Archive for June, 2013

One word cannot describe what being Singaporean means

June 26, 2013

I refer to the 9 May 2013 Straits Times report of its current events talk at VJC [1].

In response to a question about preserving national identity, Ms Zuraidah from the Straits Times asked the audience to say in one word what it meant to be Singaporean. From the multiple responses she obtained, Ms Zuraidah concluded that being Singaporean is different for different people and that the Singapore identity is fluid and can change over time except for fundamentals like multiracialism, mutual tolerance and respect.

Does the observation that different people use different single words to describe what being Singaporean is means that being Singaporean is different for different people? So if we ask several people to describe an elephant using just one word and they use different words like “big”, “heavy”, “tusks”, “trunk” and so on, the elephant therefore means different things to different people? That would be most disingenuous. Clearly the elephant means the same thing to most people but its effective description requires more than one word.

Ms Zuraidah should have followed on by asking the audience whether each of the single words thrown up like rojak and kiasu indeed describe what being Singaporean is. If the words struck a chord with the audience and they collectively agreed that the words describe what it means to be Singaporean, then we have a set of words that collectively describes what being Singaporean means and that reflects our national identity.

Fluidity is not a given but depends on the immigration tap. The more the immigration tap is turned on, the more fluid the national identity becomes and the more time it will take for the identity to set. The notion that the Singapore identity is fluid and can change while multiracialism and mutual tolerance / respect cannot suggests artificial elements at play preventing change amidst fluidity. But who should decide which aspects of our identity gets to stay and which gets to be washed away by fluidity? Should we allow a handful of elites decide and define our national identity?

[1] Straits Times, Population issue fires up students, 9 May 2013

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A failed attempt at classifying nations

June 26, 2013

I refer to Mr Mahbubani’s 8 Jun 2013 Straits Times article “So, what is a Singaporean?”

Mr Mahbubani classifies France, Russia, China and Spain as old nations based on such descriptions as a common culture, common language, common history and relative ethnic homogeneity.

The common culture description is not valid for Russia and China since both are multi-ethnic and multi-cultural. If multi-cultural Russia and China are considered to have common cultures respectively, then multi-cultural Singapore can also be said to have a common culture.

The common language description applies to Singapore as well since we have English as our common language.

The common history description is true only after the respective nations attained their present day boundaries. For example, French territories like Alsace-Lorraine and Burgundy once belonged to other powers or were once independent and so had different histories prior to their absorption into France. Similarly various Russian and Chinese territories had different histories prior to their absorption into the respective nations. Spain used to be separate kingdoms of Leon-Castile, Aragon, Granada and Navarre. These nations began building their respective common histories after they attained their present day boundaries. Similarly, Singapore began building its common history since 1819, the day we were founded.

If Mr Mahbubani considers Russia which comprises 80% ethnic Russians to be relatively homogeneous ethnically, he should also consider Singapore which comprises 75% ethnic Chinese to be relatively homogeneous ethnically too.

So by examining how the examples given by Mr Mahbubani, especially of Russia, fit into his description of what constitutes an old nation, Singapore should be considered an old nation too. Yet Mr Mahbubani doesn’t consider Singapore to be an old nation.

It’s strange that Mr Mahbubani classifies China as an old nation and India as an old-new nation when the Republic of China was founded in 1912 with the end of Manchu rule just as the Republic of India was founded in 1947 with the end of British rule. Thus, China has ‘new elements’ as India has and so should be considered old-new too if India is considered old-new.

It’s also strange that Mr Mahbubani would reset America’s age as a nation according to the time of their civil war. Spain’s last civil war ended in 1939, so by Mr Mahbubani’s civil war age reset theory; Spain should be a new country of 74 years of age only. Yet Mr Mahbubani classifies Spain as an old nation. Mr Mahbubani resets America’s age due to civil war but doesn’t reset Spain’s age due to civil war. Mr Mahbubani’s definitions of old and new nations fail to stand the test of his own examples.

Mr Mahbubani has no doubt that an American will recognise a fellow American when the latter opens his mouth. But according to our MP Mr Hri Kumar, Singaporeans don’t even need to open our mouths for people to recognise that we are Singaporeans [2].

After categorising nations with descriptions that fail to properly categorise them, Mr Mahbubani then claims that Singapore doesn’t belong to any of his ill-defined categories. Instead, Mr Mahbubani defines Singapore as an accidental nation as though the incidents that led to America’s War of Independence were deliberate and inevitable. Singapore is no more accidental as America is having been the product of historical events as America has been.

Conclusion: Mr Mahbubani fails in his attempt to classify nations and to show that Singapore is one of a kind that doesn’t belong to any category.

[1] Straits Times, So, what is a Singaporean?, 8 Jun 2013, Kishore Mahbubani

[2] Straits Times, Playing Robin Hood ‘may cause class wars’, 7 Mar 2013

On a hot day in Bangkok, my two Chinese friends and I walked towards a street vendor selling drinks. Before we could say a word, he looked at us and said ‘Singaporean.’ We asked him how he knew. He said: ‘Different colour, walk together; must be Singaporean.’

Mr Hri Kumar Nair (Bishan-Toa Payoh GRC), on a backpacking trip he took in 1991 and being proud to be a Singaporean

Mr Lee Kuan Yew wasn’t the visionary leader who brought success to our nation

June 23, 2013

Dear Professor Tan,

I refer to the 5 Jun 2013 Straits Times report of your speech on the occasion of the conference of Doctor of Laws to Mr Lee Kuan Yew by NUS [1].

Mr Lee wasn’t the visionary leader who brought success to the nation. Neither was he the man of imagination who pursued the unconventional. Instead, he pushed for import substitution, the conventional policy of developing nations then that eventually proved inferior to the less conventional policy of export industrialisation proposed by Dr Winsemius [2]. Luckily for us Mr Lee’s plans were scuttled with our expulsion from Malaysia and in the end; it was Dr Winsemius’ export industrialisation plans that ultimately brought success to our nation [2]. The qualities crucial to Singapore’s past success and big picture perspectives can thus be found in Dr Winsemius, not Mr Lee.

Mr Lee did not lead Singapore from Third World to First for Singapore was already Upper Middle Income status according to World Bank’s classification of our 1960 per capita GNP [3]. At most, Singapore went from Next to First World to First World, led not by Mr Lee but by Dr Winsemius who was the leader behind Mr Lee.

Mr Lee is thus not the global visionary you claim he is since the most important achievements associated with him actually belong to others. He may not be the best candidate to inspire the next generation for that might mean inspiring them to lock up opponents without trial, get more credit than they deserve and not fight for Singapore when Singapore is being invaded.

All sense of hope and collective purpose is lost in Mr Lee’s leadership when he makes statements like these:
• If Aljunied decides to go that way, well Aljunied has five years to live and repent.
• If they choose the opposition, then I say, good luck to them. They have five years to ruminate and to regret what they did. And I have no doubts they will regret it.
• If native Singaporeans are falling behind because the spurs are not stuck into the hide, that is their problem.
• [our] women will become maids in other people’s countries, foreign workers

Mr Lee isn’t quite the deep thinker you claim he is as he often cuts through complex issues wrongly or superficially. For example:
• He theorised that high TFR in pre-world war 2 Germany led to war and expansion even though Germany in the mid-1960s had similar TFR levels but did not pursue war [4].
• He claimed to be the long range radar looking for opportunities and threats but yet couldn’t see the impending collapse of the Global Financial markets in 2008 and the subsequent loss of billions by GIC and Temasek Holdings [5].
• He claimed that we either embraced F1 and all the glitz of our globalised world today or we risk going out of business and running out of food [5] when the whole tourism industry constituted only 4% of our GDP (Singapore Tourism Board Annual Report 2011/2012 page 5).
• He said New Zealand is green because it is the last stop on the bus line when similarly last-stop Easter Island and the Anasazi have become ruins over time [5].
• He said English connected us to modern sciences [6] even as Japan, Taiwan, South Korea and Germany didn’t need English to be similarly connected to modern sciences.

