ladder. As I have mentioned earlier, the school system enables pupils to undergo at least 10 years of education. If their PSLE results are poor, students have the chance to undergo normal stream education at secondary school with an interesting range of technical and commercial courses using sophisticated teaching equipment like computers, etc. But what about poor students in the Islamic religious schools? In this case, I hope the Islamic Religious Council could consider running similar courses to provide weaker students with the basic requirements to enter the job market, while keeping to our objective of imparting religious teachings. School dropouts have the potential of getting involved in anti-social activities such as drug abuse and juvenile delinquency. The percentage of criminal cases involving school dropouts is large. These young people will be entering the labour market as low-paid workers. And they will then be mixing around in the challenging world of adults. They soon emulate the adult way of life, enjoy their entertainment and, saddest of all, get involved in drugs and gangster activities. As such, besides the schools playing a role to curb the rate of dropouts among their own pupils, the Government, in particular the Ministry of Education and the Ministry of Labour, should continue to monitor cases of dropouts in order that these students will be able to receive basic education to enhance their skills in the job that they have chosen. We have to do something to prevent them from getting involved in anti-social problems. 1.55 pm

Sir, I support the motion standing in the name of Mr Loh Meng See. During Mr Lee Kuan Yew's prime ministership, the Government was faced with the formidable task of building up Singapore. Hence, the Government adopted a single-minded policy of nation building. There was no national wealth to talk of then. By the time political leadership was smoothly handed over to Mr Goh Chok Tong, some of the nation's foundation pillars have been laid. We now have some national wealth which we should be thankful for and can be proud of. The PAP Government under PM Goh switched gear and moved into building up the assets of Singapore. In terms of national assets, the people must matter most. Hence, wealth accumulated in the past has slowly been shared with Singaporeans in various forms. A stronger and more tenacious bond to the nation must be built with the people having a greater share of the country. First, there is the on-going upgrading scheme of HDB flats. Though 90% of Singaporeans own their own flats, the Government took it upon themselves to upgrade these HDB flats with the owners contributing only a small proportion. The people welcome this scheme. Following the launch of the pilot projects, others are now asking that their housing estates be accorded priority to be upgraded. In their minds, they need only pay 10% and the Government will foot the rest. As if the Government's promise of 10 years of heavily subsidised education is not enough, a sum of money in Edusave is now set aside to ensure that every Singaporean school pupil gets an enriched education. While Medisave is the safety valve to ensure everyone's basic health care, the Government now brings in Medifund to further ensure that no one is denied basic health care just because they are poor. In a more tangible form of wealth sharing, shares of the lucrative statutory board, Singapore Telecom, were not only sold to Singaporeans at a discount, the Government actually gave each Singaporean $200 to buy the shares. There was a broad-base windfall for Singaporeans. What more can we ask for? The sale of shophouses at a discount rate also created a windfall, although for a small group of shopkeepers. But there has been some resentment on two fronts. For some taxpayers who are obviously not shopkeepers, they are asking why is such good fortune available only to these few. The first batch of buyers bought their shophouses at a discount rate while the later batches are buying theirs closer to prevailing market rates. These later batches of shopkeepers are unhappy at having to pay what they consider to be more than what their contemporaries have paid earlier. With the President confirming that hawkers stalls will be sold, hawkers are now expecting similar windfalls when the stalls are up for sale. Sir, the talk of 1993 must surely be the privatisation of Singapore Telecom. The Government was generous in more ways than one. First, there was the mad rush to be entitled to the $200 gift from the Government. Then there was the near riot to be eligible to apply for Singapore Telecom shares which illustrated the popularity of the Government's generosity. So, Mr Speaker, Sir, indeed the Goh Chok Tong Government has been Santa Claus for the last two years. Goodies after goodies were dished out to the people. Having received so much for the last two years, it would have been natural to expect some form of appreciation, if not gratitude from Singaporeans for the good work of the Government. If the feedback to the listing of Singapore Telecom shares is any indication, at best, the Government is thought to be performing its rightful duty. At worse, there was some mistrust over the intentions of privatising Singapore Telecom. Sir, what caused this numbness and what caused the ungrateful response to this overt princely effort on the part of the Goh Chok Tong Government? I am afraid that the Government in its effort to share wealth has unwittingly inflated people's expectations. The end result has been an insatiable appetite to want more from the Government. When the Prime Minister launched "Invest Singapore", the Government's intention was to allow people to be shareholders of Singapore's wealth. The main intention was and still is on investments. But it contributed to a super bull run because people went in with a gambler's attitude. Now, shares are in the lips of everyone in Singapore. It permeates all levels of Singapore. The Chinese paper revealed the pork seller with SBCText at his stall. But this example was not unique. I have seen other hawkers now putting up SBCText at their stalls as well. Maybe they are just following the cue from the pork seller. But all this shows the ridiculous extreme the whole situation has become. The President, in his Address to this House, promised more shares to be offered at a discount to the people. Sir, in future efforts to share wealth with Singaporeans, perhaps there are better ways of ensuring that people invest, and not speculate or gamble. My concern is that now that the Government has whetted the people's appetite in sharing the nation's wealth, can the Government go on meeting this unquenchable thirst for wealth? Can the role of Santa Claus be played indefinitely? Will there come a day when the Government cannot deliver the goodies to the people? If that day comes, would not the country be in an awkward position? The country will not only be unable to ask its people what they can do for the country, in the same breath, the people will be disappointed with what the country cannot do for them. Something needs to be done. One is, of course, better explanation of policies and aims, something which was eloquently discussed in this House on Friday by Mr Bernard Chen. Sir, we can recall the initial uproar when time-based telephone charges were announced. But this uproar stopped when the time-based system was in place and everyone gets a bill which is much lower than before. So explanation of new policies must be able to convey the right message, and explanations must be simple enough for all to understand. In conclusion, Sir, I believe there is also a strong need for an on-going education programme to remind the people of their responsibilities that they need to contribute to the nation's economy in order to continue enjoying a share of the nation's wealth.

