Text of Sr Consultant Dr Paul Tambyah’s speech at SDP’s Rally on 5 May 2011
Friends, fellow Singaporeans,
My name is Paul Ananth Tambyah. I am a doctor working at a major local university hospital. I am not a member of the SDP partly because I work in a corporatized civil service organisation and as you know, civil servants cannot enter politics unless they are unemployed. I am grateful to the SDP for giving me this opportunity to be a guest speaker at this famous historical platform. I am speaking entirely in my personal capacity. I am not a politician. I am still doing my national service and in fact have two SAF 100s sitting in my inbox despite the fact that my job involves saving lives.
As a medical doctor, I come into contact with patients on a regular basis. I hear them tell me that in Singapore, you can afford to die but you cannot afford to get sick. I see people who have to sell their homes and move into rental flats to pay for their medical bills. Do you think this is right?
They are Singaporeans just like the Health Minister and his millionaire colleagues. If they need a bypass, they have to pay much more than $8/- in cash. At the very minimum, they have to pay cash for the Specialist Outpatient Clinic charges before admission. I have written letters, articles, posted on Mr Khaw’s facebook page, met him in Feedback sessions. He gives me polite answers but nothing changes. That is why I am here today – To ask you to help me to send him a message. I just wanted to send him a simple message to have a heart for Singaporeans who are sick. Now I realise that the message that you are sending is a little stronger – you want to send him somewhere.
Mr Khaw is a good administrator. He was the CEO of NUH when I was a medical student and ran the hospital with a much smaller staff than any of the current restructured hospitals. But he seems to have run out of ideas for Singapore’s healthcare. It is good that he is finally listening to the voice of the people but perhaps it is a little too late. He might need to seek alternative employment and would make a very good administrator of a nursing home in Johor Bahru.
The problems with our healthcare system are known to you all – mostly they are about money.
The major source of healthcare financing is Medisave – the first of the three Ms. Most patients in hospital are elderly. They have little in their Medisave accounts and depend on their children. Fortunately for that generation, they had many children and their children’s Medisave can cover most of their hospital bills. My generation however, is the “stop at two” generation. We have even fewer children ourselves. When we get sick, who is going to be able to pay our bills if we depend primarily on Medisave as our own Medisave is depleted for the previous generation.
Medishield is a compulsory health insurance program that we all have to pay into from the time we are born. Problem is that it excludes congenital illnesses and mental illnesses which affect 5% of the Singapore population. It is the only national compulsory health insurance in the world that practices such cherry picking.
Medifund the endowment fund is limited to those who have already sold their homes and exhausted their children’s Medisave. Every year it is not fully utilised as it is so restrictive.
These problems however, are more than just theoretical ones. They affect the lives of ordinary Singaporeans. A Patient of mine has an infection that has caused him a stroke. He needs medication that costs more than $250 a day. There is no subsidy for this medication . It is recommended in all the guidelines including local guidelines. If he does not take this medication, he will most likely have another stroke and could even die. I tried to help him by appealing to the medical social worker. We received the reply that he was unlikely to get help as he lives in a private condo with one of his sons. The other five siblings are not well off but this one son living in a condo disqualifies this citizen of Singapore from financial assistance. We even went to the extent of writing a prescription so he could buy his medications in Johor Baru but this did not work. How many people do you know living in condos with their own families can afford to pay $250 a day or $7500 a month for medications for three to six months on top of the needs of their own families??? There is something seriously wrong with our system.
The SDP has an alternative proposal. It is a well thought out document and can be crystallised into a number of key points. First, increase the investment in healthcare to first world levels. In fiscal year 2009, the Singapore government spent only 1.4% of GDP on healthcare – the lowest in the developed world. This is partly because our population is still young but it is also because such a large proportion of healthcare costs are borne by the people – you and I – mainly through our Medisave – our own money. One of the key elements in the SDP plan, their shadow budget and in their economic plan is raising the healthcare budget significantly up to three times.
Second, focus on primary healthcare by bringing care to the people using nurse practitioners and allied health professionals in void deck health centers. These do not need to be run by doctors – nurses and physiotherapists and occupational therapists can manage chronic illnesses much more responsively and cost-effectively.
Third, reduce the crunch on healthcare workers in public hospitals by allowing GPs and specialists to work in the public hospitals. Singapore does not really have a shortage of doctors (unless our population really gets to 6.5 million) – it is more a problem of maldistribution. Public hospital doctors and nurses are overworked and overstressed. Doctors and nurses are leaving the public hospitals en masse because of work conditions. Once they leave, however, many GPs end up with problems paying the exorbitant rentals demanded by the HDB and other landlords. They thus have to raise charges or are forced to do cosmetic procedures. These hard working skilled Singaporean GPs could be better deployed in our public hospitals instead of depending on overseas foreign medical staff who may not speak the local languages.
Healthcare is not the only area where a message needs to be sent from the people of Singapore. My 73 year old mother has dedicated her entire adult life to the support of disabled children because she believes that every child should be allowed to develop to their fullest potential regardless of disability. She started Singaproe’s first school for multiple disabled children and the first program to comprehensively integrate children with disabilities into mainstream schools. She was Singapore’s woman of the year in 1994. How much did she get paid for all this? Nothing! We were fortunate that my Dad worked hard and had a good job but she worked tirelessly, often late into the night because of passion and love, not for money or power. Right now, her major campaign is for disabled children to be included for compulsory education in SG. This is what the parents want, it is only fair. In fact, it will save the government money in the long term if all disabled children are educated and are less of a burden on society when they grow older. But this is something that the current government does not seem to understand. As we have seen with Jee Say’s economic masterpiece, a government that is obsessed with annual KPIs and short term gains,cannot see far enough into the future. They cannot see how an investment in people can bring Singapore up to the next stage of development in the long run.
Vote wisely this election for yourself, your children, your grandchildren, your neighbours, young , old, Sick, well, we are all Singaporeans. Do not be afraid that someone will track your vote. It is impossible. They cannot even catch a limping man in a baju kurung swimming across the sea with a rubber ducky how are they going to track down the more than one million Singaporeans who will vote for alternative parties on Saturday! Like Mr Tan Jee Say, I voted for the opposition the last time I voted. In 1991, I voted for the Singapore Democratic Party. Nobody knew how I voted. I have received several promotions in both work and even in my reservist unit. Last night, I spoke at the Rally in Sembawang. No one in authority called me up to tell me that my career was over. My Dean and Vice Chancellor are good and reasonable people and they value a diversity of views as they know that this is good for Singapore. Finance Minister Tharman has said on TV that it would be good for Singapore to have a strong opposition.
My time is running out. These are excellent people here in the SDP lineup. Like many in the PAP, they want the best for Singapore. Unlike the PAP, they do not demand huge financial rewards for serving the country. They also have a very different vision of how to achieve the best for Singapore. It is not a top down, “we know better” approach but it is all about you. Two weeks of campaigning have made the government finally listen to the people – make unprecedented apologies, take notice of the issues. Think what five years could do.
Dr Vivian Balakrishnan is an excellent eye surgeon. Singapore needs good eye surgeons. You can help return him to clinical practice. I wish I could vote in Yuhua, Bt Panjang, Holland Bukit Timah or Sembawang but I live in Tanjong Pagar. I was denied the right to vote by 35 seconds., That is the Singapore of today. IT does not have to be the Singapore of tomorrow. The future is in your hands vote wisely. Thank you.
