Transcript of an interview conducted by Dr Thum Ping Tjin with the Singapore Democratic Party’s Dr Paul Ananth Tambyah on TOC’s livetalk show, filmed on 2 July 2020.
PJ: What actually is your vision, the SDP (Singapore Democratic Party)’s vision for Singapore? And how is that different from the People’s Action Party’s vision?
Paul: Well, thanks, you know the SDP’s vision is radically different from the PAP’s vision, and part of it is because of the fundamental principles and the fundamental values. We believe that certain things are fundamental basic rights: economic rights, human rights, and I’ll take the few which I am most familiar with, which is healthcare. The SDP believes that healthcare is a basic human right, and that nobody should be denied basic healthcare because they can’t afford to.
The PAP pays lip service to that, in that they have safety nets. But the safety nets are available for the very poor, and you get people who slip through the cracks, who are not poor enough to enjoy the safety net benefit, and then you get situations where well-meaning social workers tell them, you know, you got to become a little bit more poorer, then you get the benefits, which is kind of crazy.
And this is not a Singaporean invention. What it is, is this, is unfortunately the neoliberal view of health care, which sees healthcare not as a public good but as a commodity. And as I tell academics who come into Singapore, they’re so impressed by what they see and then they see people, you know, 50 year-olds who are going blind with amputations from diabetes, which is not well-controlled, we say how can this happen in Singapore?
And I say, well, you know, they have to pay upfront for their consultations—there’s a co-payment, there’s deductibles, and they get limited amount of paid time off and you see, that’s crazy, that’s what we have in America. I say to them, unfortunately, Singapore seems to be determined to repeat every mistake of US healthcare financing of the last 20 years. So instead of looking to Taiwan and Korea, which have very successful universal healthcare systems, you know, the neoliberal agenda is driving the healthcare financing system, and that’s frustrating. It’s frustrating to me, it’s frustrating to so many others—the patients, the healthcare workers, to professionals and academics alike.
PJ: Okay, but the obvious response to that is how would you handle costs, right? Healthcare is something where no one ever, if the costs are not restrained, no one ever restrains themselves from consuming healthcare. You always need more healthcare. As someone who lived in the UK a long time, I love the NHS, I had all my treatments for free there. I have a chronic skin condition, right, and it was great working with them, but the costs were always an issue, and the challenge of restraining these costs was something that every government has tried to address in very, very, different ways, some with greater success, some with greater failure. So how would you restrain costs?
Paul: Yeah, there’s a one-word answer to that, and then there’s a more detailed one. The one word answer, unfortunately, is ‘rationing’, and rationing is the term that’s used by neoliberals all the time, to try and tar the whole approach of universal healthcare. And it’s as you say, when you are providing a universal public good, you know, you cannot provide a Rolls-Royce to everybody, so the question is whether, what is the level of healthcare that you’re willing to provide.
Now, the more detailed answer comes from Uwe Reinhardt from Princeton, who recently passed away, and he made this argument that healthcare is like a three-legged stool. There are three parts to it: there’s excellence, there’s efficiency, and there’s equity, and they say there is no healthcare system in the world which has all three. The United States has excellence and efficiency, you know, but no equity. So you’ve got really good healthcare, it’s really fast, you get an MRI scan within an hour, but you pay through your nose, and there are 40 million uninsured. The UK has got excellence and equity, but no efficiency—you wait forever for your appointment, right? But it’s got some of the top hospitals in the world, it’s got really good surgeons.
PJ: And it’s free . . .
Paul: . . . and it’s free at the point of care . . .
PJ: So no one ever has to worry about accessing healthcare and that to me is such a psychologically, such an important step, to know that you’re never going to be denied healthcare . . .
Paul: Exactly. So Singapore, unfortunately, has a little bit of each, see, so we have some pretty good excellence, we have some pretty decent efficiency, and we have, sort of, like ‘halfway-there equity’. And in Singaporean terms, what this is, is actually it’s ‘cheaper better faster’, you know—you can only be cheaper and better, but you cannot be faster, or you can be cheaper and faster, but you cannot be better. So, ultimately, it comes down to values. See the United States is a society is, you know, this pioneering idea, the ‘pull yourself up by the bootstraps’ . . .
