63
   

Turning The Ballot Box Against Republicans

 
 
neptuneblue
 
  3  
Reply Sun 25 Oct, 2020 01:24 pm
@oralloy,
oralloy wrote:
The Republican plan is Singapore-style health savings accounts.



There has been NO PLAN.

EVER,

Trump lied and so are you.
snood
 
  2  
Reply Sun 25 Oct, 2020 01:54 pm
@neptuneblue,
neptuneblue wrote:

oralloy wrote:
The Republican plan is Singapore-style health savings accounts.



There has been NO PLAN.

EVER,

Trump lied and so are you.


It’s twisted, man. I mean, the lying by Trump is one thing, but these nimrods feel like they have to lie for him.
neptuneblue
 
  1  
Reply Sun 25 Oct, 2020 02:12 pm
@snood,
Well, to be fair, there ONCE was a plan... It FAILED miserably. If this is what Oralloy is referring to, no wonder it's a lost preposition. And it's never been brought up since it's failure.


A group of Republicans has unveiled its healthcare plan. Here is what's new and what isn't
by Robert King | Oct 22, 2019 3:10pm

The Republican Study Committee, a group of 145 GOP lawmakers, released a new plan on how to tackle healthcare that closely resembles prior plans to repeal the Affordable Care Act.

The Republican Study Committee (RSC), a group of 145 House GOP lawmakers, rolled out a new healthcare plan to counter Democrats’ call for “Medicare for All.”

However, the plan itself closely resembles the Affordable Care Act (ACA) repeal bill called the American Health Care Act (AHCA) that the House passed in 2017 and contributed greatly to the loss of the GOP House majority in 2018.

For the plan to become law, Republicans would have to retake the House in 2020, and President Donald Trump would need to be reelected. However, if those victories happen, the plan could be a blueprint for how a GOP-controlled Congress would move forward on healthcare, as the committee counts among its members both GOP leadership and rank and file.

Here are three takeaways from the plan:

Shifting to high-risk pools

The plan would retain the ACA’s requirement that individual market plans cover pre-existing conditions. However, it takes out provisions that ensure patients with pre-existing conditions get affordable coverage such as requirements that prevent plans from charging sicker people higher premiums than healthy customers.

The plan does introduce high-risk pools that would be used by people with high healthcare costs, a commonly deployed tactic by states for the individual market before the ACA. The high-risk pools would be funded by repackaging the funding used for the ACA’s subsidies and the Medicaid expansion.

RELATED: KFF: 27% of non-elderly U.S. adults have pre-existing conditions that would have been declined without ACA

However, the plan doesn’t identify the full amount that should be devoted to high-risk pools, which segregate high-cost customers on the individual market.

The plan cites a 2017 report from consulting firm Milliman that estimated a federally supported high-risk pool could require $3.3 billion to $16.7 billion a year. The AHCA also called for high-risk pools but only gave $2.5 billion a year to help states fund them.

While the “$17 billion annual price tag may not seem ideal, it sets up a sustainable path for the individual market,” the RSC report said.

The desire for more funding for high-risk pools is likely a nod to Democratic attacks during the 2018 midterms that the AHCA threatened pre-existing condition protections. The nonpartisan Congressional Budget Office said the AHCA, which let states waive pre-existing condition protections, would lead to people in those states not getting affordable coverage for their pre-existing conditions.

While the AHCA had funding for high-risk pools, experts across the healthcare spectrum said that it wasn’t enough. It would remain to be seen how much more funding would be needed.

Doubling down again on health savings accounts

Bolstering health savings accounts has been a very popular reform idea among Republicans, and that enthusiasm is clear in the RSC plan.

The plan proposes to increase how much an employee can contribute to a health savings account. Currently, an individual can contribute $3,500 and a family can contribute $7,000.

RELATED: Premiums on benchmark HealthCare.gov plans decline 4% for 2020: CMS

A 2018 bill that passed out of the House but didn’t make it through Congress increased the contribution cap to $6,650 for an individual and $13,300 for a family.