Lee was never a champion of education. For him, education always served the political purpose, not the other way round. When Singapore was to merge into Malaysia, Lee emphasised both Malay and English in schools but after our ejection from Malaysia, he emphasised English only [7].

Similarly, Lee’s so-called transformation of Singapore education wasn’t for education’s sake but for politics sake. His closure of Chinese stream schools and Nanyang University and the undermining of the economic value of Chinese education were for the purpose of eradicating the political power of the Chinese educated masses [8].

Finally, it was Lee Kong Chian, not Lee Kuan Yew, who first proposed bilingual policy in 1953 [9]. Lee Kong Chian even introduced bilingual education to the Chinese High School as early as 1949 [9] and many vernacular schools were already teaching English before that.

[1] Straits Times, Top NUS accolade for Mr Lee Kuan Yew, 5 Jun 2013

[2]
• The Fraser Institute, Case Studies in the Relationship between Political, Economic and Civil Freedoms, page 155

Lee Kuan Yew and the PAP proposed a political union with Malaysia, which would provide a good-sized domestic market for an industrial strategy of import substitution. Expulsion from the union with Malaysia in 1965, on political grounds by the government in Kuala Lumpur, destroyed the import-substitution strategy.

• Lee Kuan Yew School of Public Policy, Asia Competitiveness Institute, Remaking Singapore, Michael Porter and Christian Ketels and Neo Boon Siong and Susan Chung, July 2008

During the federation period and immediately afterward, Lee’s government initially pursued an import substitution strategy … but the alienation from Malaysia, with its much larger market, rendered the strategy impractical.

• Helen Hughes, The Dangers of export pessimism: developing countries and industrial markets, page 225

Until 1965, the economic strategy of the country hinged on a merger with Malaya to establish the larger domestic market, deemed necessary for economic viability [5-3].

• Jacques Charmes, In-service training: five Asian experiences, Bernard Salomé, Page 21

Singapore at first adopted the industrialisation policy of import substitution, followed after 1966 by the export of labour intensive manufactured goods.

• Robert Fitzgerald, The Competitive advantages of Far Eastern business, Page 55

Singapore’s industrialisation strategy was originally dependent on policies of import substitution within the Malaysian common market, but the attainment of political independence in 1965 led to export industrialisation.

• Eddie C. Y. Kuo / Chee Meng Loh / K. S. Raman, Information technology and Singapore society, Page 87

Import substitution was adopted in the early 1960s in anticipation of the Malayan common market. However, Singapore separated from Malaysia in 1965 dashing the hopes of the common market, hence an export strategy was promoted instead.

• Sikko Visscher, The business of politics and ethnicity: a history of the Singapore Chinese Chamber of Commerce and Industry, page 171

Lee Kuan Yew, appearing in tears on television when announcing separation, was devastated. His feelings strongly contrasted with scenes in Chinatown where firecrackers were set off to celebrate liberation from rule by Malays from Kuala Lumpur. Most Singaporeans did not share the government’s dismay. Winsemius also did not share Lee’s dismay. He said in a 1981 interview: To my amazement, a discussion had started: can Singapore survive? That is the only time I got angry in Singapore. I said: ‘now you have your hands free – use them!’ It was the best thing that happened during the whole period from 1960 till today.

• Tong Dow Ngiam, A Mandarin and the Making of Public Policy: Reflections, page 66

Dr Winsemius and I.F. Tang in their heart of hearts never believed in a Malaysian Common Market.

Dr Winsemius and I.F. Tang made extraordinary contributions to the economic development of Singapore as leader and secretary of the first UN Industrialisation Survey Team in 1961.

• Philip Nalliah Pillai, State enterprise in Singapore: legal importation and development, Page 30

With Singapore’s secession in 1965, the United Nations Proposed Industrialization Programme for the State of Singapore became the basis for Singapore’s industrialisation strategy.

• Danny M Leipziger, Lessons from East Asia, Page 240

The 1960-61 United Nations mission led by Albert Winsemius helped develop a blueprint for Singapore’s industrialisation and development plan and recommended the establishment of EDB.

[3]

World Bank classifies nations as follows:

Category Criteria (based on 2011 per capita GNI)
High Income US$12,476 or higher
Upper Middle Income From US$4,036 to US$12,475
Lower Middle Income From US$1,026 to US$4,035
Low Income US$1,025 or below

World Bank GNI figures only stretch back to 1980. So have to rely on Penn World Tables instead. Although Penn World Tables doesn’t have GNI figures, it has GNP to GDP ratios which can be used to obtain GNP figures from GDP figures. GNP figures are similar to GNI figures and they stretch all the way back to 1960 for Singapore. The figures, in 2005 PPP USD, are then converted to 2010 PPP USD to obtain US$4,794 which puts Singapore in the Upper Middle Income bracket. 2010 is the last year available in Penn World Tables and is as close to 2011 as one can get.

This is further supported by Carl A. Trocki who wrote on page 166 of his book “Singapore: wealth, power and the culture of control”: Singapore had already attained a middle income status in 1960 with a per capita GDP of $1,330.

[4] Straits Times, Declining populations make peaceful neighbours, 1 Mar 2013, Lee Kuan Yew

[5] Straits Times, 6 Jan 2010, excerpts interview with Mark Jacobson of the National Geographic

[6] Straits Times, Mr Lee on…. 6 Sept 2011

[7] Christopher Tremewan, The political economy of social control in Singapore, page 80

PAP emphasised both Malay and English to establish credentials for merger with Malaya but when ejected from Malaya subsequently, emphasized English only.

[8]
• Carl A. Trocki, Singapore: wealth, power and the culture of control”, page 150

– PAP systematically undercut Chinese education as it saw the Chinese educated as both political and cultural threats
– PAP set about neutralising Chinese schools, which were powerful auxiliaries to labour unions and the Singapore Chinese Chamber of Commerce which is the major funding and controlling body for Chinese education in a bid to control education
– PAP, through government policies, strengthened social and economic forces that reduced the number of Chinese schools
– PAP quite often levelled the charge of “chauvinism” on prominent businessmen of the SCCC to destroy them

• Christopher Tremewan, The political economy of social control in Singapore

– Page 81 – PAP sought to destroy Chinese education
– Page 84 – Racial integration policy was a cover for an all-out attack on Chinese education
– Page 85 – PAP undermined Chinese education autonomy while attempting to win Malay support by appearing to be multiracial
– Page 89 – the 1969 bilingual policy, while appeasing Chinese public opinion, completed the demolition of the Chinese education system
– Page 79 – The government being the largest employer in Singapore could have given better job opportunities to the Chinese educated but refused to.

• Tong Chee Kiong, Identity and ethnic relations in Southeast Asia: racializing Chineseness, page 62
– PAP promised equal treatment for all language streams but not equal employment opportunities for people from non-English streams

• Stephan M. Haggard, Behind East Asian Growth – Political foundations of prosperity, business, politics and policy, page 89
– The questionable political loyalty of local Chinese businesses was a possible reason why the PAP government favoured GLCs and MNCs over local entreprises then.

