March 18, 2017
THE CONSERVATIVE ALTERNATIVE TO NATIONAL HEALTH:
Make America Singapore (Ross Douthat MARCH 18, 2017, NY Times)
Republicans will give us greater coverage and less choice.Singaporeans pay for much of their own care out of their own pockets, and their major insurance program is designed to cover long-term illnesses and prolonged hospitalizations, not routine care. The combination has produced genuinely extraordinary results: The island state has excellent health outcomes while spending, as of 2014, just 5 percent of G.D.P. on health care. (By comparison, a typical Western European country that year spent around 10 percent; the United States spent 17 percent.)However, there has never been a major Republican policy proposal that just imitates what Singapore actually does. That's because the Singaporean vision is built around personal responsibility and private spending, but also a degree of statism and paternalism that present-day American conservatism instinctively rejects.First, Singaporeans do not spend money voluntarily saved in health-savings accounts. Under their Medisave program, they spend money saved in mandatory health-savings accounts, to which employers contribute as well. Second, their catastrophic insurance doesn't come from a bevy of competing health insurance companies, but from a government-run single-payer system, MediShield. And then the government maintains a further safety net, Medifund, for patients who can't cover their bills, while topping off Medisave accounts for poorer, older Singaporeans, and maintaining other supplemental programs as well.So the Singaporean structure does not necessarily minimize state involvement or redistribution. It minimizes direct public spending and third-party payments, while maximizing people's exposure to what treatments actually cost. And the results are, again, extremely impressive: By forcing its citizens to save and manage their own spending, the Singaporean system seems to free up an awful lot of money to spend on goods besides health care over the longer haul of life.
Posted by Orrin Judd at March 18, 2017 2:49 PM