Now, the RSC plan wants to increase the figures again, this time to $9,000 per individual and $18,000 for families, in line with a proposal from libertarian think tank Cato Institute.


“The RSC plan would also expand health savings accounts so that they could be used for a number of health services and products that currently must be paid for with after-tax dollars,” the plan said.

Replace Medicaid expansion with a block grant

This is another common reform in ACA repeal plans. The bill would phase out the enhanced federal matching rate for the Medicaid expansion to pre-expansion levels.

In addition, the bill would replace the existing open-ended federal match with a fixed amount in a block grant.

RELATED: Handful of states mull getting off HealthCare.gov for their own exchanges

But the plan has a new twist in a new “flex-grant” that would give more funding to states that adopt a work requirement. However, half of the funding for any flex-grant must go toward supporting the purchase of private plans for low-income individuals.

So far, 12 states have gotten approval from the Trump administration to install work requirements for their Medicaid expansion population. But of those 12 states, three have had their work requirement programs struck down by legal challenges.

Some states are also considering installing their own block grants. Tennessee has released a draft proposal for a block grant but has yet to get federal approval.
0 Replies
 
hightor
 
  3  
Reply Sun 25 Oct, 2020 02:19 pm
@snood,
I like this imaginary description of non-existent plan:

Quote:
The Republican plan is Singapore-style health savings accounts.


This is a cruel joke when you barely make enough money to cover food and rent. Even before the pandemic 40% of USAmericans couldn't come up with $400 to meet an emergency. So many of the working poor have lost their jobs and many are threatened with eviction. The very demographic most in need of affordable health care will be hard-pressed to contribute anything to a medical savings account.
BillW
 
  3  
Reply Sun 25 Oct, 2020 02:50 pm
@hightor,
hightor wrote:

I like this imaginary description of non-existent plan:

Quote:
The Republican plan is Singapore-style health savings accounts.


This is a cruel joke when you barely make enough money to cover food and rent. Even before the pandemic 40% of USAmericans couldn't come up with $400 to meet an emergency. So many of the working poor have lost their jobs and many are threatened with eviction. The very demographic most in need of affordable health care will be hard-pressed to contribute anything to a medical savings account.


The Singapore plan covers people when they run out of savings in their account, poor people that can't afford any savings and people in final stages of life requiring heavy personal services (hospice care). If you turn required insurance payments into savings accounts, there is no difference with a good healthcare system that ACA could be with proper changes.

Why are Insurance companies the longest existing corporations in history, they get to keep what the don't need to spend and throw people out on the street when they exceed their spending. I would prefer ACA to become savings accounts for sure.
snood
 
  1  
Reply Sun 25 Oct, 2020 03:23 pm
@hightor,
hightor wrote:

I like this imaginary description of non-existent plan:

Quote:
The Republican plan is Singapore-style health savings accounts.


This is a cruel joke when you barely make enough money to cover food and rent. Even before the pandemic 40% of USAmericans couldn't come up with $400 to meet an emergency. So many of the working poor have lost their jobs and many are threatened with eviction. The very demographic most in need of affordable health care will be hard-pressed to contribute anything to a medical savings account.


Yeah, it reminds me of the “advice” that Commerce Secretary Wilber Ross gave to unpaid federal workers during a government shutdown who were having to go to food banks. He said he couldn’t quite understand why they just don’t take out loans. Ross was personally worth 2.9 billion at the time.
0 Replies
 
coldjoint
 
  0  
Reply Sun 25 Oct, 2020 03:45 pm
@hightor,
hightor wrote:

I like this imaginary description of non-existent plan:

Quote:
The Republican plan is Singapore-style health savings accounts.


This is a cruel joke when you barely make enough money to cover food and rent. Even before the pandemic 40% of USAmericans couldn't come up with $400 to meet an emergency. So many of the working poor have lost their jobs and many are threatened with eviction. The very demographic most in need of affordable health care will be hard-pressed to contribute anything to a medical savings account.

