Sunday, April 07, 2019

Understanding about National Debt


A journalist asked me if i could respond to this speech from PM Dr M. He asked 'Is the PM's target realistic and is the national debt really that big of a problem?'
I am always serious to journalist's question put forward to me. Here is my reply:
First, the public has to understand the nature of so-called national debt. According to the Economic Outlook published by MOF, the Federal government debt is estimated to reach RM725.2 billion or 50.7% GDP, where 97% are domestic debt. What are the components? Treasury bills, Malaysian Government Investment Issues (MGII), Malaysian Government Securities (MGS) and Government Housing Sukuk. MGII and MGS are the two most prominent sources, took 95% of all domestic debts. These are the capitals that the government raised for public spending and infrastructure development, and the investors are for the returns. As long as the government understands that they have a duty to repay on time the interest accrued due to these capital investment, and make sure their fiscal policy is sound and prudent, do not continue raising capitals unsustainably and go waste or splurge, then the fiscal position is under control. No one is asking the government to immediately repay the whole debt, instead we should ask the Prime Minister Dr Mahathir what does he actually mean by 'recover from past administrative, financial problems in three years' and 'we will be able to settle out debts'? To what extend? What is the target or measurement yardstick? The debt sum that he quoted 'RM 1 trillion', I presume that he has actually included the contingent liabilities especially the loan guarantees to GLCs and Statutory Bodies (RM179 bil and RM60 bil, respectively in 2017).
Second, many countries (including advanced economies) do have a norm to have consistent budget deficit and reasonable high debt. For example Singapore has 112.2% government debt to GDP ratio, it is not the measure or reflection of fiscal health. The PH government's priority should be ensuring the public spending and investment are adequate to address the current needs of people, and future.
Third, cutting down the expenditure, especially the mega projects, is the obvious way to go, but the government has to consider the options carefully. Most mega projects are infrastructure development projects, they are normally borne by GLCs. For example, the MRT projects are developed by MRT corp; LRT projects are by Prasarana , both are GLCs under MOF. Cutting cost, if it is by cutting corner (ie. compromising the quality of delivery and user friendliness), this will not bring returns to the companies. One should not think negatively about the capital raised (ie. debt) to fund these public infrastructure projects, because when they are done properly, they will be 'assets' in the company books, many are often conveniently overlooking this fact. Even in the context of cost-cutting, the government has to make sure by the time when the projects are completed, this brings maximum values to the public. If the public and communities are not utilising the infrastructure, it will be even bigger losses suffered by the GLCs (and the government) when operating and maintaining the assets and services. A cantonese idiom often reminds us not to, 'just because you wanna gain a candy, you burn down the whole factory' (“给你一粒糖,烧掉整间厂”)

改革社会福利制度

记得某天下班,我在檳州中央医院大走廊恰好碰到一位坐医院免费提供的轮椅、行走不便的印度老兄正向路过的每一位乞討买麵包。我好奇,於是与他交谈瞭解情况。
他直言,不喜欢低声乞討,但他当时依赖每月微不足道的150令吉残障人士失业福利津贴,难以温饱过活。他告诉我,若他找到工作,他的残障援助津贴才会提升双倍至300令吉。

我心想,这样的福利政策设计就是为了鼓励他去找工啊。我反问他是否有去积极找工,他委屈道出他被上份工作辞退后,一直还没找到工作,才陷入財务困境。

残障人士受职场歧视

他之前从事一些手工艺品工作,尝试去应徵不少的工作单位,有的看到他就直接说公司刚好不需要请人;有些告诉他由於工作场所环境设计无法兼顾他的需求所以只好推拒;有些则叫他慢慢等消息,往往最后无下文了。

他在檳城无依无靠,仅有叔叔留下给他的一间小房。他要我帮忙介绍工作,我义不容辞答应了,还买麵包给他。他吩咐,他有手机號码但已没预付额,若哪个工作单位有兴趣聘请,务必请他们直接拨电。

隔天我找上了一家附近小有名气的残障关怀中心。他们听到了我的描述,就接手这个案例。过了一段日子,我想起他,拨电询问该中心是否已僱用他,可惜他们说他先答应却又缺席无回应。我也没再见到他了。

上个月我在群议社和共思社联办的《我是布莱克》(I,Daniel Blake)电影分享会里就感慨地道出了这段往事,正好这部电影触及的主题是英国官僚体制下冰冷无情的社会福利政策,以及城市社会底下阶层的日常贫穷挣扎。

就如我国政府的福利政策原本存有善意鼓励残障人士就业,却往往忽略了残障人士的最大挑战就是职场歧视,最后迫使他人陷入贫困而乞討。那不是违背了福利政策设计的初衷吗?

