Response to speranza nuova: who should pick up the bill for social assistance?

speranza nuova posted this comment in response to my posting on the TODAY article "How Many Portions Of Help, Sir?":

Hi Mr Siew,

While on this topic, I thought you might want to peek at an article written by one of my Singapore Angle colleagues:

On a Not Uncommon Line of Argument

It raises a difficult issue: Who should pick up the bill, when an elderly person's family has chosen not to provide support?

I thought this to be too important to bury in a comment, so I will respond to that article in this post. It has taken me a few days to write this.

Before I start, I will state for the record that I am fortunate enough to pay taxes (both direct and indirect), and a lot more taxes than what I directly receive from the system. (I am undecided on whether to put quotation marks around "fortunate" -- nobody likes paying taxes, but all things considered, including the fact that my revenue is almost 100% taxable income, I would rather be paying income tax than not. Unfortunately for me, I am not one of those lawyers whose salaries form the basis of the MR4 and SR9 benchmarks...) Please feel free to make of and extrapolate from that whatever you will.

Firstly, I'd like to take a step back from all that intellectualisation and rationalisation and philosophising in and around that article, and talk about what a society is or should be about.

To quote Wikipedia -- as unreliable as that can be for contentious issues:

"A society is a grouping of individuals, which is characterized by common interest and may have distinctive culture and institutions. ... In the social sciences such as sociology society has been used to mean a group of people that form a semi-closed social system, in which most interactions are with other individuals belonging to the group."

I guess that is the "technical" meaning. To that I would the concept of values -- a society is also characterised by a common (if not universal) set of values and goals/aspirations.

So what sort of values and goals/aspirations should Singapore as a society have? What do we want it to be? Is it enough for Singapore society to exist in purely economic terms? Or do we want it to be something more?

I for one want it to be something more. I want Singapore to be a society that cares for and looks after its under-privileged and the less fortunate. I want it to be compassionate and inclusive, as over-used as that term has become. I want it to to go beyond numbers and statistics and economics and cold logic. I want it to empathise and sympathise.

In short, I want Singapore to have a heart. And I do not think that that is necessarily inconsistent or irreconciliable with Singapore as a functioning, effective, successful capitalist economy plugged into a globalised world.

So let's go back to the article. As I see it, the problem is that the article is too intellectualised and overly-grounded in economic theory. It approaches the issue in a vacuum of economic theory. It is perfect fodder for technocrats, but it does not describe real life.

A government that is nothing more than a technocracy would make for a truly sad society. I do not think -- and I pray -- that we do not have such a government or such a society.

Yes, this is a more emotive and emotional approach than the stone-cold rationality and logic employed in the article. I do not see that as a flaw, but as a strength.

So let's move from a generalised critique to a more detailed examination of the article's points.

I have already defined what sort of society I want Singapore to be. In theory, this may be achieved by the efforts of the Government, non-governmental actors (such as private charities), or of both.

Zeroing in on the specific issue of the care of elderly citizens who are not being cared for by their children or family, I think the situation in Singapore is that both the Government and private charities play a role, under the so-called "many helping hands" approach. But the primary expectation is for people to take care of themselves, or for their families to step up.

My question is: what happens when people are not, for any reason (including their own financial irresponsibility), able to take care of themselves, and their families do not step up, and they somehow fall through the cracks of private charities? Do we then adopt a judgmental view of them and their actions and their irresponsibility, and deny them assistance on the basis that "they should have known better" and that doing so would be economically inefficient?

Government is about hard choices. But does the choice have to be so hard for other people?

It is fundamentally an issue of one's view on what is the acceptable/requisite level of economic (in)efficiency when allocating scarce resources. I think Singapore as a society can afford to, and should, allocate our resources in a manner that is less economically efficient, but more (to my mind) holistically beneficial. (And that is also my problem with the HDB's position when it comes to allocating rental flats and other forms of accomodation assistance to the needy. Denying help to people who are "financially irresponsible" is not, to my mind, defensible. Not in this day and age of plenty and prosperity.)

I do not advocate unlimited provision of assistance, but I do believe we can do more. It may be economically inefficient, but not everything can or should be reduced to a question of economic efficiency.

