Today I read a heartbreaking account in state media mouthpiece CNA about foreign workers who keep quiet when they get early symptoms of life threatening illnesses such as cancer because they fear being sent home with no means to support their family. I read about an FDW who discovered a lump in her breast in 2019 but did not report it because she had four young children to support until 2024 when she collapsed and she was diagnosed with Stage 4 breast cancer.

However on the same day on CNA I read about a young Singaporean woman (legally still a child since you don’t become an adult till you’re 21 but if you’re a man have to serve NS and risk your life) who at 17 was diagnosed with a number of debilitating and likely ultimately fatal conditions. The report did not mention whether there are treatments for these that would be free in countries with universal health insurance like the UK but that our Government insists Singaporeans have to pay for in case they overconsume but then restricts their use of Medisave or coverage under Medishield). The report says her medicine and hospital visits are covered by insurance but does not specify whether that is basic Medishield or a private policy that her parents had to pay for. However the costs of her medical equipment, such as an infusion pump, are not. Neither does the Government pay for a carer or provide a disability allowance as they would in the UK, Scandinavia and the EU. A few months ago I wrote about a Grab driver with kidney failure who was giving up on expensive dialysis treatments and conserving money for his family. Again dialysis treatment would be free in the UK and either free or covered by insurance in most countries at the same level of development. There are numerous examples of Singaporeans who have stopped cancer treatment because of the ruinous expense of drugs that would be provided on the NHS in the UK or by the state in the EU. And Singapore has an unacceptably high level of amputees in relation to other developed countries caused by diabetics skipping regular treatment for their condition because the cost is too high.

It’s not as though we cannot afford to provide all Singaporeans with universal health insurance. Using the same logic as I used previously, we can infer from Budget 2025 that the Government has at least $3 trillion of reserves if we exclude those assets that back the Government Securities Fund or likely over $4 trillion if we don’t. Instead of a contribution of $27 billion from the reserves we should easily be able to afford (provided the Government is not lying to us) to spend more than double or three times that and still leave the reserves growing after accounting for inflation. And remember that $20 billion of the NIRC goes straight back into the reserves through Top-Ups to Endowments and Trust Funds. The Government also spends money from the trust funds but usually well below what it puts in. In 2024 for instance it put $22 billion from the NIRC back into the reserves but only spent $15 billion in 2023.

I have written before about the notorious opacity of Government healthcare spending in Singapore. Budget 2025 is no exception. Healthcare expenditure rises to $21 billion form $18 billion in 2024. Doing a quick calculation on the back of an envelope I estimate that the UK Government through the NHS spends aboout $4,600 per head of population whereas if you divide our $21 billion MOH budget by Singapore’s resident population of 4.2 million you get an expenditure per capita of over $5,000. How can SIngaporeans get such bad value from their Government and not be able to afford treatment for diseases that are free in the UK, particularly as their Medisave balances are over $110 billion and Medishield has been in permanent surplus from Day One? The Government shields the whole state medical system in secrecy. The accounts of MOH Holdings, the privatised company that runs all the state hospitals and polyclinics, are hidden behind a paywall and not presented to Parliament each year. When I obtained the accounts a few years ago with some difficulty and after paying $80, I found that Government subsidies to MOH Holdings were only some $8-9 billon and that MOH Holdings are hoarding some $10 billion in reserves. Presumably this was be transferred into the Government’s reserves at some stage as is allowed under the Constitution.

Just as with the HDB system, which keeps supply tight and prices high, while providing “subsidies” to Singaporeans and to HDB through the Budget which then wind up in the reserves, I suspect but can’t prove something similar is going on with MOH’s budget. I have asked the Government and the Health Minister repeatedly for clarification but they refuse to provide it. Meanwhile our Government proclaims itself to be against “populism” which they seem to define as any investment in Singaporeans that doesn’t get channelled back into the reserves. As LHL famously said, the best way to avoid high medical expenses is to stay healthy. Is that what he thinks about the case of the unfortunate young woman above while presumably the costs of his treatment are met from state funds?

As Singaporeans are treated to a daily diet of superlatives for LW’s Budget and what a great job it does in supporting them from the PAP’s re-election team paid for with your money, they have to decide whether a few hundred dollars in shopping vouchers (costing the Government approximately $1-2 billion, a lot less than their face value, and probably encouraging retailers to raise prices thus negating much of their benefit))are enough for them to continue supporting a Government that is keener on increasing our already colossal reserves than it is on supporting them. The time for helping Singaporeans is now, not scrimping and saving to accumulate reserves for future generations, most of whom won’t be born here anyway.

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