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A Few Questions for the Health Minister

Firstly my commiserations on missing out on becoming the interim seat-warmer in waiting (at least until your boss LHL, whom you served loyally as PPS from 2002 to 2004, changes his mind yet again).

However the reason I am writing to you today is that I have grave concerns about red flags and discrepancies in your Ministry’s budget for 2022. This was passed by Parliament with little or no scrutiny by the Opposition yet it is now the single highest spending Ministry. By way of comparison Education received $13.6 billion while Defence got $16.4 billion. From an expenditure of $2 billion as recently as 2006 your budget has grown to over $19 billion in 2022, a nearly ten-fold increase. 92% of this is operating expenditure ($17.84 billion) so the money is not going to finance the increase in capacity which you laud in your speech to the Committee of Supply. In fact your speech is remarkably short on facts and figures.

If we divide your Ministry’s budget by the number of Singaporean residents we get a spending figure of approximately $4,750 per resident. I assume that all healthcare spending on foreign workers including Employment Pass holders is private and that the Government is not making Singaporean taxpayers pay for their healthcare. I would also argue that a more appropriate denominator should be the number of Singapore citizens and not include PRs, who should not benefit from subsidised healthcare as male PRs have not done NS. However I will ignore that for the time being.

Government spending of $4,750 per Singapore resident in 2022 compares with a budget of around £2,600 (or $4565 at current exchange rates) per person for 2022/2023 in the UK, the bulk of which goes to fund the National Health Service (NHS) which is free at the point of delivery to all UK residents. So the UK, with a publicly funded health service out of taxation) appears to be spending only very slightly more per capita than Singapore. As I am sure you are aware having studied at the London School of Economics, all visits to the GP are free and so are all specialist consultations and hospital operations including the costs of beds and surgery. There is a charge for prescriptions but many categories (the over 60s, the disabled, those with chronic conditions) are exempted

The Singapore healthcare system is of course not remotely as generous. The overarching principle of your Government’s philosophy is that Singaporeans must pay for everything because there is no such thing as a free lunch. Presumably the revenue collected from Singaporeans for healthcare (whether at poly clinics or hospitals) must go somewhere yet it does not appear to be shown in the Budget. I am guessing that the revenue is collected by MOH Holdings Pte Ltd, the company the Government set up to manage the public healthcare clusters back in the early 2000s. Why are the accounts not included in the Budget or at the very least available easily on the MOH Holdings website? Why the secrecy?

I have tried to gain access to the accounts of MOH Holdings through the Accounting and Corporate Regulatory Authority’s (ACRA) website but despite paying $26 out of my own pocket for the last set of accounts I was sent an extract with no accounts attached. My emails to ACRA pointing out the error and asking to be sent the accounts have gone unanswered. I also emailed MOH Holdings directly but was rebuffed by one Sheela Narayanan, who did not disclose her job title until requested. She then told me she was Deputy Director Corporate Communications. Ms Narayanan declined to provide the accounts merely stating that I could obtain them from ACRA.

I do not see why as a Singapore citizen I am unable to see the accounts of MOH Holdings and when I do pay for it I do not receive the information I paid for. I would be grateful if your Ministry would send me a copy of the financial statements of MOH Holdings for the last three years. I hope you will not rebuff me with the argument that MOH Holdings is a private company and therefore Singaporeans are not entitled to the information, which was the argument used by your senior colleague Lawrence Wong when refusing to provide Parliament with amount that the PM has paid his wife as head of Temasek.

I would like answers to the following initial questions (either from you or from the Minister of Finance Lawrence Wong) :

1. Why does the Budget only include spending by MOH and not revenues collected, either directly from Singaporeans or through their Medisave accounts or Medishield Life policies apart from the insignificant sum of $93 million? I am perplexed because your website shows that Medisave balances reached $110 billion as far back as 2020 and that Singaporeans used only $1 billion in 2020 to pay for direct medical expenses.

2. On your website it also states that over 90% of the cost of treatment in B/C class wards is covered by Medisave and Medishield (I presume the balance is covered by out-of-pocked expenditures by SIngaporeans). If that means the $1 billion withdrawn to pay for direct medical expenses then why is your Ministry requesting a budget of $19 billion and $17 billion for operating expenditures? It is difficult to believe that the Ministry’s healthcare expenditures per Singaporean resident could be so high and more than in the UK, given that the proportion of over 65s in Singapore is lower (under 16% compared to over 18% in the UK) and the cost of manpower (except possibly doctors) is so much lower.

