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Title: What we can learn from Singapore's health-care model
Source:
Washington Post
URL Source: http://www.washingtonpost.com/wp-dy ... 010/03/03/AR2010030301396.html
Published: Mar 3, 2010
Author: Matt Miller
Post Date: 2010-10-23 13:43:18 by lucysmom
Keywords: government, health care, insurance
Views: 33500
Comments: 52
We interrupt Washington's feud over the president's "way forward" for a brief word on a path not taken, courtesy of the only rich nation that boasts universal coverage with health outcomes better than ours while spending one-fifth as much per person on health care. Introducing (drum roll please): Singapore. Yes, it's an island city-state of just 5 million people. Yes, it's more or less a benevolent dictatorship. And, yes, until recently, bringing chewing gum into Singapore could land you in jail. But Singapore, a poor country a few decades ago, now boasts a higher per capita income (when adjusted for local purchasing power) than the United States. And here's the astonishing fact: Singapore spends less than 4 percent of its GDP on health care. We spend 17 percent (and Singapore's somewhat younger population doesn't begin to explain the difference). Matching Singapore's performance in our $15 trillion economy would free up $2 trillion a year for other public and private purposes. Do I have I your attention? Today we can't find cash to recruit a new generation of great teachers, rebuild our roads and bridges, pay down the national debt, or invest in better airports, high-speed rail, a clean energy revolution or any of a hundred other things sensible patriots know we should do to renew the country. We can't do these things in large part because the Medical Industrial Complex vacuums up every spare dollar in sight. It's only slightly melodramatic to assert that if we could run our health-care system as efficiently as Singapore's, we could solve most of our other problems. So how does Singapore do it?
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#12. To: WhiteSands (#8)
(Edited)
I am not advocating that we import Singapore's political system, only it's healthcare system. However, calling Singapore a dictatorship is a complete mis-characterization. Singapore is not a dictatorship, benevolent or otherwise. It is also not a democracy like Italy with 11 political parties in parliament all vying for a piece of the government largess. America is not a democracy either. We have a court system that can overturn the will of the majority (which causes many Europeans to characterize us as a bit of a dictatorship too). America also has a political system that makes it almost impossible to compete with the two established parties (I don't like it, but in this respect our system is closer to Singapore's then it is to most of Europe). Singapore's government is very legalistic and squeaky clean on corruption. Singapore has consistently been rated as one of the least corrupt countries in the world by Transparency International. They also have an independent judiciary, which along with Hong Kong is rated as the best judiciaries in Asia. They have a highly transparent market economy. The government enforces transparency across the board, including on itself (unlike the U.S., the government does live by the rules it passes). They have a British style system of property rights, as does the U.S. However, most real estate transactions in the U.S. are "fee simple" while most in Singapore are "leasehold", with a general term of 99 years. (When I first went to Singapore, it took me a long time to wrap my head around this.) Their legal system is based on English common law, but they do not have trial by jury. If you are accused of a crime, you are ultimately found guilty or not guilt by a judge. Singapore still has corporal punishment (caning) for vandalism -- which they got from the British (flogging). Pornography is illegal in Singapore (which is typical for Asia), however prostitution is legal in Singapore (which is also typical for Asia). I haven't seen much in the way of "blue laws". Clubs can be open all night long. If you are convicted of trafficking drugs, they will hang you (another thing which is very typical for Asia). Singapore is neither a "democracy" or "dictatorship". ditto for the U.S. The first time I went to Singapore, I met a guy who immigrated to Singapore from Israel. He told me that Singapore is a really, really nice place. He was right. Singapore is spotlessly clean (like Disneyland); has low crime; is very prosperous; modern; has a great climate; and more.. Again, if I ever had to leave the U.S., Singapore would be on my short list of destinations.
I have never been to Singapore. I handled Japan, HK, and South Korea. The others in my office that handled Singapore said its a really nice nation. My point is that Chinese eat a healthier diet and live a more active lifstyle . Even in the West, Canada, they have the lowest health care costs and lowest impact on the health system. Their costs will be lower. Read the article and see that Singapore pushes the higher cost medical procedures on to private enterprise / insurance policies. Imagine how well that will work here. "Blacks can be seen for sore throats but not valve replacements" , the news titles will read.
