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[Mr. Palau]

Singapore is 80% government paid, 20% copay.  It's about as freemarket as Medicare.

And apparently the metric for the success in switzerland is that the fail but not as hard as they should?  Wow, way to go free market?

I would assume that you got the 80% government paid statistic at http://www.moh.gov.sg/content/moh_web/home/costs_and_financing.html
the website of the Singaporean government. If you examine the page you will see that "The public sector dominates the acute care sector, delivering 80% of the care in this sector. The primary care sector is dominated by private sector providers, which account for about 80% of the market." Clearly not what you are stating, and official government statistics. 

Further more: "The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP." That means the private sector expenditure on health care was 3% of GDP, which is 230% higher than the government percentage of GDP, about as free market as Medicare, yeah.
http://econlog.econlib.org/archives/2008/01/singapores_heal.html

Again the reason Singapore's system works is that it allows consumer choice to cut costs in the primary care market, which makes up the vast majority of the healthcare market and when properly provided drastically reduces costs down the line. The efficient primary care providers, drastically reduce the costs Singapore would otherwise face. Primary care is really the only area in healthcare that functions like a proper market, when it comes to acute and chronic care the costs are just too high to enable a person to exercise consumer choice. By taking advantage of the market based nature of primary care Singapore is able to reduce costs in healthcare sectors that do not respond to the pressures of consumer choice.

Irregardless, we shouldn't be forced to pay a company for a product. It just allows for too many problems to pop up as far as quality and abuse go. Efficiency is hardly reason enough for a hand wave when you look at the problems that could come out of having a 100% mandatory product on the market. Few companies would be efficient to the benefit of the customer.

So I take it that you don't drive?  Because state laws in all 50 states require you to have auto insurance.

Constitution wise states are exempt. All powers not enumerated to the federal government, including forcing you to purchase insurance, are relegated to them. To be a Devil's advocate.

[Knight of Fools]

So I take it that you don't drive?  Because state laws in all 50 states require you to have auto insurance.

I'm pretty sure we discussed this all the way on page 1.

[mainiac]

So I take it that you don't drive?  Because state laws in all 50 states require you to have auto insurance.

I'm pretty sure we discussed this all the way on page 1.

Bringing it up for a different reason though.

Further more: "The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP." That means the private sector expenditure on health care was 3% of GDP, which is 230% higher than the government percentage of GDP, about as free market as Medicare, yeah.
http://econlog.econlib.org/archives/2008/01/singapores_heal.html

So if Forbes doesn't convince me a libertarian think tank will?

I'll admit that my numbers before were outdated but this guy is just pulling stuff out of his ass and it does not correlate to what the WHO found at the same time.  Look here:
http://apps.who.int/ghodata/
Click Health Systems -> Health Financing -> Health Expenditure Ratios

Wonderful data from all over for 2009.  Scroll down to Singapore.  Government expenditures were 41.5%.  So they do win the prize for having one of the few systems in the world with lower government share then the US.  But it's not like the government isn't the major player here.

And then consider what you get in the "private" funding.  It's mandatory contributions to a government administered account.  The government dictates the prices that you pay with "your" money.  The government provides a backstop for you if your account runs dry.  And the government plays a key role in deciding whether or not you should get expensive treatments.  Patient initiative never even enters into the decision making process.  The only part that is truly out of pocket is the co-pay.  We have co-pays here in the US.

But this is away from the central point which is that Singapore has some very, very crucial differences from everywhere else that drives it's success.  It's a country that is vastly wealthier then it's surroundings and can afford to hire manpower for a pittance.  They can hire however much migrant labor they need for their economy.  They can get doctors from abroad because the low wages of the poor keep the cost of living down for the rich.  It's a place where 15% of the households are millionaires but they still have a reputation for low labor costs.  If you wanted to emulate Singapore you aren't just going to need to set up health savings accounts, you'd need to completely redevelop American society.  You'd need to kick out all the high wage American workers and import a bunch of low wage workers from elsewhere.  You'd need to shed the rural parts of the country in the name of efficiency and just hold onto places like New York, the Bay Area, etc.  Then attract some highly paid Europeans and Canadians with all the cheap labor they could want.  It's not a good model for our country.  You might as well ask why we can't emulate the cheap costs of Singapore's portside loading and unloading facilities.

If you want the personal responsibility with a government backstop model without the cheap labor then you are looking at Switzerland or the Netherlands or (partially) Germany.

[Mr. Palau]

Further more: "The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP." That means the private sector expenditure on health care was 3% of GDP, which is 230% higher than the government percentage of GDP, about as free market as Medicare, yeah.
http://econlog.econlib.org/archives/2008/01/singapores_heal.html

So if Forbes doesn't convince me a libertarian think tank will?