And the working poor have to compete with illegals for jobs. That is a problem that could be solved. And giving illegals healthcare for free will not help either. Democrats support that, or at least Biden does.
0 Replies
 
coldjoint
 
  0  
Reply Sun 25 Oct, 2020 04:06 pm
Remember Uncle Buck on SNL? Now we have Uncle Hunter.

Not that I like dragging families through the mud but Democrats seem to have no compunction doing so. So in the interest of fairness....
0 Replies
 
oralloy
 
  -1  
Reply Sun 25 Oct, 2020 06:03 pm
@snood,
snood wrote:
Republicans, who resist all manner of relief for poor people including Medicaid, food stamps, unemployment and now even pandemic relief money, often characterize black and brown people as the populations that want handouts and “free stuff”. It’s been a part if their Southern strategy for decades - memes about black womenswear who drive Cadillacs and have babies to get more welfare checks, to the big black bucks who hate work but love using their food stamps to buy crab legs. Anyone denying that this has been part of Republican strategy since the 60’s is just full of crap.

Medicaid is pretty lousy relief for poor people. I'll admit that it's better than no relief at all. But it's hardly decent health care.
0 Replies
 
oralloy
 
  -1  
Reply Sun 25 Oct, 2020 06:04 pm
@neptuneblue,
neptuneblue wrote:
There has been NO PLAN.
EVER,
Trump lied

Wrong. Republicans favor Singapore-style health savings accounts.


neptuneblue wrote:
and so are you.

You cannot provide any examples of an untrue statement in any of my posts.
0 Replies
 
oralloy
 
  -1  
Reply Sun 25 Oct, 2020 06:05 pm
@snood,
snood wrote:
It’s twisted, man. I mean, the lying by Trump is one thing, but these nimrods feel like they have to lie for him.

The only liar here is Barack Obama.

First Barack Obama lied and said that if we liked our current insurance plans we could keep them.

Then Barack Obama lied and said that he was only forcing people off from substandard insurance plans.
0 Replies
 
oralloy
 
  -1  
Reply Sun 25 Oct, 2020 06:06 pm
@hightor,
hightor wrote:
I like this imaginary description of non-existent plan:

Hardly imaginary. Hardly non-existent.


hightor wrote:
This is a cruel joke when you barely make enough money to cover food and rent. Even before the pandemic 40% of USAmericans couldn't come up with $400 to meet an emergency. So many of the working poor have lost their jobs and many are threatened with eviction. The very demographic most in need of affordable health care will be hard-pressed to contribute anything to a medical savings account.

Singapore offers health care subsidies to people who are poor. So does Obamacare.

There is no reason why an American version of health savings accounts could not offer subsidies for poor people too.
oralloy
 
  -1  
Reply Sun 25 Oct, 2020 06:08 pm
@BillW,
BillW wrote:
The Singapore plan covers people when they run out of savings in their account, poor people that can't afford any savings and people in final stages of life requiring heavy personal services (hospice care). If you turn required insurance payments into savings accounts, there is no difference with a good healthcare system that ACA could be with proper changes.

Why are Insurance companies the longest existing corporations in history, they get to keep what the don't need to spend and throw people out on the street when they exceed their spending. I would prefer ACA to become savings accounts for sure.

Well said. You should post like this more often instead of resorting to childish name-calling.