An analysis using only economic theory assumes that everything is quantifiable and reducible to value and utility -- well, can you quantify your soul? Can you reduce to a dollar value, or any other objective metric, the general feeling of well-being and security that comes from knowing that you will never be completely abandoned and left in the cold? (And while I do not intend to talk about Bhutan's happiness index because I think it is cliched, I do believe that it is cliched for a good reason. That example does show up the drawbacks of using economic theory as the sole analytical tool and economic efficiency as the only indicator of good governance.)

In a recent posting on Tomorrow.sg, a blogger wrote about how wonderful the UK NHS was -- because he and his wife were benefitting from it. Even though they were foreigners and neither citizens nor PRs. A good friend of mine, whose girlfriend's mum is terminal ill-health in Canada, shares the same view about the Canadian system, which is providing her with free medical care and at a qualitatively high level as well.

These systems are, by most conventional accounts, economically inefficient. But to their beneficiaries, they are important and give huge amounts of comfort. My memory of A-Level Economics is that economic efficiency is about matching cost with utility. So just how do we account for all that utility when assessing whether these public health systems are economically efficient? Do we simply ignore that, just because it is not quantifiable?

I would be the first to admit, that assessments of whether a non-quantifiable benefit is worth the economic inefficiency is inherently subjective. But an argument based purely on economic efficiency itself masks an underlying subjective view, that economic efficiency is the only (or primary) standard of evaluation of policy.

It is true that when I advocate more spending on helping the elderly for whom no other help is available or easily available, I am ultimately advocating how to spend other people's money. I pay a bit in taxes, but I am under no illusion about just how much I spend!

Having said that, the same is true of all public expenditures, even public expenditure on public goods. Take street lighting. The amount of benefit I get from street lighting does also depend on where I live, whether I drive, how far I have to walk to get home, etc. Or defence -- how much it means to me depends on how globally mobile I am, whether I can emigrate, whether I have overseas PR.

So even public goods benefit some more than others. We do not quibble with public goods on that basis. So why do we quibble with private goods on that basis?

If spending a bit more on this would deprive some others of Governmental expenditure, then that merits a closer scrutiny and more thinking about which resource utilisation is more meritorious. But I think our Government has enough money (theoretical Budget deficit notwithstanding -- mark my words, at the end of this Government's term, we will somehow still have accumulated enough surpluses for a generous benefits package) that it is not a zero-sum game.

In conclusion, I would say this. Government is not just about management. It is not just about managing dollars and cents, or an exclusive focus on ensuring an economically-efficient allocation of resources, or an overriding respect for private actors' freedom to allocate their property as they deem fit without state intervention. It is not just about cold hard logic and economic theory.

Government is about all that. But it is also about more. It is also about leadership, political, economic and most of all moral. It is about empathy and compassion. It is about caring and sharing, and ensuring that no one gets left too far behind.

And yes, it is about emotions. Because at the end of the day, people are people. People have hearts. People have feelings. People are not digits. And we always need to remember that.

How Many Portions Of Help, Sir?

This article from today's edition of TODAY talks about Singapore's version of a welfare scheme. Welfare-fearing rhetoric from our leaders aside, Singapore is not so heartless that we don't have any welfare schemes at all -- we do.

It's called the Public Assistance scheme. There are only about 3,000 households are on it. I am not sure if that's because there are only 3,000 households that need this kind of assistance, or because of the stringency of the eligibility requirements, viz. Singapore citizens who (a) are unable to work owing to old age, illness or unfavourable family circumstances; AND (b) have no means of subsistence and no family members to depend on. (underlining added)

There is a cash grant component to it, with the amounts on a sliding scale depending on household size and the number of adults and children in the household. A single-adult household is currently given $260 per month, but this number is due to rise to $290 per month.

I don't think the PA scheme was very widely-known outside of the social assistance/welfare sector, at least not until a recent exchange in Parliament between MP Lily Neo and Mr Sin Boon Ann on one side, and Minister Vivian Balakrishnan on the other, that was quite widely reported in the media.

For background, Dr Neo had earlier done a rough survey of her constituents on PA, and discovered that a fair proportion of the single adults on PA had to skip at least one meal a day to get by on $260 per month. By her estimate, a single-adult household on PA actually needed about $400 per month to get by. She had filed a PQ on it in February that was not fully discussed due to time, and also because it preceded the COS debate on MCYS and so the response given to her was "wait for the Budget debate".