I'll admit that my numbers before were outdated but this guy is just pulling stuff out of his ass and it does not correlate to what the WHO found at the same time.  Look here:
http://apps.who.int/ghodata/
Click Health Systems -> Health Financing -> Health Expenditure Ratios

Wonderful data from all over for 2009.  Scroll down to Singapore.  Government expenditures were 41.5%.  So they do win the prize for having one of the few systems in the world with lower government share then the US.  But it's not like the government isn't the major player here.

Yeah didn't consider the Forbes-Libertarian connection  , hey it the first good article in the google search don't kill me for it.

The guy's data is form 2002, so obviously some things have changed. What I don't know what is though is why Singaporeans get more healthcare form the Gov now then 2002, as their standard of living increased you would have expected them to receive more private care, all else equal. The only thing I can think of is an increase in treatments covered, expanded coverage of the population, increased costs in the Gov healthcare sector vs. the private healthcare sector, and increases in subsides of already covered treatments to the already covered population.

And then consider what you get in the "private" funding.  It's mandatory contributions to a government administered account.  The government dictates the prices that you pay with "your" money.  The government provides a backstop for you if your account runs dry.  And the government plays a key role in deciding whether or not you should get expensive treatments.  Patient initiative never even enters into the decision making process.  The only part that is truly out of pocket is the co-pay.  We have co-pays here in the US.

Well yeah it is a difined contribution plan to a government account, but thats only to force you to save enough many so you don't need insurance and can see the price of what you are using and try to save money on things you don't really need. The Singaporean government issues prices for government services, which forces the private sector to compete in order to do it at lower cost. They really set a benchmark, because if I can get my medication for 500 from the gov, why go to a private sector provider for 600? I think that thing about expensive treatments is true of your healthsavings account, as well as any other government provided care. Of course if you pay out of pocket for the expensive care you can get it. Patient initiative influences the decision making process of individuals who fund their health savings accounts from their own money, so they try to avoid treatments that don't over a good cost-benefit ratio in order to save money. Yeah everyone who has subsidized care doesn't get to choose.  Co-pays and as I mentioned before expensive treatments are out of pocket.

But this is away from the central point which is that Singapore has some very, very crucial differences from everywhere else that drives it's success.  It's a country that is vastly wealthier then it's surroundings and can afford to hire manpower for a pittance.  They can hire however much migrant labor they need for their economy.  They can get doctors from abroad because the low wages of the poor keep the cost of living down for the rich.  It's a place where 15% of the households are millionaires but they still have a reputation for low labor costs.  If you wanted to emulate Singapore you aren't just going to need to set up health savings accounts, you'd need to completely redevelop American society.  You'd need to kick out all the high wage American workers and import a bunch of low wage workers from elsewhere.  You'd need to shed the rural parts of the country in the name of efficiency and just hold onto places like New York, the Bay Area, etc.  Then attract some highly paid Europeans and Canadians with all the cheap labor they could want.  It's not a good model for our country.  You might as well ask why we can't emulate the cheap costs of Singapore's portside loading and unloading facilities.

If you want the personal responsibility with a government backstop model without the cheap labor then you are looking at Switzerland or the Netherlands or (partially) Germany.

Actually it appears that most of Singapore's cheap labour in the healthcare sector are sourced domesticly. There are horror stores apperantly.
http://forums.salary.sg/income-jobs/793-how-life-doctor-singapore.html
The pay is pretty much the same for low-level doctors as in the West, but they work a ridiculious amount of hours. Read the big post in the first thread, he explains it pretty well. As you will see throughout the rest of the thread, many of the higher level doctors are paid either the same or better. The reason costs are so low is that
http://en.wikipedia.org/wiki/National_University_of_Singapore, National University of Singapore forces students to either work for the healthcare system for 5 years, or pay a huge sum of money in order to be able to go get any other job. So this bonded labour is avalible at a very low cost, relative to other doctors pay, to the system. Since they make up the bulk of the work force, and are unable to bargin or leave, they lower wages for every other relativly unskilled doctor. Its like the situation in the late Roman Empire where the masses of slaves lowered the wages of poor free men due to their low cost over time.  It is actully like slavery, in that it is forced labor.
And he isn't lying the government website says it too.
http://www.nus.edu.sg/registrar/edu/UG/fees.html
You know if having doctors work slave's hours I don't think I want healthcare as cheap and as good as Singapore. Its all ways too good to be true  . Why don't any of the proponents of single payer bring this up when conservetives raise the Singaporean health care system as a counter example ?

Also i apoligize for the disparaging tone some of my posts had, you are clearly very inteligent. If anything appears condescending here, it was not intended and I apoligize.

[mainiac]

Well that was overwhelmingly respectful and brought things to my attention that I didn't know.  Is the internet broken?

[Mr. Palau]

Well that was overwhelmingly respectful and brought things to my attention that I didn't know.  Is the internet broken?