电影里的布莱克是一名优秀的老木匠。失去老伴的他不幸遇到了心臟病被医疗团队奉劝留在家待康復。没有工作收入的他申请失业支援津贴,当局却因与他心臟病无关的体能检验项目表现「及格」而断然拒绝批准津贴。

同时,明知布莱克因养病仍不可工作,当局依然劝告布莱克申请求职者津贴。布莱克因需收入维持家用,不得不吃下官僚制度的苦头。为了质问当局的来函决定,他打电话等了接近1.5小时才接通到电话服务员,却被告知要等待该局人员的正式电话通知才可上诉;要上诉和申请另一个津贴,表格还得要从网站下载和处理,而他完全是个电脑文盲;不能工作还得去上覆歷指导班、到处投书寻找工作来证明自己「正求职」。这些制度的生硬设计若不是为了刁难和麻烦弱势群体,就是要忽悠和羞辱他们。

我相信类似布莱克的遭遇同样也在我国上演,我在檳城遇到欲求职不得的残障人士就是冰山一角受害例子。或许读者想知道,我国的福利制度如何运作和出现了什么结构性的问题?

首先,我国联邦宪法第九附表就列明瞭社会福利乃是联邦与州政府共同的责任权限,出现在共治列表(List III Concurrent List)的第一条文。该条文也阐述对妇女、孩童与青年的保护。自从2004年,社会福利局就隶属在联邦的妇女、家庭和社区发展部。州政府则部署成立本身的社会福利州级部门以及县级福利办事处。

据报道,联邦政府在2013-2017年五年內发放了411亿令吉的福利津贴。其中最大笔的福利津贴项目就是人民生活援助金(Bantuan Sara Hidup,前称为BR1M),估计在今年会发放50亿令吉给超过400万户人家。而主要通过社会福利部发放给具体的弱势群体例如老人、小孩和残障人士的援助金,2017年的发放总额是15.1亿令吉,大约51万人或1.6%总人口因此受惠。

政府投资资源不足

学术界的一般共识认为社会福利本身就是政治產物,一旦政治人物承诺的福利政策落实后,通常比较难收回或废除,否则要面对民意反弹。一些社会福利政策或沦为政客捞取政治成本的民粹伎俩。其中可判断的方式就是观察哪些政客的脸孔或名字出现在福利金派发活动仪式,那是政客企图建立受惠群与「施主」的知恩图报关係。

另一边厢,远在布城的联邦官僚认为人民对政府的社会福利依赖是坏事,故此常强调社区的共同责任,非政府组织和民间团体应投入资源和时间进行支援工作,政府是最后的靠山。可是,投入社会服务的民间团体则喊不公,认为他们正做著政府本来应承担的服务责任,但却没得到更多的支持和奖掖。

2016年的內陆税收局数据显示,大约7千个註册的福利团体当中,仅有3.6%254个组织透过社会福利局得到政府的补贴。

不应停留在现金补给

此外,政府的设施和其容纳空间与民间团体的实力比较明显悬殊。比方说,2017年政府在全国仅有13间孩童(或孤儿)庇护所,能容纳最多1500人,但全国各州属不一定都有。而在2015年非政府组织就有927间,可容纳至28千人的孩童避风港。若不计算卫生医疗福利,联邦政府每年投资在社会福利的数额少於国內总產值的1%,距离国际劳工组织所建议的6%差別大。

有时,地方特殊复杂的社会状况和福利需求,更显得联邦政府官员山高皇帝远,埋下了伏笔製造各级政府和官僚的相互指责、內斗纷爭。更重要的是,往往政府对社会福利政策的瞭解仅停留在现金补给(cash handouts),而社会弱势群体有时真正需要的是实际具体的社会服务,比如说丧偶无儿的老人需要有专人看管协助。

金钱不能满足一切的需要,但由於福利津贴现金发放的方式较为普遍熟悉,管道已有,较易在短期內落实见效,政治决策人因此欢喜採纳。

综上所述,我认为我国社会福利政策和实际运作得改革——包括中央权力下放——以便能让真正需要援助的社会弱势群体从中受惠和受到保护。


刊登于《東方日報》東方文薈版2019年4月7日


東方日報FB po 文留言链接在此

Monday, March 18, 2019

Why are medicine prices so high?



Two weeks ago, the Employees Provident Fund (EPF) published “Belanjawanku” (My Budget), an expenditure guide for individuals and families living in the Klang Valley. It has generated some debate amongst the Malaysian public, with most doubtful of the fact that it is possible for a single youth to rent a room for only RM300 in the area. There was, however, no real public discourse on the RM30 budgeted for healthcare. Leaving aside those who have either purchased private health insurance or have health issues, respondents must be feeling very healthy and optimistic, and consequently likely did not think of allocating much of a health budget. RM30 would not be sufficient to secure any private insurance plan.