Mr Speaker, Sir, I rise to support the motion. Some Members last week spoke of the need to ensure social cohesion, and on the need for the Government to reach out to the people to explain its policies. Dr Ho Tat Kin has just echoed the refrain. Otherwise, the long term goals of the Government, while good for the people, will be derailed by short term dissatisfaction. I agree with the Members that this has to be done. The question is: how can it be done? Major policies have been debated in Parliament, scrutinised by Select Committees, and widely reported in the media. Yet many, if not most people, have not understood. For example, it had been explained that import taxes on cars will be adjusted to offset the 3% GST, yet newspapers had on more than one occasion reported people attributing the rise in COE prices to the impending GST, without the newspapers attempting to correct the misconception. Currently, newspapers report the increases in prices, such as hawker food prices, with the blame being put on the GST, which has not yet been implemented. Apart from the New Paper which is trying to highlight those taking advantage of the situation, I see no effort on the part of the media as a whole to put pressure to bear on such hawkers. The expectation seems to be that Government should do something. Yet, surely one must know that it is the consumer whose behaviour will have the greater influence on prices. Let me cite another example of how little the public understands a public programme in spite of debate in Parliament and Government's attempts to explain it to the people. It is MediShield. MediShield was introduced only after debate in Parliament. The CPF Board sent to each individual CPF account holder a brochure in four languages. Yet 99% of Singaporeans do not understand what MediShield does for them. I think even this 99% figure is an underestimate! NTUC leaders have explained how MediShield works with the revised medical benefits options for civil servants. Yet each time I meet groups of union leaders in the public sector, I have to explain how they are covered for hospitalisation, and each time when they hear this and they are told that they may even pay absolutely nothing for this cost, their eyes roll over in surprise. Dr Aline Wong has explained the scheme in this House earlier this afternoon. Members will appreciate how complex the scheme is. If we conduct a quiz now among the Members of Parliament, I am not sure how many would be able to answer the questions correctly. So given the complexity of these kinds of programmes and policies, how should the Government reach out to the people to explain public policy? Though proceedings of Parliament are widely reported in the newspapers, few seem to have read or understood. Perhaps they may not be able to understand, even though they read. Perhaps more can be done through television, as suggested by Mr Bernard Chen, even though the proceedings in Parliament have been aired. I am afraid that using television will only work if the person doing the explaining is a captivating speaker and presenter. Serious programmes on television reach only a small audience. With an increasing number of channels to choose from, and more to come, a viewing public which looks more for entertainment than for education will simply switch channels with the remote controller, without getting up from their armchairs. The task of reaching out to the public is therefore a difficult one. It will require more creative means of presentation in the printed media, over radio and on television. In the unions, it means that it is insufficient to explain to union leaders only and rely on the media to do the rest. Grassroots union leaders in turn must explain to members. So the current "confusion" or "utter chaos" in the public sector on the revised medical benefits scheme can only be cleared up by department heads and union leaders explaining to all civil servants what those options are. The union leaders are already working on this and they are willing to work with the various Ministries and agencies of Government. The Singapore Teachers Union, for example, has given a detailed explanation to teachers through its publication The Mentor, and has commenced meeting union members by going to the ground. There is no substitute for face to face dialogue with the people if we expect them to be able to understand these complex policies. For other Government policies, it will require MPs to explain policies both to grassroots leaders, as well as directly to the people in constituency functions. Sir, I now turn next to the CPF Minimum Sum Scheme. We are in the midst of making an important policy on the adjustment of the CPF Minimum Sum. I am afraid that the debate has progressed too fast and too far. Before the public can understand why the Minimum Sum has to be adjusted, there is so much focus on the reverse mortgage proposal. We have to get the public first to understand why the Minimum Sum has to be adjusted, before we discuss the quantum of adjustment, or a reverse mortgage. Why should the Minimum Sum be adjusted? Do members of the public understand that they are living longer, and their CPF savings may not be enough to see them through their retirement? Do they realise how much they require when they retire to see them through? To gauge this, I have been asking union leaders what people do when they withdraw their CPF savings at the age of 55 years. These are some of their answers. Some use the CPF savings to pay off all or part of the remaining mortgage on their HDB flats. Others took the opportunity to renovate their homes. For yet others, the cost of the children's education is highest at that age, since their children are at junior colleges or the tertiary institutions. Indian parents use their CPF savings for their daughters' weddings. For Muslims, some of them are finally able to perform the haj. For low income daily-rated employees, the ownership of a Rolex watch is a sign of having arrived, so they indulge themselves with buying one. Others took the opportunity to holiday overseas with their families, and it seems that there is considerable pressure from family members for this. For those who have money left over, they place the balance in the bank, invest in shares, or property overseas. I am afraid there are also some who squander their money. I am told that a few frittered away their CPF savings by gambling. Others set up second homes in Batam or Hatyai, returning after they have been fleeced dry. I am told now China. Fortunately, the union leaders tell me such numbers are small. With all these demands on the use of CPF savings, will the balance be enough to see workers through their retirement? Union leaders know it is not enough. How much is required? Hardly anyone in the lower income groups knows. I asked NTUC Income to do a calculation for me. It is similar to a calculation published in the Asian Wall Street Journal recently, but the assumptions have been changed for our own local situation. NTUC Income tells me that when a person retires at the age of 60 years, a man can expect to live another 20 years while a woman 25 years. That is the average life expectancy at 60. Some live longer than that. What would he expect to have to spend each month, as a proportion of his last drawn salary? For a low income worker with a monthly salary of $1,000, I think 70% of his last income is not too much, and may even be insufficient. Suppose he is now 50 years old. If he has no cash savings, what must he put aside each month now in order to be able to live on 70% of his salary each month for 25 years when he retires? The answer is a staggering 98%! If he does that now, he has nothing to live on between now and retiring ten years later. What if he has $12,000, or one year's wages in cash savings? He will still need to set aside 87% of his wages. This is also not possible. What if he has five times his annual income now in cash, ie, $60,000? He will still need to put aside 41% of his wages for the next 10 years. But few will have such savings of the order of $60,000. This example shows that premature use of CPF funds will put retired elderly persons in serious financial difficulty if they are not supported by their children when they retire. When I suggested that this is the solution that the elderly would have to be supported by their children, there was an almost unanimous "No, we cannot expect them to support us!". Why? Because their children will be supporting their own families and paying their own mortgages. What should a 50 year old worker earning $1,000 a month do then to secure a reasonable life in retirement? The best option is to work longer. Suppose he decides to retire at 65 years of age, and his employer agrees to continue employing him, how will his situation improve? If he has no cash savings now, he will have to set aside 52% of his monthly income until retirement. If he has $12,000 in cash savings, he needs to put aside 44% for the next 15 years. If he has $60,000 in cash savings, then he will need only to set aside 11% each month. By working longer, low income workers will have a reasonable chance of financial security in old age. Therefore the thrust of our policy should be to raise the retirement age, and to help our workers to save. When we look at it rationally, the logical thing to do is to raise the withdrawal age of CPF from 55 years to 60 years. When I asked union leaders whether we can do this, one union leader very quickly spoke for all when he said: "Don't touch the withdrawal age! It is a bomb! If the withdrawal age is to be raised, we will have to quit and run into hiding!" It is sad that the withdrawal age has become such an emotional issue. Can we get Singaporeans to understand? Can we get the people to release the Government from its pledge to leave the withdrawal age of CPF at 55 years of age? I hope one day it will be possible. In the meantime, the next best thing we can do is to raise the Minimum Sum. The Minimum Sum, we must remember, is only sufficient so that retirees will not starve. It is insufficient to lead a comfortable life in retirement. Let us remember that. Knowing now how much we need to live on in retirement, and if workers are to have a roof over their heads, then the Minimum Sum should be set aside in cash, and not in the form of a property. Younger workers are in a more fortunate position. If their CPF savings are managed properly, they will be fairly comfortable, if they do not expect rapid upgrading of their homes, and/or ownership of a car. But even they will have to consider building up their assets, which they can liquidate when they retire. One way is by investing wisely. If they invest in stocks, over the long term they are likely to get better returns than from leaving the cash in fixed deposits. But investing is not the same thing as punting. Mr Chiam See Tong said last week that even the NTUC is fuelling the stock market by encouraging union members to play the stock market. Unfortunately, he either distorts, or he does not understand English. Since he is a lawyer, I assume that he chooses to distort. The very reason why NTUC is studying how to help union members invest wisely in shares is because they understand little of the stock market, and are the ones most likely to get burnt. And this is what the Straits Times of 11th October 1993, before the latest surge, quoted me as saying: 'The workers are those who understand the stock market least, and they can become caught up with stock market fever. We have a role to help them invest wisely, and not to treat the stock market as a casino.' Unfortunately, Mr Chiam is not here. But if he had read the New Paper of 6th January 1994 - and the New Paper's English cannot be any simpler - he would have understood NTUC's concern over workers punting on the stock market. NTUC's advice to union members is not to play the stock market, but to invest for the long term. Better still, get experts to do the investing for them. This means investing in unit trusts or NTUC Income's Investment Bond Policy or similar policies offered by other organisations. When investments are done wisely for the long term, then workers will see their assets grow in real terms. And the more assets they have, the better off they will be in retirement.