PJ: . . . rugged individualism . . .
Paul: . . . rugged individualism . . . so for them efficiency and excellence are important, if you don’t get it, it’s because you’re weak, you’re lazy, you know, you don’t deserve that kind of healthcare, and that’s the pushback against Obamacare.
And, unfortunately, in Singapore there is a strain which is tending towards that, you hear the stories of all these PAP candidates who pull themselves up by the bootstraps, who all had these really humble backgrounds, you know, and then they did so well and became CEOs of multinational corporations you see, the implication is if I can do it, you can’t [sic] . . . I use this as a Michael Jordan example, see, if you grow up in North Carolina in the ghetto and if you’re not a multi-millionaire by the time you’re 35, then there’s something wrong with you, which is crazy, but that’s the kind of argument that people use.
Yeah and whereas in the UK the values are completely different, you know in a way, the extreme version . . . I haven’t lived in the UK for long enough, but my UK friends joke about the, you know, the mediocrity which is sort of encouraged, you know, that the ‘tall poppy’ sort of, you don’t want the guy who’s too proud and too outstanding, you know, it’s always understated and that kind of approach.
PJ: Let’s talk about values though, because this is really, really, important. And I think this is something which is never discussed enough. What would you say are the fundamental values of the SDP and how does that differ from the PAP? Now we’ve kind of answered some of that already, but can you go a bit deeper into your vision of a society in terms of the values that underpin it, and how that distinguishes it from the PAP?
Paul: Right, so, you know, basically, the excellent part of it, or rather the competency, that is a no-brainer. We all agree on that, that is something that Singapore has a reputation for, providing high standards, and that’s something that we share completely. It’s just the way you get there . . . .The PAP is deeply entrenched in this idea of the natural aristocracy.
And this actually goes back to the eugenic views that were popularized in the 1970s and ‘80s, the idea that some people are intrinsically better than others, and you got to find out who these some people are, and then you’ve got limited resources. In fact, it used to be on the GEP homepage, under the Ministry of Education’s website, there’s actually, I took a screenshot of it . . . It said that Singapore is a small country with limited resources so we have to concentrate on those who have the potential to do really well, and that’s why the GEP tries to identify the brightest students and nurture them, you know, that’s kind of Orwellian in a way.
Whereas the SDP’s approach is the opposite to that, you know, we believe that every child has the potential to do well. Not every child is going to be an Einstein, but, you know, every child is going to be really good at what they are good at doing, and you know, some children, some children have disabilities. My mom, as you know, she knows your mom very well . . .
PJ: Yes, they work together in the charity …
Paul: Yes, she has always felt that every child has the right to an education. She was one of the big movers of the compulsory education for children with disabilities and that every child has the right to live out their potential. It may not be the same for every child and it most certainly is not going to be the same.
And in fact, one of the strongest memories I have of visiting the school, the special school, which we started, was the end-of-year concert, and these kids are so disabled, you know, some of them can barely move their hands or just lift their eyebrows, and the teachers with their putting together these items and having these musical things, and the parents are there taking pictures of the kids, you know, just like a kid in a normal kindergarten, and it was just so heart-warming to see the idea that, you know, a child even with such a severe disability has the potential to appear on stage and make the parents happy.
PJ: So you’d say then, what characterizes the SDP and how it drives your policies is this, this value of inherent dignity and equality of… how would you call, characterize it?
Paul: You know, it’ a kind of egalitarianism and it’s also a recognition that we are all the same, you see, and these are things that are actually in our national pledge, to build a democratic society based on justice and equality, that’s it you see, we say this every day in school! You know, we say it really fast so we can’t maybe catch the words, but that’s it you see . . .
PJ: Yeah, but I’ve been told, online trolls have been like, don’t bring in democracy, it’s a western invention and I’m like, what, wait, it’s in our pledge …
Paul: Exactly . . .
PJ: . . . we’re supposed to achieve democracy . . .
Paul: . . . every school kid says it every day . . .