This is an edited excerpt of Prime Minister Lee Hsien Loong's National Day Rally speech on Sunday on healthcare, where he announced a new package of healthcare subsidies for the Merdeka Generation, or those born in the 1950s
Singaporeans are indeed spending more on healthcare - partly because we have more advanced treatment options and better, more sophisticated equipment. But a bigger reason is because Singaporeans are living longer, and growing older, which means we are likely to have more episodes of illness and more medical problems to treat.
How have we kept healthcare spending affordable for Singaporeans? We have our 3Ms - Medisave, MediShield and Medifund. At the same time, Government provides heavy subsidies - up to 80 per cent in our hospitals, and also for primary and long-term care. This framework has worked well for many years.
In recent years, we have made further changes. First, we upgraded MediShield to MediShield Life. The payouts are more generous, and there is no lifetime claim limit. You enjoy lifelong protection, even if you have pre-existing conditions or if you were previously uninsured. Last year alone, close to 200,000 Singaporeans benefited from MediShield Life, and the payouts amounted to over $800 million.
Second, for outpatient expenses, we introduced the Community Health Assist Scheme (Chas).
At GP clinics, your Chas card entitles you to generous subsidies, especially for the lower income. Dr Lily Neo, who is a GP, told me that after Chas was introduced, she saw more elderly patients. She said that our old folks are very resilient and generally put off seeing the doctor until they cannot tahan (Malay for endure) any more. But because of Chas, they now come to her earlier, which is better and she can treat them before their conditions worsen.
Chas has worked well. As we grow older, more of us will have chronic conditions, like diabetes or high blood pressure or cholesterol. But we can continue to live a full life if we manage these conditions - by taking good care of ourselves, eating healthily, taking our medications regularly and following up with our family doctor.
Chas covers middle-and lower-income Singaporeans. We will now extend Chas to all Singaporeans with chronic conditions, regardless of income. The benefits will continue to be tiered according to income. The Ministry of Health (MOH) will announce the details later on.
We have also improved financial support for long-term care. We have seen our own parents or grandparents getting old, growing weaker, gradually becoming unable to take care of themselves. They can no longer feed themselves, dress themselves, or move around independently. They struggle to perform these activities of daily living or ADLs: activities that when you are young, you take for granted. It is a little bit sad, you see it happen. But that is life. One day, it will happen to us.
So we have the ElderShield scheme. If you cannot do three of these ADLs, ElderShield pays out a monthly sum of $300 or $400, for up to six years. MOH has revamped ElderShield fundamentally, and we will soon have CareShield Life. CareShield Life will pay out significantly more - at least $600 a month and it will pay out for as long as you live, not just six years.
The scheme will start in 2020. It will cover all Singaporeans born in 1980 and younger. Even people with an existing disability will be covered. The Government will subsidise the premiums for lower-and middle-income families, so that these families can pay their share out of Medisave.
If you are older - born before 1980 - you can also choose to join CareShield Life. It is not compulsory, but you can join and I hope you will do so. Why? Because you will get a generous subsidy to help pay the premiums. The Government will co-pay, so you are getting a good deal. But really because it will give you and your family more peace of mind.
These are some of the major changes to our healthcare financing over the last few years. We want all Singaporeans to have access to affordable, high-quality healthcare. No one should be denied medical care because they cannot afford it and that is my commitment to you.
We have taken special care of elderly Singaporeans. Four years ago, I launched the Pioneer Generation Package (PGP) for the group of Singaporeans born in 1949 or earlier. They were a special generation, who sacrificed much to bring up their families. They did not have good educational opportunities. Most started working early, had low-paying jobs and could not put aside much for old age.
They spent most of their working lives in Third World Singapore; only to retire in First World Singapore. Understandably, they were worried about their healthcare needs. We implemented the PGP to recognise their sacrifices and to support them in their silver years. So far, we have spent more than $1.3 billion of the $8 billion we set aside for the PGP. 450,000 Pioneers have benefited - and they fully deserve it.
