I recall when we were debating health care reform on this blog, the Singapore model was brought up by opponents of universal health care as a successful model featuring private health insurance.
Aaron Carroll has a blog post up that discusses some details of Singapore’s model. It doesn’t sound like something that opponents of Obamacare would embrace:
Singapore’s system is a lot like universal, mid-range deductible Medicare with a mandatory health savings account (HSA) plus Medicaid for the poor. By the way, in Singapore, the government dictates what health services you can and cannot use your HSA funds for.
Joe Flower suggested a couple of reasons why free market competition wasn’t really viable for health care:
Medical demand is wildly random but tends to be absolute. There is little way to predict who, specifically, will need most kinds of medical care. But, when you do need it, you have to have it or you’ll die.
Medicine is usually beyond the layman’s understanding. Consequently, the buyer has to rely on the doctor’s (who is also the seller) representation of what the buyer needs. “So the seller is agent for the buyer, the seller is rewarded for doing more and punished for doing less, and neither the buyer nor the seller can easily tell the difference between what is really necessary and what is optional.”
The pre-Obamacare system was dysfunctional. I don’t expect Obamacare to be great, but I expect it to be somewhat better than what we had. The political costs of change in this market being what they are; we’ll have to make due with this half a loaf solution the best we can.
“The pre-Obamacare system was dysfunctional. I don’t expect Obamacare to be great, but I expect it to be somewhat better than what we had.”
It is only better for a small percentage of people. Those who were denied care before will now get care. Everyone else will pay, because many who were denied were the serious sick which means a lot of money will be needed for their healthcare. The healthcare companies aren’t going to foot that bill. The CEOs aren’t going to be taking 50% pay cuts. Instead, everyone who pays into a group plan will just pay more because instead of getting their cancer treatment at the state/city/county ran Medicaid hospital, they will get their treatment wherever they want.
I don’t see how adding hundreds of new regulations and levying numerous taxes will be a cure for dysfunction. I would rather have a true, complete socialist healthcare system than what we are going to end up with under Obamacare. Lets make it so all hospitals are government owned and operated. All doctors, nurses, x-ray techs are government employees. Cap wages but provide the typical government benefits. This way we can get rid of the insurance companies and their jobs. We can also limit wages of the doctors, nurses, hospital admins, etc. which will cut costs sharply.
I think the very sick were getting a lot of expensive care on the government dime already. Meanwhile, the least sick were paying insurance premiums, a large chunk of which were getting pocketed by the insurance industry without paying for actual health care. And then, you had low risk uninsured (young) who didn’t try to buy insurance until (for some of them) it was too late.
By expanding the risk pool and squeezing some of the waste out of premiums, things might end up better than before. I’m not sure the new system will work; but the old system is unsustainable.
I tend to see the patient as the widget and less as the customer.
Flower, in the first statement, is that aggregate demand is very inelastic. This is not news to most healthcare economists, except for cosmetic procedures.
The game of the provider is to maximize the revenue by providing well-reimbursed services in the most costly settings i.e. (Cancer Centers of America) and avoid the lowest reimbursed services. that is why St V;s is north and Wishard is stuck in the hood.
There are so many variables in play that it’s hard to isolate the important one. Instead of medical treatments becoming more elegant–direct, simple and effective–solutions, or at least the elements of the solutions, are becoming more complex and expensive. Treatments are coming to the point where the treatment allows (in a number of circumstances) wellness for a year if one gets the $50,000 treatment. Instead of cures, the treatment regimes are moving toward control of symptoms. So the question is: How many $50,000 do you have, or have access to, and do you really want to live under those circumstances? Just what insurance company will fund that or the possibility of that set of conditions?