3. Your Ministry has budgeted $9 billion in transfers to institutions and organisations in 2022. I assume the bulk of this goes to MOH Holdings. Given that Singaporeans pay for the bulk of their healthcare through their own savings, Medisave and Medishield, It seems likely then that MOH Holdings is running a substantial surplus. What is happening to this money? Is it being transferred directly to GIC or Temasek or used to cover losses elsewhere? It should be easier to answer these questions once you send me the accounts for MOH Holdings.

4. Elsewhere on your website it says that Government healthcare expenditures include spending from endowments and trust funds yet this has not been broken out in your Ministry’s Budget. What contributions came from the Merdeka Generation Fund, the Pioneer Generation Fund, the Eldercare Fund, the Medical Endowment Fund or the Long Term Care Support Fund? Why are these being included in the Expenditure estimates if the money has already been set aside? I have previously expressed my concern that there seems to be double counting. Money is set aside in earlier years but then is expensed against revenues a second time in the Budget. I would be grateful for your reassurance that this is not happening. If this is not a question you can answer perhaps you can pass it your senior colleague Lawrence Wong.

5. I note that the increases in healthcare expenditures in recent years seem to mirror the increases in the Net Investment Returns Contribution. I would be grateful for your reassurance that there is no connection between the two and that the Government is not trying to deceive Singaporeans through matching book entries with no new money actually entering the system.

I look forward to receiving answers to my questions. If I have made any errors then the responsibility rests with me alone. Regrettably I do not have access to the resources that you and the Finance Minister possess or even that available to the Leader of the Opposition. I am sure there is a perfectly innocent explanation for why Singaporeans are paying so much for healthcare (through both taxes and direct expenses) and have accumulated so much in apparently unnecessary Medisave balances that are loaned to the Government. If you fail to answer my questions I will assume that there is something that you do not want Singaporeans to find out. Much as I would like to believe that the PAP’s mantra of “ownself check ownself” leads to incorruptible and efficient government, it defies logic and reason for Singapore to be unique among all the world’s one party authoritarian states ruled by one man particularly as your government refuses to provide the information necessary to make sure it is properly accountable as it would be in a democracy.

 

Kenneth Jeyaretnam

 

I’m a Singaporean economist who became an opposition activist. I blog to provide an alternative to the porkies that the Pinkies tell. It just so happens that my alternative is the truth. That’s why I’ve never been sued in any civil or criminal court no matter how hard hitting my criticism. I’m quoted and interviewed and asked to speak across the world but largely censored in Singapore in an effort to silence my political opinions. The left hate me because they think I split their vote and because I eschew their outmoded economic models. Models that don’t work. The Right and the Conservatives hate me because I’m a liberal. I’m not sure what the middle think of me. I don’t think there are more than a handful of people in the middle, here in Singapore. I’m a Singaporean born and bred, dual heritage, my parents Singaporean established here before the State of Singapore was created. I’m not Eurasian. I read economics at Cambridge and could be broadly described as from the Keynesian school but I believe in interventions. I was formerly a successful hedge fund manager. After economics and politics my greatest interests are history, film and Makan. I run but I run so I can eat like a Singaporean.

 

 

yyy
READER COMMENTS BELOW

12 Responses to “A Few Questions for the Health Minister”

  • P Against People:

    “I am perplexed because your website shows that Medisave balances reached $110 billion as far back as 2020 and that Singaporeans used only $1 billion in 2020 to pay for direct medical expenses.”

    With this much balance, the investment return is many times the withdrawal. Medisave does not need any more money from us, forever.

    An old man offers a little girl a big nice candy and takes away something from her.

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  • Harder Truths:

    Ownself pay ownself. What they say is for the citizens goes back into their pockets. We are never shown where money ends up. We know we have to foot the bill. So all the government civil servants and MIW divide the loot among themselves. That is the only answer that makes sense. If I am wrong let them prove it to us. But that will never happen.

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  • panyusg:

    Good questions..

    I hear military jets flying overhead six days a week. Plus all the overseas military training in USA, Australia, Taiwan, Germany, etc. All very expensive plus Spore has high quality equipment. Hence, I can understand the need for a large Defence budget.

    The survival of Spore in the event of an external aggression is the defence force.

    As for MOH, does Spore’s survival depend on how well we fought Covid? Or the billions spent on vaccines and medical supplies? MOH did not pay for wage subsidies, business subsidies, etc. They came from the MOF.

    So, I wonder how MOH is spending such a huge budget. I heard there are 11,000 beds in public hospital. So, $19 billion equates to spending $1.7 million to maintain each bed? Wow…

    The Polyclinics are not five-hotel premises. And MOH is not doing medical research either.

    I hope we get some answers.

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  • Stupid Singaporeans Vote PAP:

    That is why they called it Annual Budget, not Annual Report.

