There are multiple instances of Lee making the claim of pushing temporarily unpopular policies, but no list of those.
He implies that making English Singapore’s public language was unpopular, and defends it by saying that being English speaking is crucial to a nation attracting productive immigrants. He also implies that he insisted on less generous provision for the poor than would have been popular.
I was trying to read some interviews with him, I get the impression his criticisms of the west are mainly about how individualistic we are, and what he perceives as moral decay. However I don’t know if moral decay really plays a role in GDP growth or if that is just his personal taste. I don’t see how people doing drugs at home or visiting prostitutes is necessarily going to affect the economy negatively. I know and have known brilliant productive people in sciences, finance, engineering, etc. who engage in ‘moral decay’ in the form of sex, prostitution, drugs, alcohol, partying, etc. It doesn’t affect their ability to be productive in the economy, if anything it functions as a release valve.
I was hoping that there would be some concrete policies that would never take place here. But all I can find is him talking about his cultural values, which aren’t the same as policies to grow GDP.
Granted, some things would probably help the US but would be deeply unpopular:
Total restructuring of the health care system
Confiscate all guns, followed by a total gun ban
Increase in taxes
Increase in highly skilled immigrants (which would displace US jobs and piss off the nationalists)
Cut funding for the elderly (SS & medicare) to increase spending in science & education
I would say the biggest plus in the German health-care system is its use of the corporatist model, to be able to use the government’s power to negotiate between the various interests for lower prices along with the generally non-profit nature of the insurance system.
I’m not going to disagree with you. On the other hand you have the more free market reforms that would decrease the corporatist reliance on insurance companies and have medicine operate in a proper marketplace. Ron Paul style reform of it, cross state competition and various other reforms. On the one hand you have the Singapore style idea which voters and politicians won’t accept and there are these reforms that established vested interests couldn’t stomach.
But what ended up happening with ACA was a neither or. A system that doesn’t really resemble the original propositions that went before congress but even in its origins it was a mess.
Sometimes when dealing with a problem like healthcare as you say, the problem is in the system itself which has to be fixed before you can work on getting things through. There was a great TED talk a while back on fixing money and influence in US (and all countries) politics. I’ll hunt it out.
You’ve missed most of the major aspects:
One major one is that “an ounce of prevention is worth a pound of cure”. For example compare the cost of a person with diabetes who has this treated and keeps his blood sugar under control–versus the massive cost of dealing with multiple system failures of untreated diabetes.
Another one: how many hundred thousand dollars worth of treatment should an individual receive when it is virtually certain he will be dead in a few months no matter what is done? In the U.S. the answer is of course quite a few–while many other countries believe that would be a waste.
For your first scenario, the person who is undertreated will die earlier saving money in the long run. I don’t think prevention is found to save money. I don’t believe. I think for all but the sickest/most expensive 1-5% of the population, prevention doesn’t save money. Even for that 1-5%, I’m not sure how much it saves over the lifetime of the patient. I saw a study recently I am having trouble finding that people who enter their senior years in good health cost more than seniors who are in poor health. The good health ones still die of expensive degenerative diseases it just takes longer.
As far as the second point, there is some validity to that. I know in the UK they use the NICE program and QALY calculations. If a treatment costs more than 35,000 pounds per year of QALY the NHS will cover the first 35,000 of it, but the patient has to cover the rest.
Its not a bad policy, however I don’t know if that explains why our health care is 2x more expensive than any other nations.
I believe over the course of a lifetime the averaged out American will spend about 700k on health care. Probably more (9k a year over 80 years, although that number was lower in the past). In other countries it is closer to 350k over the course of a lifetime. I’m sure end of life heroics plays a role, but every American would need several hundred thousand in end of life heroics to explain the price difference, and end of life heroics only happen to some people and not others.
I don’t think there is one big reason our system costs more, just 100 small reasons that each contribute. higher overhead, we resort to surgery quicker, we pay more for drugs, we use more scanning technology, end of life heroics, higher salaries, etc. etc.
What is the goal of this reform? Do you just want lower health care costs? Do you want universal coverage? Good quality care?
For “lower costs” single payer is the market-proven winner. If you want universal coverage and good health outcomes, a lot of the places that do the best have multiple payers who compete with each other. I think that Germany, Switzerland, Netherlands, and Japan have followed that path.
No, the element of competition among providers is important. Universal coverage is a different feature from single payer.
Yes, but I think that the ACA was partly modeled on systems like that.
The Netherlands could be a model for us. I think they have an exchange based system with various insurers.
But the real problem is we needed health reform 40 years ago to bend the cost curve. Our health costs have spiraled out of control, and now even with health reform all that is going to happen is people will be mandated to spend $500/month on insurance with a $6000 deductible that excludes 99% of medical providers.