[9] Singapore Infopedia: http://infopedia.nl.sg/articles/SIP_978_2006-06-16.html

• In 1949, he convinced the principal to introduce bilingual education.
• 1953: Proposed introducing bilingual and trilingual education, and equal treatment for schools of all language streams. His proposals were accepted by the colonial government and included in the White Paper on Education Policy that introduced a unified education system for Singapore.

Singapore is testament to the vision of Sir Stamford Raffles and Dr Albert Winsemius, not Lee Kuan Yew

June 22, 2013

Dear Professor Simon Chesterman,

I refer to the 5 Jun 2013 Straits Times report of your speech on the occasion of the conference of an honorary doctorate of laws to Mr Lee Kuan Yew’s [1].

Your assertion that Mr Lee’s vision of independence was sown during his time at Cambridge contradicts our Chief of Government Communications Mr Janadas Devan’s article [2] in which he wrote: “Every one of Singapore’s founding fathers began their political careers believing … that Singapore couldn’t possibly be independent.” If Mr Devan is correct, how could Mr Lee have envisioned Singapore’s independence if he didn’t even believe Singapore could ever be independent?

It wasn’t Mr Lee who led PAP to victory in the 1959 General Election. It was Mr Lim Chin Siong’s popularity with the Chinese educated masses that gave PAP its victory in 1959 [3].

Singapore did not transition from Third World to First under Mr Lee. Singapore’s purchasing power parity adjusted per capita GNP was already US$4,794 [4] back in 1960 which according to World Bank classification today [4] was already of Upper Middle Income status, just one step away from High Income status. This is further supported by Carl Trocki who wrote in his book [5] “Singapore had already attained a middle income status in 1960 with a per capita GDP of $1,330”. So at best, you can only say that Singapore transitioned from Next to First World to First World under Mr Lee, not from Third World to First.

Furthermore, our transition from Next to First World to First World was under the economic policies of Dr Albert Winsemius, not Mr Lee. Mr Lee, following conventional wisdom, actively pursued import substitution [6] which history has shown to be an inferior economic policy compared to the export industrialisation policy designed by Dr Winsemius. Thankfully, we were separated from Malaysia, which scuttled Mr Lee’s plans and freed Singapore to pursue the right path set by Dr Winsemius [6].

Why would our transition owe much to Mr Lee’s embrace of the rule of law when Singapore already had rule of law before Mr Lee came to power? It doesn’t make sense to say that we required him to embrace something that we already had.

Whether it is life expectancy or literacy rate, little if any separates Singapore from other First World nations [7]. As for greenery, Hong Kong, our closest rival, has 60% more green space per person than Singapore [8] even though Hong Kong doesn’t have Lee Kuan Yew which shows we didn’t need Lee Kuan Yew to have greenery.

Ranking first in one World Justice Project category doesn’t mean Singapore is first overall. The following table shows that when the average of all scores is taken, Singapore is more middling amongst First World nations [9]:

Country 2012 WJP Rule of Law average score As percentage of highest average
Sweden 0.88 100%
Denmark 0.88 99%
Norway 0.87 98%
Finland 0.87 98%
Netherlands 0.84 95%
New Zealand 0.83 94%
Australia 0.82 92%
Austria 0.80 91%
Singapore 0.79 90%
Japan 0.79 90%
Germany 0.79 89%
Canada 0.78 88%
United Kingdom 0.78 88%
Hong Kong 0.76 87%
France 0.76 86%
Belgium 0.74 84%
Spain 0.73 83%
Republic of Korea 0.73 83%
United States 0.72 82%
Portugal 0.66 75%
Italy 0.64 72%
Greece 0.61 69%

Strangely, many of the categories in which Singapore came in last (or near last) in the 2011 World Justice Project suddenly became unavailable in 2012. Furthermore, in categories like fundamental rights, freedom of opinion and guarantee of expression, Singapore’s ranking suddenly swung from second last to first. The extreme ranking swing from year to year makes the World Justice Project somewhat not dependable.

World Justice Project factors 2011 rank out of 23 First World nations 2012 rank
4.6 The right to privacy is effectively guaranteed. 23 #N/A
5.6 Official information is available to the public 23 #N/A
7.2 People can access and afford legal advice and representation 23 #N/A
Factor 4: Fundamental Rights 22 2
1.6 Government powers are effectively limited by non-governmental checks 22 #N/A
4.4 Freedom of opinion and expression is effectively guaranteed 22 1
4.7 Freedom of assembly and association is effectively guaranteed 22 1
5.4 The right of petition and public participation is effectively guaranteed 22 #N/A
7.6 Civil justice is free of improper government influence 21 #N/A
1.7 Transfers of power occur in accordance with the law 20 #N/A
6.5 The Government does not expropriate property without adequate compensation 20 #N/A
7.3 People can access and afford civil courts 20 #N/A
8.6 The criminal justice system is free of improper government influence 20 #N/A
1.2 Government powers are effectively limited by the legislature 19 1
Factor 1: Limited Government Powers 18 1
4.5 Freedom of belief and religion is effectively guaranteed 18 1
Factor 5: Open Government 17 2
4.2 The right to life and security of the person is effectively guaranteed 17 3

While Mr Lee may not have foreseen our success when he took leadership in 1959, Dr Winsemius did when he came onboard two years later. Just as Mr Lee was totally devastated by our separation [10], Dr Winsemius confidently said our hands are now free, we can use them and it was the best thing that happened to Singapore [6].

It was strange that Mr Lee should say in 1965 that Singapore would be a metropolis ten years on because he told American businessmen in a speech in Chicago in 1967 that we were already a metropolis [11]. If he had predicted in 1965 our road to becoming a metropolis would take 10 years, it is unlikely that the objective would suddenly be achieved in just 2 years. More likely than not, Singapore was already on the threshold of becoming a metropolis back in 1965 on the basis of our accumulated strength since 1819.

Singapore stands testament to the vision of people like Sir Stamford Raffles and Dr Albert Winsemius, not Lee Kuan Yew. Few people have had their contributions so completely blown out of proportions. Lee’s actual impact on the nation’s development is quite ordinary if important contributions from others are rightfully attributed to them and not to Lee. Lee’s impact on the nation’s character has sometimes brought us ridicule as we were at times labelled as un-entrepreneurial, cultureless or even stupid.

Singapore is not the lifework of Lee Kuan Yew but that of Sir Stamford Raffles, past British Governors, pioneers like Tan Tock Seng and generations of Singaporeans past and present. Our successful launch in 1965 wouldn’t have been possible without the 140 years of solid foundation laid during colonial times. It was a launch that resulted not from Lee’s success but from his failure to keep Singapore in Malaysia, a failure that saw us getting kicked out of Malaysia by Tungku Abdul Rahman and leaving Lee to cry on national TV on the occasion of our separation. If there had been any inspiration for the continent, it was a borrowed one and any admiration a false one for it was ultimately Dr Winsemius, not Lee who should be credited for our success formula that took us from next to First World to First World.

Conclusion:
Singapore did not transition from Third World to First under Lee for we were already Upper Middle Income status according to World Bank classification of our 1960 per capita GNP. Instead, we transitioned from Upper Middle Income status to First World status by building on 140 years of solid foundation laid by the British using Dr Winsemius’ economic plans. Singapore’s success is testament to the vision of our founder Sir Stamford Raffles, the economic plan of Dr Winsemius and the hard work of generations of Singaporeans past and present.