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Of course you are correct about the Chinese diet. Singapore and the U.S. both spent 6% of GDP on healthcare in the 1960s. Now we spend 17% and they spend 3.7%. It's an enormous difference. Diet plays a part, but not that big of a part. I am absolutely convinced that we could cut our healthcare spending in half (to the 8% to 9% of GDP range) if we adopted their market-oriented ideas. Who invented healthcare savings accounts? Singapore? No, two economists at Texas A & M University in the 1970s. Singapore adopted that system in the 1980s and completely transformed their system. An American named Edwards Deming invented the "Toyota way" of participatory manufacturing in the 1940s. The U.S. auto companies rejected it. The Japanese adopted it. Then Toyota, Honda and others kicks our ass. Anything that the government controls or heavily regulates in the U.S. is completely broken. Schools, healthcare, utilities, energy, etc. Completely broken.
I've never been to South Korea. Hong Kong is much more crowed and dirtier than Singapore. I'm curious about your take on Japan. I've been there 25+ times. Most westerns don't like Japan. My experience is that the Japanese are very polite and they treat Americans better than anyone else. (They treat other Asians, and especially Koreans like dirt.) Still, you can tell that they just don't like you. There are a lot of clubs in Japan where westerners are not allowed. Regardless, I always enjoyed my time in Japan.
Back attcha dude. I never denied that Singapore has mandated health savings accounts or that people also buy catastrophic insurance - that is indeed part of the story. Again: But that's only half the story. There's also a massive public role. For starters, adequate savings for retirement and health expenses are mandated by government (employees must sock away 20 percent of earnings each year, to which employers add 13 percent). Public hospitals provide 80 percent of the acute care, setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favor training new family doctors over pricey specialists are more extensive than similar notions Hillary Clinton pushed in the '90s. And in Singapore, if a child is obese, they don't get Rose Garden exhortations from the first lady. They get no lunch and mandatory exercise periods during school. I know this is really, really difficult for conservatives wedded to all or nothing thinking, however it does appear to be true that government run hospitals in Singapore do act on the private sector to contain prices through competition. In Singapore all the pieces fit together to make the system they have function well both in terms of quality care and cost containment.
They get no lunch and mandatory exercise periods during school Sounds similar to social security, medicaid and medicare, doesn't it? Rosie O'Donnell and the liberal fat pigs would go fookin ballistic!
Well color me clueless cause whatever you're talking about don't make no sense to me.
That isn't difficult, clueless!
I've already addressed these points many times, but I'll do it again: adequate savings for retirement and health expenses are mandated by government As opposed to government mandating Social Security and Medicare taxes, which puts senior citizens at the mercy of unscrupulous politicians. Conservatives have been arguing for privatizing retirement and healthcare savings for at least 30 years and the left keeps demagoguing the issue, which is why those systems are in so much trouble today. The RIGHT wants this. The LEFT in the won't allow it. Public hospitals provide 80 percent of the acute care Acute care is care rendered in an emergency department, ambulatory care clinic, or other short-term stay facility. Public and non-profit hospitals in the U.S. also account for a large portion of acute care in the U.S.. My sister is an emergency room nurse in a government hospital in Detroit. Private clinics and hospitals in Singapore provide most episodic care as well as care of chronic illnesses, just like the U.S. Well over 80% of urban hospitals in the U.S. are non-profit or public. Suburban hospitals are usually more of a mix of public, non-profit, and private. Half of all hospitals in Washington State are public. They are run by local "hospital districts", not the stinking federal government, which is why they work. Many of the rest are non-profit. The availability of public hospitals is not what keeps prices down in Singapore. At one point, Singapore had a socialist system. They threw it out, implemented market reforms, and prices fell dramatically. People buying their own insurance and paying their own medical bills is what keeps prices down. pricing benchmarks Do you know what a benchmark is? It's not a price control as you have repeatedly claimed on this topic in the past. Benchmarking is the process of comparing your organizations processes and performance metrics to other organizations. My company benchmarks a half dozen metrics from 9 of our competitors to gage how we are doing in relationship to industry norms. Singapore's hospitals are required to publish prices and outcomes for every procedure, which makes it easy to compare. Again, your ideological filter just won't allow you to evaluate the facts in an objective manner. You and your brain-dead leftists buddies would never allow a system with as much freedom and choice as Singapore's. That's why the left has to be booted from power permanently.