I can do no better than to direct you to the TODAY article, and to reproduce the relevant exchanges in Parliament below. As for me, I think $290 per month is disgraceful. At the very least, as pointed out by SPS Amy Khor in the TODAY article, the ministry needs to justify that figure and reconcile it with Dr Neo's $400 figure.

OPQ (by Dr Lily Neo, 12 February 2007)

Public Assistance Scheme (review)

Dr Lily Neo asked the Minister for Community Development, Youth and Sports when was the last review of the Public Assistance Scheme and whether there has been an increase in the number of families on the Public Assistance Scheme.

The Minister of State for Community Development, Youth and Sports (Mrs Yu-Foo Yee Shoon): Mr Speaker, Sir, the Public Assistance Scheme is targeted at helping needy Singaporeans who are unable to work and have no family support. The number of families on the scheme has been stable for the past five years at about 3,000 families at any one time. MCYS reviews the Public Assistance Scheme regularly and takes into consideration changes in the cost of living for families on public assistance. The scheme was last reviewed in 2002 and the revised rates were implemented on 1st January 2003. And I would like to inform hon. Members that there is good news - a review is currently ongoing and likely to be completed within the next few months.

Mr Speaker: Yes, Dr Neo, one minute left.

Dr Lily Neo: May I request that this review be commensurate with inflation because, in the past, the review had not been. And from my study on 32 elderly PA cases, it shows that they need $400 a month, whereas now, from the $260 per month, they only have to live from $5 per day, which is too little even for subsistence living. The other issue is whether we could also look into the eligibility criteria because we have been very stringent as there are less than 2,800 cases of PA allowance cases whereas, according to a study, there are 100,000 households that need assistance from charitable organisations.

Mr Speaker: Order. End of Question time.

MINISTRY OF COMMUNITY DEVELOPMENT, YOUTH AND SPORTS (9 March 2007)

Dr Lily Neo (Jalan Besar): Mr Chairman, the Minister yesterday announced that PA allowance will be increased by $30 a month, from $260 to $290. The Minister did not answer my two questions on whether PA allowance commensurates with inflation and whether there has been a study done to ascertain whether PA allowance serves the needs of the recipients.

Sir, my single constituents told me that they needed to skip one meal a day to live on the $260 per month. And now, MCYS is going to give them $1 more a day. But, Sir, $1 a day will not be able to buy them one meal a day in any hawker centre.

Dr Vivian Balakrishnan: When we did this review of the Public Assistance rates, we took into account both the impact of inflation since the last review as well as the impact of the GST increase. There will always be arguments about whether a sum that we have decided is enough or not. As I said yesterday, frankly, one limiting factor must be that the sum that we give through Public Assistance cannot be so generous as to erode the work ethic. As I said again yesterday, if you take a family with three children, the amount they can receive from Public Assistance - I do not have the exact figure now - I think exceeds $900. At that level, you are getting dangerously close to the earnings of a low-wage worker.

Having said that, I think there will always be unique circumstances when some families find that that sum is not enough. And that is where the community and grassroots organisations have to come in and look for those mitigating or exceptional circumstances and more help is necessary. So the key point is that as far as the entitlement portion is concerned, I will admit that that is set low. But have flexibility, have organisations and individuals who are able to assess special needs of special families and then respond accordingly. That is the system which we have.

The alternative is to set the entitlement at a very high level. But once you do that, I think you would not have only 3,000 families on Public Assistance, you will see many multiples of families.

Dr Lily Neo: Sir, the Minister said that the increment was done in such a way so as not to take away the work ethic. Surely, this argument cannot be applied to PA allowance recipients because this is a group of people that can never work either due to poor health, old age or disability. Therefore, this work ethic concept does not work. The other point is that the Minister said that this group of people can depend on grassroots organisations and others. Am I to understand that MCYS cannot provide adequately for the most vulnerable group of our society and that PA recipients must go and seek help from others? He said yesterday that in this globalisation, he will ensure that increasing number of Singaporeans will not feel left out and that he will provide more assistance to the poor to cope with the higher cost of living. May I ask him: should providing three meals a day not be a priority of his promise?