Private insurance companies continue to provide catastrophic coverage with health savings accounts though, for what it's worth.
0 Replies
 
TheCobbler
 
  1  
Reply Sun 25 Oct, 2020 08:54 pm

coldjoint
 
  0  
Reply Sun 25 Oct, 2020 10:09 pm
@TheCobbler,
TheCobbler wrote:

[youtube]https://www.youtube.com/watch?v=0X8hSUfVBpE[/youtube]


In 2009 Trump cut all associations with Epstein. Clinton was still dining with Maxwell.
0 Replies
 
oralloy
 
  0  
Reply Sun 25 Oct, 2020 11:07 pm
https://grrrgraphics.com/wp-content/uploads/2020/10/BIDENs-2020_debate_highlights.jpg
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0 Replies
 
neptuneblue
 
  2  
Reply Sun 25 Oct, 2020 11:17 pm
@oralloy,
oralloy wrote:
There is no reason why an American version of health savings accounts could not offer subsidies for poor people too.


Is Singapore’s “miracle” health care system the answer for America?
The Singapore model shows how liberal and conservative ideas can fuse.

By Ezra [email protected] Apr 25, 2017, 9:20am EDT
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ROSLAN RAHMAN/AFP/Getty Images Singapore’s health care system is a marvel, but the reasons it works in Singapore are the reasons it wouldn’t work in America.
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.

Here’s what Singapore’s conservative admirers get right: Singapore really is the only truly universal health insurance system in the world based on the idea that patients, not insurers, should bear the costs of routine care.

But Singapore isn’t a free market utopia. Quite the opposite, really. It’s a largely state-run health care system where the government designed the insurance products with a healthy appreciation for free market principles — the kind of policy Milton Friedman might have crafted if he’d been a socialist.


Unlike in America, where the government’s main role is in managing insurance programs, Singapore’s government controls and pays for much of the medical system itself — hospitals are overwhelmingly public, a large portion of doctors work directly for the state, patients can only use their Medisave accounts to purchase preapproved drugs, and the government subsidizes many medical bills directly.

What Singapore shows is that unusual fusions of conservative and liberal ideas in health care really are possible. Singapore is a place where the government acts to keep costs low and then uses those low costs to make a market-driven insurance system possible. One thing you quickly realize when studying their system is it would be a disaster if you tried to impose it in a country with America’s out-of-control medical prices.

That speaks to the more depressing lesson of Singapore. As soon as you begin seriously comparing where they are, and how their system works, to where the US is, and how our system works, it becomes painfully clear how far America is from having the institutions or preconditions for truly radical health care reform.

How Singapore’s health insurance system works
Books could be written on the structure of Singapore’s health care system, and indeed, they have been. Jeremy Lim’s Myth or Magic: The Singapore Healthcare System is particularly excellent, though William Haseltine’s Affordable Excellence: The Singapore Healthcare Story has the advantage of being free. A deep dive here is rewarding, and my summary will necessarily oversimplify.

But the basic structure of Singapore’s insurance system is built around the “three M’s”: Medisave, Medishield, and Medifund. Let’s take them in turn.

Medisave: When conservatives praise Singapore’s health system, they are typically praising the Medisave system. Medisave is a forced savings plan that consumes between 7 and 9.5 percent of a working Singaporean’s wages — think of it like the Social Security payroll tax, if said tax funded a health savings account. Singaporeans then pay for some routine care out of their Medisave accounts.

Conservatives like Medisave because it is built on a deep appreciation for the idea that routine medical care can be treated like any other good, and patients can be pushed to act like consumers when buying it. Which is all true. Medisave distinguishes Singapore’s system from that of the US or Western Europe, where insurers typically cover most of the cost of routine care.

But again, the way Medisave actually works is the government forces you to divert 7 to 9.5 percent of your wages into this account, and then it decides what you can do with those savings — one way Singapore keeps drug prices low, for instance, is it only allows Medisave funds to be used for drugs that the government judges cost-effective (more on this later).

So while Medisave may look like a health savings account, it’s a mandatory health savings account funded by a payroll tax and only usable in certain conditions.

Medishield: Not all medical care is routine care. For the big expenses, Singapore runs Medishield, a nationwide catastrophic insurance program. The premiums are set by your age, and the deductibles are reasonably high — roughly $1,400 in US dollars. Enrollment is automatic, though you can opt out if you choose.

