Efficient health care tied to affordable cost, high quality, and universal access is possible, at least if you’re a country called Singapore. In April, Brookings Press published Affordable Excellence, the first “comprehensive system-level description” of the Singaporean health care system. Tyler Cowen is in Singapore this week, and he’s written a few posts on its health care, pivoting off of the Brookings book and his own conversations in the country:
Yes, the system really is a marvel, and no it is not laissez-faire. The mix of “private money, public provision” has some marvelous properties for economizing on costs, not the least of which is that private hospitals and doctors and medical device salesmen do not become too strong a lobby. And the level of conscientiousness in Singapore is high enough that the public hospitals work fine, though they don’t in general have the luxuries of the private hospitals. Furthermore those public hospitals have to compete against each other for patient loyalty and thus revenue, and so the reliance on private money helps discipline public hospitals […]In any case let’s start by admitting, and keeping on the table, the notion that the current version of the Singapore system is indeed a poster child of some sort.
One thing that’s not clear to us from what we’ve read so far is if and how Singapore’s system facilitates innovation. We simply cannot solve the global health care crisis without innovations in medical technology and service delivery.Nevertheless, we do get this feeling that the tone of the debate since Obamacare’s rollout has stagnated. Singapore shows us that there are all sorts of interesting models out there that defy the easy categories of our own domestic discussion. Singapore’s system shifts a lot of costs onto the consumer directly, but it also has single payer for catastrophic insurance and lots of public provision of care. It combines these things that libertarians and conservatives generally like—see this 2012 guest piece talking Singapore up by Avik Roy—with targeted government intervention that goes beyond what American conservatives are generally comfortable with.With the very important caveat that America is a very different place than a small Asian city-state, or even a medium-sized European country, studying how other countries have gone about solving these problems is probably a very good idea.[Photo of stethoscope and money courtesy of Shutterstock.]