Tuesday, May 17, 2011

Population issues....

Last year when I did the facile estimates of our population breakdown, it was more for fun than anything else. I did not realize then how important it was going to be.

The 2010 census results confirmed that in 2010 there were a total of 3.23 million Singapore citizens, out of a total population size of about 5.08 million, i.e. roughly for every 3 people walking around the streets of Singapore, only 1 would be a non-citizen. That's really not so bad. But these computations do not make a distinction between local born Singaporeans and immigrants. In my previous estimates, in 2009, there could have been as much as 500,000 immigrant Singaporeans since 2000.

But how many of the 3.23 million citizens can vote? The census is not really clear about how many are above 21 years of age, but a reasonable estimate from their data might be about 75%. So that would give approximately 2.4 million. If we consider the PAP's electoral performance of about 60%, PAP supporters number only about 1.4 million, and have an electoral advantage of only about 500,000.

That's really a remarkable coincidence isn't it? Could it really be that the PAP's electoral advantage is essentially comprised of immigrants? This would not be far from the truth if we accept the argument that immigrants tend to vote conservatively for the ruling party. If that is really true, then the reality is quite horrifying. Has the PAP support among native Singaporeans eroded so substantially - that only 1 in 2 native born Singaporeans support the PAP?

If the above is true, it will only mean that the PAP's hand will only strengthen in time as our population growth for this coming electoral cycle will primarily come from immigration. Unless their popular support among native born Singaporeans continue to erode. Even so, it would be hard to see the erosion of support among native Singaporeans exceed the growth of immigrant support.

I am not at all suggesting that the PAP has adopted a cynical electoral strategy of propping up their flagging support through rapid immigration. But the reality of our population changes do suggest that the opposition cannot keep playing to the fears of native Singaporeans against the growing size of the immigrant population. It will be a losing cause. To survive and succeed they will have to reach out to and represent ALL Singaporeans, native or immigrant.

And what of the native Singaporeans? I am afraid all indications are that we will go the way of the dodo bird. We are a shrinking and disappearing entity. The new orang asli. Just like the peranakans before us who have all but disappeared, and only kept alive by 'acting cute', and support from the tourism industry.

Perhaps Singapore needs a bumiputra policy?

Thursday, May 12, 2011

The problem with giraffes....

For more discussions of giraffes.... see here

The unbalanced development of the giraffe's anatomy led paradoxically to a situation where his neck became too long for his legs. Although the long neck enabled better reach of the high leaves, his neck became too long to enable easy reach of the low lying water. Bizarre but true.

This tends to happen also in organizations where there is an unbalanced over-fixation on certain parts of the KPI, and and losing sight of the original mission. It's just too easy to chase after certain KPIs. People become comfortable and predictable.

George Yeo was spot on in his observation that from time to time, it is necessary to shake the box.

Wednesday, May 11, 2011

The PAP's new clothes......

Although Hans Christian Anderson popularized the story of the Emperor's New Clothes, the story actually did not originated from him. The story was rather, adapted from a Spanish original in the El Conde Lucanor (1335). Anderson's creative input was apparently to alter the punchline of the story to that of an innocent child blurting out the awesome truth: "But he isn't wearing anything at all!"

I couldn't help thinking of this as I read Mrs Lim Hwee Hua's comments of the recent elections:"We had spent the last five years working hard, trying to understand - in the areas where there are gaps - what the problems were, what the deficiencies were, and to address those," she recalled. "We have also, of course, been trying to engage the residents on some of the current issues."

"It is a surprise for us that the resentment is so deep and the unhappiness is so deep." In fact, it was only during the campaign, that "we began to fully appreciate the extent of the unhappiness and resentment towards the Government, hence the pledge by the PAP team led by Mr George Yeo for us to have a strong role in the transformation of the PAP itself."

One cannot really deny that the PAP MPs do work hard. And they are generally very good at what they do. But for Mrs Lim to admit so candidly they were caught by surprise at the level of resentment and unhappiness on the ground is indicative of how badly they had been betrayed by the people they surrounded themselves with. With their huge machinery and wide range of grassroot organizations, feedback channels, how can they not know?

They are not and will not be the only emperors who get be caught out by the sycophantic crowd. There will always be self-serving sucker-uppers who seek only to further their own fortunes by selectively telling their masters the 'truth' they want to hear.

Perhaps the first step in the transformation of the PAP is to weed out these self serving elements from within.

Tuesday, May 10, 2011

Doing the right operation..... ala Dr Vivian Balakrishnan

Dr Vivian Balakrishnan provided an interesting analogy of the consultative approach he advocated for the PAP in the future.

Stressing the value of communication, he said: "It's not good enough just to do the right operation ... It's very, very important to talk to the patient - to explain these choices and the different trade-offs and make sure the people of Singapore understand this and participate more actively in the decision-making process."

