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POLITICS AND PARANOIA
The climate of “walking on eggshells”, as he describes it, is exacerbated by how the Government handles parliamentary debates.
He describes how he thinks the ruling party can better engage the opposition.
“Every time the Workers' Party asks a question in Parliament, the Government could turn around and respond the way I might to a student who asks a question, and say, 'Oh, that’s a really good question', and start to deal with it.
“Instead, they turn around and they chide them. If you don’t have all the information and you ask a question, then you’re slammed and you’re asked to apologise like Sylvia Lim was asked to - that puts a certain amount of fear into individuals.”
He is referring to WP chairman Sylvia Lim being asked to apologise to the House earlier this year for alleging that the Government had floated “test balloons” before announcing an impending Goods and Services Tax hike.

I put it to him that most ruling parties would consider it a natural instinct to defend their policies and make a point of it if they feel the other parties are trying to cast aspersions on their intentions.
“But still, there has to be some degree of balance because otherwise it’s going to backfire. The whole Sylvia Lim example, I think it won Sylvia a lot of sympathy points - the fact that people are trying to make her apologise for asking an honest question. You can say that the question is a stupid question, you can try to criticise her for that, but trying to make her apologise for asking a question seems to be a little bit like shooting yourself in the foot because it makes you come across like a bully.
“In a parliamentary democracy, if somebody asks you a question, you can make them look small or really silly, but to treat every question as an attack on your own personal integrity, to me, that's bordering a little bit on paranoia.”

CAN THE SDP CONVINCE VOTERS?

We move on to talking about why the SDP has not made any headway in winning parliamentary seats, not even in the 2011 election.

“You must remember, we were going from a state where the party was almost non-existent. It was the subject of several lawsuits. It was on the verge of bankruptcy and to get over 30 per cent of the vote, I think, was a pretty significant achievement.”

I wonder why the party’s baggage didn’t discourage him from joining it.

“The fact that they persevered despite all of the slings and arrows that had been flung against them, that was very impressive because that shows a certain kind of courage of your convictions.”

But he feels that media coverage favouring the ruling party has worked against them.

“In 2015, on Cooling-off Day, the front-page headline on The Straits Times was Mr Khaw Boon Wan saying you may not get a PAP government. There were these WhatsApp messages going around with fake bookie odds. No one has ever owned up to propagating trying to scare people into thinking that the PAP would lose the 2015 election despite all indicators pointing in the opposite direction.”

He also cites the difficulties the party faces in holding community events as securing venues run by town councils and the People’s Association is challenging.

He puts this down partly to the “self-censorship” phenomenon we discussed earlier.

“But I’m an optimist. I don’t think that this self-censorship is going to be able to continue forever and if social media develops and as people become more open, then I think the PAP will realise that they need to come down on these people who are second-guessing them and tell them 'Hey, loosen up. We are not going to give you a phone call and tell you to not allow them. Let them have their event in some basketball court'.”

But the PAP’s ability to mobilise state resources in other ways is*“very, very difficult to try to go up against”, he says.

“During my first clinic session after the election, a patient of mine who I’ve been treating for many years wheeled himself into the room in his motorised wheelchair and he said, 'Doc, you guys ran a good campaign. Too bad you all lost.' I said, 'Thank you. By the way, where do you live?'*Then he said, 'We live in Yuhua, but you know, (Minister) Grace Fu gave us this wheelchair.'*Then I said, 'She didn’t give you the wheelchair. This is paid for by your taxes'.

“He said, 'No, no no, she came to my house with an entourage of people, with her photographers and she gave me the wheelchair'.”

Even though Dr Tambyah says he reiterated that 'it’s your money that went into this wheelchair', his patient 'refused to accept'*it.

“This was a guy I’d been looking after for*10 years. He knew me. We got on with each other very well. But at the same time, he felt indebted to the ruling party politician because she was able to, in his mind, provide him with mobility.”

However, I put it to him that if the PAP Government lets Singaporeans down, and if the opposition manages to come up with better policies, they could get the votes regardless of the PAP’s party machinery.

Considering the way Singaporeans have voted in the last two elections, I suggest to him that Singaporeans don't see the point of an opposition party or don't consider the opposition parties, including the SDP, as being worthy of a vote or as being able to govern.

But he reiterates that the various hurdles prevent the SDP from truly convincing voters of the party’s merits, even thought*they "have really dedicated volunteers, and for Single Member Constituencies (SMCs)*they can cover*almost every household at least twice".*

“The administrative constraints, the media constraints and the self-censorship issues affect people. Even social media is constrained by the licensing issue and the various actions that have been taken against individuals for crossing the poorly defined Out of*Bounds or OB markers. This deprives Singaporean voters of essential information we need to allow us to cast a ballot for the people most able and willing to take care of our interests and well-being.”

AN INDEPENDENT ELECTION COMMISSION AND MORE SMCs

However, could upcoming changes help?

For instance, Prime Minister Lee Hsien Loong has said Singaporeans are likely to see*smaller GRCs on average and more*SMCs*in the next election.

Some analysts have said this could help opposition parties who generally have fewer resources to put together large teams, but Dr Tambyah is “cynical” about this.

“You can design three-member GRCs very strategically. You could arrange it such that these three-member GRCs are all in constituencies that you could win.”

He says what he would like to see instead is “an independent Election Commission” that could ensure that “electoral*boundaries will be drawn up with all the parties and civil society and all the individuals involved”.