Together, Medishield and Medisave form the core of Singapore’s more market-oriented health insurance system — the idea is you pay routine expenses out of your Medisave account, and if things get bad enough that you hit your deductible, you begin using your Medishield account. This accords with the broader conservative view on health care: Insurance should cover unexpected costs, and for everything else, people should shop around as they do for most other products, and unleash the powers of the market.


But to make that structure work, Singapore relies on a massive amount of government coercion across the entire system. Fully funding your Medisave account is compulsory, not optional. You’re automatically enrolled in Medishield. The government limits the services both programs can purchase and, as we’ll see, often produces or reprices the services both programs purchase.

Medifund: Some Singaporeans fall through the cracks of Medisave and Medishield. For them, there’s Medifund — Singapore’s payer-of-last-resort.

Medifund’s structure is unusual in two ways. First, it’s based on a $3 billion endowment, with the government only able to spend the previous year’s investment income to pay for the needy’s medical bills; dipping into the endowment itself is forbidden. Second, it’s administered with a lot of discretion at the hospital level — so rather than qualifying for Medifund based on income, the way Americans do for Medicaid, hospital boards administer Medifund to the patients they judge needy enough to qualify. This is less restrictive than it might sound — the government says that more than 99 percent of applications are approved.

The big vulnerability of Medifund is that a bad investment year could wipe out the government’s ability to pay — and do so at the moment it was most needed. It’s a testament to Singapore’s economy, and to the government’s fiscal skill, that they’ve not faced this problem yet.

How Singapore’s health care system works
It’s easy, looking at Singapore’s insurance scheme, to see what conservatives find so attractive in the system. While there’s significant coercion, there’s also a real focus on pushing patients to act like consumers, and reserving insurance for unexpected, unusual costs. In addition, Singapore’s safety net — Medifund — is limited in its commitments and administered at the local level.

But all that happens within the context of a government-controlled — and often government-run — medical system.

This is a key difference between Singapore and America. The bulk of the American government’s intervention into the health care system is done through health insurance, and so American analysts often look at Singapore’s insurance system and stop there. But the bulk of the Singapore government’s intervention into the health care system is through the health care system itself.

Take the way the two countries subsidize medical care. In America, insurance is often subsidized — by paying the bills of Medicare or Medicaid enrollees, by giving tax credits to Obamacare enrollees and employer-sponsored health plans. In Singapore, medical treatment itself is subsidized.

More than 80 percent of the hospital beds in Singapore are in public hospitals, and those hospitals are cut into different “wards” with different levels of amenities: A-class wards provide unsubsidized care but have single rooms and air conditioning, while C-class wards are overwhelmingly subsidized but are set up like shared dormitories with common toilets. There are a number of ward levels in between, too, all with a sliding scale of comfort and subsidization. So both A-ward patients and C-ward patients are paying for their own care, but the prices they’re paying are very, very different, because the government is absorbing the direct cost of care in the C-wards.

These subsidies remain a huge part of the country’s overall health spending. In 2009, the 3 M’s only financed 23 percent of total inpatient care; by contrast, government subsidies accounted for 51 percent. (It’s worth noting that government subsidies are a lot less prominent in primary care.)


The government’s subsidies are designed to do more than simply make care affordable — they’re also designed to shape patient and provider decisions and influence pricing. “The policies around what services to subsidize, how much to subsidize, who to subsidize and what providers and patients need to do in exchange for subsidy eligibility, make subsidies one of the most impactful tools in the Ministry of Health’s policy armamentarium,” Lim writes.

Take pharmaceuticals. In 2009, Americans spent $947 per person on drugs. Singaporeans spent merely $389. A major way the Singaporean government holds down drug prices is deciding which drugs are eligible for subsidies and Medisave spending.

The Singaporean Ministry of Health publishes a “standard drug list.” These are drugs the government believes to be “cost-effective and essential.” Drugs on that list are provided at subsidized rates to patients. The government also decides which drugs can be bought with Medisave funds. Drugs that don’t appear on either list may still be available in hospitals, but at prohibitive prices.