Granted, treatment for minor illnesses would likely be affordable under such a budget. This isn’t the case for more serious ailments, however. The 2019 Global Medical Trend Rates Report published by Aon, an international professional services consultant firm, forecasts net growth of 13.6% in Malaysia’s medical inflation rates for current year – almost 5.7 times the forecast for inflation in general (Figure 1). The 2017 Malaysia National Health Expenditure findings also indicate that expenditure on medical goods already comprised 8%, or RM4.55 billion, of total health expenditure. This is a conservative calculation, one which does not include similar expenditures for inpatients.


Source: “2019 Global Medical Trend Rates Report”, Aon


The federal government in 2017 provided approximately RM2.4 billion for the procurement of medical drugs. This took up 10% of the total MOH budget in 2017. This expenditure item saw an increase of 13% relative to the preceding year, but medical supply shortages remain a problem in some public clinics and government hospitals - especially during the end of the year. This implies that the demand for public medical supplies still exceeds supply.

Unlike ordinary commodities, such as soft drinks where consumers are spoilt with choices and could have always opt out from purchasing such products, the purchase of medicine is entirely different. Under normal circumstances, patients are left with no choice but to seek treatment, particularly if their illness demands immediate attention. There are no alternative products to very specific drugs, especially when originator drugs are still under the patent protection period. This further limits the choices of patient seeking alternative medicine. What really makes the difference is the phenomenon of asymmetric information within medicine, where the judgments and drug prescription decisions of doctors and pharmacists dictate or limit the choices a patient faces.

Some are led to believe that originator drugs must be more superior than generics in terms of quality, efficacy and safety, and are therefore willing to pay a much higher price for the originator even if they were told about the existence of its generic counterpart. In Malaysia, after the successful registration of a drug patent, a product will usually enjoy a period of 20 years of market exclusivity. When the originator drug is still under intellectual property protection, it may be the market’s only option for a particular disease, and this is when the price a drug can fetch is usually at its peak. Originator drug manufacturers normally consider the cost of drug production – including investment in R&D – and operating costs (including marketing), stakeholders’ interests, as well as consumers’ purchasing power and their willingness to buy the drug in a particular country, before they set the final price tag for their product.

The reality is that generic drugs have the same active pharmaceutical ingredient, dosage, administration route and functional effectiveness as originator drugs. It is only when the patent for the originator drug has expired that generic drugs are approved to be sold in the market. The production cost and sale price of generic drug is generally significantly lower than that of the originator, even if the latter would later adjust their price to compete with the generic alternative.

According to the Medicine Prices Monitoring 2017 report, the final retail prices for generics are on average 3 times cheaper than originators. Consequently, price-sensitive consumers typically choose generics. In 2017, the average availability of generics in the public sector was 74.8% compared to originators (19.4%) (Figure 2). This is in line with the national medicine policy which encourages the use of generic medicines. However, the private sector has a tendency to use originators more often, with an average availability of 52.2%. 



Source: Medicine Prices Monitoring 2017, Ministry of Health 

In neighbouring Philippines, the law stipulates that the doctors and pharmacists must provide at least two generics (if they do exist) to accompany a prescription of an originator drug. This approach expands the availability of drug choices for patients.
In a normal medicine supply chain, drugs are produced by the manufacturer, ordered and shipped by importers, before changing hands to wholesalers or distributors who are in charge of the delivery of the products to the retailers (hospitals, clinics and pharmacies). Finally, they will reach the hands of patients or consumers. Due to the many levels of transactions within the supply chain, drug prices are inadvertently marked up at every level. Public healthcare system eschews the final retail-level mark-up, as our public healthcare system is tasked with providing medicine to the needy at almost zero cost.
Malaysia has a pharmaceutical manufacturing sector which produces almost entirely generic drugs, with sales revenue amounting to only a quarter of the total revenue of the pharmaceutical industry in 2014-2015. Some 61 percent of drugs (of equivalent revenue value) are imported, and amongst those, 87 percent of revenues were in the hands of local proxy companies for the big multinational pharmaceutical manufacturing companies. The top five companies take 47 percent of total medicinal imports, and importantly, these big multinational pharmaceutical parent companies get to decide the drug prices across countries, and they normally sell originator drugs.
Although local importers and sales proxies representing the top five multinational pharmaceutical companies did not have a big net profit margin (in between 1.6 and 3.4 percent), the average net profit margin for their parental companies is 26.2 percent - about 10 times that of their local importers! This market phenomenon indicates that the drug price-setting practice and global sales has laid golden eggs for Big Pharma companies, and left a bitter taste for patients and governments who have to make these purchases. Critics often point out that the market behaviour of the pharmaceutical companies has a significant impact on global medical inflation.
Distributors only work for the clients, provide logistics, and storage and services support, but do not own any stock of medicine. This is so they would not have influence over market pricing. A market review report shows that the mark up by wholesalers or distributors was marginal, at 2-3%. However, when the products reached the retailers – such as medical institutions and pharmacies – the mark-up is different.
According to the Medicine Prices Monitoring 2017 report, the median mark-up for originators’ and lowest-priced generics’ retail price in private hospitals was 51% and 167%, respectively, whereas in pharmacies these figures were lower, at 22.4% and 94.7% (Figure 3). This shows that the mark-up range can be exceedingly large; in some extreme cases, in private hospitals these could even spike up to 117.4% and 900%! Due to the lower production or import cost of generic drugs, this in turn allows private hospitals, clinics and pharmacies the opportunity to further mark up the final retail price which results in higher prices across the board, but greater profits.