Yeah I would like to see an anaylsis of just how effective the Singaporean system would be if they paid their doctors market wages. I would imagine costs would explode at first, and then level out after the system adjusted to the shock and market wages became normal.

I can only imagine what you thought I had posted when you opened the thread.

[mainiac]

I thought very little actually.  I haven't heard the Singaporean healthcare system discussed very much in the past.

There are some interesting similarities between what you shared about their system and the way things work in the US.  Interns are horribly underpaid in the US and internship is perquisite.

[Knight of Fools]

Yeah, being a doctor is basically a bad idea if you want to make money. You could start up your own firm, but there can only be so many private firms in the world.

[Mr. Palau]

I thought very little actually.  I haven't heard the Singaporean healthcare system discussed very much in the past.

There are some interesting similarities between what you shared about their system and the way things work in the US.  Interns are horribly underpaid in the US and internship is perquisite.

I have the urge to google internship in the USA but am just too tired after a 3 hours car ride.

[Duuvian]

So, back at it again: Yahoo Link to Romney: Overturning health care law 'right thing'

My thoughts are take out the mandatory clause and smite anything else that benefits the industry more than it needs to. All this could have been avoided if the reasonable solution of a government run competition to set the price ceiling hadn't been struck down by the insurance industry through Baucus and running away from the ghost of socialism like Shaggy and Scooby Doo. (not a great comparison since health care isn't a villian but it makes me laugh. Yikes! S-s-s-s-s-socialism! [drum roll, legs flailing]) It's like Don Knotts (or other celebrity guest) is the health care and the ghost is Socialism and the villain is anyone who wants to spook you with the idea so they can make Don Knotts be the ineffective policeman or whatever. I spent too much time on that idea. The point is the mandatory clause would have been feasible with the government 'competing' with the privates but without it you have seen the price of insurance gradually go up as I warned would happen years ago.

EDIT: Actually looking for evidence first would probably be a good idea but I'll change my post if I'm wrong, time to look at charts.

EDIT2: Strangely, google is showing me charts that cut off around 2008 despite a search for 2012 regarding price of insurance premiums. I have yet to find one for 2008-2012. I must not be doing it right or else there suddenly was a lack of information when it was inconvenient for people to see charts. I continue.

EDIT4: It was probably due to the health care bill and people reading news and thus charts being produced about health care that so many cut off at 2008/2010. All those are probably effecting google's mechanics in combination with the fact the insurance companies don't want to trumpet their extreme victory too much and don't throw charts everywhere nowadays to support their position that makes it tough to find the right charts.

EDIT3:

Spoiler: Doctors vs Insurance execs (click to show/hide)

The following chart is only applicable if 'Health Care Plans' = Health insurance which according to the 4.4% means that it does at least have the exact same percentage so I think they are same.

EDIT5: From Long link of a google image search to a blog with chart

Spoiler: 4.4% explained (click to show/hide)

In response to astonishingly high first-quarter profit reports from health insurance companies, the industry trade group America's Health Insurance Plans (AHIP), claims it is among the least profitable health care industries. AHIP says the health insurance industry profit margin is only 4.4%, and that this "low margin" represents less than one penny out of every dollar spent on all health care in the U.S. These are simplistic and misleading statistics.

AHIP's focus on profit margins is misleading and designed to protect their massive income by shifting attention away from their return on equity — a key measure of profits as a percentage of the amount invested. That return is a phenomenal 16.1% as of today. By that measure, health insurers are ranked fourth highest of the 16 industries in the health care sector. They also deliver a higher return for investors than cellphone companies, beer companies, mortgage companies, life insurance companies, TV broadcasters, drug store companies or grocery stores.

Spoiler: Gigantic Chart for 2010 Profit margin (3.56%) (click to show/hide)

Spoiler: Normal sized chart for 2011 (4.4%) (click to show/hide)

 

http://en.wikipedia.org/wiki/Profit_margins

Spoiler: Value of the dollar to a pair of reasonable currencies. (click to show/hide)

That's what I found so far. I don't know what the exact term the industry uses that they put on charts for an insurance payout that I should be searching for so I can compare the ins and outs of their business but I found the ins I think. If someone can supply the term I could be bothered to search for it to add for comparison sometime in the near future.

One interesting thing I learned from all of this is from that blog I found on accident through an image search for charts:

Spoiler (click to show/hide)

AHIP likes to talk about how insurance profits are a small share of national health spending — less then one penny of every dollar spent on health care in the U.S. — but that is an absurd, deceptive and self-serving statistic. Yet even their own chart of this data shows that the share of the health care economy sucked up by health insurance profits has more than tripled over the past decade.

One penny of the health care dollar is worth $347 billion over 10 years ending in 2019. That one penny would pay for more than one-third of the entire cost of the health reform program.