It’s actually more like 12 pages, single-spaced. About 6000 words.
I am not sure what to do with it. Here is the conclusion:
As individuals, we would like unlimited access to medical services without having to pay for them. Collectively, this leads to high spending on health care. High spending on health care is the main problem of the U.S. health care system. As we have seen, it is unlikely that this problem can be solved by changing the way health care providers are paid or by government experts devising a more efficient system.
From a health outcomes standpoint, the United States might do better to spend less on medical services and instead spend more on efforts to reduce homicides, automobile accidents, obesity, and substance abuse. There is a lot of leverage that can be obtained if improvements in those areas can be achieved.
There are two directions that the United States could go in order to reduce health care spending. The “left turn” would move in the direction of Canada. The “right turn” would move in the direction of Singapore.
The “left turn” would be to introduce government rationing of medical services. This might come about if the share of health care spending financed by taxpayers continues to rise and the consequent strain on government budgets forces government programs to restrict access to services.
The “right turn” would be to increase household’s exposure to the costs of health care and health insurance. For example, the government could eliminate the tax subsidy for employer-provided health insurance, steering more households into the individual market. The government could set up a combination of catastrophic insurance, health savings accounts, and subsidies for the poor similar to those in Singapore.
With either a “left turn” or a “right turn,” we are likely to see a two-tier health care system. With a “left turn,” the government will hold down its spending by limiting access to expensive services that are not clearly highly beneficial. But wealthy people will still be able to afford those services by paying for them privately.
With a “right turn,” people will have to self-ration their use of medical services. Poor people will be limited in what they can obtain by the nature of the subsidies that they receive. They will consume the medical services that are covered by government subsidies. Wealthy people will have ample savings accounts to obtain whatever medical services they desire.
As of now, I do not see any strong momentum either toward the left or the right. For the near future, the United States is likely to continue along its current high-spending path.
You write: “As individuals, we would like unlimited access to medical services without having to pay for them.” I don’t disagree, but this way of putting it sounds excessively self-interested. I think one should emphasize the Robin Hanson point, that advocating socially provided health care allows us to *express our caring* for others without having to pay the cost (*society* pays). We get a warm glow from contemplating our own advocacy, a glow that would not be available if our motivation were mere self-interest.
Conservatives loves to lavish praise on the Singapore healthcare system, but never remembers to state it’s pre-conditions:
1. Mandatory monthly savings from all employees (7-9%) – isn’t this another freedom killing mandate?
2. Government price controls(reimbursement rates and drug schedules)
3. Public hospitals and doctors – the government employs the physicians.
I’m waiting to see any national party willing to campaign on these tradeoffs. IMO, this is much more akin to the German, Swiss, and Dutch systems.
1. Mandatory monthly savings from all employees (7-9%) – isn’t this another freedom killing mandate?
Not saving and then forcing the medical cost on the taxpayer isn’t conservative, its irresponsible. Mandatory catastrophic insurance makes a lot of sense. Also, a lot of that money goes into personal accounts in your name, which can later be used in a manner you see fit to pay for care of your choice.
2. Government price controls (reimbursement rates and drug schedules)
Makes a ton of sense. You need to control costs to keep the system from spiraling out of control. Singapore does this with no discernible decrease in effective care or substantial waiting lists, which are the common complaints about such measures but they have avoided them through smart management.
3. Public hospitals and doctors – the government employs the physicians.
Sure, and they perform well. Public hospitals compete with one another, and individuals can choose which to go to. There is also a robust private sector for healthcare for anyone that wants to pay.
Conservatism isn’t an ideology. It’s a belief in achieving results through prudence, material evidence, and humility. Gradual reform + Chesterton’s Fence. It’s a rejection of radical action and ideology. Can’t think of a better example of it then ultra pragmatist Singapore.
Is that under the presumption two (or three) lefts make a right? This is backwards. Singapore is the left solution and Canada the right. Singapore nationalizes catastrophic which is over 70% of healthcare while Canada leaves its provision to the private sector, even if it paying the cost, it is largely doing so through premiums.
It looks to me like Medicare is already moving to the “right” solution. Medicare now provides a basic level of universal healthcare. But if you want better health care you have to buy supplemental health insurance to cover the better care basic Medicare does not provide. I actually pay more for supplementary( Advantage) Medicare coverage than I do for basic medicare. Since reporters and others are not retired this does not get much attentions because the typical young person is not aware of it. Since it does not get much attention I expect this trend of limiting the growth of basic medicare and encouraging the growth of Advantage Medicare to grow in importance. It is kind of a back door approach to the problem.
In theory Medicare looks that way. But in American practice, he “only” problem with Medicare being a “right” (read: markets) insurance solution is that (on average) the insured’s costs are not being set by market forces. The NPV of medicare taxes paid, premiums paid, plus coinsurance does not come close to covering the system’s outlays.
Singapore is only a turn to the right if you don’t understand the system. Where in any conceivable libertarian or conservative world would you make things better by having the government own the hospitals?
Steve
The top %5 of healthcare “spenders” spend half the resources ( as estimated in dollars ).
The top 1% spend a great deal of that half.
It can’t be fixed per se. So who does it better than we do? France, for one.
The biggest change in healthcare in the US the last years is the high deductible insurance which is a modest move toward Singapore system.
1) As much as companies don’t like Healthcare coverage, it is sticky with employees and without a good individual market companies have a hard time moving away from healthcare. The biggest surprise of the post Great Recession era is employer based insurance has not weaken hardly at all and was the big Obamacare miss.
2) Remember healthcare is part of compensation package to employees. So stopping employer based insurance without other compensation is a giant pay cut. (This is not included enough in the pay cuts of the Great Recession 2009 -2010.)
3) Unlike the 1974 – 2012 era, we are entering a much tighter labor market and our economy is closer the 1950s economy in reality. It won’t be a worker paradise but companies are struggling to find workers the same way as in 2010 – 2012 or the last several decades.
4) I still say the big conservative freak out is going to family formation and number of children in 10 -20 years. It is becoming no economically viable for families larger than 4 anymore without significant lowering of their lifestyle. (And notice how low Singapore birth rates are.) Family formation has a lot positive benefits outside the size of the workforce in 20 years in controlling young adult behavior.
Canada can get away with restricting access to health care because Canadians can and do simply cross the southern border and pay out of pocket for services. During the short time I worked in a hospital, I met a man who had been put on a six-month waiting list in Canada for a cardiac artery stent. He came to our hospital and had it done immediately. If the US goes that route, it will not have a US to which to flee for superior care.