As I’m going to Singapore tomorrow, it seems like a good moment to get something off my chest. I’ve often heard conservatives and libertarians praise Singapore as, broadly speaking, a model of health care policy that they embrace. Words like “free market” often get thrown around in this context. But it’s rarely clear to me what exactly it is about Singapore’s health care system that American conservatives favor. Oftentimes I think they’re simply confused. Singapore has low taxes (which conservatives definitely like) because it often finances social programs not with taxes, but by requiring firms and private citizens to spend money on certain things.
This is not a trick U.S. conservatives fall for when U.S. Democrats actually try to do it in practice, but in terms of international comparisons I think it may trip them up. At any rate, let me quote a bit from Singapore’s Health Ministry:
— Singapore has “multiple tiers of protection to ensure that no Singaporean is denied access to basic healthcare because of affordability issues.”
— “The first tier of protection is provided by heavy Government subsidies of up to 80% of the total bill in acute public hospital wards, which all Singaporeans can access.”
— “The second tier of protection is provided by Medisave, a compulsory individual medical savings account scheme … Singaporeans and their employers contribute a part of the monthly wages into the account to save up for their future medical needs.”
— As best I can tell, these Medisave accounts are deposited into the Central Provident Fund, a government-run investment pool, rather than constituting private savings as we would understand them.
— “The third level of protection is provided by MediShield, a low cost catastrophic medical insurance scheme” supplemented if like by private insurance called Integrated Shield plans and “Singaporeans must subscribe to the basic MediShield product before they can purchase the add-on private Integrated Shield Plans.”
— “Finally, Medifund is a medical endowment fund set up by the Government to act as the ultimate safety net for needy Singaporean patients who cannot afford to pay their medical bills despite heavy subsidies, Medisave and MediShield.”
None of this sounds to me like anything American conservatives favor. As in, there is no legislation that’s been championed by major Republican leaders that would do any of these things and, in general, none of these measures comports with conservative aversion to government spending and regulation. And, yes, providers are regulated by a couple of entities. Now I sometimes hear U.S. conservatives analogize health savings accounts to Sinagpore’s Medisave. But HSAs are a tax exemption for savings that are set aside for health care purchases; that’s totally different from a mandatory contribution to a sovereign wealth fund. What’s more, U.S. conservatives support tax cuts in general and tax cuts for investment income in particular. So conservative affection for HSAs seems to me to stand completely apart from whatever virtues it may have as health care policy. Note that in addition to the above financing mechanisms, the public hospital system also serves as a set of de facto price controls.