[1] Straits Times, The lawyer and his vision for S’pore, 5 Jun 2013, Simon Chesterman

[2] Straits Times, Choosing the better angels of our nature, 22 Apr 2013, Janadas Devan

[3]

• Phyllis Chew Ghim Lian, A Sociolinguistic History of Early Identities in Singapore: From Colonialism to Nationalism, Chapter 9 Language, Power and Political Identities: The 1959 Singapore Political Elections

In the 1959 elections with the implementation of compulsory voting, the PAP reaped the full voting force of the Chinese-educated and lower income groups … Lee was assured of not being over-shadowed by the charismatic Hokkien-Mandarin speaker, but yet was free to ride on the wave of Lim’s popularity.

• Haig Patapan and John Wanna and Patrick Moray Weller, Westminster Legacies: Democracy And Responsible Government in Asia And the Pacific, page 112

Lim Chin Siong and Fong Swee Suan gave the party access to trade union, student and cultural organisations that could be harnessed to mass political mobilisation. It was an uneasy but powerful alliance, ultimately bring the PAP to victory in 1959 polls.

[4]

World Bank classifies nations as follows:

Category Criteria (based on 2011 per capita GNI)
High Income US$12,476 or higher
Upper Middle Income From US$4,036 to US$12,475
Lower Middle Income From US$1,026 to US$4,035
Low Income US$1,025 or below

World Bank GNI figures only stretch back to 1980. So have to rely on Penn World Tables instead. Although Penn World Tables doesn’t have GNI figures, it has GNP to GDP ratios which can be used to obtain GNP figures from GDP figures. GNP figures are similar to GNI figures and they stretch all the way back to 1960 for Singapore. The figures, in 2005 PPP USD, are then converted to 2010 PPP USD. 2010 is the last year available in Penn World Tables and is as close to 2011 as one can get.

[5] Carl A. Trocki, Singapore: wealth, power and the culture of control, Page 166

[6]

• The Fraser Institute, Case Studies in the Relationship between Political, Economic and Civil Freedoms, page 155

Lee Kuan Yew and the PAP proposed a political union with Malaysia, which would provide a good-sized domestic market for an industrial strategy of import substitution. Expulsion from the union with Malaysia in 1965, on political grounds by the government in Kuala Lumpur, destroyed the import-substitution strategy.

• Lee Kuan Yew School of Public Policy, Asia Competitiveness Institute, Remaking Singapore, Michael Porter and Christian Ketels and Neo Boon Siong and Susan Chung, July 2008

During the federation period and immediately afterward, Lee’s government initially pursued an import substitution strategy … but the alienation from Malaysia, with its much larger market, rendered the strategy impractical.

• Helen Hughes, The Dangers of export pessimism: developing countries and industrial markets, page 225

Until 1965, the economic strategy of the country hinged on a merger with Malaya to establish the larger domestic market, deemed necessary for economic viability [5-3].

• Jacques Charmes, In-service training: five Asian experiences, Bernard Salomé, Page 21

Singapore at first adopted the industrialisation policy of import substitution, followed after 1966 by the export of labour intensive manufactured goods.

• Robert Fitzgerald, The Competitive advantages of Far Eastern business, Page 55

Singapore’s industrialisation strategy was originally dependent on policies of import substitution within the Malaysian common market, but the attainment of political independence in 1965 led to export industrialisation.

• Eddie C. Y. Kuo / Chee Meng Loh / K. S. Raman, Information technology and Singapore society, Page 87

Import substitution was adopted in the early 1960s in anticipation of the Malayan common market. However, Singapore separated from Malaysia in 1965 dashing the hopes of the common market, hence an export strategy was promoted instead.

• Sikko Visscher, The business of politics and ethnicity: a history of the Singapore Chinese Chamber of Commerce and Industry, page 171

Lee Kuan Yew, appearing in tears on television when announcing separation, was devastated. His feelings strongly contrasted with scenes in Chinatown where firecrackers were set off to celebrate liberation from rule by Malays from Kuala Lumpur. Most Singaporeans did not share the government’s dismay. Winsemius also did not share Lee’s dismay. He said in a 1981 interview: To my amazement, a discussion had started: can Singapore survive? That is the only time I got angry in Singapore. I said: ‘now you have your hands free – use them!’ It was the best thing that happened during the whole period from 1960 till today.

• Tong Dow Ngiam, A Mandarin and the Making of Public Policy: Reflections, page 66

Dr Winsemius and I.F. Tang in their heart of hearts never believed in a Malaysian Common Market.

Dr Winsemius and I.F. Tang made extraordinary contributions to the economic development of Singapore as leader and secretary of the first UN Industrialisation Survey Team in 1961.

• Philip Nalliah Pillai, State enterprise in Singapore: legal importation and development, Page 30

With Singapore’s secession in 1965, the United Nations Proposed Industrialization Programme for the State of Singapore became the basis for Singapore’s industrialisation strategy.

• Danny M Leipziger, Lessons from East Asia, Page 240

The 1960-61 United Nations mission led by Albert Winsemius helped develop a blueprint for Singapore’s industrialisation and development plan and recommended the establishment of EDB.

[7]
UN Human Development Index, Gross school enrolment rate 2002 to 2011:

Country Primary (%) Secondary (%) Tertiary (%)
France 111.0 113.0 54.5
Netherlands 108.0 120.0 62.7
Ireland 108.0 117.0 61.0
Spain 107.0 119.0 73.2
United Kingdom 106.0 102.0 58.5
Liechtenstein 106.0 70.0 34.4
Belgium 105.0 111.0 67.5
Australia 104.0 129.0 75.9
Korea (Republic of) 104.0 97.0 103.9
Japan 103.0 102.0 59.0
Italy 103.0 99.0 66.0
Germany 102.0 103.0 ..
United States 102.0 96.0 94.8
Switzerland 102.0 95.0 51.5
Hong Kong, China (SAR) 102.0 83.0 59.7
Singapore 101.8 106.9 71.0
New Zealand 101.0 119.0 82.6
Sweden 100.0 100.0 70.8
Austria 100.0 100.0 60.2
Luxembourg 100.0 98.0 10.5
Denmark 99.0 117.0 74.4
Norway 99.0 110.0 73.8
Finland 99.0 108.0 91.6
Canada 99.0 101.0 60.0

World Health Organisation Life Expectancy:

Country Name 2010 life expectancy As percentage of highest life expectancy
Japan 82.9 100%
Hong Kong SAR, China 82.9 100%
Switzerland 82.2 99%
Italy 81.7 99%
Australia 81.7 99%
Singapore 81.6 98%
Spain 81.6 98%
Sweden 81.5 98%
France 81.4 98%
Norway 81.0 98%
Canada 80.8 97%
Korea, Rep. 80.8 97%
Netherlands 80.7 97%
New Zealand 80.7 97%
United Kingdom 80.4 97%
Austria 80.4 97%
Ireland 80.3 97%
Luxembourg 80.1 97%
Germany 80.0 96%
Belgium 79.9 96%
Finland 79.9 96%
Denmark 79.1 95%
United States 78.2 94%

[8]
EIU, Asian Green City Index, Green spaces per person (m2/person)

Cities Green spaces per person (m2/person)
Guangzhou 166.3
Nanjing 108.4
Hong Kong 105.3
Beijing 88.4
Singapore 66.2
Taipei 49.6
Kuala Lumpur 43.9
Bengaluru 41
Yokohama 37.4
Seoul 23.4
Wuhan 20.9
Delhi 18.8
Shanghai 18.1
Karachi 17
Hanoi 11.2
Tokyo 10.6
Mumbai 6.6
Manila 4.5
Osaka 4.5
Bangkok 3.3
Jarkarta 2.3
Kolkata 1.8

[9]

Only high income economies considered; ex-communist nations excluded as it is unfair to compare nations that have suffered under decades of communist rule.