Sir, I rise in support of the motion standing in the name of Mr Loh Meng See. Mr Speaker, Sir, Singapore has done well. We can be justly proud of ourselves and what we have achieved. We succeeded despite not having abundant natural resources or huge land masses or a large workforce. We succeeded because we have the competitive edge - the Government and the people. Competitiveness is not just being able to give the lowest wages or the cheapest rentals. It is Government which is stable, honest and consistent in the implementation of its policies. It is people willing to work hard for what they want and adaptable to change. We have these ingredients, and we should therefore continue to do well. But will we, and can we? The present Government looks set to remain for a long time to come, but will our people be able to maintain and preserve their ethos of hard work and adaptability? I had lunch recently with a returned Singaporean expatriate in the hotel industry. He had just completed a six-year stint in Beijing. I asked him what changes impressed him most, and his reply was that the Singaporean worker's attitude had changed - no longer willing to be trained even on company time. I hope this is not pervasive. Perhaps he had returned at the wrong time when the wheel of fortune, that is, the stock market, had distracted one and all. As the region's economies mature, our neighbours' workers will soon catch up on skills and technology. New sea and airport hubs have been planned to get some trade to bypass Singapore. One neighbouring country has already set up another financial centre to give us a run for our money. At home, our domestic economy faces the prospect of hollowing out. We grapple with poor demographic figures even as our population is fast aging. We have to find enough people to defend ourselves and also to work at home and abroad. These were the long term issues we were asked to address when His Excellency, the President spoke to the nation. Sir, concern over our population trends was highlighted by the Senior Minister in his National Day Rally in 1983. Population control programmes which were necessary at the time were not hitting the right targets. Educated Singaporean females were having less children while the less educated continued to have more. An increasing number of educated females have remained single. Our fertility programmes, as the Senior Minister pointed out, had unwittingly set off profound changes on which we must think long and hard. Corrective measures, including packagings with incentives or disincentives, have only slowed the decline but not put things into reverse gear. Prime Minister Goh, speaking at the launch of the two books on "Singapore Women" and "A Woman's Place" last year, also expressed his worry over the persistent trend of increasing numbers of single females and decreasing numbers of children born per ever married woman, compounded by a high divorce rate. Marriage and procreation are very personal matters concerning the parties involved. But, to quote the new Minister for Health, "as the cock does the crowing and the hen delivers the goods," solutions to our birth problems must focus heavily on our women. It is not my wish that we impose our will on the Singaporean female. It is rather that we should appeal to her good civic sense. Ladies, if serious proposals of marriage from acceptable suitors come your way, please do not pass them up for the lure of your new found emancipation. And if you are married, please have two or more children if you can afford them, even as an act of national service. Last week, the hon. Member Mr Chia Shi Teck suggested that in order to swell our numbers, couples should have as many children as they can, even if they cannot afford them. The community can collectively nurture them through fostering. This form of irresponsible procreation is literally having others to carry your baby. It can only lead to welfarism and the crutch mentality, the very societal problems which we are fighting so hard to avoid. Nurturing is not just the provision of home, clothing, health care or a place in school. It is giving quality time to your children and providing a home environment conducive to the development of strong family values, such as filial piety, respect for elders, love and kinship, care of the young and elderly. 1994 has been designated the International Year of the Family. We must work towards making the family the basic unit of society in order to build a cohesive nation. The Chinese characters ( ) (Guo jia) for country best describe this - the nation as a large family of smaller family units. The Singapore Government is reputed for its low threshold of tolerance for marital infidelity from MPs and Ministers. Moral corruption is as bad as any other form of it. It is also a known fact that to enter this august House, one has to lead an almost monastic life, less the celibacy. I would rather that our parliamentarians not be given the same kind of silly indiscretions that have rocked the British Parliament and spoiled the chances of not a few American Presidential hopefuls. As good family people, MPs and Ministers will make good role models. The Minister for Trade and Industry, Mr Yeo Cheow Tong, and the Acting Minister for Community Development, Mr Abdullah Tarmugi, have set the pace. Strong family ties will help us to solve the kind of problems of a greying population without the need for the kind of legislation that Assoc. Prof. Walter Woon is now drafting. Just now we have also heard Mr Harun Ghani ask for more tax relief for children-in-law who are looking after their aged parents-in-law. Sir, it saddens me that when every time the subject of looking after aged parents is broached, the question of tax relief comes into the discussion and love and duty take second seat. In the 1990 Population Census Report, some interesting information has emerged. The age dependency ratios (ADRs) for those below 15 years of age from 1980 compared to 1990 are for the Chinese, 42 to 32; Malays, a drop from 49 to 45; and Indians, 37 to 35. The ADRs for those above 60 for the same period are Chinese, 12 to 14, Malays, 7 to 11, and Indians, 9 to 15. One conclusion from this is that while the Chinese are not replacing them as adequately as the other two races, they will only have a problem of having too few young to look after too many old in the future, while the Malays and Indians are already facing this problem today. The Government has already put in place measures to take care of some of these problems like affordable health care through Medisave and MediShield and the proposed increase in the CPF Minimum Sum, possibly not tied to property. But there remain some social and societal problems which are ethno-culturally biased. These may be better taken care of by the ethnic-based self-help groups like CDAC, MENDAKI and SINDA. They could extend the scope of their work beyond just helping those at the periphery to get on to the mainstream. Sir, Singapore has barely enough people for our home economy. The second wing economic diaspora will further strain our manpower resources. Selective immigration may temporarily solve our problems but is no long term solution. We have taken migrants from Hong Kong. Immigrants from Hong Kong are now returning from Canada and Australia as their adoptive countries are in recession. Will we suffer the same fate when Singapore is in crisis? More important than this is we cannot afford to lose any of our people through emigration. Statistics from the Registry of Births and Deaths show that from the year 1979 to 1980, there was an actual drop in the number of Singaporeans affecting all races, particularly those classified as "Others". They are probably the Singaporeans of Euro-Asian parentage. Their numbers fell from 50,000 to 22,187. It took almost four years for the population to get back to the 1979 levels. For the "Others", it has never recovered. As there was no natural catastrophic disaster which had exacted a high death toll, my assumption is that the attrition must have been from emigration. The reasons for this might have already been uncovered, if not, the figures bear a second look. Members may query the benefits of this exercise into a historical event. We can always take a lesson from history, as Dr Ong has also pointed out. Was it the harsh policies that caused this and were there perceptions of discrimination by the minorities? In the last few days of debate, there was a suggestion from some MPs that the Government may now be ruling more with the head than with the heart. Sir, as more Singaporeans proceed to work abroad, we should have a better tracking system so that the links then may not be severed and they remain Singaporeans at heart. Here, we can take a lesson from the Israelis. The Jewish community must be the most cohesive in the world. I have a Jewish patient who, despite being unwell himself, will travel to Israel every time a member of his extended family has a joyous or sad occasion, to celebrate or to share their sorrows. Jews around the world are known to respond to calls for enlistment when the country prepares for war. In peace, they lobby hard in foreign countries for their motherland. They form a tight network for trade and business. In conclusion, Sir, our only resource is human. Every Singaporean counts.