At this point, the Election Commission is under the Prime Minister’s Office.

He also suggests “a return to all single-member constituencies”.

“Before the GRCs came up, Singapore has*always had a multi-racial parliament. We’ve always had members of parliament from the Malay and Indian communities, and the proportion of people from the minority communities actually was highest in the earliest years when we were all single-member constituencies. So, I don’t buy the argument that GRCs are essential for racial representation.”

I point out a*survey*that showed when it comes to deciding who should hold the nation's highest positions, Singaporeans*prefer it be someone of the same race as they are.

“But obviously that was not borne out by the facts. Like in the*Bukit Batok by-election,*Mr Murali Pillai won handily against SDP Secretary-General, Dr Chee Soon Juan. It was the first by-election the PAP has won since 1992 and it was quite obvious that there was somebody from a minority race who was able to win. I think those surveys have to be taken with a pinch of salt.”

HEALTHCARE AND HOUSING

Aside from the politics though, the policies matter.

From the very beginning of his political life, Dr Tambyah has been campaigning for a better healthcare financing system.

He still feels that MediShield Life, for instance, needs to be improved. Most notably, the high deductibles concern him.

“Healthcare is a right, not charity”, he says and cites research that showed the state of healthcare financing in the early days of Singapore.

“In 1960, the World Health Organization sent a delegation to Singapore in Malaya to study the healthcare system. Our health minister at that time was Ahmad Ibrahim*and he pointed out that Singapore had a pretty decent healthcare system in 1960. The unique thing about it was that it was all free at the point of care. They introduced the S$1 charge at the Outpatient Dispensaries (OPDs) and I think it was a S$5 charge for the inpatients.”

That was how, he says, Singapore’s healthcare system operated right up till the mid-80s.

“In 1983, when we had the blue paper on Singapore healthcare, Singapore had an infant mortality rate that was lower than the UK and the US. So we had really good health outcomes with very cheap healthcare and that I think shows that it’s achievable. If you wanted to pay a bit more to stay in some private hospital, you could but basically, you should not have to worry about getting your cancer treated or your bypass done because it could be done for a really cheap price if the government was the sole proprietor.

He feels that the privatisation of healthcare was a "mistake", but*wouldn’t an entirely state-run system run the risk of being inefficient?

He acknowledges this and suggests instead a national universal health insurance system where the government takes over administering insurance, but not the provision of services. *

“The government is the financier but not the provider. This is what happens in Australia and France. Also Germany to a certain extent.”

His vision includes basic healthcare with minimal deductibles and co-payments.

When I raise the risk of overconsumption under such a system, he says it may not be a direct effect of enhanced insurance.**

“There is no direct evidence that significant numbers of patients are going out of their way to subject themselves to unnecessary surgeries or treatments just because these are paid for by insurance riders or free. Most people do not like to see the doctor or subject themselves to chemotherapy or injections or to take bitter medicines.”

He says that cases of overconsumption that we are seeing today could be due to other reasons.

“There is an asymmetry of information. Most people have a very limited knowledge of medicine or medical procedures and depend on their healthcare providers for the information that they need to make decisions about what procedures and treatments are best to deal with their ailments.

“Healthcare costs have risen in Singapore for many reasons including, primarily, the commercialisation of healthcare which has led to the need to provide returns to shareholders who own major healthcare providers.*This leads to incentives which distort the market by rewarding overconsumption of resources.”

For example, he says some patients do certain tests and procedures as inpatients to “claim insurance benefits” and thus maximise profits for the owners of the healthcare infrastructure, rather than as outpatients which would have been cheaper.

"The doctor becomes an*employee who has to answer to the shareholder while at the same time, maintain an ethical practice towards his patients. So it's a huge challenge."*

He also points out that the medico-legal environment in Singapore and elsewhere may encourage doctors to potentially over-investigate patients for fear of litigation or being accused of negligence.

“A well-run, evidence-based national health insurance scheme similar to what is proposed in the SDP Healthcare Plan would avoid the problem of overconsumption by restricting benefits to those*procedures*which are proven*and supported*by solid scientific evidence,” he says.

To finance Singapore’s future needs such as healthcare, naturally, more funds will be required. I ask him how best he thinks these can be generated.

“In Singapore currently,*you don’t have pay estate duty, you don’t have to pay capital gains tax, you don’t have to pay tax on dividends, you don’t have to pay tax on fixed deposits interests.”

He thinks it’s time Singaporeans do.

But might this make Singapore less competitive as a wealth management hub?

“I don’t think so because I think we have the skillset, individuals with the talents, the infrastructure, so if we just went back to some kind of a more equitable, a progressive taxation system, I don’t think that we’ll undersell ourselves. These are people who are just parking their money here. If they paid a little price, I don’t think they would feel it that badly.”

Among the other policy issues that concern him is housing.

“Somewhere along the way, public housing lost its focus. Instead of becoming a basic human right to have a roof over your head, with the asset enhancement policy, it became a tool for multiplying your wealth or a vehicle for speculation.”

He calls it a “misguided” approach to public housing.

When I remark that many Singaporeans have, in fact, benefited from this, he says it’s just a “short-term gain”.

“If you’ve got more money, then you should invest in private property.”

He also points to how the Ministry of National Development has recently highlighted the*limits of HDB leases.

“I think the Government is going to deal with it. They’re probably going to extend the lease. It’s too much of a political time bomb.”