Is Singapore’s “miracle” health care system the answer for America?
The Singapore model shows how liberal and conservative ideas can fuse.
When liberals talk about their health care utopia, they have scores of examples to choose from. Some name France’s high-performing multi-payer system (No. 1 on the World Health Organization’s rankings, in case you haven’t heard). Others point to Canada’s single-payer simplicity. The Scandinavian countries all do health care well, and there’s much to recommend Germany’s hybrid approach.
Conservatives really only have one example of a free market health care paradise to point to: Singapore. But oh, what an example it is! In a New York Times column called
“Make America Singapore,” Ross Douthat called it “the marvel of the wealthy world.” After the election, Fox News published an op-ed headlined,
"Want to ditch ObamaCare? Let's copy Singapore's health care miracle.”
Why are conservatives so taken with Singapore? The American Enterprise Institute’s
glowing write-up explains it well:
What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends.
Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care.
Here’s what Singapore’s conservative admirers get right: Singapore really is the only truly universal health insurance system in the world based on the idea that patients, not insurers, should bear the costs of routine care.
But Singapore isn’t a free market utopia. Quite the opposite, really. It’s a largely state-run health care system where the government designed the insurance products with a healthy appreciation for free market principles — the kind of policy Milton Friedman might have crafted if he’d been a socialist.
Unlike in America, where the government’s main role is in managing insurance programs, Singapore’s government controls and pays for much of the medical system itself — hospitals are overwhelmingly public, a large portion of doctors work directly for the state, patients can only use their Medisave accounts to purchase preapproved drugs, and the government subsidizes many medical bills directly.
What Singapore shows is that unusual fusions of conservative and liberal ideas in health care really are possible. Singapore is a place where the government acts to keep costs low and then uses those low costs to make a market-driven insurance system possible. One thing you quickly realize when studying their system is it would be a disaster if you tried to impose it in a country with America’s out-of-control medical prices.
That speaks to the more depressing lesson of Singapore. As soon as you begin seriously comparing where they are, and how their system works, to where the US is, and how our system works, it becomes painfully clear how far America is from having the institutions or preconditions for truly radical health care reform.
