For the past 50 years, we've tried to control health care spending and no one is satisfied with the results. Yet, for the most part, we have better care, more advanced technology and more effective medicines than we did 50 years ago. But there's no question we waste enormous amounts of money and even more is lost to fraud. We cut back again and again on payments to doctors who treat Medicaid and Medicare patients with the result that make almost no money treating such patients.
Seems to me there are two ways to go. Either the government takes over and imposes price controls and rations health care or we let the market do it. Now, I can hear you say, but the market hasn't done it and it's not fair.
One country did it and did it well while spending far less. Singapore put the consumer in control with money each individual was required to put aside for health care. By using the money wisely and getting the care they wanted, they had money left over they could use in retirement. A twofer.
American health care policies are sick by Robert Herbold
I believe it's just plain silly for the folks in Washington D.C. to consider spending an additional $600 billion for healthcare. Why throw money at an ineffective and bureaucratic system that is totally out-of-control? Why not figure out how to get it under control before deciding to drown it with more borrowed money from the Chinese or, even worse, further taxing the rich and thus retarding investment that might have a chance of turning around our economy?
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So, what countries seem to be handling healthcare most effectively and efficiently? Well, there's one nation that has the lowest infant mortality rate in the world as well as the third longest average lifespan for its citizens - and it spends only 3.7 percent of its GDP on healthcare. That country is Singapore.
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Singaporeans participate in a mandatory savings program that sets up a "Medisave" account for each individual. The individual is required to pay a small percentage of his or her income each month into that account, and employers also make a contribution. For individuals who are unemployed, there is a government subsidy. Singaporeans also engage in a "Medishield" program, which is a national catastrophic illness insurance plan. Premiums for the Medishield program are small, because it is government subsidized; as a result, the premiums are paid for out of an individual's Medisave account.
Choice and Competition
Most significantly, when individuals in Singapore feel the need to go to a physician, they select the doctor based on the quality of the care they believe they will get and the cost associated with going to that physician. In essence, physicians compete for the patient's business. Individuals select carefully since it's their Medisave account money that's used to pay for the chosen physician.
Individuals cannot take money out of their Medisave accounts except for medical use. On the other hand, these accounts grow steadily over time because the government invests these funds for the individual in a safe and modestly performing investment fund.
What's important here is that the money is not the government's. It's the individual's money and, at retirement age, people actually have access to these funds. That's why individuals use the funds wisely.
Posted by Jill Fallon at May 13, 2009 12:12 PM | PermalinkI have dedicated the lions share of my blog reading and posting for the last few months to the health care debate. I have learned a lot and abandoned a lot of my old ideas, including wistful looks abroad at other countries where they seem to do so much better taking care of their citizens. I'm especially impressed with the German and French systems, but like systems world-wide they are culturally unique.
Paul Starr's "Social Transformation of American Medicine" is dry but classic, a good place to start. The Health Care Blog and Maggie Mahar's Health Beat are readable with long, intelligent comment threads.
There is no way to predict what will come out of the Congressional sausage grinder, but this time a lot of smart people are working hard to get it right. There is no way for me to summarize in a comment what I have learned, but I would urge interested people to quit complaining and looking at the stars and start digging. In the last two days I have come across two or three links that may stir up some interest...
http://www.thehealthcareblog.com/the_health_care_blog/2009/05/beware-the-bursting-of-the-health-care-bubble.html#more
http://www.france24.com/en/category/tags-emissions/debate [Two part video discussion "Who should pay for health care?"]
http://www.politico.com/news/stories/0509/22155.html [Instructions to opponents how best to shape opposition]
http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf [the campaign plan]
http://www.esresearch.org/RWJ11PDF/singer.pdf [the Enthoven plan, pdf, nineteen pages, very dry tough reading]
http://medinnovationblog.blogspot.com/2009/05/health-reform-incentives-positive-and.html
As far as I can tell the "single-payer" option (i.e. Canadian) is off the table.
The reason all the big players are putting up so many smiles and good intentions is that they are scared of a ticking bomb: Medicare Part E, the "everyone" option, which would allow anyone to enroll in Medicare which has no need for executive bonuses, share-holder profits or other non-medical expenses. So far this has not been talked about much publicly, but you can be sure it is on everyone's mind.
Back when Hilary Clinton and Obama were competing for the nomination, one of the few policy differences they had was their two health care plans. Her's mandated universal participation, but his was voluntary. Moreover, he made the statement that anyone who was happy with their existing plan could keep it.
I thought her's would be more practical but I have changed his mind because the Obama plan is more politically feasible. There are just too many big money interests embedded in our current system to allow much change. Anything we do will have to be added with the hope that we can find enough money somewhere to pay for it. (There are ways, but it will be bitter medicine for the insurance people more than the medical community.)
In the end we will all benefit because part of the wasted money is for too many drugs, procedures and devices that add nothing to better outcomes. That's what "comparative effectiveness research" is about. It's why places like the Mayo Clinic and the Kaiser people get better outcomes with much lower costs per patient and at the same time have greater patient/family approval.
I could go on, but this is not the place.
Anyone serious about the discussion is welcome to wade in and join the fun.