With a chorus of "ayes", universal health insurance became a reality in Singapore yesterday as Parliament passed the MediShield Life Scheme Bill into law.
It is a historic moment that marks the coming together of all Singaporeans to "build a health-care safety net that leaves no one behind", Health Minister Gan Kim Yong said as he announced more government subsidies for the higher premiums needed to support the new scheme.
The Government will subsidise at least 90 per cent of any increase in premium in the first year and at least 70 per cent in the second year, up from the 80 per cent and 60 per cent proposed earlier.
This means those without pre-existing medical conditions will not pay more than $3 a month in higher premiums for the first two years of the scheme, which will replace MediShield.
But even after the five-year transition period, two out of three households will continue to get permanent premium subsidies from a $4 billion fund.
MediShield Life provides lifetime coverage for all Singaporeans and permanent residents, regardless of age or pre-existing health conditions.
It gives the authorities powers to access their medical and income records to calculate premiums and subsidies - although individuals can opt out.
It also lets the authorities recover unpaid premiums through payroll deduction or measures such as barring the defaulter from leaving the country.
Defaulters who wilfully refuse to pay face a fine of up to 17 per cent on outstanding premiums and interest on the amount owed.
Many of the 23 MPs who rose to speak during the five-hour debate yesterday were worried that overly harsh action would be taken against defaulters, noting that this group may include the very poor, the very old and those in sudden financial difficulty.
Mr Gan assured them that a flexible and compassionate approach to defaulters would be taken, promising: "No one, especially our pioneers, will lose their MediShield Life coverage due to the inability to pay their premiums."
Action would be taken only against wilful defaulters - those who can pay but will not, he said.
MPs also stressed the need to safeguard confidential medical and income information, and to keep the list of pre-existing medical conditions as short as possible.
Those with pre-existing conditions must pay an additional premium of 30 per cent over 10 years due to their required treatments.
But on the fundamentals of the Bill, no MP disagreed.
All welcomed what Ms Denise Phua (Moulmein-Kallang GRC) called "the manifestation of the spirit of belonging to a country".
The key issue now, noted MPs like Dr Chia Shi-Lu (Tanjong Pagar GRC), is the scheme's sustainability: Medical costs could spiral as patients demand more expensive treatments, or people slacken in taking care of their health.
Agreeing, Mr Gan said the Government can monitor medical claims only for excessiveness, and the rest of society must step up.
Ordinary Singaporeans should "encourage each other to make healthy choices", he said. "All of us - patients, health-care providers, insurers, family members - need to do our part."
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