Those in the sector often claim that price setting operations for medical products are within the bounds of the free market, or in other words, that mark-up behaviour is totally within legal boundaries, although it is considered by many to be unethical. Particularly when the prices for prescription or controlled medicines are hardly transparent, it is difficult for consumers to clearly compare prices and make informed decisions. In fact, the free market dogma entails that prices be made transparent so that market could be made more efficient, with consumers making the best decision for themselves!

However, the situation we have now often ‘encourages’ retailers to raise their prices arbitrarily while patients or consumers are not properly informed. Patients receiving medical treatment services often find that medicinal purchases constitute the most significant expenditure item in medical bills; this indicates that the mark-ups set by medical institutions undeniably add to patients’ financial burdens.

Two months ago, I participated a conference on rising medical costs. Throughout the conference, representatives from the participating multinational pharmaceutical companies, local private hospitals, as well as chain pharmacies all claimed that their profits are entirely justifiable because margins are reasonably low. A representative of a local chain pharmacy even commented to the audience that the large volume of medical products they sold were only of such a small profit to them that they have to diversify and rely on selling ice cream to subsist! This claim blatantly contradicts what data indicates.

Dealing with the factors contributing to rising drug cost, the Ministry of Health (MOH) has mooted the introduction of a mechanism to control medicine prices. This would be an interesting, if complex and challenging, proposal. Besides this, the pharmaceutical services department under the MOH is making efforts to increasing the transparency of medicine prices. Therefore, since 2015 a Consumer Price Guide has been uploaded on their website to enable people to make price comparisons. In the name of fairness and transparency, I hope the private sector takes the initiative to display all retail medicine prices to allow the public to make informed judgments. After all, for a laissez-faire market to work efficiently and effectively, there should be a free flow of pricing information for consumers to make the most economical decisions.

The article was published here at Malaysiakini, Opinion, March 17, 2019


Sunday, March 10, 2019

为何药价会高?