Words of wisdom. Lessons learnt .... apparently.... until you note the first part of what he actually said: "....It's not good enough just to do the RIGHT operation".

So what he actually meant was that the PAP was right all along, and that the electorate had misunderstood all along. The PAP only failed in so far as it did not persuade the electorate of its 'rightness'. Informed consent to him, is to persuade the patient to agree to the correctness of the solution administered. Really?

Sodesne !.... And all the while I thought they were going to be truly more consultative.

To be fair, his boss, PM Lee had in the post-election press conference hinted at a future more inclusive relationship with the electorate: "And that means not only the Government working hard on its own with a population of passive but engaging Singaporeans in the more difficult decisions and trade-offs which governing Singapore involves. There are often no easy choices and the more we can appreciate this and grapple with the dilemmas and the trade-offs together, I think the better the answers we'll come up with, and the more we'll be able to have workable solutions."

I for one am truly hopeful that there will be a reformed PAP that will seek to lead rather than rule. They have done a magnificent job thus far as rulers, but I want much more than that. I really want to see them enter into a new social contract with Singaporeans, one that includes a greater degree of engagement and involvement in decision making with respect to critical problems. But the real deal-breaker is whether they trust Singaporeans enough to be transparent in their decision making processes. Or whether they will just continue to pretend to be consultative, but secretly (well, not so secret...) go on believing they have the only truth and only real solution, and just work harder to convince Singaporeans to be compliant.

I think that would be a disaster.

Friday, May 6, 2011

I am proud of you, Singapore

For the first time in many years, I can say I am proud to be a Singaporean. Not just happy to be a beneficiary of GDP growth, but actually proud to be witnessing this exciting political awakening in Singapore, and this spontaneous outpouring of passion and nationalism around GE2011. True, the nationalism at times sounded somewhat xenophobic, but I don't believe the true emotions behind all that bluster about foreigners truly stems from xenophobism.

Specifically, I am so pleased to see

a] the relatively "clean" campaigns that all the parties have been running. True, the ruling party has had more than a moderate excess of campaign advantages on their side, but I think this has been relatively 'muted' (or not as effective) during these elections. Certainly there has been a minimum of personal attacks launched;

b] the PAP come to terms with the heart behind the cold rationality of their otherwise effective policies. True, this has been more forced upon them by the strong opposition showing than spontaneous development from with the party, but it is better this than not at all. I just hope that this is a true indication of changes within the party logic so that we will see a more wholesome PAP in the future;

c] the ability of the opposition to attract better qualified people into their fold. Particularly surprised and impressed by the ability of the SDP to re-engineer itself away from the self-destructive unnecessarily combative antics of their leader.

d] the emergence of a true-blue Singapore folk hero from the ranks of the opposition parties, such as Mr Chiam See Tong. He has so much love and respect from us all, and he will be so much missed when he finally retires. The sad reality is that he has run out of time, but this should not detract from his immense achievements on behalf of all Singaporeans;

e] the increasing confirmation and acceptability of Mr Low Thia Khiang, also Ms Sylvia Lim as clear definitive opposition voices on behalf of us all. He is another hero in the making, but not yet;

f] the public participation of professionals such as Assoc Professor Tambyah on the opposition platform. There had always been constraints for professionals within gov and quasi-gov institutions to be seen publicly consorting with the opposition, so Assoc Professor Tambyah's very visible participation in opposition politics is a significant milestone and very much welcomed. I truly hope that MoH will not be reactive and start to clip his wings. That would be a a monumental mistake, I think. Certainly the public will watch and pass judgement on such vindictiveness.

g] the emergence of online The Temasek Review and The Online Citizen as alternative voices for the mainstream media. Thank you guys. Please soldier on and do not give up.

h] and most heartwarming of all was the demonstration that the pledge taking can be such a stirring and emotional event as seen at the opposition rallies. Thank you so much to the opposition parties for making use of the pledge in that way (yes, they were making use of it, but thanks anyway). For too long, pledge taking had come across as formal, dead and uninspiring. Almost as if we were being punished.

So it is truly a watershed event, this GE2011. Congratulations Singapore. I am so proud, whatever the outcome.

Thursday, May 5, 2011

The Singapore Pledge, as never heard or witnessed before

The Singapore Pledge

One of the amazing and most memorable things about this GE - seeing the Pledge taken as passionately and so committedly as never witnessed before in all the years since independence.

And this coming from an opposition rally.

Where and how did the PAP get it all so wrong?

Associate Professor Paul Ananth Tambyah's speech at the SDP rally

I am proud to be able to post a link and copy of Assoc Prof Paul Ananth Tambyah's recent speech here on this blog. Hope it reaches a wider audience because of this.
Assoc Professor Paul Ananth Tambyah's speech video

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.