Singapore's Health Care System: A Free Lunch You Can Sink Your Teeth Into

[Bono]

http://econlog.econlib.org/archives/2008/01/singapores_heal.html

Singapore's Health Care System: A Free Lunch You Can Sink Your Teeth Into
Bryan Caplan

In The Undercover Economist, Tim Harford highly praised the health care policies of Singapore. But it wasn't until I read the section on health care in Ghesquiere's Singapore's Success that I realized how amazing the official numbers are. If the following is true, all the comparisons showing that the U.S. greatly outspends Europe without getting better health are beside the point, because Singapore makes Europe look like the U.S.:

    The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970... Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States... It is true that such indicators are also related to the overall living environment and not only to healthcare spending. Nonetheless, international experts rank Singapore's healthcare system among the most successful in the world in terms of cost-effectiveness and community health results.

How does Singapore do it? Singapore is no libertarian health care paradise, but it does self-consciously try to maintain good incentives by narrowly tailoring its departures from laissez-faire:

    The price mechanism and keen attention to incentives facing individuals are relied upon to discourage excessive consumption and to keep waste and costs in check by requiring co-payment by users.

    [...]

    The state recovers 20-100 percent of its public healthcare outlay through user fees. A patient in a government hospital who chooses the open ward is subsidized by the government at 80 percent. Better-off patients choose more comfortable wards with lower or no government subsidy, in a self-administered means test.

I've heard a lot of smart people warn that co-payments are penny-wise but pound-foolish, because people cut back on high-benefit preventive care. Unless someone is willing to dispute Singapore's budgetary and health data, it looks like we've got strong counter-evidence to this view: Either Singaporeans don't skimp on preventive care when you raise the price, or preventive care isn't all it's cracked up to be.

More details on how Singapore's system works:

    * There are mandatory health savings accounts: "Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions... Only approved categories of medical treatment can be paid for by deducting one's Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash..."
    * "The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available."
    * Private healthcare providers are required to publish price lists to encourage comparison shopping.
    * The government pays for "basic healthcare services... subject to tight expenditure control." Bottom line: The government pays 80% of "basic public healthcare services."
    * Government plays a big role with contagious disease, and adds some paternalism on top: "Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority."
    * The government provides optional low-cost catatrophic health insurance, plus a safety net "subject to stringent means-testing."

Last year, Robin Hanson stuck his neck out and argued that we should cut health spending in half. If Singapore's numbers are right, Robin was being conservative. Singapore has achieved American health outcomes for about a quarter of the share of GDP the U.S. spends. Furthermore, if Canada shows that socialized medicine can save a few percent of GDP without hurting health, Singapore shows that the free lunch offered by greater government control is meager compared to the free lunch offered by old-fashioned individual incentives.

[StateBoiler]

Why are you sticking up for an authoritarian dictatorship?

[Verily]

Why are you sticking up for an authoritarian dictatorship?

Because apparently the perfect libertarian state can only exist as contained within the perfect authoritarian one

Plus, the odds that Singapore cooks its books on health care are off the charts anyway. And it's all urban, so it doesn't have to worry about rural areas, which are, in the modern day, often the least healthy (and certainly drive up health care costs massively by the need to have small hospitals interspersed across the countryside).

[ottermax]

Singapore is rich, so of course it has an amazing health care system.

 

Why are you sticking up for an authoritarian dictatorship?

Singapore is one of the happiest nations on earth. Singaporeans enjoy the fact that government basically tells them everything to do. True democracy would scare the hell out of Singaporeans. They like knowing that their families are safe and that their city is clean. If Singapore wanted democracy and a multi-party state, they would vote for it, but they choose to have dictatorship.

So, while Singapore has an amazing system for Singapore it would be insane to apply it to America. We are just too big and uneducated.

[dead0man]

Hey no fair, rich people still get better medical care!  Everybody should have the same medical care available, right lefties?

[Alcon]

Verily pretty much summed it up.  It's kind of funny how willing libertarians are to trust the government of Singapore.  Apparently government-libertarian solidarity runs high when it's ideologically convenient.  Not that the Singaporean system doesn't have its ups, though.

[dead0man]

I suddenly feel the need to point out I'm not supporting the Singapore model or suggesting we should adopt it.  I was just pointing out that in their system the rich get better care than the poor, just like most (all?) systems.  Many of the American left is under the impression everybody deserves (and should be forced to recieve) the exact same level of care and that's just silly.