不久前,公积金局公佈了一项巴生谷个人与家庭开销预算指南,引起了全城热门討论。其中最多人关注的是,如何让单身的年轻人每月只用300令吉来找房子住。较少人討论看似不太合理的是30令吉的健康预算。除了那些平时就有购买私人健保配套的消费者,不然就是有健康问题在身而购买药物或保健品的人士,笔者揣测大部分健康正常的受访者並不怎么会有健康预算,再况且30令吉也没法买到私人健保。
一旦生病起来,一般人小病还好可负担,大病就不得了。国际专业咨询服务公司AON的2019年《全球医疗趋势率》报告就估算今年我国的医疗通膨率可达13.6%净成长,差不多是一般通膨率的5.6倍!2017年的国家卫生账户(Malaysia National Health Accounts)报告指出,单单是医药开销就佔了卫生领域总消费的大约8%或45亿令吉,而且这还是最保守的计算,未包括入院病人的医药开销。
对药物认知不对称
政府提供的公共医疗就在同年消费了大约24亿令吉添购医药,或10%卫生部的整体预算。这笔开销相比起2016年虽已增加了13%,但民眾仍对公共诊所和政府医院的医药短缺现象常有听闻,这表示公共医药仍「求大于供」。
一般人得病就要医,购买药物不似购买汽水般可有眾多不同选择,或甚至决定不买。通常针对性的医药没有替代產品,特別是该原厂医药仍处于专利保护期。与日常货品不同,医生和药剂师,以及一般民眾对医药產品资讯的认知不对称,他们为病人配药的判断和决定往往就左右或限制了民眾可作出的选择。
不少民眾对医药存有误解或偏见,迷信认为原厂药一定比仿製药品质更好、更有效及更安全。在我国,一般医药专利成功註册后便可享有长达20年的市场独佔期。当原厂药仍处在知识產权保护期,它或许就是当时市场上针对某个特定的疾病症状唯一药品或「救命仙丹」,价格通常能达最高。药厂一般会胥视药物生產和公司营运成本、利益相关者盈利,再加上该国市场消费者的经济负担能力等因素,而制定药价。
一般使用仿製药
仿製药事实上是有效药剂成份、剂量、服用方式和功能成效一样的药物,通常是在原厂药的专利失效后才被批准打入市场。仿製药的生產成本和售价肯定比原厂药显著低很多(虽然后者也会调整价格来竞爭)。所以,一旦有选择,精明的消费者应要选择价格最低廉的药品。我国政府公共医疗系统下的药库,2017年一共有大约四分之三的药物是仿製药,反观私人医疗界倾向使用原厂药(佔药库的52%)。卫生部的2017年《药品价格调查》报告结果显示私人医疗的药品售价,仿製药要比原厂药平均便宜接近3倍!
在菲律宾,该国法律强制医生和药剂师必须为病人提供至少两种仿製药的额外选择(若有相关药品的存在),这措施间接把財务负担考量和斟酌选择权交回给病人。
药物其实从生產商,到进口商,再转手到批发商负责分销至医疗中心和药房,最后才卖给病人或消费者。药价因供应链物流转手而在每一层被抬价;公共医疗系统则省免了最后一层的涨价,因为政府几乎免费为人民提供药物。
我国有製药业,生產的都是仿製药,其销售收入额仅佔我国製药业的四分之一。61%(等值)的药物都是进口货,其中87%的销售收入由外国製药公司授权的本地代理所囊括(其中最大的5家公司就已佔据接近进口市场的47%)。这也意味著首先决定药价的是海外的製药公司,他们通常卖的是原厂药。
儘管五大国际药厂的本地进口和销售代理的生意赚幅不大(净利介于1.6至3.4%),可是母公司的净利平均是26.2%,大约10倍赚幅之多!可见药价制定和销售量为国际药厂下金蛋,苦的是买单的病人和政府。前者的市场行为往往牵动著全球的医疗费通胀,令人詬病。
零售抬价病人负担重
批发分销商仅为客户提供后勤、存货及支援服务,並没有实际拥有医药囤货支配市场能力,因此间中的抬价涨幅仅为2-3%。但货物到了最后的医疗中心和药房等零售商,抬价幅度又不同了。
根据以上所述的2017年《药》报告,我国私人医院的原厂药和最低价仿製药的零售中位抬价分別是51%和167%;而药行零售中位抬价分別为22.4%及94.7%。零售商的抬价赚幅范围其实非常大,有些私人医院的极端案例甚至可达117.4%和900%!由于仿製药的生產或进口原价价位低,这反而提供私人医院、诊所和药房空间和机会拉高零售价,尝试「厚」利多销。
目前私人医疗业与药剂业为药物定价乃是自由市场运作,意味著他们的抬价行为不算犯法,儘管可能不道德。处方药或控制药品的价格尤其不透明化,所以消费者要货比三家也困难,这往往更纵容零售商肆意抬价。病人接受医疗服务,通常账单里最显著的开销项目就是医药购买,医院诊所的抬价幅度无可否认將加重人民的负担。
卫部努力控制药价
两个月前,笔者出席一场攸关医疗费用上涨的研討会,见识到赴会的国际药厂、本地私人医院和连锁药房代表各自申诉他们的赚幅没有很大,反而自圆其说称很合理。一位连锁药房的代表甚至表示他们都尝试「薄利多销」,更多要靠卖杂货维持生意。这些说法与笔者的认知有出入。
针对以上所述的种种让药价高涨的原因和弊病,卫生部有意要探討落实控制药价的措施。笔者虽然乐见其成但也瞭解到其复杂困难度。此外,卫生部底下的药剂服务支部也欲为药品价格透明化付出努力,从2015年起就在网站架设了一个消费者价格指南(Consumer Price Guide)以方便人民作比较。笔者更期望私人界的所有药品零售价必须要公开展示给民眾检验和比较,以示公平和透明。要有自由市场,消费者的资讯也得要有自由。
刊登于《東方日報》東方文薈版2019年3月10日
(此po文修改了一些文字,编辑版本稍有不同)

東方日報FB po 文留言链接在此

Sunday, February 10, 2019

「传宗接代」背后思考


新春佳节遇到亲朋戚友,相信他们对你的好奇和关注的议题通常围绕在那几样一般见识和预料的事。我也不例外,但今年我遇到比较有深度的问题。有位至今仍单身的好友问我这个已当爸的:「为什么要有孩子?」。看似简单的问题,以我目前的身份情况本应要有个完整的答案——我尝试当场回答却不太满意我的答案。
回到最根本,我与伴侣喜欢小孩纯粹一起「想要」,討论的是「要多少个」,而从没想过「为何不要」。我也不曾问过我父母为何他们要把我带来这个世界。前阵子就发生了一个趣闻,有位来自印度孟买的年轻人扬言要起诉父母「未经他的同意」就把他生出来。
传宗接代是答案?
「为什么要有孩子?」值得深思,因为世上有不少父母因「意外」而诞生小孩。有些因此奉子成婚,有些则成为单亲。后者未必比前者的情况更糟糕,关键在于前者的婚姻生活是否美满。更常见的社会问题可能是已婚伴侣未作好准备为人父母,就为了符合家庭期望和/或屈服社会压力(包括每年新年会遇到三姑六婆的「拷问」)「传宗接代」去了。
或许在传统家庭文化下的熏陶,很多人不假思索地认为「就是要这样做才正確」。其实,我认识的同辈朋友当中,也有一些开始质问这个传统的观念。他们想过了,决定不要有小孩。我一点都不会用道德批判这些朋友,反而会接受和尊重他们的决定,只要他们已理智地经过深思熟虑。
先从「不要有小孩」这个立场角度分析为何这不是个坏事。有些人已清楚知道自己不喜欢小孩,特別没耐心和爱心长时间照顾他们。一旦当上父母,就是一辈子(或至少到孩子成年前)的养育责任,这不是能中断、反悔或逆转的结果。如果已知不会对孩子友善、不准备花时间和精力陪伴孩子成长、给他们美好童年和塑造他们的人格思想,那么最好还是不要生小孩。与其孩子来到世上对双方都是伤害或是不快乐的泉源,就乾脆不要。
有时我想,那些虐待、忽略或遗弃孩子的父母,是不是在以上所述的思想状態下错误地把孩子带来世间受苦?
  不要小孩的现实理由