[10]

Straits Times, What if there had been no Toh Chin Chye?, 4 Feb 2012

During the Big Split … Dr Goh Keng Swee … recalled Dr Toh Chin Chye visiting him in his Fullerton Building office in 1961, after seeing Mr Lee, saying: ‘I have just come from Harry’s office. He was staring at the ceiling just like you did. You should snap out of this mood. The fighting has just begun. It is going to be long and nasty. But if we keep wringing our hands in anguish, we are sure to lose.

[11] Peter Wilson / Gavin Peebles, Economic growth and development in Singapore: past and future, Page 26

LKY had already acknowledged in an Aug 1967 speech to American businessmen in Chicago that we were already a metropolis.

Myth of healthcare statistics

June 18, 2013

Dear Dr Jeremy Lim,

I refer to your 14 Jun 2013 Straits Times article [1] in which you cited Professor William Haseltine’s new book and Ms Gillian Tett’s subsequent commentary as examples of how Singapore healthcare is being held up as a model for low spending and impressive population health metrics. Sadly, there is a fundamental flaw in Professor Haseltine’s study, a flaw which Ms Tett didn’t detect but which completely changes the rosy picture that he painted.

Professor Haseltine failed to consider old age dependency when he compared Singapore’s healthcare costs to those of Western nations. All else being equal, a more aged population will have higher healthcare costs and since Western nations have more aged populations than Singapore, they naturally will have higher healthcare costs all else being the same. As Singapore’s population ages thirty years down the road, our healthcare costs will go up too even if our healthcare system remains unchanged. So if we were to compare Singapore today versus Singapore 30 years down the road, do we say that Singapore’s cost efficiency has deteriorated over the years or do we say that Singapore’s cost efficiency hasn’t changed but the population has aged and hence incurs higher healthcare costs? Controlling for old age dependency is important without which, there can be no proper or meaningful comparison of healthcare costs across nations.

Old age dependency ratios can be obtained from World Bank. When these are regressed against World Health Organisation’s healthcare costs, a significant relationship is obtained with a p-value of 8.4 × 10-23. The regression relationship is thus a credible predictor of how healthcare costs should vary with old age dependency. Against this predictor, Singapore fares poorly, overspending by 83% compared to old age predicted healthcare spending.

Country 2011 old age dependency ratio 2011 per capita health expenditure 2011 old age dependency predicted per capita health expenditure 2011 % healthcare overspending compared to predicted value
Italy 31.5 $3,436 $4,305 -20%
Korea, Rep. 15.9 $1,616 $1,765 -8%
Spain 25.3 $3,027 $3,290 -8%
UK 25.6 $3,609 $3,340 8%
Germany 31.2 $4,875 $4,251 15%
Finland 27 $4,325 $3,571 21%
Sweden 28.6 $5,331 $3,837 39%
Belgium 26.9 $4,962 $3,551 40%
France 26.4 $4,952 $3,480 42%
New Zealand 20 $3,666 $2,441 50%
Austria 26.4 $5,280 $3,478 52%
Singapore 12.7 $2,286 $1,248 83%
Denmark 25.8 $6,648 $3,384 96%
Netherlands 23.6 $5,995 $3,020 99%
Ireland 17.8 $4,542 $2,079 118%
Canada 20.8 $5,630 $2,570 119%
Australia 20.3 $5,939 $2,487 139%
Switzerland 25.1 $9,121 $3,255 180%
Norway 22.6 $8,987 $2,852 215%
Luxembourg 20.3 $8,798 $2,486 254%
United States 20 $8,608 $2,426 255%

The other issue with Professor Haseltine’s study is his comparison of healthcare costs as a percentage of GDP instead of healthcare costs itself. It is not a particularly meaningful comparison as the following example illustrates.

Both Mr Jones and Ah Huat are of similar age, health and fitness. Mr Jones earns $10,000 a month and spends $200 a month on healthcare. Mr Jones’ healthcare expenditure as a percentage of his salary is therefore 2%. Ah Huat earns $1,000 a month and spends $50 a month on healthcare. Ah Huat’s healthcare expenditure as a percentage of his salary is thus 5%. Therefore, according to the statistics, Ah Huat’s 5% expenditure is higher than Mr Jones’ 2% expenditure even though Ah Huat spends only $50 a month compared to Mr Jones who spends $200 a month.

The notion that Singapore has much better population health metrics than Western nations is also questionable. The following table [2] shows that very little separates Singapore from Western nations in terms of population health metrics.

Country 2011 Life Expectancy (both sexes) 2011 infant survival rate (probability of surviving between birth and age 1 per 1000 live births for both sexes) 2011 adult survival rate (probability of surviving between 15 and 60 years per 1000 population, both sexes) Average
San Marino 100% 100% 100% 100%
Switzerland 100% 100% 100% 100%
Iceland 99% 100% 100% 100%
Japan 100% 100% 99% 100%
Singapore 99% 100% 99% 99%
Italy 99% 100% 99% 99%
Sweden 99% 100% 99% 99%
Israel 99% 100% 99% 99%
Australia 99% 100% 99% 99%
Spain 99% 100% 98% 99%
Luxembourg 99% 100% 98% 99%
Andorra 99% 100% 98% 99%
Cyprus 98% 100% 99% 99%
Canada 99% 100% 98% 99%
Qatar 99% 100% 98% 99%
Norway 98% 100% 99% 99%
Netherlands 98% 100% 99% 99%
Ireland 98% 100% 98% 99%
Monaco 99% 100% 97% 99%
Kuwait 96% 99% 100% 98%
France 99% 100% 97% 98%
New Zealand 98% 100% 98% 98%
Austria 98% 100% 98% 98%
Malta 96% 100% 99% 98%
South Korea 98% 100% 98% 98%
Greece 98% 100% 98% 98%
Germany 98% 100% 98% 98%
Finland 98% 100% 97% 98%
United Kingdom 96% 100% 98% 98%
Bahrain 95% 99% 99% 98%
Belgium 96% 100% 97% 98%
Portugal 96% 100% 97% 98%
Slovenia 96% 100% 96% 98%
Denmark 95% 100% 97% 97%
Chile 95% 99% 96% 97%
Costa Rica 95% 99% 96% 97%
Saudi Arabia 92% 99% 99% 97%
Maldives 93% 99% 97% 96%
Czech Republic 94% 100% 95% 96%
USA 95% 100% 94% 96%

It is these false comparisons have led to Singapore’s health system being wrongly held up as a model for international attention which it rightfully doesn’t deserve. And if as you assert, the controlling hand of our healthcare market is that of our government, then you may have to contend with the reality that the controlling hand has potentially led to 83% overspending in healthcare.

