Friday, January 17, 2014

Singapore Health Care System Touted By True Believing Libertarian Who Is Almost Completely Wrong On It Being Market Oriented

There is no free market. And, you know what? We are the only country in the world that insists on the notion that there can be a free market. Everybody else has tried something else and it works better. They get better health care results at a much lower cost ~ Steven Brill (dob 8/22/1950) a columnist for Time Magazine, whose most recent story is Bitter Pill: Why Medical Bills Are Killing Us, which is a "special report" in Time's March 4, 2013 issue. Quote from an interview with Jon Stewart on the 1/16/2014 episode of The Daily Show.

This commentary addresses yet more misinformation from the true believing Libertarian who "is wholly incapable of critical thinking [and] at the very minimum useless". This time the misinformation the non-critical thinker believes to be true when it isn't comes from a commentary he titled "Toward a Free Market Solution to Healthcare and a Hell of a Good Lesson to Learn"...

Libertarian Blogger: Singapore's system is one of personal health savings accounts (mandated but with subsidies for people who need it) supplemented with catastrophic plans for emergencies. (1/14/2014 AT 4:47pm)

Not quite true. Not by a long shot. The method Singapore uses to fund it's health care payments system is significantly dissimilar to health savings accounts (HSAs) as they exist in the United States, as explained in a 10/23/2013 Slate article...

Matthew Yglesias, writing for Slate: [Funding for health care in Singapore is provided for 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. [However] ...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. HSAs [As they exist in the United Sates], 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 Do Conservatives Like About Health Care in Singapore?, Slate 10/23/2013)

This sounds very much like our system currently works. The employee pays a portion and the employer pays a portion. In the US the portion paid by the employer is considered by the employer as a cost of retaining the employee (part of their wage). US health savings accounts, on the other hand, are wholly funded by individuals, are not compulsory, and the accounts are controlled by the individual, not the government. US HSAs and Singapore's Medisave are clearly quite different animals.

Also, as pointed out by Slate, Singaporeans rely heavily on socialized direct payments to hospitals...

Slate: 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 is the Medisave program, and the third tier is] MediShield, a low cost catastrophic medical insurance [program] supplemented if like by private insurance called Integrated Shield. (source same as above).

So, what we have here is a highly socialized health care system that includes publicly-owned highly subsidized hospitals that a Libertarian is holding up as a "free market" solution that we should consider adopting in the United States.

But a 8/23/2013 HuffPo article on the most efficient health care systems in the world (which has Singapore ranking 2nd), says "the unifying factor seems to be tight government control over a universal system". I don't know about you, but "tight government control" does not sound very Libertarian to me.

So, where does the "free market" come in? Mr. LB says it is a "free market" approach in Singapore that keeps costs down via competition... according to this excerpt from Mr. LB's misinformed commentary...

Libertarian Blogger: [the Singapore system] has in fact produced solid healthcare outcomes while at the same time bending the cost-curve. I mean, just take a look at these huge comparisons; hysterectomy - $20,000 in the U.S., $7,000 in Singapore, hip replacement - $43,000 in the U.S., $12,000 in Singapore, heart bypass - $127,000 in the U.S., $22,500 in Singapore... (1/14/2014 AT 4:47pm)

So, does the "free market" and competition keep prices down as Mr. LB claims? The answer is NO, as this blog post by Maggie Mahar (author of Money-Driven Medicine: The Real Reason Health Care Costs So Much) reveals...

Maggie Mahar, Writing on Her Blog "Health Beat": The government... put price caps on all services and procedures delivered in public hospitals, which provide 80 percent of hospital care in Singapore. These caps apply not only to procedures like surgery, but also to ward stays. So while patients are in fact able to choose between types of accommodations for a price, those prices are fixed by the government (except in the case of private hospitals, which can charge whatever they want). (Health Care in Singapore: What's the Secret? by Maggie Mahar 7/30/2008).

So, no HSAs and no competition keeping prices down (but rather price controls). In addition, one of the reforms instituted by Singapore to keep costs down was to restrict "how fast new, unproven technology can be introduced into government hospitals"... so none of that "cutting edge" technology we're so proud of in the US.

As for the publicly-owned hospitals, Singapore's Ministry of Health website reports the following...

Ministry of Health/Hospital Services: In 2012, there were a total of about 10,756 hospital beds in the 25 hospitals and specialty centres in Singapore, giving a ratio of 2.0 beds per 1,000 total population. About 85% of the beds are in the 15 public hospitals and specialty centres with bed complements between 185 to 2,010 beds.

Does a figure of 85 percent socialized (AKA government owned) when it comes to available hospital beds sound like competition? What about a government that covers 80 percent of the bill, uses price controls to keep costs down, and has a Medicare-like program for the poor called "Medifund aid"... does that sound like the "free market" in action? Or does it sound like Socialism?

To me it sounds like the success of the Singaporean system is due to Socialism. And it also sounds to me like Mr. LB's assertions have been thoroughly debunked. And, while Mr. LB says "Progressive goals but with free market solutions is kind where I am right now", the ACTUAL "hell of a good lesson to learn" from Singapore is that they didn't attain efficiency via free market competition. The REAL lesson to be learned, as Maggie Mahar concludes is...

Maggie Mahar: Singapore's health care experience isn't an argument for consumer-driven medicine, but for targeted government interventions and smart, timely, regulation of over-treatment. (Health Care in Singapore: What's the Secret? by Maggie Mahar 7/30/2008).

Laughably, the latest from Mr. LB is his enthusiasm for "ridiculously low prices" he thinks are the result of free market competition in Singapore (and this from an individual who often cries about doctors not getting paid enough... under Medicaid and potentially the ACA).

But there is no notion that there should be a "free market solution" in any other country in the world (including Singapore) as Steven Brill points out (see quote at the top of this commentary). That Mr. LB believes otherwise is, frankly, delusional.

SWTD #226, wDel #47.


  1. Well done, Dervish. An excellent and well documented rebuttal to LB's personalized and self-serving interpertion of Singapore's healthcare cost data.

  2. All the effort on SHC system. Yet our own needs work, and will need a LOT more post ACA SNAFU.

    Dervish got one thing right for sure. USA hasn't had a truly free market in well over 114 years.

  3. Hey I don't have words to describe this post. I simply want to say that absolutely informative post. It inspires me a lot. Keep posting.
    Herbal Potpourri


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