As President Obama tries to push his health reform bill through Congress, there is some interest in the Singapore healthcare system. The article below in the Washington Post wrote about our system in glowing terms. Our system is by no means perfect but it avoids many of the problems healthcare systems in other countries face.
George Yeo
Link:
Washington Post
What we can learn from Singapore's health-care model
By Matt Miller
Wednesday, March 3, 2010; 10:45 AM
We interrupt Washington's feud over the president's "way forward" for a brief word on a path not
taken, courtesy of the only rich nation that boasts universal coverage with health outcomes better
than ours while spending one-fifth as much per person on health care. Introducing (drum roll
please): Singapore.
Yes, it's an island city-state of just 5 million people. Yes, it's more or less a benevolent
dictatorship. And, yes, until recently, bringing chewing gum into Singapore could land you in jail.
But Singapore, a poor country a few decades ago, now boasts a higher per capita income (when
adjusted for local purchasing power) than the United States. And here's the astonishing fact:
Singapore spends less than 4 percent of its GDP on health care. We spend 17 percent (and
Singapore's somewhat younger population doesn't begin to explain the difference). Matching
Singapore's performance in our $15 trillion economy would free up $2 trillion a year for other
public and private purposes.
Do I have I your attention?
Today we can't find cash to recruit a new generation of great teachers, rebuild our roads and
bridges, pay down the national debt, or invest in better airports, high-speed rail, a clean energy
revolution or any of a hundred other things sensible patriots know we should do to renew the
country. We can't do these things in large part because the Medical Industrial Complex vacuums
up every spare dollar in sight. It's only slightly melodramatic to assert that if we could run our
health-care system as efficiently as Singapore's, we could solve most of our other problems.
So how does Singapore do it?
In health circles it's always conservatives who bring up Singapore, because of the primacy it
places on personal responsibility. According to Phua Kai Hong of the National University of
Singapore, roughly one-third of health spending in Singapore is paid directly by individuals (who
typically buy catastrophic coverage as well); in the United States, by contrast, nearly 90 percent
is picked up by third-party insurers, employers and governments. Singaporeans make these
payments out of earnings as well as from health savings accounts. The system is chock-full of
incentives for thrift. If you want a private hospital room, for example, you pay through the nose;
most people choose less expensive wards.
Conservatives are right: Singaporeans have the kind of "skin in the game" that promotes
prudence.
But that's only half the story. There's also a massive public role. For starters, adequate savings
for retirement and health expenses are mandated by government (employees must sock away 20
percent of earnings each year, to which employers add 13 percent). Public hospitals provide 80
percent of the acute care, setting affordable pricing benchmarks with which private providers
compete. Supply-side rules that favor training new family doctors over pricey specialists are
more extensive than similar notions Hillary Clinton pushed in the '90s. And in Singapore, if a
child is obese, they don't get Rose Garden exhortations from the first lady. They get no lunch and
mandatory exercise periods during school.
There's more (including an ample safety net for the poor), but you get the gist: Singapore
achieves world-class results thanks to a bold, unconventional synthesis of liberal and
conservative approaches. It's further to the left and further to the right than what President
Obama or his foes now seek. The island's real ideology is pragmatic problem-solving. It works
thanks to cultural traditions that let this eclectic blend flourish. The system is nurtured by
talented, highly paid officials who have the luxury of governing for the long-term without being
buffeted much by politics.
We obviously can't transplant Singapore's approach wholesale to the United States. But the
reason we can't emulate even some of Singapore's success has to do with that iron law of health-
care politics: Every dollar of health-care "waste" is somebody's dollar of income. As a stable
advanced democracy, we're so overrun by groups with stakes in today's waste that real efficiency
gains are perennially blocked.
Any hope for something better starts with tallying the price of today's paralysis. Think about that
$2 trillion the next time you see states, citing budget woes, shut the door to college on tens of
thousands of poor American students. Or when the next firm moves jobs overseas because health
costs here are soaring. Or when the next bridge collapses. Thanks, Medical Industrial Complex!
We return now to our regularly scheduled political battle, which (no matter the outcome,
according to some projections) will leave health costs headed to more than 20 percent of GDP by
2019.
Matt Miller, a senior fellow at the Center for American Progress and co-host of public radio's
"Left, Right & Center," writes a weekly column for The Post. He can be reached at
[email protected].
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