Sunday, August 16, 2009

Why Singapore's health care system beats ObamaCare

Singapore's health care system is entirely different than anything the Democrats are trying to do. Singapore's health care system is one libertarians should love, because people there pay for their own health care out of their own pocket. Singapore's health care system is basically a system of health savings accounts for everyone, combined with catastrophic (high-deductible) health insurance. There is also free health care for the poor, analogous to Medicaid in the U.S.

Why is Singapore's health care system superior to ObamaCare? Let's compare Singapore to the Democratic Party ideal (Western Europe and Canada).

Singaporeans live longer than people in the Western European countries whose health care systems the Democrats want to copy:


Singapore's health care system costs less than those in the Western European countries that the Democrats want to copy:


Government spending on health care is lower in Singapore than in the U.S. This is something the small-government crowd should love and the ObamaCare crowd should hate:


While some Democrats are trying to abolish health savings accounts in the U.S. (the Republicans introduced them a few years ago, but they are rarely used), Singapore is evidence that universal health savings accounts are superior to any kind of "public option" or "single payer system".

The reason health savings accounts are so successful is because they get supply and demand working the way they should. This doesn't occur when someone else (e.g. an insurance company or the government) pays the bill.

It is a false choice to believe that the only health care options we have are either big-government or the status quo. Universal health savings accounts provide a third alternative.

Data source.

To learn more about Singapore's health care system, click here.

Update: The Washington Post has an article with more details about the Singaporean health care system. Also according to Wikipedia, "Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000."

22 comments:

  1. How one can compare a city to a country baffles me
    Singapore's statistics are twisted: a third of the population participates to the GDP but does not participate to the cost, they also do not lower down the life expectancy: the low wage workers do not get sick, do not die on Singapore, they can only do that in their own country

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  2. I am a Singaporean and let me tell you, in Singapore there is a popular saying amongst its people- It is better to fall sick and die than to fall sick and linger.

    While basic healthcare is generally affordable, any kind of serious illness will basically leave you in financial ruin. The Singapore government spends as little as they can on healthcare and whatever they deign to spend on is usually on infrastructure than on the people themselves.

    Only the very poor are heavily subsidized while the middle classes are expected to take care of themselves either through their own savings or through health insurance.

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  3. I'm a Singapore too but my opinion differs from that of Marc's. I feel that Singapore's system works because it is one that is sustainable. People avoid unnecessary treatments because they are paying everything out of their own pockets. For the middle-income, many turns to private insurance to complement their savings account (we call it Medisave)so personal responsibility is crucial.

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  4. I am also a Singaporean who is currently residing in the US for work. Well, for one thing, I used to bitch about the H/C sys in SG until I move to the US. Personal accountability is definitely key and moral hazards should be mitigated. I forgot when's the last time I had my teeth cleaned simply because I do not have dental insurance. That would be a $50 walk-in service back home.

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  5. Having stayed in both Singapore (20 years) and USA (3 years). I totally agree with what YoGi has said. Comparing with Singapore, the health care system in the US SUCKS!!!!! Going to any doctors, dentist, be it hospital or clinic, you need insurance and the insurance cost up to US700 per month for a family of 3. THAT IS RIDICULOUS!!!! You will never see that in Singapore.

    The popular saying that "It is better to fall sick and die than to fall sick and linger" is true but you have the choice to fall sick and see a doctor. Over in the US, the saying would be "Fall sick and die if you do not have insurance"!!!

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  6. from the perspective of a medical professional...

    most junior doctors in singapore get to work at 6am and often do not leave till 7 or 8pm. saturdays and sundays are half-days (730 to 12). lunch is often optional, and 4-5 times a month they stay back after work and do not go home till almost 12pm the next day.

    that is a 90 hour workweek for a take home pay of about 2400 sgd/month (1700 usd).

    the system is quite simply overworked. visiting the polyclinic is often a whole-day affair, with the patient seeing the dr for 15mins and waiting for tests, meds, etc the rest of the time. hospital bed occupancy rates are almost always 70-100%. drs have 60 patients to see in an allotted clinic time of 4 hours. increasing numbers of healthcare workers have to be brought in from overseas to help our increasingly-swamped local doctors... cheap healthcare comes at a price. the price is the health and well-being of our healthcare personnel, who slog long hours for so little pay. our system is not terrible, but it is by no means perfect.. at least from my perspective.

