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Mar 5, 2010: US can get pointers from S'pore's health-care system, By Matt Miller
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.
We interrupt Washington's feud over President Barack Obama'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 America's 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 about 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 per cent of its gross domestic product on health care. The US spends 17 per cent - and Singapore's somewhat younger population doesn't begin to explain the difference. Matching Singapore's performance in health care in America's US$15 trillion (S$21 trillion) economy would free up US$2 trillion a year for other public and private purposes.
Do I have your attention?
Today the US can't find cash to recruit a new generation of great teachers, rebuild its 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 American patriots know the US should do to renew the country. They 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 the US could run its health-care system as efficiently as Singapore does its system, it could solve most of its 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 Professor 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 US, by contrast, nearly 90 per cent 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 per cent of earnings each year, to which employers add 13 per cent).
Public hospitals provide 80 per cent of the acute care, setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favour training new family doctors over pricey specialists are more extensive than similar notions Mrs Hillary Clinton pushed in the 1990s. And in Singapore, if the children are 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.
Americans obviously can't transplant Singapore's approach wholesale to the US. But the reason they 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, the US is 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. Americans should think about that US$2 trillion the next time they 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 in the US 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 per cent of GDP by 2019.
WASHINGTON POST- www.straitstimes.com//Review/Others/STIStory_498085.html
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