The majority of American citizens won't allow it. Just like prop 13 in California, Social Security and Medicare are third rail programs. Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history. There is a tiny splinter group, of course, that believes you can do these things. Among them are H.L. Hunt (you possibly know his background). a few other Texas oil millionaires, and an occasional politician or business man from other areas. Their number is negligible and they are stupid. President Eisenhower
Ummm - acute care is also what follows surgery. Acute care simply means short term vs chronic, or long term care. Do you know what a benchmark is? It's not a price control as you have repeatedly claimed on this topic in the past. Benchmarking is the process of comparing your organizations processes and performance metrics to other organizations. My company benchmarks a half dozen metrics from 9 of our competitors to gage how we are doing in relationship to industry norms. Singapore's hospitals are required to publish prices and outcomes for every procedure, which makes it easy to compare. Yep. You have said the same thing I said, just using more and different words. (your attempt to prove you know what benchmark means by citing your business experience was gratuitous). You don't have to keep telling me your a big important guy, just let me figure it out. That's why the left has to be booted from power permanently. You've made clear that you prefer Singapore style single party rule.
The problem comes in what you do if there's another big market crash. Do you bail out those who've lost their retirement savings because financial companies implode again like they did in 2008? Who do you trust more, unscrupulous politicians who have to directly answer to voters, or unscrupulous heads of companies like AIG who don't?
They won't allow it because they've been lied to for several decades by Democrat politicians, who claim that payroll taxes are savings being put away into a "trust fund". None of that is true. Today, Social Security is paying out more than it is taking in. The Social Security Trustees predict escalating deficits starting in 2014. The only choices will be to dramatically raise the payroll tax or cut benefits. Medicare is in even worse shape. Senior citizens are at the mercy of unscrupulous politicians. Singapore has a better way for both retirement and healthcare.
That really is the bottom line.
Just put the money in a savings account / CD. Don't let people put their retirement or health savings in the stock market. It's really simple.
Social Security has something like a 2.3 trillion dollar surplus that has been lent to the government and collects interest. The last 5 Trustees Reports have indicated that Social Security's Old-Age, Survivors, and Disability Insurance (OASDI) Trust Funds would become exhausted between 2037 and 2041 under the intermediate set of economic and demographic assumptions provided in each report. If no legislative change in enacted, scheduled tax revenues will be sufficient to pay only about three fourths of the scheduled benefits after trust fund exhaustion. Many policymakers have developed proposals and options to address this long-range solvency problem. www.ssa.gov/OACT/solvency/index.html Either you don't understand how Social Security was designed to work, or you are deliberately misleading.
Do you really have to ask that? The reelection rate for House members averages well over 90%. At most, 10% to 15% of the House districts in the U.S. are swing districts. They only swing when the seat is vacant or when something is really, really wrong. Even this year when people are "mad as hell", the opposition might pick up 45 seats, and some of those are open seats. So the reelection rate will still be around 90%. There are people in Congress who have been there 20, 30, 40 years. They are certainly not accountable to anyone except their narrow special interests. I trust the free market. If I don't like GM, I'll buy a Honda. If I don't like Walmart, I'll shop at Target. If I don't like McDonalds, I'll eat at Subway. People making billions of choices everyday with their dollars is a more effective approach than choosing the lessor of evils every two, four, or six years. No, the bailouts to AIG, etc. are not the free market. Who bailed out AIG? Politicians who are generally not accountable to the public.
Right, and the banks invest in bum mortages. The only reason savings accounts are safe is because the government mandates insurance and bails out banks when they screw up big time.
I know exactly how Social Security works. It's a pyramid scheme, which is illegal in the private sector. Social Security is a pay as you go system. As soon as Social Security taxes are collected, they are paid out. The Social Security "trust fund" is not a trust fund in the real sense. It is an accounting device. For a long time, Social Security revenues exceeded expenditures. The problem is that by law 100% of the surpluses were "invested" in Treasury securities, and the money was immediately spent on other government programs. The Social Security "trust fund" doesn't have any actual resources with which to pay Social Security benefits. It is exactly the same as if you "borrowed" money from your savings account, put it in your checking account, immediately spent it, and wrote an IOU to keep track of the money you owe yourself. The only way to balance your books is: A.) earn more money or B.) tear up some of the IOUs. Here's what the Social Security trustees actually say: Social Security expenditures are expected to exceed tax receipts this year for the first time since 1983. The projected deficit of $41 billion this year (excluding interest income) is attributable to the recession and to an expected $25 billion downward adjustment to 2010 income that corrects for excess payroll tax revenue credited to the trust funds in earlier years. This deficit is expected to shrink substantially for 2011 and to return to small surpluses for years 2012-2014 due to the improving economy. After 2014 deficits are expected to grow rapidly as the baby boom generation’s retirement causes the number of beneficiaries to grow substantially more rapidly than the number of covered workers. There is no way around this. The payroll tax will have to be increased dramatically or benefits will have to be dramatically cut.
Then buy gold and bury it in your back yard. Geez o pete. Are you so incompetent that you don't know how to take care of yourself?