Singapore is unusually secretive about how its pharmaceutical decisions are made — Britain’s much-criticized National Institute for Health and Care Excellence, which makes decisions about which drugs will qualify for public funds, is far more transparent. A previous health minister of Singapore says the opacity is to prevent “intense lobbying by pharmaceutical companies” — what they want are pharmaceutical companies selling all drugs at low prices in the hopes of getting onto the standard list. That’s how Singapore uses their subsidies to lower prices not just for the subsidized but for everyone.

Compare all this with America, where Medicare is prohibited, by law, from negotiating down the price of pharmaceuticals, even for its own enrollees!

One lesson of Singapore: everything is easier when costs are lower
According to the World Bank, in 2014 Singapore spent $2,752 per person on health care. America spent $9,403. Given this, it’s worth asking a few questions about what Singapore’s model really has to teach the US.

Are Singaporeans really more exposed to health costs than Americans? 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. Americans, by contrast, have their care paid for by insurers and employers and the government, and so they have little incentive to act like shoppers and push back on prices. But is that actually true?

I doubt it. The chasm in total spending is the first problem. 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. Given the growing size of deductibles and copays in the US, I doubt that’s true now, if it ever was. (It’s worth noting that, on average, Singaporeans are richer than Americans, so the issue here is not that we have more money to blow on health care.)

According to Singapore’s data, in 2008 cash and Medisave financed a bit less than half of the system’s total costs. Let’s say, generously, that’s $1,200 in annual spending. According to the Kaiser Family Foundation, the average deductible in employer health plans is now $1,478 — and that’s to say nothing of premiums, copays, etc. And of course, average deductibles outside the employer market are much, much higher.


Singapore’s system is probably better designed in terms of how consumers spend their own money. But the lower overall prices make them much less exposed to health costs than both patients and employers inside the American system — which suggests to me that Americans have at least as much incentive as Singaporeans to try to use their power as consumers to cut costs.

The fact that that hasn’t worked is, I think, a reason to believe we’ve gotten the lesson of Singapore’s health system backward. 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.

In America, conservatives want to apply that strategy in reverse: working off a baseline of extremely high prices, they want to force people to pay out of pocket as a strategy to bring those prices down. That hasn’t worked so far, and my guess is efforts to double down on it — of which the Republican Obamacare alternative is one — will continue to fail.

What would happen if you brought Singapore’s system to the US? Spend a moment imagining a transition to a Singapore-like system in the US, given our prices. With per capita health spending over $9,000, we would need to force people to save far more than Singapore’s paltry 7 to 9.5 percent of monthly wages to build reasonable health savings accounts (remember, children and the elderly don’t earn much, and so need their expenses covered by their family’s savings).

A policy like this would make Obamacare’s individual mandate look gentle. Remember, the mandate doesn’t even apply if you can’t find a comprehensive health insurance plan that costs less than 8 percent of your household income. Here, you’d be forced to save more than 8 percent of household income, and that’s just for the part of the system managing out-of-pocket costs for routine care.

Which is all to say that there are a lot of program designs that are possible when health care is cheap, and very few that are possible when health care is as expensive as it is in the United States. Admirers of Singapore’s system often reverse the causality of their experiment: The Singaporean system is possible because the government keeps costs so low. If prices rose to US levels, their system wouldn’t be possible, as the out-of-pocket costs would lead to revolt.

Oh, and everything else in Singapore is different too
One difficulty with comparing anything in Singapore to anything anywhere else is Singapore is very, very weird.

It’s a city-state of 6 million people that’s only been governing itself since about 1960. Though elections are now considered broadly free in Singapore, power has only ever been held by one party — in part because that party has proven itself perhaps the most successful group of technocrats in human history. Singapore has gone from a poor country in the 1950s to holding the third highest per capita income today.