[Iosif is a COTHO]

  Many of the American left is under the impression everybody deserves (and should be forced to recieve) the exact same level of care and that's just silly.

No, sane people believe that it is entirely within reason for the state to provide a basic, good standard of health care for every citizen. If you want to pay a lot of money for a higher standard or for a 'vanity' operation, that's your prerogative. Your use of the term 'forced to receive' is dishonest.

While we're misrepresenting opinions, perhaps I should say that Libertarians just want everyone to tough it out with a rag in their mouth?

[dead0man]

Well you should put a "many" in there like I did.  Broad brushes and all that. Maybe I should have said "a few"?

[Person Man]

This does look like the Romney/Clinton plan in a lot of respects-

- Mandatory Health Insurance
- With Government Subsidies to cover those who can't afford to be insured

I think this plan is a good comprimise. We need to ensure that everyone has health insurance, but we should allow for competition and responsibility as well.

I think Obama's plan is closer to this, but without the loss of civil and economic liberties. 
McCain's plan is just to give out free money to people and hope for the best.

[Bono]

This does look like the Romney/Clinton plan in a lot of respects-

- Mandatory Health Insurance
- With Government Subsidies to cover those who can't afford to be insured

I think this plan is a good comprimise. We need to ensure that everyone has health insurance, but we should allow for competition and responsibility as well.

I think Obama's plan is closer to this, but without the loss of civil and economic liberties. 
McCain's plan is just to give out free money to people and hope for the best.

Actually, what's mandatory is the Medical Savings Accounts, not health insurance.

[Хahar 🤔]

Singapore disgusts me. But the Singaporeans like it...

[Person Man]

This does look like the Romney/Clinton plan in a lot of respects-

- Mandatory Health Insurance
- With Government Subsidies to cover those who can't afford to be insured

I think this plan is a good comprimise. We need to ensure that everyone has health insurance, but we should allow for competition and responsibility as well.

I think Obama's plan is closer to this, but without the loss of civil and economic liberties. 
McCain's plan is just to give out free money to people and hope for the best.

Actually, what's mandatory is the Medical Savings Accounts, not health insurance.

So, people would actually pay themselves if something bad enough came up? I guess that would work if there was price controls and mandatory co-pays.

[Ban my account ffs!]

Here's the main reason that Singapore is completely incomparable to the U.S.



No babies, no old people.. just healthy, happy middle aged people at the peak of their health.


Here is the United States:



More babies, more old people.. and just lots and lots more people in general.

Then in Europe, which experienced a similar "middle age bulge" until recently, is beginning to suffer from the boom of babies followed by a prolonged bust.



In Germany, the babies born leading up to WWII, to be Hitler's new generation, are getting into their 70s, and they are more numerous than babies today.

In 25 years, Singapore will be spending a lot more of its GDP on health care, I can guarantee you that!

Taiwan and South Korea are headed in the same direction

[CultureKing]

Hmm... A small, rich, city-state is having an easier time with health care than one of the largest nations in the world (both in population and area). Weird...

[Bono]

This does look like the Romney/Clinton plan in a lot of respects-

- Mandatory Health Insurance
- With Government Subsidies to cover those who can't afford to be insured

I think this plan is a good comprimise. We need to ensure that everyone has health insurance, but we should allow for competition and responsibility as well.

I think Obama's plan is closer to this, but without the loss of civil and economic liberties. 
McCain's plan is just to give out free money to people and hope for the best.

Actually, what's mandatory is the Medical Savings Accounts, not health insurance.

So, people would actually pay themselves if something bad enough came up? I guess that would work if there was price controls and mandatory co-pays.

As the article says too, the government offers low-cost catastrophic insurance under a stringent means-test for those who cannot afford it.

[Eleanor Martins]

Singapore is rich, so of course it has an amazing health care system.

 

Why are you sticking up for an authoritarian dictatorship?

Singapore is one of the happiest nations on earth. Singaporeans enjoy the fact that government basically tells them everything to do. True democracy would scare the hell out of Singaporeans. They like knowing that their families are safe and that their city is clean. If Singapore wanted democracy and a multi-party state, they would vote for it, but they choose to have dictatorship.

So, while Singapore has an amazing system for Singapore it would be insane to apply it to America. We are just too big and uneducated.

Well done, you've just bought into the stuff Lee Kuan Yew peddles about Singaporeans being fundamentally unsuited to the liberal democracy of the West. I assure you that this truly isn't a monolithic belief.

