Why no love for Singapore’s health care system?

Great Debates
#1

It’s pretty much accepted, from what this poor New Zealander can tell, that the US system of health provision is has problems. Huge amounts of money spent in ways that often result in poor outcomes. It also seems apparent that the public sentitment is towards a “socialising” of health care: wanting intervention by the state to ensure that basic care is available to everyone.

Now it seems that a lot of the debate surrounds whether to move to a universal health care system along the lines of Britain’s NHS. What I was wondering was why there never seems to be discussion of other models of “universal” health care that would, at least to me, seem to be more suited to American governance philosophies.

One in particular that stands out for me is Singapore’s model, summarised at this blog entry:

http://healthcare-economist.com on Singapores health care system

So why no love for this type of system? It seems to be to be a very effective hybrid of private and public health care, ensuring competition while guaranteeing basic health care. Or am I missing some element that makes it un-reproducable? Does the more authoritarian nature of Signapore’s government somehow make this plan work where it would fail spectacularly in the West?

#2

I could probably compromise on it.

What I most dislike and fear about the various proposed plans, and partiuclarl single-payer ones, is that they heavily discourage innovation and gives the government a very, very powerful say in what you are allowed to have. No matter what plan you have, that is absolutely unacceptable for me, and I will do anything to stop it. Period.

#3

I don’t want my dentist to cane me if I’m not flossing well enough.

#4

Singapore maintains a huge and harshly disciplined conscript army, with Swiss style compulsory national service for all male citizens with no deferments and continued service in the reserves until age 50. Obesity, a major source of health problems, is…uncommon amongst the male population.

Singapore has a large population of guest workers who are outside the national health care system.

Those two factors would tend to skew their health care outcomes somewhat.

#5

History, are you just being modest in not also pointing to New Zealand’s own health care system? It seems to do a pretty good job in combining publicly-funded universal care with additional options for those who choose to buy private health insurance, and my Kiwi friends seem pretty satisfied with it.

#6

Well that’s a helpful if unfunny and ignorant answer and I’m sure we would all floss and eat from the food pyramid religiously if we were in Singapore.

To answer History, Mystery and the Wolf the biggest problem that I have with Singapore’s system (and I have been living here for eight years) is that it is very skewed towards the “middle class”.

There are many many people that are earning lower incomes that do have huge problems with chronic care.

Taking even the simple example of our daughter’s birth.

We pre-payed about $1,000 of this, got a subsidy from the government of (if I recall) around $3,000, payed another $3,000 from our medisave (enforced savings for medical care) but still had to come up with another $2k odd on checkout.

And ours was a reasonably simple birth - there was an urgent C - Section but no complications. Now we had all the money for this so it wasn’t a problem.

BUT can you imagine the couple that didn’t have the medi-save funds, and were in low paying jobs - even after government subisdy where would they come up with the money?

And what about chronic care? Maybe I have enough to pay for my heart bypass, but then I may well need $300 + a month for medication, (after subisdy) and may not be working. To get this is going to be pretty damn hard and there are few real alternatives available.

That said, the Singapore system does work really well for the “middle” class - I am not so convinced though for the less well off.

#7

Thanks bengangmo, that answer was really useful.