Mr Speaker, Sir, I rise to support the motion standing in the name of Mr Loh Meng See, thanking the President for his Address delivered on behalf of the Government. In his Address, the President emphasised on the long-term policies of the Government to position Singaporeans for the next stage of nation building. In the area of economics, the major thrust of the Government is to encourage Singaporeans to venture abroad, to develop trade and investment links with neighbouring countries, and tap the vitality and opportunities in a fast growing region. As stated in the Addendum on the Ministry of Trade and Industry, Singapore will step up its regionalisation thrust. The Regional Business Forum will be established for exchanging dialogue with the private sector, and Government regulations and financial assistance will be streamlined to facilitate overseas business operations. Currently, the Government has developed more than 60 assistance schemes and programmes that have benefited many companies. For example, from 1987 to 1992, over 57,000 Skills Development Fund cases, and $73 million in grants were approved for worker training. Since 1976, over $2.5 billion in loans have been extended to local enterprises to fund more than 12,000 projects under the Local Enterprise Finance Scheme. In addition, over $60 million in grants have been committed to support more than 3,000 projects under the Local Enterprise Technical Assistance Scheme. These are impressive records. However, these assistance schemes were designed from the 70s and 80s where the emphasis was on the development of local entrepreneurs who can build up supporting industries for the many multi-national corporations operating in Singapore. Since 1993, the Government has decided that Singaporeans should also be encouraged to venture abroad. The Government should, therefore, introduce more assistance schemes and programmes to help local entrepreneurs to go offshore. In view of the high production costs in Singapore, many local entrepreneurs are transferring their production facilities to lower production cost centres, like Indonesia, China or Vietnam and retaining their product development and marketing activities in Singapore. Is the Government prepared to give financial assistance to a local entrepreneur to set up a factory in China? Under current rules for the Local Enterprise Finance Scheme, the answer is no. Can these rules be reviewed? Mr Speaker, Sir, as the Government encourages companies in Singapore to build up an external wing by going offshore, we must not forget the plight of our local entrepreneurs as they will be forced to move overseas with the principal customers. They will need funds to set up their factories and machinery financing for the production equipment. They will need short-term loans to finance their materials for production in their overseas factories. These are just some examples of the many problems that local entrepreneurs will have to face when they go regional. As the President has said, "Fast growth in the region means more opportunities but also formidable challenges." The Government has successfully developed a range of assistance schemes and programmes to support local entrepreneurs for their domestic growth. The challenge for the Government is to revise these assistance schemes and programmes and to introduce new schemes to support local entrepreneurs for their regional expansion. Mr Speaker, Sir, with that, I support the motion.

Order. I suspend the Sitting and will take the Chair again at 3.10 pm. Sitting accordingly suspended at 2.40 pm until 3.10 pm Sitting resumed at 3.10 pm

Debate resumed.

Mr Speaker, Sir, I support the motion standing in the name of Mr Loh Meng See, Member for Kampong Glam GRC. Singapore has done well last year, chalking up an impressive economic growth of 9.8% despite weak economic performance of the developed countries. Many companies improved their profits significantly; some, a result of having ventured abroad in the region. Workers had good wage increases and bonuses as a result. The people had their assets enhanced through HDB Upgrading Programmes and the privatisation of State-owned business entities. The success of the companies and the people has been due in no small part to the visible hand of the Government. I would have been much happier if we had achieved the same degree of success with less Government support and intervention. It would be a signal that our people have matured, are independent and self reliant, and are able to compete here and abroad even without Government help. Let me clarify that I am not against Government support or intervention per se. Government intervention is necessary only when the free market fails, when the public good must be balanced against private interest. In the fields of education, health care, environment, defence, community development, Government involvement is necessary to ensure that the long-term interest of the country is taken into consideration. But within each of these areas can be found niches where private enterprise can and should be allowed to flourish. Hence, private schools, hospitals, clinics and homes for the aged should be encouraged and allowed to thrive to cater to the higher segment of the consumer market. In the area of public housing, the Government should concentrate on the lower and middle income housing, and not on executive housing which should be left to the private sector. What has disturbed me recently are incidents of people pressuring the Government to intervene even in situations where free market can and should be left to operate freely, eg, the COE tender prices and the share and property markets. The crutch mentality of the people seems to be: the free market is fine as long as the end results are to their liking. The volatility of these markets is, in my view, a mark of immaturity in our people. They seem not to be focusing on fundamentals that are sustainable in the long term, but appear to be driven by rumours and greed. They over-react. When things go well, they reap the benefits and take the credit for themselves, but when things turn sour, they expect the Government to step in and salvage the situation. On Friday, even Mr Chiam See Tong here was asking the Government to restore confidence in the stock market through verbal reassurance by some Government Ministers. The rise in prices in that cup of coffee or bowl of noodles at the hawker centres is another case in point. People seem to expect the Government to step in and control the prices. If the Government does so, should it not also control the prices at coffee houses and restaurants? Such expectation of Government intervention is totally undesirable. The retail situation is very competitive in Singapore. Even at the best or worst of times, without any impending GST, there would be some chicken rice costing $1.50 at hawker centres and others $15 at coffee houses in hotels. The people should be mature enough to decide for themselves where they would like to have their chicken rice and not expect the Government to bring all chicken rice down to the same price. This is the free market at work. I do not think the people in Hong Kong, for example, expect the Government to intervene just because prices at the corner shop have risen, whatever the cause. They are very independent and learn to fend for themselves. They have been brought up that way. Singaporeans too should learn to be self-reliant. The Government should not encourage this crutch mentality with too much intervention, otherwise, how can we compete and succeed overseas on our own? As our society matures and people become more educated, there should be less of Government in our lives, not more. The Government's role in a free market is not to control prices, threatening enterprise, but to ensure market competition through regulation of supply, and to facilitate perfect market information through education and efficient communication. This spirit of self-reliance and independence should be inculcated in our children early in schools. They should be taught to think for themselves and not rely too much on rote-learning and spoon-feeding by teachers, tutors and even parents. Transforming the mindset of our people is a long term problem which we should start working on now so that our people and our children will be more confident and self-reliant. With an increasingly borderless world, our people must independently compete with the best in the world. I firmly believe that the environment in which we nurture our people in plays an important part in whether they will succeed on their own. And as a first step, the Government can help by staying less visible and less pervasive in our lives.