[1] Straits Times, Myth of the invisible hand in health care, 14 Jun 2013, Jeremy Lim

[2]
• 2011 Life Expectancy, Infant mortality and Adult mortality are from World Health Organisation
• For life expectancy, comparison is based on percentage of highest life expectancy which is 83 years for San Marino, Switzerland and Japan
• Infant survival rate is used instead of infant mortality to convert the score to one where the higher it is the better it is. Infant survival rate is 1000 – infant mortality rate. Comparison is based on percentage of highest infant survival rate which is close to 100% for almost all First World nations.
• Adult survival rate is used instead of adult mortality to convert the score to one where the higher it is the better it is. Adult survival rate is 1000 – adult mortality rate. Comparison is based on percentage of highest adult survival rate which is 95% for San Marino, Switzerland and Iceland.

Not true Singaporeans earn higher real wages

June 17, 2013

Mr Leon Perera’s Straits Times article [1] highlighted the contrast between Singapore’s high GDP growth and Singaporean’s low income growth which he attributed in part to Singapore’s low wage share of GDP. Previously, Straits Times also highlighted that wage levels hasn’t kept up with our high per capita GDP and also attributed it to low wage share of GDP [2].

The reply from MTI’s Mrs Cindy Keng [3] was that Singaporeans actually earn higher real wages compared to many developed economies. She referred readers to MTI’s 1Q 2013 Quarterly Economic Survey [4] for more details. The MTI report compared only 12 countries / economies and concluded there is no clear relationship between wages and wage shares across countries. MTI may have gotten better results if it had compared more countries. In any case, MTI figures cannot be verified so the numbers had to be worked out independently using exactly quotable sources instead [5].

There are two kinds of purchasing power parities – one for GDP and one for private consumption. The more appropriate PPP adjustment for wages is PPP for private consumption, not PPP for GDP because wages correspond more closely to consumption than to GDP. The table below shows that when adjusted for PPP (private consumption), Singapore wage is low amongst First World nations, contrary to Mrs Keng’s statement and MTI’s report [6].

Country World Bank PPP adjusted (consumption) average wage 2000 – 2009 (2009 USD)
United States $4,139
Luxembourg $4,132
Switzerland $3,924
Netherlands $3,576
Ireland $3,547
Belgium $3,493
United Kingdom $3,460
Australia $3,401
Denmark $3,349
Austria $3,296
Canada $3,197
Norway $3,184
Germany $3,059
France $2,865
Sweden $2,817
Finland $2,727
Japan $2,674
Italy $2,637
Singapore $2,546
Korea $2,538
Spain $2,530

It’s quite possible that MTI had adjusted wages using purchasing power parity meant for GDP. The table [6] below shows that without adjustments Singapore’s wage is low amongst First World nations. It becomes high only after adjusting for purchasing power parity meant for GDP.

Country Average wage 2000 – 2009 (2009 USD) Country PPP (GDP) adjusted average wage 2000 – 2009 (2009 USD)
Switzerland $6,053 Luxembourg $4,448
Luxembourg $5,636 Switzerland $4,313
Denmark $5,374 United States $4,139
Ireland $5,000 Ireland $4,012
Norway $4,976 Singapore $3,833
Belgium $4,402 Netherlands $3,683
Netherlands $4,329 Belgium $3,672
United States $4,139 Denmark $3,657
Austria $3,992 United Kingdom $3,656
Australia $3,866 Australia $3,655
Finland $3,797 Canada $3,480
United Kingdom $3,756 Norway $3,475
Germany $3,672 Austria $3,385
Canada $3,651 Germany $3,249
Japan $3,646 Finland $3,009
France $3,609 France $3,001
Sweden $3,397 Japan $2,932
Italy $3,102 Sweden $2,900
Spain $2,773 Italy $2,850
Singapore $2,656 Spain $2,798
Korea $1,760 Korea $2,768

It is the same story with our per capita GDP. Singapore’s per capita GDP [7] is, on its own low amongst First World nations but becomes high only after adjusting for purchasing power parity (GDP).

Country Average per capita GDP 2000 – 2009 (2009 USD) Country PPP (GDP) adjusted average per capita GDP 2000 – 2009 (2009 USD)
Luxembourg $99,060 Luxembourg $78,183
Norway $76,760 Norway $53,598
Switzerland $63,839 Singapore $47,681
Denmark $57,546 United States $45,641
Ireland $51,574 Switzerland $45,487
Netherlands $46,635 Ireland $41,387
United States $45,641 Netherlands $39,676
Finland $44,537 Denmark $39,166
Austria $44,472 Austria $37,711
Belgium $43,178 Canada $37,641
Sweden $43,117 Australia $37,442
France $40,587 Sweden $36,811
Japan $39,995 Belgium $36,014
Australia $39,610 Finland $35,302
Germany $39,541 Germany $34,981
Canada $39,492 United Kingdom $33,985
Italy $36,956 Italy $33,946
United Kingdom $34,919 France $33,749
Singapore $33,046 Japan $32,165
Spain $31,590 Spain $31,876
Korea, Rep. $15,009 Korea, Rep. $23,613

Thus, one reason why our per capita GDP is high while our wages are low is because GDPs are mostly compared on a purchasing power parity (for GDP) basis whereas wages are not. Wages are mostly compared in US dollars unadjusted for purchasing power parity. Purchasing power parity (for GDP) could be the essential ingredient that makes or breaks Singapore statistics, be it per capita GDP or wage.

Consider Singapore’s 2009 purchasing power parity (for GDP) to exchange rate ratio of 0.69. This means that Singapore’s 2009 price level was only 0.69 that of the US’ or what USD $0.69 can buy in Singapore will require USD $1 to buy in America. That would be like saying that a US$690,000 property in Singapore costs US$1 million in the US which is too good to be true considering that our HDB resale flats can be more expensive than US bungalows. Most international surveys also do not support the notion that Singapore’s 2009 price level was only 0.69 that of the US’.

Consider the Economist Intelligence Unit’s 2009 Cost of Living survey; Singapore’s index of 112 was higher than New York’s index of 100, not lower.

Consider too Mercer’s 2009 Cost of Living survey; only New York’s price level was comparable to Singapore’s. All other US cities had much lower price levels which can only mean that the overall US price level had to be lower than Singapore’s, not higher.

Cities Index
New York 100
Singapore 98
Los Angeles 87.6
White Plains 84.7
San Francisco 82.5
Honolulu 81.6
Miami 81.4
Chicago 80.7
Boston 77.3
Houston 76.4
Washington 75.5
Atlanta 73.7
Morristown 73.5
Seattle 71.1
Denver 70.8
Cleveland 68.9
St Louis 68.4
Portland 66.1
Detroit 65.5
Pittsburgh 65.2
Winston Salem 63.8

Or consider UBS Prices and Earnings 2009; with the exception of New York, most American cities had price levels comparable to Singapore’s, not as high as the 1 / 0.69 ratio suggests.

Cities Price level (include rent)
New York 100
Los Angeles 72.7
Chicago 72
Singapore 70.7
Miami 69.6

Conclusion: MTI’s failure to find a clear relationship between wage and wage share of GDP could be due to the small sample size of 12 economies studied. Be it wage or per capita GDP, Singapore ranks low amongst First World nations when no adjustments are made for purchasing power parity. There are two types of purchasing power parity, one for consumption and one for GDP. Our wages, when adjusted for purchasing power parity meant for consumption, remains low amongst First World nations. Our wages and per capita GDP becomes high only after adjusting for purchasing power parity meant for GDP. It may not be appropriate to adjust wages using PPP meant for GDP. Singapore’s PPP for GDP also doesn’t match up well to international surveys on cost of living.

