Health Care: Singapore versus America

Ezra Klein makes a fascinating comparison of the health care systems of Singapore and the United States in his Vox editorial, "Is Singapore’s “miracle” health care system the answer for America?"

As Klein describes it:

When liberals talk about their health care utopia, they have scores of examples to choose from. Some name France’s high-performing multi-payer system (No. 1 on the World Health Organization’s rankings, in case you haven’t heard). Others point to Canada’s single-payer simplicity. The Scandinavian countries all do health care well, and there’s much to recommend Germany’s hybrid approach.

Conservatives really only have one example of a free market health care paradise to point to: Singapore. But oh, what an example it is! In a New York Times column called “Make America Singapore,” Ross Douthat called it “the marvel of the wealthy world.” After the election, Fox News published an op-ed headlined, "Want to ditch ObamaCare? Let's copy Singapore's health care miracle.”

Why are conservatives so taken with Singapore? The American Enterprise Institute’s glowing write-up explains it well:

What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends.

Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care.

Klein goes on to make a reasonably fair assessment, both pros and cons, of Singapore's system.

But like any kind of comparisons between different countries, including the ones Klein mentions in the beginning of his editorial, there are many other factors which come into play, including living expenses (cost of living is important because health care workers have to live too).

So when Klein mentions the differences between Singapore and America as a factor in why their system wouldn't work here, he needs to remember that is also why the French, Canadian, Scandinavian, and German systems also will not work in America. Aside from living expense differences, there is a size difference: Smaller populations require less bureaucracy to make their systems run. In addition, there are fewer cultural differences in smaller populations, leading to a more homogenized thinking within a country. That doesn't mean all 81 million Germans think the same way, but you have a better chance there than in the United States, with 300 million people from a patchwork of cultures around the world.

To make an effective health care system in the United States, it will have to be done at the state level, regardless of whether it is modeled after Singapore, France, or something even better.