(10-12-2011, 07:51 AM)kandrathe Wrote: Singapore defies your claims.
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Yes, that fairy tale world is in Singapore. They spend only 4% of GDP on health care (compared to ~14% in the US. ~7% in the UK, ~10% in the other OECD), and achieve equal to higher life expectancy than the US or UK.
(If we want to talk Health Care, perhaps a new thread is in order? Religion in the US was close enough, but this is a whole other ballpark.)
Exporting the Singapore model is very difficult, for several reasons.
1) Singapore is unique - a rich, developed, city-state. Government power is extreme, but enforcement and monitoring costs (means testing) are low.
2) Singapore is a major medical tourism destination, and thus, can cross subsidize its system by selling excess capacity. The US does this, but see point 1 - the US is huge.
3) Singapore maintains parallel and competitive private and public health care, with heavy regulation and price controls. In a larger market, this balance is more difficult to control.
4) Singapore is extremely paternalist - the government quite literally tells you how to run your life in all sorts of ways, health included. Few countries tolerate this, probably because of point 1.
5) Singapore can work with very low levels of redundancy. Socialized systems are plagued with waiting lists and patient transfers, whereas the US is plagued with phenomenally expensive slack capacity. Singapore avoids both, because of population density. They can predict demand with high accuracy, and have no problems with poor coverage.
6) Singaporean culture is healthy eating and high exercise, for reasons that are difficult if not impossible to emulate.
7) (Warning: Speculation!) The Singaporean economy has an unusual relationship with foreign workers and Malaysia in general. There may be disguised costs and especially disguised negative outcomes hidden by migration and statistics collection criteria. If a poor worker goes to Singapore to work (high wages), but retires to Malaysia (low costs), that improves Singaporean stats, and reduces Malaysian stats - while saying nothing about their respective systems' efficiency. I do not know how relevant this is, but foreign workers are a *large* (40%) chunk of the Singaporean workforce. (See, Average Income, Luxembourgish.)
Some aspects might be borrowed - a sliding scale of subsidy vs. co-payments might be possible, with sufficient income data. The provision of all basic health care, essentially free, would go a long way. Co-payment for nontrivial, nonessential services are probably a good idea. Tax-free savings accounts are one method of ensuring medical care, although it is unclear how this improves on an insurance model.
I really wouldn't expect miracles from copying Singapore. Improvement, certainly - almost anything is better than the unbelievably expensive US system. But 4% of GDP is just a fantasy for the US, or most countries.
-Jester