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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

The Missing Singapore Model



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I intend to write more about Singapore’s approach to healthcare in the near future. I’ll just make a simple observation: many on the left emphasize the virtues of the National Health Service, most strikingly the fact that health expenditures in the UK amount to roughly 8.4 percent of GDP, slightly more than half of what the public and private sectors spend on health in the United States. But Singapore, which has a system built around catastrophic insurance coverage and health savings accounts, spends less than 4 percent of GDP. And according to the World Health Organization, Singapore has the world’s sixth best healthcare system, miles ahead of Britain or the United States. Rowan Callick wrote a brief and useful summary of the virtues of Singapore’s approach in The American last spring.

To grossly oversimplify, Singapore relies on a mix of mandatory savings and universal catastrophic coverage. David Goldhill has proposed something similar for the U.S. in The Atlantic. So has Brad DeLong. Ross and I backed a similar approach in Grand New Party. And Ron Bailey made the case in Reason back in 2004

One thing to keep in mind: we really do need a big healthcare overhaul. Defending the status quo is attractive in the short term, but it will cause serious problems in the long term, as Ross argued in his latest column for the Times. 

If the Democratic Party’s attempt at health care reform perishes, senior citizens will have done it in, not talk-radio listeners and Glenn Beck acolytes. It’s the skepticism of over-65 Americans that’s dragging support for reform southward. And it’s their opposition to cost-cutting that makes finding the money to pay for it so difficult.

While Republicans are very eager to beat Obamacare, their opposition to IMAC and other Medicare cost-containment measures will undermine the cause of limited government. Ross says it well:

Maybe Republicans will be able to cast themselves as the protectors of entitlements today, and then impose their own even more sweeping reforms tomorrow. That’s the playbook that McConnell, Brownback and others seem to have in mind: first, save Medicare from Obama; then, save Medicare from itself.

But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.

Not all Republicans are falling into this trap. Paul Ryan, for example, has done an excellent job of emphasizing the trade-offs that are at work. But there are only so many Ryans in the House.  



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