当然也有一些人不要有小孩是因为经济考量。他们认为养育小孩花费庞大,在薪水近乎停滯、增长赶不上生活费通货膨胀的情况下,真的「很贵,养不起」。我承认小孩赡养费不小,但很多人(包括我们的父母和其他长辈)在財务状况比目前的这些人还更糟糕恶劣的情况下,依然决定要生下小孩。一来可能是现实的他们寧愿把钱留给自己也不愿意「投资」或花费在小孩身上,又或者他们真的觉得无法在財务上给孩子一个「有素质、有保障」的生活。
华裔生育率最低
那么,如果自己已过了「不要小孩」那关,是否就等同于知道为何要生孩子?传宗接代或许是传统观念,但无可否认很多人仍持有该观念,认为这是一个人生必经的道路、必执行的神圣任务。
虽说如此,但我国统计局的总和生育率(Total Fertility Rate)数据显示,15至49岁之间的妇女生育率已从1970年的4.9婴孩跌到2017年的1.9婴孩。自从2013,我国的总和生育率就一直处于2.1以下,换言之就是无法达到人口更替水平標准。华裔妇女的生育率仅1.2,为三大种族中最低(巫裔:2.5,印裔:1.3)。
虽然没有数据显示多少对已婚华裔伴侣没小孩,相信生育率低除了是现代男女不育问题、太迟婚或不婚、因各种原因停留在只生育1-2个小孩,还有不育主义的男男女女(包括同性恋)。
对城市华裔新家庭来说,纯粹靠减税优惠和特別拨款育儿奖掖政策,任凭华裔政治或乡团领袖在报章媒体或活动上高呼「华裔要多生育(保住华裔权益)」,应该都难以激起任何鼓舞作用。
男女在社会上扮演的传统角色一日不转型往男女平权分担家事,上班女性就越感到育儿吃力不討好。然而政府在发展(公共)托儿所政策上后知后觉,至今大部分私人企业直接忽视职业女性的需要,造成既使有心要生育到「子孙满堂」的伴侣也败在现实中的挑战和不利环境。
新手父母应上产前辅导课
妇女、家庭及社会发展部副部长杨巧双去年11月倡议非穆斯林伴侣欲结婚需强制上婚前辅导课,这是对应离婚率上升的政策建议。我认为还有一个相当重要的是產前辅导课,因为我发觉越来越多已婚伴侣,不懂得也不在乎事先瞭解做爸妈的育儿技术和知识,甚至出现观念贫乏或错误。
没认真准备育儿的后果导致后来他们易患上「人云亦云」毛病,在育儿事务上失去了判断能力和执行力。不少现代父母甚至把亲生子女直接托付交给本身的父母照顾,结果没有累积到或发展相关经验。
回到我朋友的前文提问,他也透露,凡遇到有孩子的朋友他都会这样问道:照顾孩子过程中,多少成分是「喜悦」,多少则是「苦劳」?他普遍得到的答案是1/10「喜悦」,其他的是「苦劳」,暗示著为了享有天伦之乐,更多的是辛苦的付出,很多人最后还是表示那种付出还是值得的。
我並不那么悲观,认为那些都是「苦劳」;为了得到「天伦喜悦」也不能解释我要有孩子的原因。
我相信答案因人而异。所谓「十年树木,百年树人」,对我来说这是此生的一个计划和理想。有人说,这个世界只会变得更糟糕,为何要把后代带来世间受罪?我不买这套,坚信「前人种树后人乘凉」,现在就得树立起好榜样,相信以后我们的后代会成为社会有用的人。这样这世界才不会只走向更糟糕的一条路。

刊登于《東方日報》東方文薈版2019年2月10日
(此po文采用原文小题,编辑版本稍有不同)

