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tamson
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What Singapore Can Teach the White House

Singapore

Critics of this island-nation often have fun referring to it as the "nanny state" for its laws against spitting, littering, or leaving behind an unflushed loo.

When it comes to health care, however, Uncle Sam has better claim to the nanny title. From our federal price "negotiations" and state regulations to discrimination in the tax code, government distortions prop up a system that puts key health-care decisions in the hands of everyone but the patient. Each new government intrusion, moreover, begets only higher costs—and a call for more intervention to fix the problem.

In Singapore, by contrast, they already have universal coverage. They also have world-class quality care at world-competitive prices. And in a week when White House chief of staff Rahm Emanuel is meeting behind closed doors with Senate Majority Leader Harry Reid, Singapore's example might have something to teach them about the kind of reform Americans really need.

"When I'm asked to describe the differences between the U.S. and Singapore systems, my one-word answer is 'complexity,'" says Dr. Jason Yap, director of marketing for Raffles Hospital, a leading private care facility in downtown Singapore. "There are so many parties in the American system that do not really contribute to care."

Dr. Yap is referring to the higher costs that come from an American system that depends on regulation and oversight to accomplish what Singapore tries to do with competition and choice. At the Raffles lounge for international patients, he shows me an example of the latter. It's a one-page, easy-to-read list of fees.

At the high end of accommodation, a patient can choose the Raffles/Victory suite for about $1,438 per night. That price includes a 24-hour private nurse, a refrigerator stocked with drinks, and an adjoining living room to entertain. At the other end of the scale, a bed in a six-person room goes for just $99.

As Dr. Yap points out, the actual care is the same whether a patient decides to stay in a deluxe suite or a dormitory-style room. But the choice is the patient's; the financial incentives encourage the patient to think about those choices; and the low-priced options help keep the overall costs down.

This is no accident. Like ours, Singapore's system is a mix of public and private care and financing. Unlike ours, Singapore's system is anchored, as the Ministry of Health puts it, "on the twin philosophies of individual responsibility and affordable health care for all."

"Individual responsibility" is not just a buzzword. All but the abjectly poor have to pay for some of their care, another downward pressure on prices. Perhaps most important, almost all working Singaporeans are required to put money in a medical savings account that they use for out of pocket expenses. It's their money, and they control it. As a result, they are careful about spending it.

"In Singapore almost everyone has to pay something for their care," says Dr. Yap. "When it's your money, you really ask yourself: Do I really need this?"

It seems to be working. According to a Raffles Hospital official, a knee replacement surgery runs between U.S. $12,000 and $14,000. Spinal fusion runs between $10,500 and $14,000, and a heart bypass (coronary artery bypass graft) from $23,000 to $26,500. Conservatively speaking, these prices are less than a third of what the same procedure would cost in the U.S.—that is, when you can even get the price.

As any American who has ever tried to make sense of a hospital bill or haggled with his insurance company over a payment can tell you, even for those who have decent coverage our system can be a bureaucratic nightmare. Singapore's system isn't perfect. It does suggest, however, that the Average Joe stands more to gain from a system where hospitals and doctors compete for patients, where patients have different price options for their hospital stays and appointments, and where they pay for some of it out of pocket.

Yes, a city-state with three million citizens has some advantages over a nation of more than 300 million people in 50 states. Yes, health care in Singapore is hardly the laissez-faire ideal. Still, there's intervention and there's intervention: What makes Singapore's health care work is that it is designed to swim with the market and not against it.

In macro terms, that means Singaporeans spend only about 4% of GDP on health care—against 17% for the United States. At the same time, Singapore scores better than the U.S. on life expectancy, infant mortality, and other key international measures.

In his address to Congress last month, President Obama complained that "we spend one and a half times more per person on health care than any other country, but we aren't any healthier for it." That's a good point. And the lessons Singapore has to offer suggests that what Americans need most in Washington today are fewer closed-door meetings and more open minds.

Printed in The Wall Street Journal, page A19

2009-10-20 11:47 AM

liuyedao
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QUOTE:

Originally posted by tamson at 2009-10-20 11:47
In his address to Congress last month, President Obama complained that "we spend one and a half times more per person on health care than any other country, but we aren't any healthier for it." ...

2009-10-20 11:51 AM

liuyedao
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Maybe the problem in the US lies within the health/medical industrial complex, where the sick and germs/ viruses/ cancers are source of big bucks.

2009-10-20 11:53 AM

greendragon
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Reply #2 liuyedao's post

USA economy is 12% for Healthcare!

Mr. Obama could cripple such a vital part of the American economy!!!

Green DRagon
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2009-10-20 12:20 PM

liuyedao
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QUOTE:

Originally posted by greendragon at 2009-10-20 12:20
USA economy is 12% for Healthcare!

Mr. Obama could cripple such a vital part of the American economy!!!

Green DRagon
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You should read how the neocons, white supremacists, Fox and other right wing extremists assault him.

I think his best choice now is to become a martyr.

2009-10-20 01:57 PM

interesting (Steven Schreiber)
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A lot of Singapore's advantages are created by: (1) its status as a parasitic economy engaged in regulatory arbitrage, (2) its system of immigration, which adds a large cheap labor pool with few rights.

2009-10-21 07:47 PM

constance6891 (Pls no question nationality)
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Well, it's a challenge to many even if it's $99 a day.

First, the housing is very expensive. I think an average house can cost around $250000 to $300000 now. Actually if you can get a house with that price range, it's below average for a house.

Also the transport can be really expensive too.

I really don't think healthcare is that affordable in Singapore. Is not bad but not as great as the report claims to be.

2009-10-21 10:04 PM

normancelt
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Well, in Australia we have free health care for the poor while the middle/rich classes only have to spend about 1,5% of their income on it.

Fortunately we don't have to live in an autocratic nightmare like Singapore to get it.

I find it amusing that Singaporeans will go to any lengths to fulfill the apologists' boots.
There are other countries out there apart from Singapore/China/Japan/US you know.....

BTW, I couldn't care less about American health care. It's just too much fun watching Republicans slit their own throats.

2009-10-21 10:12 PM

xinghai
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Post #1

Singapore is among the many nations that provide excellent health benefits to its people in terms of universal healthcare.

It is pathetic that the United States spends far more on healthcare and provides far less benefits. There are also those who cry "too socialistic, too autocratic, or too public, or too nighmarish" when one sixth of the population in the United States have no healthcare coverage and live in poverty.

[ Last edited by xinghai at 2009-10-22 01:43 AM ]

2009-10-22 01:41 AM

tradervic (Uncle Laowai)
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<arched eyebrow> Same advice...

QUOTE:

Originally posted by liuyedao at 10/20/2009 12:57 AM
I think his best choice now is to become a martyr.

... that you would give the politburo? Sorry northwest - even if you try to spin this as a joke, it is in poor taste.

2009-10-22 01:59 AM

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