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  7. Tra, you must be a houseman. heads up, it gets better, or at least the pay does, and Singapore would still have an efficient health care to boast of. At least our relative would most likely be able to afford any form of healthcare! Living in US now, i don't even dare to go to any Emergency room! so well, i guess hard work is always the trade off. no free lunch...

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  8. Guys go 2 d UK. Now that is an awesome healthcare system. Btw i agree wif marc n wif yogi. Helath systems in US an SG suck. btw Anonymous u said that SG healthcare is sustainable? we onli spend 3% of our GDP. we can sure as hell afford more. remember our reserves?

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  9. Anonymous said...
    "we onli spend 3% of our GDP. we can sure as hell afford more."

    Wait, you're complaining that Singapore's health care system isn't expensive enough? Singapore has one of the longest life expectancies in the entire world. (3 years longer than the U.K.) Why would you want a more expensive and less effective health care system like the U.K.'s?

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  10. A doc in the US would have to do 50 knee replacements just to pay his malpractice insurance, An OB doc likely has to deliver about 50 babies or more to cover his. before any other expense. This cost is ultimately borne by the consumer.

    The high cost of the privilege of suing for millions.

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  11. What drives people to go to such lengths to expose their ignorance for all the world to see? The author of this post obviously does not understand the Singapore health care system.

    Employers in Singapore are required to deduct 6-8% of your pay, add a contribution of their own, and deposit the money into a government-run HSA account whose disbursements are strictly regulated. With few exceptions (dialysis is an exception) you can't use your HSA to pay for outpatient expenses, and the amount you can use toward any given hospital expense is limited to what your costs would be if you had used a "Class 2B/C restructured hospital." The main catastrophic insurance plan is government-run as well, and subsidized by the government to keep premiums low. Public hospitals provide 80% of the more costly hospital care with the remaining 20% by private hospital care.

    Yes, Singapore has HSAs and catastrophic insurance, but it's the extensive role their government plays in their system that keeps costs down, and it's more government that even any Democrat here would propose. Don't take *my* word for it, read what the Singapore Health Ministry has to say about it:

    http://www.moh.gov.sg/mohcorp/hcsystem.aspx

    "The high cost of the privilege of suing for millions."

    Another myth. Texas implemented a serious of tort reform measures in 2003 and 2005 and health care costs continued to rise. The savings from tort reform were not passed on to patients or insurers.

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  12. Anonymous said...
    Yes, Singapore has HSAs and catastrophic insurance, but it's the extensive role their government plays in their system that keeps costs down, and it's more government that even any Democrat here would propose. Don't take *my* word for it, read what the Singapore Health Ministry has to say about it:

    http://www.moh.gov.sg/mohcorp/hcsystem.aspx


    OK, let's look at the source you provided, which I've read before. Go straight to the bottom of the page. It says, "In 2005, Singapore spent about S$ 7.6 billion or 3.8% of GDP on healthcare. Out of this the Government expended S$1.8 billion or 0.9% of GDP on health services."

    Let's do the math. $1.8 billion / $7.6 billion = 23.68. So, government in Singapore pays 24% of total health care expenses. Wow! Shocking! That's basically what you'd find by looking at the graphs I posted above.

    Compare that with the United States. Government spending on health care here is about 6.9% of GDP, while total health care spending is about 15% of GDP. (See the graphs in my post, above.) That means in the U.S., government spending is about 45% of total health care spending. That's far higher than Singapore!

    Those of you who claim that Singapore's health care system is so inexpensive because of massive government subsidies really need help with your math. Government subsidies in Singapore make up a much smaller percentage of total health care spending than most developed countries. They make up a much smaller percentage of total GDP than most developed countries, too.

    Let's look at more of what the Singapore Ministry of Health says on the page you pointed to:

    "Our philosophy promotes individual responsibility towards healthy living and medical expenses. ... Private practitioners provide 80% of primary healthcare services while government polyclinics provide the remaining 20%."

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  13. y compare? these places all have different population numbers. USA has abt 300 million people but S'pore has 4.8 million. if u wan compare, compare the money spent per person, its fairer.

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  14. Anonymous said...
    "y compare? these places all have different population numbers. USA has abt 300 million people but S'pore has 4.8 million. if u wan compare, compare the money spent per person, its fairer."

    Wow, someone is clueless. The measurements are as a percentage of GDP, so population and wealth don't distort the graphs. "Money spent per person" fails to account for differences in wealth between countries.