In part for that reason, trust in the government is extraordinarily high, and the government wields that power aggressively. Singapore’s health outcomes are excellent, but that’s not only because its health system is well-designed. Singapore manages a nanny state beyond anything Americans can imagine, or would permit.

Despite the country’s wealth, only 15 percent of Singaporeans have cars, because the government makes car ownership prohibitively expensive. There’s virtually no illegal drugs or gun crime in Singapore, in part because drug dealers are executed and guns are outlawed. Cigarette and alcohol taxes are enormous by American standards. As Matt Yglesias said in our episode of The Weeds discussing Singapore, “If you imagine America with no guns, less booze, much less drugs, and radically less driving, our public health outcomes would soar.”


There’s much America could learn from Singapore. But the lessons need to be taken in whole. The Singaporean system is unusually good at applying market forces to routine health expenses. But that happens within a context where the government is aggressively managing the supply of health services, the price of treatments, and the broader behavioral environment in which the system operates. Singapore’s health care system relies much more on the government, and much less on the market, than America’s does.

Which is not to say liberals should be confident about adopting Singapore’s model either. America is far from having the kinds of low costs or faith in public institutions needed to replicate Singapore’s “miracle.”

A point that both Lim and Haseltine make in their books is that the Singaporean government has sought to keep control of the health system because leaders’ study of other countries persuaded them that once costs and medical interest groups grew out of control, the government could no longer effectively regulate the system. Quoting a former Singaporean health minister, Haseltine writes, “f the public healthcare system is too small, it becomes the ‘tail that tries to wag the dog.’ Once a private healthcare system becomes the dominant entrenched player, it is very difficult to unwind it — there are many vested interests and many pockets will be hurt.”

In America, the private health care system is the dominant entrenched player. And that makes radical reform, either toward a Singapore-like system or toward any other public-driven system, very, very difficult. There’s much you can imagine designing if we were starting from scratch, but it’s very challenging to design high-performing, clean systems that we could smoothly transition to from here, given how many hospitals and doctors and employers and even patients are dependent on the money flowing through system we have, and would viciously fight efforts to upend it.

https://www.vox.com/policy-and-politics/2017/4/25/15356118/singapore-health-care-system-explained
oralloy
 
  0  
Reply Sun 25 Oct, 2020 11:50 pm
@neptuneblue,
Good article.
0 Replies
 
oralloy
 
  -1  
Reply Mon 26 Oct, 2020 12:11 am
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0 Replies
 
hightor
 
  1  
Reply Mon 26 Oct, 2020 02:44 am
@oralloy,
Quote:
There is no reason why an American version of health savings accounts could not offer subsidies for poor people too.

How will these subsidies be funded? The MAGAsaurus certainly isn't going to raise taxes. The subsidies for the ACA are another cruel joke if you happen to make enough to stand on the other side of the "cliff" and get nothing. (If Democrats win big they should address this.) What role will there be for private insurance companies? How will they be compensated for the pre-existing conditions requirement, an obvious risk for them?

vox.com wrote:

There’s much America could learn from Singapore. But the lessons need to be taken in whole. The Singaporean system is unusually good at applying market forces to routine health expenses. But that happens within a context where the government is aggressively managing the supply of health services, the price of treatments, and the broader behavioral environment in which the system operates. Singapore’s health care system relies much more on the government, and much less on the market, than America’s does.

Which is not to say liberals should be confident about adopting Singapore’s model either. America is far from having the kinds of low costs or faith in public institutions needed to replicate Singapore’s “miracle.”


Or, as I explained to you last week:

I wrote:
The median wealth of Singapore is significantly higher than that of the USA , the country is smaller, unemployment is lower, crime rates are lower, ethnic diversity is lower, and poverty rates are lower. The fact that the system works well in that tiny country doesn't mean that it would work well here.
 

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Snowdon is a dummy - Discussion by cicerone imposter
GAFFNEY: Whose side is Obama on? - Discussion by gungasnake
 
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