Or when a bank takes my deposit and lends it out. Money doesn't "stay" anywhere unless one puts it under the mattress.
If I am, then that kind of blows the claim that I know better what to do with my money than government, doesn't it.
Absolutely not. The government is lending to itself. There is no third party to pay it back. The only way the government can pay it back is by dramatically raising the payroll tax. Or they cannot pay the money and cut benefits instead. Both are coming. Guaranteed.
I've never seen you claim that. All I see is you agitating for more and more government to take care of you.
Back in the old days when paying off the national debt looked like a real possibility, the plan was to use the money saved on interest payments to pay back social security. BTW, where does the money come from to pay back what we borrow from, say, China, for instance?
No, I don't claim that. Its the argument used to convince the ignorant that the rich shouldn't be burdened with taxes.
what do you do about folks who blow their investments, or manage them so poorly that they don't have enough for retirement. Can they then get welfare or medicaid?
Don't allow them to invest their mandatory savings in the stock market. Make them put it in an interest bearing savings account.
And what if they don't earn enough to contribute sufficient funds to cover their retirement? When you start to work through all the what-ifs, and then determine the amount of bureaucracy required to manage it, Social Security doesn't look that bad. FWIW, the biggest problem with privatizing the program, IMHO, is the cost of covering current obligations while younger workers reduce or stop their contributions.
Ok, so you aren't competent enough to take care of yourself. Do you also need someone to change your diaper after you take a dump?
What did people do before government provided medicare and social security?
They died, starved, went homeless, etc., which is WHY programs like Medicare and Social Security were created in the first place.
I thought they moved to Alaska and became alcoholics and drug addicts.
Are you projecting again?
People aren't homeless and don't die today? Absolutely fookin amazing. You do live in lalaland!
ROTFLMAO. There were very few homeless people when I was a kid in the 1960s. Now they are all over the place. Everything Johnson did, except for the Voting Rights Act, has been a complete and utter disaster. I don't give Johnson credit for the Voting Rights Act either, because he opposed a similar measure (The Civil Rights Act of 1957) that Eisenhower submitted to Congress when Johnson was Senate Majority Leader. Johnson and the Senate Democrats completely gutted the bill and then passed it. Of course, Johnson being the two-faced power monger that he was, sought recognition from civil rights advocates for passing the bill while also receiving accolades from southern anti-civil rights Democrats for "killing the bill". Johnson is the most evil President this country has ever had.
social security started in the 1930's. But you really should rely more on data rather than what you remember as a kid. At the time of Social Security's passage, the elderly poverty rate was over 50%. At the time of passage of Medicare, it was around 35.2 %. As of now, it's around 10% (See: http://www.povertyinamerica.psu.edu/2005/07/ and http://en.wikipedia.org/wiki/Social_Security_(United_States)) If you want to advocate policies that would return more seniors to poverty, be my guest.
LoL!
You prefer to bankrupt the country, via the Cloward-Piven Strategy? Since the current system is unsustainable, and irrevocably broke, what's YOUR solution, Einstein?
Getting tired of the bozoed calcon following me around on the 'net, wanting to discuss "tossing salad." Sorry, you sick rump-ranger. NOT interested.
So what was the homeless rate prior to the enactment of SS?
Maybe you can get skidmark to assist you in researching.
benevolent dictatorship
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#13. To: jwpegler (#12)
Liberals:
-Pro nuclear proliferation.
-Support fundamentalist religion that execute gays.
-Have no issues with inmate abuse.
-In discussions to release J.Pollard.
#14. To: WhiteSands (#13)
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#15. To: WhiteSands (#13)
(Edited)
I handled Japan, HK, and South Korea.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#16. To: jwpegler (#2)
It is amazing to me that you can read this article and come up with exactly the wrong conclusions. Your ideological blinders are the strongest I've ever seen. It is truly remarkable.
#17. To: lucysmom (#16)
adequate savings for retirement and health expenses are mandated by government (employees must sock away 20 percent of earnings each year, to which employers add 13 percent).
#18. To: Ibluafartsky (#17)
Sounds similar to social security, medicaid and medicare, doesn't it?
#19. To: lucysmom (#18)
Well color me clueless
#20. To: lucysmom (#16)
(Edited)
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#21. To: jwpegler (#20)
Conservatives have been arguing for privatizing retirement and healthcare savings for at least 30 years and the left keeps demagoguing the issue, which is why those systems are in so much trouble today. The RIGHT wants this. The LEFT in the won't allow it.
