Today state media mouthpiece CNA published an article entitled ‘We’re at the brink’’: Kidney disease crisis looms in Singapore as some doctors urge more action. It highlighted the fact that 300,000 people in Singapore have chronic kidney disease (CKD) with an estimated 200,000 others with the disease going undetected. Dialysis centres are under huge pressure with nearly every slot in the National Kidney Foundation (NKF) dialysis facilities filled. According to a 2018 study published in the International Journal of Nephrology, by 2035 almost a quarter of Singapore residents over the age of 21, or could have.CKD while 500,000 cases could be undiagnosed.

The article states that dialysis now costs $300 million annually and this figure is expected. to increase rapidly. There’s no breakdown between how much is funded by the Government and how much by payments from charities, Medisave, and out-of-pocket expenditure. According to NKF’s 2021/2022 accounts, it appears to have been responsible for nearly 50% of the country’s annual dialysis expenditure and of this nearly 50% was funded privately, either through charges, insurance payments or donations. (NKF lost a staggering $13 million in investments in 2021/2022 which isn’t explained but that’s something to be investigated another time). The Government funded about $85 million directly. It’s not clear how much of the rest of the $160 million balance spent on dialysis annually is funded by the Government through subsidies but if the bulk of the rest is private then the answer is probably very little.

The Government also is failing to fully fund screening for Singaporeans despite the obvious and enormous cost savings if CKD is caught early allowing patients to be treated before they progress to the need for dialysis. Even the Screen for Life programme does not test kidney function. Charging for tests that wouldn’t cost much that can save significant money further down the road seems particularly economically illiterate. It probably deters some low income Singaporeans, who are likely to be more vulnerable, from coming forward for testing. The PAP presumably justify this on the basis that Singaporeans should save for their own healthcare costs and not rely on Government help as otherwise they’re incentivised to fall sick and become a burden on the reserves.

This also seems to be the attitude in another tragic case that I recently read about in which a baby would have died of spinal muscular atrophy (SMA) because of the Government’s refusal to fund the $2.9 million cost of the new drug treatment approved by the US Food and Drug Administration. Fortunately private donors stepped in to fill the gap. By contrast the drug has been available on the NHS (in other words free at point of use to the parents) in the UK for some time.

The paltry amounts that the Government actually spends on major health issues for Singaporeans such as diabetes and kidney disease and its refusal to fund life saving treatments for children (presumably on the grounds that to do so would incentivize children to develop the disease) is at variance with the MOH budget of around $20 billion last year. In many blogs I have questioned how the Government seems to be spending almost as much capita on Singapore residents as the UK NHS while Singaporeans have to shoulder most of the costs themselves. They are often unable even to use the $120 billion in Medisave balances which the Government makes difficult to access, presumably because it wants to earn a premium above the interest it pays on the balances.

The money collected from Singaporeans sits in MOH Holdings whose accounts are hidden behind a paywall in another shocking illustration of the PAP’s lack of transparency. I have said frequently that this is one of the ways of siphoning money squeezed from Singaporeans who can ill afford it into the reserves. Despite the fiction of a Net Investment Returns Contribution, I have said the reality is that Singaporeans have never seen any benefit from the reserves. Instead they are a gigantic black hole lurking at the very centre of Government. Farcically the PM’s wife recently said that the President didn’t need to know how much was in the reserves to hold the key, thus reducing the Elected President to the person who holds the second key to a safe deposit box without knowing the contents.

LHL and his cronies appear to be on their last legs and are trying at all costs to intimidate Singaporeans through an unending hail of POFMAs. Instead of answering my questions the PAP Government may choose to POFMA me. Yet they think it’s somehow OK to try and stop Singaporeans from asking questions without providing the information we seek. At all costs they want to preserve their asymmetry of information which has allowed them to fool Singaporeans for so long.

While the Government is extremely stingy when it comes to helping ordinary SIngaporeans this does not apply to Ministers and the PAP elite. While HDB dwellers are lectured on the importance of not draining the reserves (whatever they may be), Teo Chee Hean stood up in Parliament on 3 July and said that the huge tract of land which Shanmugam was able to annex adjacent to his mansion at 26 Ridout Road was virtually valueless. The taxpayer paid for the land to be cleared and the mere $2,000 a month extra rent that Shanmugam has been charged isn’t going to pay back that outlay any time soon. Why wasn’t this land offered publicly to other Singaporeans whom I am sure would have been delighted to form a syndicate to pay $2,000 a month for a 13,000 square metre plot of land that could have been used as a picnic spot or a park.

The difference between what the land should have yielded on the open market and the rents Shanmugam and Balakrishnan are paying would alone have paid for a couple of treatments for babies born with SMA a year or paid for dialysis for at least 100 patients a year. Subsidies for Ministers and their families and cronies, austerity and unnecessary hardship for everyone else. At the next election, which the Government should be made to call soon, Singaporeans can decide if this is a Government that has its priorities right.

Published by kjeyaretnam

I'm a Singaporean economist who became an opposition activist. I blog to provide an alternative to the porkies that the Pinkies tell. It just so happens that my alternative is the truth. That's why I've never been sued in any civil or criminal court no matter how hard hitting my criticism. I'm quoted and interviewed and asked to speak across the world but largely censored in Singapore in an effort to silence my political opinions. The left hate me because they think I split their vote and because I eschew their outmoded economic models. Models that don't work. The Right and the Conservatives hate me because I'm a liberal. I'm not sure what the middle think of me. I don't think there are more than a handful of people in the middle, here in Singapore. I'm a Singaporean born and bred, dual heritage, my parents Singaporean established here before the State of Singapore was created. I'm not Eurasian. I read economics at Cambridge and could be broadly described as from the Keynesian school but I believe in interventions. I was formerly a successful hedge fund manager. After economics and politics my greatest interests are history, film and Makan. I run but I run so I can eat like a Singaporean. View all posts by kjeyaretnam