東方日報FB po 文留言底下反應熱烈,故此存檔鏈接一下,以供未來參考 xD

Monday, February 04, 2019

政治不能無視倫理道德

前言:
記得總是有一些社運朋友對另一些社運友人用政治道德語言批判政治人物和時局,感到不滿。其中前者批評後者企圖用‘聖人政治’從‘道德高地’評論時局。
這些都看在我眼裡,激發我本身再專研深入探討政治、目的與倫理之間的關係,以及國際政治歷史發展的演變。美國知名哈佛大學政治哲學學者Michael Sandel, 尤其是他的TED talk: 'The lost art of democratic debate' 是我的切入點。他點出,亞里士多德教導我們的是,我們要追溯和探討某樣事物的原始目的,舉例說笛子存在的目的是悅耳的笛子音樂,所以笛子最好還是給會吹奏笛子的人(所以其他分配笛子的方式並不relevant,例如財富標準、社會地位或隨機派送)。追溯原始目的有助於了解為何近年代的民主社會討論頻頻出現了問題,比如說政治語言被市場經濟語言騎劫,再不然或被‘表面象征化’成為偽民主言不由衷的政治表演。當政治已不再是人民想象的原本目的,就失去了代表性和作用。民主辯論也變得蒼白空洞。
在政治與倫理課題上,給我最大啟發最深影響的是,反而是當代基督民主學者Robin Lovin 在2014年在美國國會圖書館的一場相關課題的講座“Ethics, Politics and Institutions: A Moral Vocabulary for Modern Democracy”。就如他的前輩Reinhold Nienbuhr如此告誡,在政治世界裡沒有任何東西可以自我延續或自我修正('nothing in politics is self-sustaining or self-correcting'),政治與道德詞彙的運用也隨著世界政治思想和時局演變,產生了根本性的價值變化。當我們看到使用(憲政)民主制度的國家在冷戰後處於政治正確影響的巔峰狀態當兒,卻看到各種民主亂象開始出現包括人民對主流政治越感失望、疏遠,導致極右極左以及玩笑政黨開始顛覆系統。其中一個最大原因,不是制度問題,而是道德語言和權威的喪失,使人們失去了對政治的原始目的應有的想象。這是現代民主政治在多國面對的正統性(Legitimacy)挑戰。
在我國,雖然剛‘改朝換代’了,會不會讓人民朝向現代民主國家的問題發展趨勢走去?我擔心不是無理的,一旦越來越多原本有期望‘新政治’可以‘救國’,最後若到頭來發現情況差不多還是在原地踏步,那麼那種失望可能導致絕望,會讓他們難以重拾對政治的信心、信任和期望。如果政治人物不再根據過去的信念和原則做事,而讓人一再地給人抓到前言不對後語、反反復復政治立場的痛腳記錄,政治道德倫理危機將可能導致民主的倒退。我認為,目前的情況是,不是普遍社會論述上充斥太多的‘道德’,反而是在台上的政治人物缺乏道德辭藻論述,不是言不由衷就是言而無信,才是最大的問題。
所以我寫了這篇文章支持人民繼續給政治人物大力度的道德批判,同時也要求政治人物正視‘道德倫理’缺陷/缺席給民主帶來的危機和後果。不是評論人站在道德高地的關係,而是有些政客的所作所為真的太low了。
P/s: 我與同伴們聯手創辦的非政府組織Agora Society Malaysia 群议社 ,其中我們相信和秉持著類似文中的哲學性思考,要民主社會回到政治的原始真諦和目的,就是政治為眾利益,為人民創造更美好生活。Agora本來就是個公共市集場所,民主和政治應該就發生在日常生活的地方,成為大家可共同議論的生活事物。
我們一再堅持政治要遵循道德原則做事的重要性——如果作出有違從政的目的,若真的為了‘大局/現實’而妥協,到底哪裡才是真的止損線?不喜歡給人道德批判又想要招搖撞騙誤導人民,我們奉勸他們回頭是岸,回歸原始的政治目的和理想吧,不然就等著別人‘拆招牌’,還是‘關店’算了。
文章:
有人主張不談個人道德或人治,要談制度和法治。但立法和設計制度過程中,無可避免涉及目標和其中價值取向,並非是道德空洞論述。二十年前「烈火莫熄」政改運動,不是矢言大破大立嗎?為何如今堅持信念卻招致「站在道德高地」之譏?若要人民繼續關心政治,打造一個有活力、永續的政治共同體,先決條件就是這個社會要有可以憑靠的道德辭藻,成為政治理想信念的原動力。民主社會應該樂見有道德原則者持續臧否政治人物,反而要担心為政者變質、失去道德原則卻不再有人批評,才對!