#22. To: jwpegler (#20)
Acute care is care rendered in an emergency department, ambulatory care clinic, or other short-term stay facility. Public and non-profit hospitals in the U.S. also account for a large portion of acute care in the U.S.. My sister is an emergency room nurse in a government hospital in Detroit. Private clinics and hospitals in Singapore provide most episodic care as well as care of chronic illnesses, just like the U.S.
#23. To: jwpegler (#20)
As opposed to government mandating Social Security and Medicare taxes, which puts senior citizens at the mercy of unscrupulous politicians. Conservatives have been arguing for privatizing retirement and healthcare savings for at least 30 years and the left keeps demagoguing the issue, which is why those systems are in so much trouble today. The RIGHT wants this. The LEFT in the won't allow it.
On January 3, 2011 the GOP assumes responsibility for deficit spending.
#24. To: lucysmom (#21)
The majority of American citizens won't allow it. Just like prop 13 in California, Social Security and Medicare are third rail programs.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#25. To: go65 (#23)
Who do you trust more, unscrupulous politicians who have to directly answer to voters, or unscrupulous heads of companies like AIG who don't?
#26. To: go65 (#23)
The problem comes in what you do if there's another big market crash.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#27. To: jwpegler (#24)
Today, Social Security is paying out more than it is taking in. The Social Security Trustees predict escalating deficits starting in 2014. The only choices will be to dramatically raise the payroll tax or cut benefits.
#28. To: go65 (#23)
Who do you trust more, unscrupulous politicians...
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#29. To: jwpegler (#26)
Just put the money in a savings account / CD. Don't let people put their retirement or health savings in the stock market. It's really simple.
#30. To: lucysmom (#27)
Either you don't understand how Social Security was designed to work, or you are deliberately misleading.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#31. To: lucysmom (#29)
(Edited)
Right, and the banks invest in bum mortages.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#32. To: jwpegler (#30)
The Social Security "trust fund" doesn't have any actual resources with which to pay Social Security benefits. It is exactly the same as if you "borrowed" money from your savings account, put it in your checking account, immediately spent it, and wrote an IOU to keep track of the money you owe yourself.
#33. To: jwpegler (#31)
Are you so incompetent that you don't know how to take care of yourself?
#34. To: lucysmom (#32)
(Edited)
Or when a bank takes my deposit and lends it out.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#35. To: lucysmom (#33)
If I am, then that kind of blows the claim that I know better what to do with my money than government, doesn't it.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#36. To: jwpegler (#34)
Absolutely not. The government is lending to itself. There is no third party to pay it back. The only way the government can pay it back is by dramatically raising the payroll tax. Or they cannot pay the money and cut benefits instead. Both are coming. Guaranteed.
#37. To: jwpegler (#35)
I've never seen you claim that.
#38. To: jwpegler (#34)
Absolutely not. The government is lending to itself. There is no third party to pay it back. The only way the government can pay it back is by dramatically raising the payroll tax. Or they cannot pay the money and cut benefits instead. Both are coming. Guaranteed.
On January 3, 2011 the GOP assumes responsibility for deficit spending.
#39. To: go65 (#38)
what do you do about folks who blow their investments
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#40. To: jwpegler (#39)
Don't allow them to invest their mandatory savings in the stock market. Make them put it in an interest bearing savings account.
On January 3, 2011 the GOP assumes responsibility for deficit spending.
#41. To: lucysmom (#37)
No, I don't claim that.
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#42. To: go65 (#40)
And what if they don't earn enough to contribute sufficient funds to cover their retirement?
#43. To: Ibluafartsky (#42)
What did people do before government provided medicare and social security?
On January 3, 2011 the GOP assumes responsibility for deficit spending.
#44. To: go65 (#43)
#45. To: jwpegler (#41)
Do you also need someone to change your diaper after you take a dump?
#46. To: go65 (#43)
They died, starved, went homeless, etc.,
#47. To: go65 (#43)
(Edited)
They died, starved, went homeless
"To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves is sinful and tyrannical." -- Thomas Jefferson
#48. To: jwpegler (#47)
There were very few homeless people when I was a kid in the 1960s. Now they are all over the place.
On January 3, 2011 the GOP assumes responsibility for deficit spending.
#49. To: Skip Intro (#44)
I thought they moved to Alaska and became alcoholics and drug addicts.
On January 3, 2011 the GOP assumes responsibility for deficit spending.
#50. To: go65 (#48)
If you want to advocate policies that would return more seniors to poverty, be my guest.
#51. To: go65 (#48)
social security started in the 1930's.
#52. To: go65, skidmark (#51)
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