Dr Vivian Balakrishnan: I take the Member's point that for Public Assistance, we have fairly strict criteria. But having said that, I am still not willing to go to the other extreme and say that since we have got strict criteria, we can afford to be generous. This is the same point that Mr Seah Kian Peng raised yesterday. I have sympathy for that point, but I would still appeal to Members of this House to exercise caution.

Her second question was: why must they go and seek help? Why must they ask for it? I would like to remind her again of my speech yesterday when I said that if it is going to be low on entitlement and high on flexibility, then we do want some effort to be exerted on the part of the recipients. Yes, we do want them to go and ask for help. But I also said yesterday that, let us not get too carried away and reach a stage where if someone does not know or does not want to ask for help, we ignore that person. I have also asked the community organisations, neighbours, voluntary welfare organisations and the rest of us, if we see someone who needs more help, enquire about that person and organise the help.

Let us talk about meals since the Member has phrased her question specifically about three square meals. You and I, in fact, all of us, know that there are programmes for meals at home. There are organisations which specifically bring bread and rations, many of which are bought from FairPrice, gratitude to Mr Seah as well. But there are schemes like this. That allows me to say with a clear conscience to both the PAP and the Opposition MPs that nobody in Singapore needs to starve, nobody needs to be deprived of healthcare, and nobody needs to be deprived of a roof over his or her head. If someone indeed is so destitute and is starving, we have other means and other safety nets for them. We can bring them to the Pelangi Home, and I would invite all of you to come to Pelangi Home and see the standard of care, the facilities, the food and the way we look after them.

So, please do not run away with the misconception that Singapore is a cold, heartless place where, because we are so strict on criteria and entitlements, people are starving, freezing and denied the dignities of life. All I am asking members is just to bear these principles in mind. Entitlements will always be low, ie, the person has to ask you for help and not bang on your table for help. We will always need the many-helping-hands model, not because the Government is broke. We can always do more and we can always raise GST further. But that is not the tone of the society that we are trying to create. We are saying that, yes, there will always be problems in society and it cannot be only the Government to do it because, if you want the Government to do it all, it means higher taxes and a large bureaucracy. As we can see in many other countries who have created elaborate welfare-states based on the best of intentions and the softest of hearts, such systems ultimately failed, they are not efficient and they are going to run out of money. We will see that happen in our lifetime, but we will make sure that that does not happen in Singapore.

As the Minister for MCYS, those are the dilemmas and the trade-offs that I have to make.

Mr Sin Boon Ann: This relates to the same point too. I am assured by the Minister's reply that no one in Singapore needs to go hungry. But the fact remains that we come across people who are indeed hungry, people who are left out and who basically fall through the cracks. I suppose this must be something to do with our communication process, our ability to reach out to these people and to tell them where help can be delivered. Surely, the Minister would also, in his deliberations, consider whether or not the communication channel or the outreach channel, is adequate and could the Ministry be doing more in this regard to reach out to these needy Singaporeans.

Dr Vivian Balakrishnan: Absolutely. I shared the story of Tan Sai Siong yesterday to make the point that it just needs sometimes one email or one phone call. Singapore is a very small place. It is not difficult for Members to contact the Prime Minister or myself directly. I am not saying that that should be the modus operandi here and everything should be solved that way. But what I am saying is that, if you do detect families in such distress, do something about it. Do not just complain but ask yourself first what should you do about it and who else can help. As far as the Government is concerned, what systems, structures, institutions and policies are needed. I want to get these things clear in our minds that there is a role for the individual to help himself or to seek help. There is a role for families. There is a role for community organisations. There is a role for interested and compassionate individuals and Tan Sai Siong was an example. And there is a role for Government. But let us keep all these respective roles organised in such a way that each one does what he or she is best at.

That is why I am appealing for understanding that our entitlement system will be low. That also means, as the Member has quite rightly said, we need to communicate, we need to keep all channels of communication open and we need to keep our eyes open. We cannot, like what I said yesterday, whenever you see someone whom you think needs help, just shrug our shoulders and say, "See, that is the Government's job." Ask yourself what you yourself have done about that individual and about that family. Singapore has got to where it is now, not just because of hard work but also because there have been family obligations and community compassion. And we have been almost schizophrenic in the sense that I believe that we have done better than communist and socialist countries in looking after the poor.