( In Mandarin): Mr Speaker, Sir, I support the motion standing in the name of Mr Loh Meng See. On 12th January, 1994, the Feedback Unit conducted a dialogue session on the Presidential Address. I spent more than three hours discussing the substance and form of the Presidential Address with some 30-odd grassroots leaders, unionists and professionals. The notes of the dialogue session have been sent to the Prime Minister with a copy to the Acting Minister for Community Development. There are three important points raised at the dialogue which I feel deserve special mention in this House for the reference of our parliamentary colleagues here. Firstly, the vast majority of participants supported the raising of the CPF Minimum Sum. Some suggestions were also raised by the participants, such as the introduction of reverse mortgage, purchase of annuity for the younger CPF members, and higher interest rates for CPF Minimum Sum deposits. These, in conjunction with the raising of the CPF Minimum Sum, will enable the people to meet at least the basic cost of living upon retirement. Secondly, most participants also agreed with the Government's asset enhancement programme. However, a good number of them feared that the "Invest Singapore" campaign might bring about some undesirable social trends, such as encouraging people to "get rich quick", to involve in speculation and gambling, thus resulting in some of them being unable to concentrate on their work or studies. Thirdly, some participants felt that the Presidential Address placed too much emphasis on economics and neglected the non-materialistic issues such as family concept, personal moral values and culture. These are some of the views brought up by the participants in the Feedback Unit's dialogue session. My personal view is that given the present trend of emphasizing economic development, placing the focus on venturing abroad, upgrading the domestic economy and distributing wealth to enable our people to share the fruits of Singapore's success is only natural and correct. Venturing abroad will give us greater economic space; it enables us to make use of the ample labour supply, vast land area and rich natural resources of other countries to help us overcome the constraints of a small population size, limited land area and no natural resources. Furthermore, in the face of increasingly keen competition, we have to improve our productivity, to raise our technological level, and to move towards knowledge-intensive and technology-intensive economic activities. We must first be able to create wealth before we can distribute wealth. However, we must not concentrate on economic issues and neglect other issues. The cultivation of correct moral values should form an integral component of our long term policy. However, we find no mention of such issues in the Presidential Address itself, nor the Addenda on the various Government ministries, except the Addendum on the Ministry of Community Development which mentioned about the importance of "strengthening family". This is the first Address by our first Elected President, and this is the "International Year of the Family". If we fail to incorporate the cultivation of family concept and moral values into our long term policy, then people may misunderstand and feel that we are too enthusiastic on the construction of materialistic well-being ( ) and are neglecting the construction of our spiritual well-being ( ). We must realize that "Man does not live on bread and butter alone", and that "Money alone cannot build up the natural bonds and ethical relationships between members of a family" ( ). To an individual, his personal values reflect his character ( ). To a nation, its collective values represent its national spirit ( ). In fact, moral values are relevant to several issues mentioned in the President's Address. Let me elaborate. Firstly, if we have a strong family concept, everybody in the family lives harmoniously with one another, and all the children regard the looking after of their parents as their natural duty, then this will provide good security and protection for the elder citizens, in addition to the CPF Minimum Sum Scheme. On the other hand, if our young parents attach more importance to their family lives, then they would spend more time and effort in looking after and bringing up their children, instead of leaving them to the care of foreign maids or relying on television as baby-sitters. This would prevent the children from over-indulging in materialistic enjoyment, without self-discipline. Secondly, maintaining the spirit of diligence, commitment and job loyalty and the search for excellence, will correspondingly discourage people from gambling and speculating in the stock and property markets to the extent of neglecting their proper work and cultivating a "get rich quick" mentality which would well develop into a "casino syndrome" in our society. Thirdly, in venturing overseas, we cannot grudge our investors and businessmen for resorting to various business tactics to cope with the local situations. However, they should exercise great care to avoid yielding to desirable temptations. Apart from their economic gains, they should value the harmony of family lives, the image of Singaporeans overseas, and protect the national interest of Singapore. Fourthly, in this era of scientific and technological advancement, consumerism and rapid environmental changes, we should reaffirm our sense of dedication and sense of mission. Mr Speaker, Sir, perhaps I am a product of the "Dinosaur Age". I am still a firm believer that we should have a sense of dedication and a sense of mission. Only when we reaffirm the values of a sense of dedication and a sense of mission can we motivate the elites in our society to take up the noble responsibility to rule the nation. Of course, we cannot overlook the reality of "high growth, high rewards". But, at the same time, we should also emphasise the lofty ideals of our personal lives. When the world is tuned to higher and better material enjoyment, the sense of dedication and sense of mission of the elites are even more important. In fact, in our society, we still have a large number of community leaders, social workers, and volunteers in the educational and arts fields who are silently ploughing and weeding, holding on to their respective posts to serve society, and pursuing an ideal other than money. Mr Speaker Sir, our long-term policy is to ensure that when we march into the next century, we can still maintain our competitive edge. Our advantage comes from our collective organisational ability. This strength comes from two sources. First, the cohesiveness of our people and, second, the quality of our national leaders. If we have lost the proper moral values, if we are unable to deal with the short-term problems which are affecting the daily lives of our people, such as cost of living, cost of doing business, medical cost, COE and GST problems, etc., and if we are unable to narrow the differences of perceptions between our people and the Government, then the cohesiveness of our people will be eroded. At the same time, if we are unable to attract and retain a group of dedicated elites from our society to run the nation, then the quality of the team of Government leaders will gradually deteriorate. These will result in our not being able to maintain the advantage based on our collective organisational ability to compete with the rest of the world. This is the real underlying worry of our nation. Originally, I have wanted to make my speech short. But I heard our Minister without Portfolio, Mr Lim Boon Heng, sighing with emotion, on the difficulty of explaining Government policies to the people. I fully sympathise with him because I have spent almost a year with him, discussing problems relating to the cost of living.

