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Healthcare: Look anywhere you like for answers, just not the US

America’s healthcare Clusterf**k offers no solutions

The Singapore solution

But Delong wasn't actually the person who thought that up. He may have done so independently but someone (or something) certainly got there before him. Singapore did in fact: they seem to be the only people (possibly because they came to it later than everyone else, for the reason of being very poor immediately post WWII) who actually have sat down and pondered it all.

X per cent of wages (and an allocation if you are unemployed) goes into a medical savings account. Anything you don't spend gets added to your pension savings when you retire (to give a decent incentive both to save but also to spend enough of it to reach pension age).

Serious illness entirely paid for by government. The producers can be anything - for profit, state owned, charitable, whatever: although as it happens most of them are state owned and run, but they are also competing with each other.

The outcome? Well, the outcome is interesting. Healthcare in Singapore is certainly as equitable as it is under the NHS. The out turn in ages achieved are similar, and it does slightly better, from memory, in mortality amenable to healthcare (thus taking out population differences etc).

It also has great efficacy: you don't hear tales of people waiting three months for elective surgery.

And finally, it is gloriously efficient. Depends who's counting and exactly how, but the US spends some 18 per cent of GDP on healthcare, the UK 8 per cent (NHS only) or 11 per cent (total) and Singapore 4.5 per cent for the same equity as the NHS, offering vastly greater equity than the US, pretty much the same treatment outcomes for those who actually get treatment (if not a little better than the NHS) with vastly less money spent.

The end result of all of this is that to have the best healthcare system we can, one that balances our desires for efficacy, equity and efficiency, we do actually need a mixture of both government and markets. But the government necessity seems to come in on the paying-for-stuff side, not the actual provision, as the NHS does. And the paying-of-it side, not private insurance, as the US does.

Over on the provision side we want patients to be exposed to prices on routine care, so that they do indeed buck up providers, but not on extreme or emergency care.

Everyone's right you know, we really do need to have both government and markets. It's just that it would be useful to sit down and think about which we need where and when.

Then we too in Blighty could have healthcare better than the NHS at half the price, the US could have it as good as they do for everyone, instead of just the majority, at a quarter of the price. The power of thinking about things, eh? ®

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