[1] Straits Times, Different spin on wheels of productivity, 21 May 2013, Leon Perera
• From 2001 to 2010, while real GDP growth averaged well over 5 per cent a year, real median monthly income growth for Singaporeans averaged 1.2 per cent a year.
• The battle must be fought on two fronts: raise the wage share of GDP to ensure that the gains from productivity growth are well distributed

[2] Straits Times, First World country, but not First World wages, 15 May 2010
• As a result, workers get a slice of Singapore’s gross domestic product (GDP) that is considered unusually small compared with their counterparts’ share in those countries
• This means that Singapore may have achieved one of the highest per capita GDPs – at $51,656 last year – but the superlative showing may not reflect the wealth of workers or benefit them as much.
• So are wage levels keeping pace with economic growth? Or is Singapore’s low wage share of GDP an indication that workers have been losing out?

[3] Straits Times, Govt’s goal to create good jobs for S’poreans, 24 May 2013, Mrs Cindy Keng
• Compared to those in many developed countries, Singaporeans earn higher real wages even though our wage share is lower. A more detailed analysis of wage shares can be found in the 1Q 2013 Quarterly Economic Survey released yesterday.

[4] MTI 1Q 2013 Quarterly Economic Survey
• Exhibit 5: Average Monthly Remuneration Per Worker (PPP-adjusted, in 2009 Dollars)
• In Singapore’s case, our PPP-adjusted average monthly remuneration per worker, at US$3,106 between 2000 and 2009, in fact exceeds that of workers in countries like Japan, the Euro area and South Korea even though they have higher wage shares.
• their PPP-adjusted average monthly remunerations were US$2,935, US$2,919 and US$2,025 respectively
• Our PPP-adjusted wage level is higher than that in many other developed economies.
• the PPP-adjusted average remuneration for the two economies are only US$10 apart at US$3,250 and US$3,260 respectively

[5]
MTI didn’t provide the actual wages in local currencies; neither did MTI provide the PPP conversion rate used nor the specific source of data. The following table shows that none of the PPPs from World Bank, Penn World Tables or IMF could yield MTI’s PPP adjusted wages:

Wage (from OECD) adjusted for PPP using various PPP sources Ireland Japan Korea, Rep. United Kingdom
World Bank PPP for GDP $3,848 $2,906 $2,711 $3,665
World Bank PPP for consumption $3,519 $2,601 $2,430 $3,555
Penn World Tables PPP $3,941 $3,001 $2,674 $3,826
IMF implied PPP $3,773 $2,898 $2,698 $3,601
MTI $3,250 $2,935 $2,025 $3,260

A similar issue was faced trying to verify MTI’s PPP adjusted wage for Singapore. The only Singapore average monthly wage data from 2000 to 2009 I could obtain from the Internet was the International Labour Organisation, Key Indicators of the Labour Market 7th Edition, Table 15, Average Monthly Wages. It corresponded partially to the Ministry of Manpower, Report on Wages in Singapore, 2011, Table 7, Average (mean) monthly earnings per employee by industry and sex, 2006 – 2011.

Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
ILO $3,063 $3,134 $3,158 $3,213 $3,329 $3,444 $3,554 $3,773 $3,977 $3,872
MOM $3,554 $3,773 $3,977 $3,872

The wages, given in current prices (meaning the respective years’ prices), had to be adjusted for inflation using the CPI to arrive at 2009 prices. The average was then taken to arrive at the 2000-2009 average monthly wage of SGD $3,758 at 2009 prices:

Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Wage (current prices) $3,063 $3,134 $3,158 $3,213 $3,329 $3,444 $3,554 $3,773 $3,977 $3,872
CPI 87.6 88.4 88.1 88.5 90 90.4 91.3 93.2 99.4 100
Wage (2009 price) $3,497 $3,545 $3,585 $3,631 $3,699 $3,810 $3,893 $4,048 $4,001 $3,872

Neither of the PPPs from World Bank or the Penn World Tables when applied to Singapore’s average wage of SGD $3,758 could yield MTI’s figure of US$3,106.

2009 PPP (SGD per USD) PPP adjusted average wage from 2000 to 2009 (2009 USD)
Penn World Tables 2009 PPP for SG 1.107 $3,395
IMF 2009 implied PPP for SG 1.074 $3,499
World Bank 2009 PPP for SG GDP 0.981 $3,831

[6]
Wage data in national currencies are from OECD (except for Singapore which is from ILO). OECD has full set of wage data for each of the years from 2000 to 2009. ILO data is often incomplete for most countries. Only First World democracies are compared. OECD has its own purchasing power parity figures but to be comparable to Singapore which is not an OECD member, PPP adjustment is done through World Bank’s PPP figures.

[7] per capita GDP (2000 USD), per capita GDP (current USD), PPP adjusted per capita GDP (2005 USD) and PPP adjusted per capita GDP (current USD) all from World Bank

False justifications on why Singapore’s health-care system works

June 12, 2013

Dear Gillian,

Taking calculated risks to save lives is not the sole premise of Singapore doctors but doctors all over the world including American doctors. The following case is very similar to yours where US doctors injected different kinds of antibiotics to save a patient suffering from meningitis:

• Eric had Bacterial Meningitis and the prognosis was not good. They immediately started him on several different antibiotics and sent him to P.I.C.U … [2-1].

The following is an example where US doctors took risks to treat meningitis even before tests had been processed.

• It was our paediatrician’s nurse that first advised us to immediately go to the hospital with Paisley, and pressed us not to delay based upon what we thought of as unremarkable symptoms. The doctors at the hospital took the strongest actions possible, assuming the worst case scenario and treating for meningitis before the tests had been processed. Their proactive playbook and prioritization of her case made a difference, in a struggle where lost time can mean irreversible repercussions [2-2].

Thus, contrary to your insinuation, American doctors do take risks to save lives. It’s never useful to form conclusions from anecdotal evidences, it is more important to rely on statistical evidence to form proper judgements instead. Although there is no worldwide meningitis mortality rate statistics to compare, we can compare communicable disease mortality rates instead since meningitis is a form of communicable disease. The following table [3] shows that Singapore has a far higher mortality rate due to communicable diseases than most First World nations. In fact, our mortality rate is even higher than China’s. US mortality rate due to communicable disease is almost half that of Singapore’s, a statistic you can be proud of.

Rank Country 2008 age-standardized mortality rate (per 100 000 population) – communicable disease
1 Finland 11
2 Austria 14
3 New Zealand 15
4 Hungary 16
5 Italy 16
6 Andorra 16
7 Montenegro 17
8 Switzerland 17
9 Serbia 17
10 Cyprus 17
11 Australia 18
15 Sweden 20
16 Germany 21
22 Canada 23
23 France 23
25 Spain 24
26 Luxembourg 25
30 Denmark 27
31 Norway 27
32 Netherlands 28
34 Ireland 29
35 Republic of Korea 29
42 Belgium 33
43 United States of America 34
46 United Kingdom 36
48 Japan 40
60 China 58
66 Singapore 66

It is unfortunate that you should also quote the work of Professor William Haseltine because his work contains a fundamental flaw which basically invalidates what he is trying to establish. Professor Haseltine, like nearly everyone else, compares healthcare costs without taking into consideration old age dependency. Western nations, having higher old age dependency ratios than Singapore are bound to have higher healthcare costs than us all else being the same. Comparing the healthcare cost of Singapore with those of Western nations without adjusting for old age dependency is like comparing the healthcare cost of yourself with that of your grandmother’s. It’s a no brainer that your grandma’s healthcare costs will be higher than yours on average even though both of you are under the same healthcare system. The following table [4] shows that after adjusting for old age dependency, Singapore is far from top notch in terms of healthcare cost efficiency.