3.25 pm Let me make one observation. As our people become better educated, it would be more difficult for them to accept our explanations on policies right away. First, they want to digest what they have been told and come to their own conclusions before accepting these policies. Most people, including the educated ones, would only be concerned with Government policies or measures only when these policies or measures affect them personally. At the same time, once they have formed an impression or even misconception of a certain policy or measure, it is not easy to persuade them to change their views, even if you place all the facts and figures in front of them. However, I would like to encourage Mr Lim Boon Heng and the other younger Ministers that although it is difficult to explain the policies, we have to continue to do so. I have some suggestions to make. Firstly, before any major policy is introduced, we should present the broad outline of the said policy in the form of a White Paper, a report, or in any other manner which would enable the Government to discuss with the relevant groups and to obtain their views or, at least, to hear what the public or neutral parties have to say about the intended policy. Secondly, we have to pay attention to the scheduling of major policies in order to avoid introducing too many major policies in one year. Mr Deputy Speaker, Sir, I am sure you understand what I am trying to say. In 1993 alone, we introduced so many major policies and measures. It is not easy for the people to digest them, all at the same time. Thirdly, when we introduce any of these policies, we should focus on the broad concepts rather than the details. Just now, taking the civil servants' medical benefits scheme as an example, Mr Lim Boon Heng asked how many of our Backbenchers in this House had understood the details of the scheme. Likewise, I would ask the Members on the other side, how many of them have fully understood all the details of the scheme. If even Members of Parliament could not understand the details of the civil servants' medical benefits scheme, how can we expect our grassroots leaders, trade union leaders and some other people, including members of the press, to understand these policies. Therefore, when we explain any Government policy, we must focus on the broad concept rather than going into the details. Finally, the people have to be fully and sincerely convinced ( ). We may have won a debate, but if the people are not genuinely convinced, then the policy is of no use. No matter how much time and effort you have spent to explain the policy, it is useless. We should recall that in the 1960s, and even the early 1970s, the educational level of our people was not high. Why was it that most of the people at that time had so much trust in our first generation leaders? This is a very important question! The most important thing is the people's confidence in the government. "Confidence" ( ) is the word! Just as it is said, "We can rest assured that whatever you do, it will be all right." This is all we need to achieve. The rest will be just a matter of details.