When we introduced the PGP, we knew that Singaporeans a little younger than the pioneers... would just miss out... those born between 1950 and 1959.
We have not forgotten this group. They lived through the tumultuous years of the 1950s and early 1960s.
First came the struggle for independence from the British. Domestically, Singapore politics was fiercely fought, over different visions of the colony's future. In 1959, Singapore gained internal self-government, one big step towards independence. The PAP (People's Action Party) won the general election that year, and formed the government for the first time. Then came the split with the communists, merger with Malaysia, and then separation and unexpected independence - alone.
For those born in the 1950s, these were indelible, formative experiences that shaped them for life. They were too young to participate in events but most were old enough to sense the electricity in the air, to share the excitement of the changes, to feel the hope of a brighter tomorrow.
They saw the posters and banners that festooned the streets, and were stirred by the rallying cry "merdeka". One word that meant so much - liberation, freedom, independence. One word that expressed the determination and the passion, the ambitions and aspirations, of a people who were roused and on the move.
And seldom were the people more roused than on June 3, 1959, when Mr Lee Kuan Yew, newly elected Prime Minister, addressed a huge rally at the Padang. As he told the crowd from the City Hall steps: "Once in a long while, in the history of a people, there comes a moment of great change. Tonight is such a moment in our lives… We begin a new chapter in the history of Singapore."
This group born in the 1950s are the Merdeka Generation. There are 500,000 of the Merdeka Generation today. I am proud to be one of them.
Having lived through the battles and upheavals of the Merdeka struggle, and seen how their parents have scraped and slogged for them, when the Merdeka Generation grew up, they understood instinctively what was at stake. They accepted hardships, made sacrifices, answered the call of duty, and worked with their leaders to build a better tomorrow. The men were among the earliest batches called up for national service. They were the first of the SAF (Singapore Armed Forces) - the army, navy and air force.
Many, especially girls, did not complete their education. They came out to work early, to support the family and younger siblings. Some joined the workforce amidst economic uncertainty and high unemployment, as the British forces withdrew from Singapore. All started working when wages were still low. Together with the Pioneer Generation, the Merdeka Generation contributed to building Singapore, to making Merdeka - independence - a success.
Compared to the Pioneer Generation, the Merdeka Generation are better off. They were born later, and benefited from an extra decade of economic growth. They were generally better educated than the pioneers, especially the younger ones.
The Merdeka Generation earned more over their lifetimes, and accumulated more CPF savings, because in the early 80s, wages increased sharply. CPF rates also went up significantly. But of course, the cohorts that came after them did even better. As we improved the education system, year by year, more of the younger cohorts earned diplomas and degrees, and found higher skilled and better paid jobs.
Most of the Merdeka Generation today are in their 60s. They have either left the workforce, or will soon be retiring. Many have similar healthcare concerns as the Pioneers. They are looking at their CPF (Central Provident Fund) savings and Medisave accounts, worried about having enough for their medical needs as they grow older. I think we owe something to them.
The Government will work out a "Merdeka Generation Package". The Merdeka Generation Package will help this group to meet their medical expenses. We will announce the details next year.
It will cover similar areas as the PG Package. For example, outpatient subsidies, Medisave top-ups, MediShield Life premium subsidies, and payouts for long-term care. The benefits will not be as large as for the Pioneer Generation, who had much less advantage in life. But the Merdeka Generation Package will go some way to relieve their healthcare worries.
More importantly, it will show our appreciation for the Merdeka Generation and their contributions.
In summary, we are making big changes to our healthcare financing framework. We have strengthened the 3Ms, and introduced MediShield Life. We will soon enhance Chas and introduce CareShield Life. We implemented the PG Package. We will set aside a significant sum to implement a Merdeka Generation Package.
Our schemes are now more comprehensive and inclusive, and Singaporeans can have more peace of mind that their healthcare needs are well taken care of.
A version of this article appeared in the print edition of The Straits Times on August 22, 2018, with the headline 'The Merdeka Generation is not forgotten'. Print Edition | Subscribe
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