Yet, we have also been one of the most free-market capitalist economies. It is this ability to pick and use the best aspects of both capitalism and socialism - the head and the heart - which is the secret to our success. So we must disagree, we must have tensions and we must debate this, but let us not lose that sense of balance. I am sure there will be implementational and operational problems. And when these come up, Members must tell me and I must do my best to fix it. But when it comes to policy and entitlements, I will tell Members quite frankly that I start from a rather stringent and tight perspective.

That is why, yesterday, I said that I am not here to argue for a bigger budget for MCYS, although I also showed Members yesterday that the budget is increasing at a very significant rate. But I am more focused on the policies, the rules, the systems and organisational roles than on absolute sums. It is very easy for me to stand here and say, "I can double public assistance", and try to persuade my Cabinet colleagues to agree to that. But, in my heart of hearts, I will know that it is wrong and that, ultimately, it will short change the very poor that we are trying to help and the entire group of people called Singaporeans.

Dr Lily Neo: Sir, I want to check with the Minister again when he said on the strict criteria on the entitlement for PA recipients. May I ask him what is his definition of "subsistence living"? Am I correct to say that, out of $260 per month for PA recipients, $100 goes to rental, power supply and S&C and leaving them with only $5 a day to live on? Am I correct to say that any basic meal in any hawker centre is already $2.50 to $3.00 per meal? Therefore, is it too much to ask for just three meals a day as an entitlement for the PA recipients?

Dr Vivian Balakrishnan: How much do you want? Do you want three meals in a hawker centre, food court or restaurant?

Dr Lily Neo: It is cheaper to cook for one person.

Dr Vivian Balakrishnan: It is cheaper to cook for one person.

The point I was trying to make is that every family will have different needs and preferences. I am not by any stretch of the imagination claiming that what we are offering as public assistance is a generous package. I am not saying that. But what I am saying is that it is enough, by and large, for most families to get by and, for those who have needs over and beyond that, there are other means to do so. If every one was starving on this amount that we are giving and is totally devoid of any other sources of help, Pelangi Home would be overcrowded, and I would be building many, many more Pelangi Homes. So, in the end, the proof of the pudding is in the eating. Yes, any one of us, if we search hard enough, may be able to find a family or people who need additional help. But I would also say that any one of us, if we really put our minds to it, is capable of finding those additional sources of help. What I am designing is a system in which public assistance can and should be complemented by other sources of help. I think we can continue arguing this and we can continue finetuning the exact amount that is needed. But let us just bear in mind the fact that the system is set up with a certain amount of tension, and it is a healthy tension.

Pain Plus Progress

Last Friday's edition of TODAY carried a story about the upgrading of HDB flats. It reported on how HDB's ongoing Project Life (Lift Improvement and Facilities Enhancement for the Elderly) programme to upgrade one-room rental flats (which is A Very Good Thing) has resulted in some of the tenants having to sleep in the corridors and common areas (which is self-evidently A Very Bad Thing).

If you have ever been through or seen what happens during an upgrading exercise, you will understand why that happens. If a man's home is his castle, then upgrading represents a temporary invasion and occupation of that castle by well-meaning, benevolent invaders.

Your flat becomes a huge mess, with plastic sheets and tarpaulins draped all over your stuff, workers trampling all over the place, and dust and dirt all over the floor. You lose the part of your flat that is being worked upon. And when it's a one-room flat, that basically means you lose your flat. So I'm not surprised that some of the tenants preferred to sleep in the corridor.

There were two things in this article that really hit home for me. The first was the quote by Mr Chan Sai Meng, about HDB's response to his request for the unused rental flats to be opened up for temporary use, that it was "too tough" administratively. The civil service might have a No Wrong Door policy, but it's pointless when the right door opens directly into a brick wall.

The second thing was Mr Chan's parting shot at the end of the article, and his last two sentences really, really affected me:

“You must have a solution before this programme starts... The Government said (to) progress together with the people. I don’t want to progress if it is so painful and without dignity. You go ahead.”

The next Parliamentary sitting is on 9 April 2007. I am going to file a PQ on this. It is not acceptable.