Country 2011 old age dependency ratio 2011 per capita health expenditure 2011 old age dependency predicted per capita health expenditure 2011 % healthcare overspending compared to predicted value
Italy 31.5 $3,436 $4,305 -20%
Korea, Rep. 15.9 $1,616 $1,765 -8%
Spain 25.3 $3,027 $3,290 -8%
UK 25.6 $3,609 $3,340 8%
Germany 31.2 $4,875 $4,251 15%
Finland 27 $4,325 $3,571 21%
Sweden 28.6 $5,331 $3,837 39%
Belgium 26.9 $4,962 $3,551 40%
France 26.4 $4,952 $3,480 42%
New Zealand 20 $3,666 $2,441 50%
Austria 26.4 $5,280 $3,478 52%
Singapore 12.7 $2,286 $1,248 83%
Denmark 25.8 $6,648 $3,384 96%
Netherlands 23.6 $5,995 $3,020 99%
Ireland 17.8 $4,542 $2,079 118%
Canada 20.8 $5,630 $2,570 119%
Australia 20.3 $5,939 $2,487 139%
Switzerland 25.1 $9,121 $3,255 180%
Norway 22.6 $8,987 $2,852 215%
Luxembourg 20.3 $8,798 $2,486 254%
United States 20 $8,608 $2,426 255%

The other issue with Professor Haseltine’s study is his comparison of healthcare costs as a percentage of GDP. That is like comparing your healthcare expenditure as a percentage of your salary. Suppose your healthcare expenditure didn’t change but you now earn twice as much as before, your healthcare expenditure as a percentage of your salary will halve so that your numbers will look twice as good as before even though your healthcare expenditure never changed. So it’s better and more meaningful to compare per capita healthcare expenditure itself instead.

The claim that Singapore has much better life expectancy, infant mortality, premature adult death and emergency care is also questionable. The following table [5] shows that very little separates Singapore from Western nations in terms of life expectancy, infant mortality or adult death.

Country 2011 Life Expectancy (both sexes) 2011 infant survival rate (probability of surviving between birth and age 1 per 1000 live births for both sexes) 2011 adult survival rate (probability of surviving between 15 and 60 years per 1000 population, both sexes) Average
San Marino 100% 100% 100% 100%
Switzerland 100% 100% 100% 100%
Iceland 99% 100% 100% 100%
Japan 100% 100% 99% 100%
Singapore 99% 100% 99% 99%
Italy 99% 100% 99% 99%
Sweden 99% 100% 99% 99%
Israel 99% 100% 99% 99%
Australia 99% 100% 99% 99%
Spain 99% 100% 98% 99%
Luxembourg 99% 100% 98% 99%
Andorra 99% 100% 98% 99%
Cyprus 98% 100% 99% 99%
Canada 99% 100% 98% 99%
Qatar 99% 100% 98% 99%
Norway 98% 100% 99% 99%
Netherlands 98% 100% 99% 99%
Ireland 98% 100% 98% 99%
Monaco 99% 100% 97% 99%
Kuwait 96% 99% 100% 98%
France 99% 100% 97% 98%
New Zealand 98% 100% 98% 98%
Austria 98% 100% 98% 98%
Malta 96% 100% 99% 98%
South Korea 98% 100% 98% 98%
Greece 98% 100% 98% 98%
Germany 98% 100% 98% 98%
Finland 98% 100% 97% 98%
United Kingdom 96% 100% 98% 98%
Bahrain 95% 99% 99% 98%
Belgium 96% 100% 97% 98%
Portugal 96% 100% 97% 98%
Slovenia 96% 100% 96% 98%
Denmark 95% 100% 97% 97%
Chile 95% 99% 96% 97%
Costa Rica 95% 99% 96% 97%
Saudi Arabia 92% 99% 99% 97%
Maldives 93% 99% 97% 96%
Czech Republic 94% 100% 95% 96%
USA 95% 100% 94% 96%

Our healthcare insurance premiums may be a fraction of those in America but our coverage is also much lower too [6]. To begin with, our Medishield has a deductible of $1,500 for C class wards or $2,000 for B2 class wards or better [7], which means only medical bills that go beyond $1,500 or $2,000 respectively are covered. Our Medishield claims totalled $291.4 million for 262,009 claims in 2011 or an average of $1,112 per claim. This means that on average, patients only claimed $1,112 while paying $1,500 or $2,000 from their own pockets. In percentage terms, patients only claimed back between 35.7% and 42.6% while footing between 57.4% and 64.3% of medical bills themselves. This is excluding many other patients whose medical bills didn’t exceed $1,500 or $2,000 and so claimed nothing but had to pay everything themselves.

It is a shame that you are of the opinion that Singapore statistics puts US and other Western nations to shame because they don’t. Singapore healthcare when adjusted for old age dependency is more costly than countries like UK and Germany. At the same time, Singapore healthcare outcomes are not significantly better than most Western nations. So it should be the wrong use of statistics that ought to be shamed instead.

[1] Straits Times, Why Singapore’s health-care system works, 9 Jun 2013, Gillian Tett

[2] http://www.nmaus.org/programs/share-your-story/readotherstories.htm
[2-1] Beverly, Parent of Josh, meningococcal disease survivor Iowa
[2-2] Paisley: Texas, 12 days old

[3] World Health Organisation, Global Health Observatory Data Repository, Cause-specific mortality and morbidity (2008 is latest available)

[4]
• 2011 old age dependency ratio is from World Bank data
• 2011 per capita healthcare expenditure is from World Health Organisation

[5]
• 2011 Life Expectancy, Infant mortality and Adult mortality are from World Health Organisation
• For life expectancy, comparison is based on percentage of highest life expectancy which is 83 years for San Marino, Switzerland and Japan
• Infant survival rate is used instead of infant mortality to convert the score to one where the higher it is the better it is. Infant survival rate is 1000 – infant mortality rate. Comparison is based on percentage of highest infant survival rate which is close to 100% for almost all First World nations.
• Adult survival rate is used instead of adult mortality to convert the score to one where the higher it is the better it is. Adult survival rate is 1000 – adult mortality rate. Comparison is based on percentage of highest adult survival rate which is 95% for San Marino, Switzerland and Iceland.
• WHO has no emergency care statistics to compare

[6]

Today, ElderShield under fire, 26 April 2012

Lee Kuan Yew School of Public Policy Professor Phua Kai Hong, an authoritative figure in the region on healthcare policy and management, first voiced his concern about ElderShield, which is the sole national insurance scheme for intermediate and long-term care, at a closed-door discussion earlier this month.

Speaking to Today, he reiterated that the scheme is “completely inadequate”. Said Prof Phua: “People are calling our hospitals a First World sector, but that our long-term care is Third World standard. Besides the over-reliance on voluntary welfare organisations, patients’ families and cheap labour, the financial structure in this sector needs to be thoroughly re-looked.”

[7]

http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield/How_MediShield_Works.html

A deductible is the initial amount you need to pay for claim(s) made in a policy year, before there is MediShield payout. No reimbursement would be made from the MediShield if the claimable amount falls below the deductible.

If you choose to stay in a Class C ward during your hospitalisation, the applicable deductible would be $1,500. For Class B2 and above wards, the applicable deductible would be $2,000.