    IMHO, using a company’s to compare, MOH is just a part of the Company like Sales & Marketing Department, for example. Annually, they are given a budget to spend to bring in sales & to generate revenues for the Company.

    The Sales & Marketing Department Annual Report will detail how much had been spent & how much Revenue had been generated to the Company. The result is their +/-KPI.

    The Company Annual Report is an important document be it a private entity or public listed company. It is the CEO’s responsibility to provide the Annual Report for filing and make public.

    Both are reporting to the shares holders and or stake owners, and must submit to ACRA for taxation purpose and also for appropriate legal actions to be taken if the CEO misappropriated or like monkey “put the hands into the cookies jar”.

    The public listed is more stringent. It has to provide Quarterly Reports. They are scrutinized earnestly by all. This is how the system is set by the law of the land, where NO ONE is above the law.

    In case, if this is not done and the law is broken yet The Law is not taking action since the law has been broken, the system is deemed to be corrupted. Which also put it in layman term means the Ownself-Check-Ownself fellow is not doing the ownself check ownself thing.

    It can only happen because the CEO is the boss of The Law. And if the law is set legal that the CEO can be The Law, then what can the shareholders do? THE SYSTEM IS DEEMED NOT CORRUPTED.

    The shares holders can only kick out the CEO once every five years. But if the shares holders keep reappointing him, don’t blame the CEO, blame the shares holders. You have given him so much power that you are the fault, not him.

    You also give him so much power to change the law, to suit him, without your consents. A day will come if he changes the law to do away the once in five years VTO thing. Then, a new North Korea is born. You blame yourselves, not the CEO.

    Your investments in this entity is not generating profits for you. FOOLS

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  • Stents Are Consumable Items ?:

    I may need to go for an operation in a government hospital probably requiring the use of stents. I went to the Customer Service Department to find out the details. The clerical officer there told me that the cost is around S3.000 and there will not be any subsidy for it as stents are considered as consumable items.

    Would anybody request for stents if there is no urgent need for it ?

    Is the information provided correct ?

    Tech: Same here in China. Stents are not covered by medical insurance and I need to pay the full cost for it and imported ones are much more reliable but expensive.

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  • Transparency:

    Transparency is still the best policy.
    Make all information available and let the experts explain in simple term to the Citizen to build trust.
    Truth will always prevail eventually…

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  • Militarymyass:

    Training and buying expensive war items is “PLAIN STUPID”

    ONLY BENEFITS UNCLE SAM, BUT THEN AS GOV PUPPET OF SAM, WHAT CAN WE DO, EXCEPT BEING COOK WITH SLOW FIRE IN POT ….

    our flats has bomb shelter, every floor, keep you safe ? No water, food, lifts to every floor , but not yours or downstairs neighbour ???

    Better die first, right, or wait for returned of our f18′s, what a sick JOKE !!!

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  • illiterate pap voters:

    Transparency:
    Transparency is still the best policy.
    Make all information available and let the experts explain in simple term to the Citizen to build trust.
    Truth will always prevail eventually…

    pap has many things to hide.

    practically everything pap says is a lie.

    1, all schools are good schools? pure lie.

    2, cannot eat degree? which pap Lj or pap Cb does not send his or her children to overseas U if they can make it?

    3, INDIAN is malay for the pap selected president.

    4, INSIDE 200m is not within 200m.

    5, GST is to help the poor.

    6, aliens create jobs for cotton sheep.

    7, HDB is an asset which grow in value if pap is voted into power.

    8, etc.

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  • Trust only myself:

    KY should be in parliament getting all the answers we need……of course excluding unthinking Singaporeans who only need to pay and pay.

    If the minister does not reply to KJ, then obviously……..this is what many people already know of the whole group, dishonorable and liars…….

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  • MarBowling:

    THINK we shouldn’t disturb Sneaky-Eyed Ong Yee Con at this period of his life: since the Holee announcement that Son of Wangsa and NOT HIM is chosen as the LEEDERSHIT of the 4G, he must be experiencing the WORSE period in his entire political career!

    After doing soooooooo much(volunteered to squat on the Mother of HOttest Seat as the Hell oops Health Minister, a post that subject to chiding and scolding and Kenna labeled as the MOST HATED Minister of the PAPIGS)for his Big Boss Mai Hum, and in the end, this is WHAT HE GOT AND KENNA!

    Heaven has eyes. Man proposes god disposes!

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  • Pioneer speaks:

    All that lky instituted values gone,
    We are told we will get military hardware togive a bite to those who push us around now upgrading of hardware more like keeping up with joneses

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  • KJ is way out of YouCon’s league, all the policies are not even formulated by him, how one can expect him to answer such hard questions?

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