Mr Speaker, Sir, I would like to join my Parliamentary colleagues in this debate. I would like to thank President Ong Teng Cheong for his comprehensive outline of the Government's long-term policies for Singapore's next stage of nation building. I am also happy to note that, in pursuing our economic goals, the Government has not neglected Singapore's own social development. Its long-term policy, as stated in the Presidential Address, is to encourage self-reliance of the family and the extended family. I would like to urge the Government to conduct a comprehensive review of the issues and policies which have both a direct and indirect impact on the well-being of the family. The trends in marriages, divorces, the extended family structure, erosion of family values and the ageing population do not have an immediate impact. But over the long term, they have huge effects on our social fabric and the dynamism of our nation. Many of the developed countries are now realising the mistakes they made in the 1970s, and discovering the huge cost they have to pay and the difficulty of reversing these undesirable social trends. There is no better time to review our policies than this year, which is the International Year of the Family. We should take stock of emerging social trends in Singapore, and how the behaviour and personal choices of individuals can have an impact on society. What I am referring to are personal choices of whether to marry or not; whether to have children and, if so, how many; whether to live in an extended family or form their own nucleur family; how to juggle their time between work and family commitments; how to bring up their children; relationships between elderly parents, grown-up children and grandchildren; and how to lead a meaningful life in old age. Social trends Fewer marriages It is an established trend that more Singaporeans, both men and women, are choosing to remain single. According to the Census of Population of those aged between 35 and 44 years, the proportion of single men rose by a third, from 9.4% in 1980 to 15% in 1990, and the proportion of single women nearly doubled from 7.3% in 1980 to 14% in 1990. Those who marry do so later. In 1990, the mean age of marriage for women was 23 years, compared to 21 years in 1980. This trend is not unlike that in the European countries, where the mean age of marriage for women has risen from 23 years in the late 1970s to 25 years today. In the West, the decline in marriage has been offset by a rise in cohabitation. In Singapore, we do not know how widespread this practice is as there are no records. However, if we look at the results of the survey conducted by the Censorship Review Committee in 1992 to gauge Singaporeans' changing moral values, one-quarter of married respondents and almost half of single ones do not disapprove of cohabitation. So, will more and more Singaporeans adopt this liberal attitude? Trend towards unmarried parenthood A few years ago, a group of professional American women visited Singapore, and one lady above 60 years old asked me out of the blue if I would accept unmarried motherhood. I told her that it is a social stigma in our society to be an unmarried mother. She said that 30 years ago, when she was my age then, women in America thought like I did too. That was the 1950s and 1960s in America. By the 1970s, three-quarters of American women felt that it was not morally wrong to have a child outside marriage. Today, about 30% of American babies are born to unmarried mothers, a figure rising by one percentage point a year. In the European Community, the proportion of children born out of wedlock increased from 9% in 1980 to 20% in 1992. There is little social stigma attached to unmarried mothers now in the West. This shows that social consensus and moral values can change within a generation. Last year, the Straits Times carried a report on a handful of single, unmarried women in Singapore who want to be mothers or have succeeded in doing so. Is this an emerging trend? What are Singaporeans' views on illegitimacy and are these values changing? The Straits Times also carried a story on a family where three generations of women were unmarried mothers. Will boys born into such an environment grow up to be responsible fathers? More divorces Besides fewer marriages, we also register more divorces. The general divorce rate has increased from 4 to 6 per 1,000 married persons between 1982 and 1992, up by one-third. Generally, the divorce rate was higher among younger married persons. The divorce rate among those between 20 and 24 years old doubled from 8 to 17 per 1,000 married persons between 1982 and 1992. I have double checked this figure. In the 1950s, most American parents believed in putting up with one another in an unhappy marriage for the sake of their children. By the mid-1970s, the view was rejected. As a result, half of all American marriages ended up in divorces now. Are Singaporeans' views towards divorce also changing? Our statistics show that divorcees under the Women's Charter did so after about 11 to 12 years of marriage. On the other hand, divorcees under the Administration of Muslim Law Act were likely to separate after 8 to 9 years. They become single parents to their young children. Research in the United States shows that a child's emotional and psychological health is likely to be adversely affected by the breakdown of the family. A child from a broken home is likely to have emotional and behaviourial problems, to be poorer, to perform worse in school, to get pregnant as teenagers, to abuse drugs, to be in trouble with the law, and to be physically or sexually abused. Do we want that for our children? Breakdown of extended family structure In the past years, we have seen how extended families have broken down into several smaller nucleuses. The proportion of one family nucleur household increased from 81% in 1980 to 85% in 1990. Of the households with at least one family nucleus, only 15% consists of three or more generations. This is expected, as young couples prefer to set up their own homes instead of living with their parents. And HDB policies have been liberalised to cater to these aspirations. I understand that HDB also has schemes to cater to families who want to stay close together. To prevent further erosion of extended family ties, HDB should continue to explore ways to provide incentives for extended families to stay close to one and another, either in the same housing estate or even the same neighbourhood. For example, children should be encouraged to ballot for new homes near to their parents, or siblings could get flats within the same estate more easily. The breakup of the extended family structure means that the majority of young working couples do not have the help of their parents to look after their children, while the aged do not have the support of their children. Grandparents are also deprived of the valuable role they can play in inculcating the right values to their grandchildren. What are our children learning from their peers at school? Do we have youths who are groping blindly by themselves to find out what is right and wrong, what is socially acceptable and what is not? Do our youths come under the influence of gangs and secret societies in the hope of finding some friendship? Who are their role models? What are our youths learning from the mass media? What sort of behaviour and values are they learning from television, video, cinema, magazines, computer and video games, and pop music? Are they exposed to unhealthy pornographic and violent materials? The mass media can exert unhealthy influence on our vulnerable children. Unlike adults, children do not understand the difference between reality and artistic imagination. We must not allow unhealthy social mores to develop in the name of art. Frequent exposure to sex, violence and crime could confuse children into thinking that that is the real world, and many may start to imitate these actions. Were the two 11-year old boys imitating something they saw on TV when they so cold-bloodedly murdered a two-year old boy in England? The Board of Film Censors must maintain a high standard in screening out pornographic and violent materials. Our local SBC productions must not compromise moral standard for the sake of higher profits. It is regrettable to note that recent SBC productions have resorted to more sex, violence and ghost stories to boost viewership. Have we thought of the damage to our young? Parenting is an important part of family life. The ultimate responsibility for bringing up children rests with parents. They have to devote time and energy to take care of and communicate with their children. However, parents also need the help of schools and Government to inculcate values to the young. The emphasis in moral education should be strengthened in our schools. We can kill two birds with one stone by transmitting moral values through mother-tongue teaching. Mother-tongue lessons will be enlivened by interesting folk tales, historical stories and meaningful idioms. Problems of the aged Singapore has one of the fastest growing ageing populations. Today, one in 11 Singaporeans is 60 years and above. This will increase to one in four by 2030. In other words, while there are eight working persons supporting one aged person today, there will be only 2.2 working persons supporting one aged person in 40 years' time. With the breakdown of the extended family, more and more aged are expected to live with their equally aged spouse or alone. According to the 1990 Census of Population, about 9,000 old people (or 4% of the elderly population) live alone in one-person household. This is not an encouraging development. In 1992, there were 12 reported cases of old people who were not known to have died, until someone noticed their absence. Last year, there were 14 such cases. A recent study on suicide showed that more elderly persons have been attempting suicide, and many are those who lived alone in abject poverty. Is there a decline in values, such as filial piety? What can we do to ensure that our aged parents are taken care of by their children? We may need to address this problem seriously and urgently through legislation. CPF savings can help to provide some financial security for Singaporeans in their retirement. The average cash balance of CPF members between the age of 50 and 54 years old is about $39,000. Men tend to have more CPF savings than women, about $49,000. But are CPF savings enough, especially for those who have no other sources of income? If a member leaves a Minimum Sum of $34,600 in his account, he can draw from it a sum of $266 per month from the age of 60 till the principal and its interest are exhausted. This will be in 10 to 15 years' time. Is $266 per month too little? What if he outlives his CPF savings? And what about medical costs? How much do we have to set aside for old-age medical costs? The likelihood of hospitalisation for those above 60 years is two to three times higher than the average rate for the population. The average length of hospitalisation for the elderly is 14 days, almost twice that for younger patients. It has been estimated that a person spends about 80% of total life-time hospitalisation expenses in the last two years of his or her life. Therefore, it is crucial for those still working to plan ahead for retirement, and for those already in retirement, to assess their situation. How should we manage our funds? Should we continue to work beyond 60, or even 65? Can we manage? The family plays a central role in supporting the aged as they face all these challenges. Caring for the aged can be stressful, but meaningful. According to the Department of Statistics' Pilot Study on Composite Social Indices, family conditions deteriorated between 1986 and 1992 in that total fertility rate had dropped, divorces had gone up and so had the number of singles. We can say that we have a mixed report card on the health of the family. And if some existing negative trends persist, or worse, pick up momentum, the family structure will be undermined. I do realise that there are different departments under various Ministries which are overseeing the issues that I have talked about, for example, we have an Advisory Council on Family and the Aged under MCD, population planning, health care for aged under MOH, SDU under the Ministry of Finance (I do not know why Finance), censorship under MITA, and so on. We also know that all these very important issues are closely inter-related and policies in one area will have an impact on another. I would like to suggest that Government establish a high-powered executive ministerial committee to plan, review and coordinate policies related to the family, including issues related to our young, women, and the aging population. This standing committee could consist of Ministers from the relevant Ministries, supported by senior civil servants. This committee will provide the driving force to help solve these long-term problems more effectively. Government can only help Singaporeans who help themselves. Ultimately, Singaporeans have to decide for themselves what they can and should do to counter the negative trends. Singaporeans have to examine their values and decide whether to continue to cherish, respect and preserve the family unit. What will be the fate of the family as a time-honoured institution in 10 to 20 years' time? The answer will depend on the decisions of each one of us.

