By: Michael Han/
There is no doubt that Amy Khor agonises over the decision to implement gender-differentiated premium payment for Careshield Life.
For those who are wondering what it’s all about, it is about added financial security for those above 65 who are at risk of suffering from severe disability, which are age-related.
Undoubtedly, the government’s effort here is laudable save for one gender-dividing blemish, which I would highlight in due course.
As a complement to other social safety net, Amy said in Parliament that “CareShield Life is not just an insurance scheme, but will be an important part of our social safety net.”
She added that “it will provide universal coverage for all future cohorts of Singaporeans born 1980 or later, regardless of financial, health, or disability status. This means that all Singaporeans in these cohorts will have basic protection for their long-term care should they become severely disabled.”
But what has caused a public and online uproar is that men would pay lesser premium than women.
Under the proposed scheme, “a 30-year-old man in 2020 will pay an annual premium of $206, while a woman of the same age pays $253. Both sums are before subsidies.”
Though it is not a huge sum by yearly estimate, the signal it sends out in society that is supposedly based on “justice and equality” is nevertheless palpably significant.
In any event, it has definitely opened up some age-old or ancient wounds on gender-inequality, and it is really unfortunate that our government has chosen to bet on an actuarial horse rather than a gender-equality one. The former may run faster, but it is the latter that endures longer and stays faithful in the home to build a surer familial foundation for our nation.
Nevertheless, Amy shared that when push comes to shove, or in this case, when the “actuarial” rubber meets the “gender-equality” road, the government is duty-bound in the name of technocratic efficiency to lean on the side of the impersonal science of statistics.
Here is how she puts it in Parliament: “In 2017, the average life expectancy at birth for women is 85.2 years as compared to 80.7 years for men…Breaking this down by gender using the same information and statistics, 3 in 5 healthy women at age 65 are expected to become severely disabled by the end of their lives, compared to 2 in 5 healthy men at age 65.”
At this juncture, quite uncannily though, I am reminded of the saying that men bear arms, but women bear army.
As such, should our minister even split hair on gender-differentiated premium payment considering the immeasurable contributions made by both men and women in a society that is trying its darnest to be inclusive, fair and equal?
Now, it has to be noted that the difficulty that Amy Khor went through to eventually go for a gender-differentiated premium payment scheme are based on these three justifications.
First, she said that “at the older ages, when disability is likely to take place, women are also more likely to remain in disability for a longer time than men and hence draw on CareShield Life payouts for a longer period should they remain severely disabled.”
This may be so, but, as the three women representatives of the online petition (which I have signed) for equal premium payment (which has garnered more than 1,600 signatures as of yesterday) said:
“It is an outrage that women are being penalised for living longer. What statement are we sending to women, young and old, when we penalise them for simply… existing? What message does this send to the world about our nation?” – Charissa Chua, Anneliese Quek and Chan Jia En).
Alas, have our government put the technocratic cart before the gender-equality horse?
Amy’s second justification is this: “Based on a longitudinal survey of older Singaporeans in 2009 and 2011 to 2012, researchers estimated women aged 60 are expected to spend 7.8 years requiring assistance with any of the ADLs (Activity Daily Living) compared to 2.6 years for men aged 60.”
I am no expert in statistics, but as an ordinary tax-paying citizen, one has to ask these questions:
“How reliable and accurate is this so-called longitudinal survey of older Singaporeans in 2009 and 2011 to 2012? What is the timespan of the study? Are there more information about it, any qualification/caveat to it, and any criticism/shortcoming/limitations arising from it?”
Her third defence of the gender-differentiated premium payment is based on yet another statistics.
She said: “Other countries, like the US, found similar gender-differentiated disability trends. In a longitudinal study of US men and women between 1982 and 2011, researchers estimated women aged 65 in 2011 are expected to spend about 6 years requiring assistance with ADLs (Activity Daily Living) compared to about 3.5 years for men aged 65 in 2011. Two-thirds of long-term insurance claims benefits paid out in 2012 went towards females.”
Here, I am in even darker waters when it comes to interpreting the statistical results.
But, one still has to ask whether a foreign country’s longitudinal studies about gender-differentiated disability is a reliable fit to (or match for) the gender-differentiated disability of women in our country?
Aren’t there crucial differences in the health outcome between different cultures with different evolved genetic-makeup and history, and have these and other factors been taken into account?
If there are, is the comparison justified for the purposes of formulating and finalising national policies in our case?
And although Amy took a statistical page off US longitudinal studies (to lend support in arriving at what she deemed was a “difficult decision”), is she forgetting that Obamacare, despite its flaws, has been lauded by many for not taking the gender-differentiated path that our health minister has taken?
And on that note, it has to be said that America may have gotten many things not quite right with their liberal values since independence, and at times, way off track, but on healthcare, I think they got the balance just right when they deliberately and consciously seek to put gender equality before actuarial science.
Let me end on a personal note by risking being personal about the issue.
Firstly, if I have crossed the line with what I am going to say (or write) here, I first and foremost wish to apologise to Amy whose heart I believe has always been in the right place.
But, when I first heard about this controversial issue about gender-differentiated premium payment, I naively thought that it must have been a man who is advocating or tabling it.
Then, I realised that the face or “frontman” of the policy is a woman. It’s Amy. She is a mother, a daughter and a wife.
And, this is where it gets a little personal and admittedly deviating from the issue at hand, I thought about the fact that if anyone were to understand what a woman has to go through in an essentially male-dominated society like ours, Amy should be the one who understands it more than any other – yes, even more so because she is a woman.
And this is made even more ironically so since during the debate on CareShield Life in Parliament, “a dozen MPs out of the 19 who spoke on the proposed scheme were opposed to women paying higher premiums than men.” (Opposition MP?)
So, even if you put the sex of our health minister aside, which is a wrong presupposition on my part to start with (and it could also demonstrate her objectivity regardless of her gender), the opposition in parliament (who came forward) ought to have raised more than just a few red flags on the questionable “difficult decision” that Amy had nevertheless arrived at.
What’s more, it can’t be disputed that, as one Facebook user Evon Qin pointed out in question form, “Why didn’t they factor in the fact that women get paid 43 per cent less than men in Singapore?”
This point was in fact acknowledged to some extent by Amy when she said: “The Committee did consider that women have less savings on average, and could therefore be better supported by the men.”
And to add to the irony, in a recent pink tax project (worldwide), it is discovered that women generally pay more for everyday items (like razor and deodorant) than men.
Despite all that, that is, the lesser pay women get, the MPs who oppose, and the survey that women generally pay more than men, when it comes down to making a decision that would send a strong message to our society that women are not the weaker sex but the more oppressed one, our health minister has this to say:
“…the decision to have women pay more was a difficult one but actuarially sound as women’s life expectancy is 85.2 years and men’s, 80.7 years. Disability is more likely to happen in a person’s older years…(it) would more accurately reflect the differences in risk between men and women.”
Alas, what is “actuarially sound” actually trumps over what is maternally life affirming.
I am therefore concerned that when a society puts facts, figures, risk assessment and numbers over and above what is the value of motherhood in order to achieve what it considers as fair and equitable, then the problem is no longer about the process whereby our government arrives at a particular policy decision, but it is the measure they use to value the worth of things, people and gender.
This article first appeared here. It has been re-published with the author’s permission.
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