【文/林志翰】
希望聯盟執政超過八個月,越來越多選民失望。競選承諾跳票或久未推動,政府豈能戲言敷衍人民?首相馬哈迪承認「希盟宣言是指南並非聖經」後,民間不滿情绪開始發酵。根據「The Harapan Tracker」最新統計,希盟宣言裡的545項大大小小的承諾,至今只落實了23項(4.2%),411項(近四分之三)紋風不動。華社擔心統考承認事宜,可能是永遠走不完的「一哩路」,情感上難免受傷。
民權組織非議政府不只無意廢除煽動法令等多項惡法,還繼續援引來調查去年杪的興都廟騷亂事件。在某些政策頻頻急轉彎、出爾反爾U轉(如簽署反歧視國際公約ICERD),那些惡評如潮的政策如第三國產車計劃卻一意孤行。政府漸漸少提「改革議程」,常歸咎「都是前朝政府的錯」來當擋箭牌。希盟要員忙著招兵買馬搶奪資源,安插親信入官聯公司。
當政治人物言而無信,終日盤算利益,卻有支持者辯稱希盟政府經驗尚淺,還在邯鄲學步,批評者要有耐心不得操之過急。更有者反唇相譏指「聖人」總愛在道德制高點指指點點,沒有顧全大局,不諳實際政治操作就是要下場「把手弄髒」(Dirty Hands)。
從政者需有倫理誠信
問題是,若視政治本質為黑箱作業、赤裸裸的權力鬥爭,當初就不會相信選票會帶來改變。回顧歷史,政治不能也不應離開道德倫理的討論。古希臘哲學家亞里士多德認為政治乃一切事物所繫,引領我們活出美好生活(to live a good life)。那本應是政治的目的、從政者追求的基本價值。就如醫生要有醫德,為了治好病人,以病人為先。我們可以接受醫生教師等專業人士欺騙、忽略我們的要求嗎?那麼對政治人物也應有基本職業倫理與誠信要求,以人民利益為本。
根據遠景研究中心(CENBET)2018年最新民調,馬來西亞政治人物的公眾信任度僅有16%。72%受訪者認為一個有信用的政治人物應誠實問政;63%認為應有處理複雜國是的勇氣,至於有無高教育程度(29%)或財富(19%)並不重要。
對亞里士多德來說,人類是「政治動物」(political animal)——政治是眾人之事,並不「外包」給專業政治人物。透過政治實踐,可獲取生活技巧、辨別是非,培養美德。打從西方文明開始,政治就是攸關眾人的大規模倫理實踐。除了需商榷最好的方法和手段,也需靠各方合作,相互支援(尤其是那些既得利益及支配者),才能共同達致美好生活。春秋戰國的中國是政治思想最百花齊放的時期,儒家思想也強調以倫理政治為核心。所謂「遊文六經之中,留意於仁義之際」,「仁義」是儒家的中心思想,常用來規範自身行為。
有人看到的盡是負面教材,因而認為亞里士多德太天真、太理想主義、太「離地」,政治豈可能扯上倫理道德?他們誤以為,有人起初是追求正義的理想主義者,赫然發現原來政治是為了權力鬥爭,後來無不變成「現實主義者」(realist)。這裡頭可以想像的代表是马基维利(Machiavelli)、霍布斯或列寧,論述的秩序總是理想在先,權力現實在後。可是,公元前四世紀的古希臘雅典人並不是這麼想,他們熱衷反思批判,假設可以不再因循前人,就能釋放自我、改變現狀。年少輕狂的我們不也曾想這樣改變世界?二十年前「烈火莫熄」政改運動,不是矢言大破大立嗎?當時政治論述、道德判斷可曾缺席。為何如今堅持信念卻招致「站在道德高地」之譏?
公民社會應參與決策
亞里士多德認為,我們可以為個人及整體社會生活抉擇,養成好習慣,多培養美德,有了歷練才能確保作出好的選擇。換句話說,公民社會得積極參與決策,才會有良好的選擇結果。這就是亞里士多德所謂的「審議政治」(Politics of deliberation)。縱使審議政治不在於所有人需達成共識、同意某項說法,但過程中得判斷抉擇,說服其他不同意見者。
現代政治論述最棘手的是道德詞彙匱乏,逐漸被市場和經濟語言取代。後者貌似中立客觀,其實不然。大學掌舵人盲目追求提升大學國際排名,衡量政策能否帶來更多投資回酬,卻已遺忘大學之本必須是教育與學術機構;社會也不能用捐款多寡,來決定是否值得支持公共圖書館;藍領階級勞工領取低薪,可能與他們的「生產量」或「效率」提升與否無關。道德詞彙如說「公平」(薪資)和「自由」(意見表達),更能反映出主體事物的目的、功能與社會價值。這些不是經濟數據和市場價格可以反映出來的。
有人主張不談個人道德或人治,要談制度和法治。但立法和設計制度過程中,無可避免涉及目標和其中價值取向,並非是道德空洞論述。若要人民繼續關心政治,打造一個有活力、永續的政治共同體,先決條件就是這個社會要有可以憑靠的道德辭藻,成為政治理想信念的原動力。民主社會應該樂見有道德原則者持續臧否政治人物,反而要担心為政者變質、失去道德原則卻不再有人批評,才對!

原文鏈接:http://contemporary-review.com.my/2019/02/03/1-145/