Mr Deputy Speaker, Sir, I support the motion to thank the President for his Speech at the Opening of this Parliament. We are well on the track to become a developed country by the year 2000. We have enjoyed continuous stability and prosperity for the last three decades. The President has called on us to prepare ourselves for the next stage of nation building and to do that, we must elect honest and competent Members of Parliament to form a good and clean Government. Many Members have spoken on the importance of ensuring dedicated and capable people coming forward to form a Government and none more eloquently and comprehensively than that by our Senior Minister, Mr Lee. It is no doubt that we are able to harvest the fruits of success now. The credit must be due to the leadership provided by Mr Lee's team and Mr Goh's team. Qian ren zhong shu, hou ren shou ( ), roughly translated, it means that the generation before us planted the trees, so that our generation can harvest the fruits. Therefore, it is important that capable Singaporeans, with the same commitment and dedication, continue the planting process so that new trees can take root and bear fruits for our future generation. When Mr Ong was elected President, my personal feeling was one of joy and relief that an able and upright person has been elected to the highest position in the nation. But at the same time, I am apprehensive because, since the last General Election, four senior Cabinet Ministers have left the Cabinet. They are Mr Ong himself, Dr Tony Tan, Mr Dhanabalan and Dr Ahmad Mattar, and later, in July, this year, Dr Yeo Ning Hong will also take leave. Although we have able and younger leaders to succeed them, nevertheless, as the Prime Minster has expressed, it is a worrying situation to lose so many experienced Ministers in such a short time. And if we do not have sufficient number of equally dedicated and experienced younger leaders to come forward, then our vision to be a developed country by the year 2000 may not be so easily realised. It has always been difficult to induce capable people into politics because of the stringent demand and the need for personal sacrifice. I remember that last year, we had listened to the Nominated MP, Dr Soin, arguing passionately about getting more women into this House. She even asked the Prime Minister to legislate to make it compulsory for women to be elected as Members of Parliament. I totally agree that we should have more women in Parliament and it is rightly so because 50% of our population are women. But if we are short of women Members in Parliament, it is definitely not because the Government has put up any obstacles. In fact, the Prime Minister has expressed that he would like to see at least eight or nine women to be elected into this House. So why then do we have so few women who are prepared to take up this challenge? Perhaps, Dr Soin herself can provide the answer since she is amply qualified and capable and believe so passionately in this cause and, yet, she did not come forward to seek election into this House. How then can we expect some other less committed to do so? For this, I must express my great admiration and respect for my fellow women colleagues, Dr Aline Wong, Mrs Yu-Foo and those who served in this House before, for having the courage and dedication to do something which they believe in, took up the challenge and came forward, not only to serve the women's cause but to serve the whole nation. Apart from having to ensure that young capable leaders are in place to continue the work of the first and second generation leaders, Singapore needs to maintain a cohesive society and Singaporeans need to build strong family units. It is disturbing to see the breaking down of family values in the west. It is more alarming that this trend is slowly creeping into our eastern society. I am glad that the Government has spared no effort in stressing the importance of traditional family values, one of which is maintaining that it is the husband's responsibility to look after the family needs. Unfortunately, this concept of family system is being challenged and has been interpreted or misinterpreted as subjecting our women to playing a subordinate role and even suggesting that this is the reason why young women are reluctant to get married. We all know very well that these young women who are not entering marriage belong mostly to the group who are better educated, more competent and, therefore, more independent. They are the least to have to worry about being made to be subordinate. In fact, it is this sense of newly gained independence that makes marriage become their secondary option. And, certainly, traditional values are not the cause of the decline in the number of young women wanting to get married. Sir, while there should be mutual respect and consideration between husband and wife, marriages should never be equated with forming a business partnership, that everything must be equal, equal share, equal duties and, therefore, equal profit. Marriage is a union. The main objective of this union should be raising a family, sharing in love and companionship with each other and to enjoy the joy of this union. It requires the traditional values of love, respect and understanding to make marriage work. Tolerance and even compromises have to be shown by each party from time to time. I think most of us would hate to see the practice of having to draw up pre-nuptial contract before marriage as it is now becoming a necessity in the west. The husband or wife has to choose his or her own role. If the wife chooses the role that puts more emphasis on bringing up children and take care of the home than in her career, it is because she feels that this would bring her more happiness and contentment in life. She can, in no way, be perceived as playing a subordinate role to her husband and definitely cannot be interpreted as being suppressed or deprived. In fact, perhaps it is this role that most women derive most satisfaction from life because there is no greater achievement than that of a mother who has successfully built up the family and nurtured the children into successful individuals. Let us not confuse traditional values by equating them with some old practices, like keeping concubine, and deliberately making women to have a lesser status than men, as in some societies. In Singapore, the Government has always ensured equal rights for the women. Hence, the Women's Charter. Let us not let the view of the vocal minority undermine the fabric of our society. This actually happens in the west and is likely to happen to us given today's highly developed communication technology, television has become one of the most influential media in our everyday life. While we cannot reverse the progress in communication, or it is desirable to do so, we should guard against undesirable influence whether it is from the west or self-created. Murphy Brown is, perhaps, very entertaining as a television show but I honestly cannot see many of our women in Singapore cherishing that type of lifestyle. But should any woman here want to choose the lifestyle, she is free to do so in Singapore. It is the silent majority that the Government has to protect and it is the Government's responsibility to give direction and guidance for moving the nation forward. We have made an impact in the world as a nation which is economically strong, politically stable, above all, socially cohesive. How far we can consolidate this position will really depend on how well future Singaporeans come forward to take up the challenge in nation building.

With the consent of Mr Deputy Speaker and the general assent of Members present, Question put and agreed to. Resolved, "That the debate be now adjourned." - [Mr Wong Kan Seng].

Mr Loh, resumption of debate on what day?

Tomorrow, Sir.

Resolved, "That Parliament do now adjourn." - [Mr Wong Kan Seng]. Adjourned accordingly at Four o'clock pm. Annex 1 - MEDISHIELD BENEFITS AND CLAIMABLE LIMITS (Cols. 249 - 250) Annex 2 - Reimbursement Computation for MediShield Plus Plan A (Class A), Reimbursement Computation for MediShield Plus Plan B (Class B1) (Cols. 251 - 254) Annex 3 - ANNUAL MEDISHIELD PREMIUMS (Cols. 255 - 256) Annex 4 - ANNUAL PREMIUMS FOR CO-PAY ASSIST (Cols. 257 - 258) tables - ANNUAL OUTPATIENT CO-PAYMENT UNDER OPTION B, INCREMENTAL CO-PAYMENT ON HOSPITAL BILL FOR OFFICER ON OPTION B, ANNUALISED INCREMENTAL COST OF HOSPITAL BILL UNDER OPTION B, ANNUALISED INCREMENTAL OUTPATIENT AND HOSPITALISATION EXPENSES UNDER OPTION B COMPARED WITH ANNUAL SALARY GAIN, REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS, ANNUAL INCREMENTAL MEDICAL COST OF OPTION B WITHOUT AND WITH CO-PAY ASSIST PLAN (Cols. 259 - 276)