[Person Man]

This does look like the Romney/Clinton plan in a lot of respects-

- Mandatory Health Insurance
- With Government Subsidies to cover those who can't afford to be insured

I think this plan is a good comprimise. We need to ensure that everyone has health insurance, but we should allow for competition and responsibility as well.

I think Obama's plan is closer to this, but without the loss of civil and economic liberties. 
McCain's plan is just to give out free money to people and hope for the best.

Actually, what's mandatory is the Medical Savings Accounts, not health insurance.

So, people would actually pay themselves if something bad enough came up? I guess that would work if there was price controls and mandatory co-pays.

As the article says too, the government offers low-cost catastrophic insurance under a stringent means-test for those who cannot afford it.

...I guess that would work. But Snowguy has a point about children. Old People, not so much. The graph was skeewed. Then again, our economy depends on our ability to reduce the numbers of years that people are infeebled before death by being able to succesfully manipulate the aging process until geriatrics is no longer an issue or the geriatric period between youth and death is made a lot shorter and cheaper.

[ottermax]

Singapore is rich, so of course it has an amazing health care system.

 

Why are you sticking up for an authoritarian dictatorship?

Singapore is one of the happiest nations on earth. Singaporeans enjoy the fact that government basically tells them everything to do. True democracy would scare the hell out of Singaporeans. They like knowing that their families are safe and that their city is clean. If Singapore wanted democracy and a multi-party state, they would vote for it, but they choose to have dictatorship.

So, while Singapore has an amazing system for Singapore it would be insane to apply it to America. We are just too big and uneducated.

Well done, you've just bought into the stuff Lee Kuan Yew peddles about Singaporeans being fundamentally unsuited to the liberal democracy of the West. I assure you that this truly isn't a monolithic belief.

In most of Asia the vast majority have far too much faith and trust in government. Even in Japan today people are afraid to vote for the opposition or participate in a jury process. There is a small minority of people who believe in liberal democracy and while it would be great for Singapore to be a liberal democracy, the people choose their system. Singapore might as well be a liberal democracy, but it doesn't want to be.

[War on Want]

Singapore is rich, so of course it has an amazing health care system.

 

Why are you sticking up for an authoritarian dictatorship?

Singapore is one of the happiest nations on earth. Singaporeans enjoy the fact that government basically tells them everything to do. True democracy would scare the hell out of Singaporeans. They like knowing that their families are safe and that their city is clean. If Singapore wanted democracy and a multi-party state, they would vote for it, but they choose to have dictatorship.

So, while Singapore has an amazing system for Singapore it would be insane to apply it to America. We are just too big and uneducated.

Dude you aren't much of a liberal at all. When people get settled in with a government of course they begin to enjoy it but it never makes it right. I recall somebody saying in a quote once"The average person will take all sorts of restrictions on their personal lives if it means there is a stable economy."

[??????????]

Singapore is rich, so of course it has an amazing health care system.

 

Why are you sticking up for an authoritarian dictatorship?

Singapore is one of the happiest nations on earth. Singaporeans enjoy the fact that government basically tells them everything to do. True democracy would scare the hell out of Singaporeans. They like knowing that their families are safe and that their city is clean. If Singapore wanted democracy and a multi-party state, they would vote for it, but they choose to have dictatorship.

So, while Singapore has an amazing system for Singapore it would be insane to apply it to America. We are just too big and uneducated.

Well done, you've just bought into the stuff Lee Kuan Yew peddles about Singaporeans being fundamentally unsuited to the liberal democracy of the West. I assure you that this truly isn't a monolithic belief.

In most of Asia the vast majority have far too much faith and trust in government. Even in Japan today people are afraid to vote for the opposition or participate in a jury process. There is a small minority of people who believe in liberal democracy and while it would be great for Singapore to be a liberal democracy, the people choose their system. Singapore might as well be a liberal democracy, but it doesn't want to be.

The sheeple have spoken.

[I spent the winter writing songs about getting better]

I've never understood the constant Singaporean apologism in the US. "Oh sure authoritarian dictatorships are wrong in almost every case, but no, Singapore is different!"

[Stranger in a strange land]

I've never understood the constant Singaporean apologism in the US. "Oh sure authoritarian dictatorships are wrong in almost every case, but no, Singapore is different!"

If you've ever met a singaporean, they come across as brainwashed and mindlessly naive in their alliegence to their government, their ruling party, and Lee Kuan Yew.