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  15. ~ Wow, someone is clueless. The measurements are as a percentage of GDP, so population and wealth don't distort the graphs. "Money spent per person" fails to account for differences in wealth between countries. ~

    From what i gathered, Singapore's heatlh care system is currently boasting numerous accolades that the citizens are proud of themselves while the American President skips lunch with Australia and Indonesia to solve this ongoing problem of US. It simply shows a clear difference that there is a problem in the health care service in US. Singapore on the other hand can of course do better and improve more.

    Anyways, even if the US has been spending more, James, I suggest they spend the money effectively.
    Graphs and measurement are just one of the few factors that could indicate good health care services but there are many other factors which has to be considered as well.

    If you insist on arguing for the US health care services when Obama himself says that the health care services are horrible in US, I think the Republicans would really love to have you on their team!

    Cheers!

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  16. Betty, I can't figure out what the point of your comment is. As far as I can tell, you didn't understand the original blog post. If you did understand the original blog post, you would know that I am not "arguing for the US health care services". Instead, I am arguing for a system more like Singapore's.

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  17. K., there's no cherry-picking. You claim that I don't mention that HSA's are mandatory, but I repeatedly referred to "universal health savings accounts". Universal means EVERYONE HAS ONE.

    You say I don't mention the "publicly-owned, privatized hospitals". First, that's a nonsensical phrase. Something can't be both publicly-owned and privatized. The point is irrelevant, however. The vast majority of U.S. hospitals are either public or not-for-profit. Public status only matters if they are subsidized by the government, but as my graphs pointed out, the Singaporean government spends LESS on health care than the U.S. That means they subsidize health care LESS than America, not more.

    Yes, there are lots of other aspects of the Singaporean health care system that I could have written about, but I was writing a blog post, not a book.

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  18. In regards to your statement about getting "supply and demand working the way they should", I would argue that HSA plans have their own way of skewing the invisible hand of the free market.

    I and my family have been in various HSA plans since 2008, through the small business I work for. In 2008 and 2010, we did not meet our family deductible of $5,000, so we were very frugal in regards to using medical services throughout the year. However, in 2009, I was hospitalized for three days in April, and we therefore met our deductible by September of 2008. From September through December, it was "game on" for our family. Since we were 100% covered once our deductible was met, we went to every specialist and had every procedure, test, etc. done that we could think of. I kept a spreadsheet of what we paid and what our provider paid. Our provider paid out $9,800 as a result. I paid $7,987 to our provider (Coventry) for our premium, so my provider only paid $1,800 more than they received from me.

    This year, my deductible went up to $6,000 and my cost for the plan is $8,620. In other words, I will have to pay $14,620 out of my own pocket before I will see a dime paid by my insurance provider (this year it's Humana).

    One problem I have with HSAs is that the high cost of the initial deductible discourages participants from getting routine procedures like mammograms, colonoscopies, etc. As a result, the cost of fixing problems once they are discovered is typically much higher. For example, removing a pre-cancerous polyp during a colonoscopy is going to be much, much cheaper than treating the same individual once the polyp has evolved into colon cancer. I used this example, because a friend of our family has stage-IV terminal colon cancer. Because she was/is very poor, she couldn't afford health insurance and thus ignored the initial symptoms and didn't see a doctor until the cancer had spread.

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  19. I have lived here for 5 yrs.The guy is right...its a great system.Very far and the individual is in total control( he/shee builds his account...the Governement encorages via matching).Its a winner all round.great public/private doctors ...no queues..it works great.

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  20. When I read the beginning of the last paragraph, almost panicked for a minute! I'm almost happy that the rest of us are destined for eyestrain!

    Knee arthritis

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  21. Christopher Wei the CEO of Great eastern said: “Ontario has a national healthcare model,
    100 percent government healthcare. What that means is people have an
    entitlement attitude. Everything is free, the smallest thing is tested. To me
    it’s a very inefficient model.

    I think the healthcare model put family at risk more than it helped. I have a very specific example. When my son
    was very young, we took him to hospital for something. We didn’t get to see the
    doctor for 10 hours. To me, that was a real flaw. My wife and I thought we paid
    a lot of taxes. More fundamentally, if you can’t rely on a healthcare system,
    how are you a top-tier country? It was one of the reason we moved to Asia”

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  22. because I don't have to pay anything for it. Everyone gets treated regardless of your residential status and no one goes bankrupt.

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