We should to be able to put all 325 million Americans on Medicare/Medicaid/VA, etc., without spending a dime more. So our current bloated health care spending levels means that America is not able to choose either the Singapore or the European system, we are stuck with a far worse, system—the American health care system.
But if we insist on dreaming the impossible dream, then why not shoot for the best? And the first step toward getting there is cutting costs, by doing things like replacing the tax deductibility of health insurance with a lump sum tax credit.
Are Singaporeans really more exposed to health costs than Americans? Health care prices are so much lower in Singapore that Singaporeans would have to pay for three times more of their care to feel as much total expense as Americans do.
The basic argument for the Singaporean system is that Singaporeans, through Medisave and the deductibles in Medishield, pay more of the cost of their care, and so hold costs down. Given the growing size of deductibles and copays in the US, I doubt that’s true now, if it ever was.
For example, it would be easy to streamline the approval process for bio-similars even further than it already has been. RPLong, Because it’s the biggest single problem, by far.
It could be done in a day, would save the industry millions, would save customers millions, would increase the supply of medication, and would be a politically popular move. Under our current tax system, the government pays roughly 40% of the cost of many private medical expenses.
Singapore heavily regulates both the pricing and provision of medical care to keep costs low (as do all other developed countries) and then, working off that baseline of low costs, has Singaporeans pay out of pocket in order to keep them mindful of how much they’re spending.. There are massive subsidies to employer provided health insurance. My personal lifetime health care consumption has been at least doubled by various subsidies (including tax breaks), and it has not improved my health one iota. There are huge regulatory barriers to the efficient provision of health care, at virtually every level of the system. There are barriers to the immigration of foreign doctors and nurses. My dream policy would start with massive deregulation, as well as the elimination of all tax deductions for health care, to get costs as low as possible.
Then add mandatory health savings accounts to get costs even lower.
* Singaporeans are far healthier than Americans with 3% who are obese compared to 35% of Americans, which adds a fourth major strain on health care costs.
Klein makes a reference to this toward the end of the article but without the details that show how stark the differences are.