Based on the lecture “The Cure That Works--How to Have the World's Best Healthcare--at a Quarter of the Price” by Dr. Sean Masaki Flynn. (https://video.okstate.edu/media/1_i7w9ngz8)
How Can We Fix the U.S. Healthcare System?
How the United States Could Learn from Singapore’s Healthcare Model
After watching Dr. Sean Masaki Flynn’s lecture “The Cure That Works--How to Have the World's Best Healthcare--at a Quarter of the Price,” I learned a lot about the healthcare system. The United States healthcare system is among the most expensive but has nowhere near the best outcomes. Singapore has high-quality health care but charges a much lower cost. By adopting some elements of Singapore’s system, the U.S. could achieve more affordable and efficient healthcare without sacrificing quality. Before this lecture, I would say I was pretty ignorant of the structure of other countries’ healthcare systems. I feel much more educated but also much more concerned about the United States System.
What Brought the United States Healthcare System to Where It Is Today
Flynn spoke a little about how the healthcare system got to where it is today. In the early 20th century, U.S. healthcare was much more private, with doctors charging patients directly. During World War II, wage controls prevented employers who needed workers from raising salaries as incentives, so they offered health insurance as a job benefit. This is how the U.S. employer-based insurance system, which still dominates today, was created. It is called the 3rd party payer system. In the 1960s, Medicare and Medicaid, which are government programs created to provide healthcare for struggling individuals, were instated throughout the U.S. While these programs provided some help, they also drove healthcare costs up, as they incentivized providers to charge more. Over time, insurance companies have grown in power, and healthcare has become tied to employment. Market forces dictate prices in the U.S. We continue to struggle with inefficiencies, high prices, and unequal access to care.
Medicaid Patients Have Worse Health Outcomes
A fact that I was really shocked and saddened to hear is that Medicaid patients are even more likely to die than those who are uninsured. I looked into it more after finishing the lecture, and there are many factors that cause this. And while it is not true for every case, it is still very concerning. Many people who qualify for Medicaid are from low-income populations, which often see higher rates of illnesses like diabetes, heart disease, and obesity. Medicaid covers many individuals who are already sick or disabled when they enroll, meaning their overall mortality rates are higher. Medicaid pay rates for doctors are lower than private insurance or Medicare, leading many high-quality doctors and specialists to reject Medicaid patients or limit their availability. This leads to longer wait times for treatment at better hospitals and reliance on lower-quality hospitals that may not provide the best care. Many Medicaid beneficiaries struggle with transportation issues, appointment scheduling, and a lack of healthcare literacy, leading to issues with their treatment. Since Medicaid patients often rely on overcrowded public hospitals, their follow-up care can be inconsistent. After looking into this issue, a lot of information for this argument is more complex than just higher death rates, but it is still a matter to consider.
Singapore- Health Savings Accounts
Now, to look at how the U.S. could learn a lot from Singapore, there are a handful of factors that would improve our system. One of Singapore’s most important strategies they instate is mandatory health savings accounts (HSAs) through the MediSave program. Flynn spoke a lot about the three M’s of Singapore’s system. In this method, individuals and employers contribute a portion of wages to personal medical savings accounts, ensuring people have funds set aside for healthcare expenses. The U.S. could do something like this, requiring the contribution into a savings account while offering subsidies for low-income individuals. This would encourage personal responsibility and reduce reliance on expensive insurance plans. Many U.S. citizens do not save for healthcare emergencies since many cannot afford to.
Price Menus
Another thing that I found very interesting from the lecture is how Singapore offers “pricing menus” for healthcare services. The country emphasizes price transparency and cost control. Since their hospitals are mostly publicly owned, there is a lot of competition within the market. Hospitals and clinics post their prices publicly, allowing consumers to compare prices and make decisions about their care. The U.S. does not show its prices before care, and that often leads to unknown charges to consumers down the line.
Public Vs. Private Companies
A tiered healthcare system, meaning both private and public hospital care, allows Singaporeans to choose between options. Government subsidies ensure that essential services are affordable, but individuals can pay more for private care if they want to, leaving the power in the consumer's hands. The U.S. could improve its public healthcare offerings while maintaining private insurance options, creating a balance between accessibility and freedom of choice. Since the U.S. is all about freedom, I would hope that this freedom of choice would be well accepted.
How Whole Foods And The State Of Indiana Run Their Insurance Policy
Flynn showed that Singaporean systems could work in the United States by giving instances of examples that already implement similar structures. He provided the example of Whole Foods offering a unique health insurance policy for its employees, emphasizing personal responsibility and more preventive care. The company's healthcare approach was designed with its broader corporate philosophy of promoting healthy lifestyles and cost-conscious consumer choices. One of the key features of Whole Foods' healthcare policy was its highly-deductible health insurance plans along with HSAs. Under this system, employees were motivated to save money in tax-advantaged accounts to cover medical expenses, much like Singapore’s MediSave system. Whole Foods would contribute to these HSAs, giving employees support for medical needs while lowering premiums. The company encouraged healthy lifestyles by offering discounts on health-related expenses, like gym memberships and wellness programs. The other example Flynn brought up was Indiana's healthcare policy. It is a blend of public programs, legislative initiatives, and reforms to enhance the accessibility, affordability, and quality of healthcare for the residents of the state. The state offers several health coverage options through the Family and Social Services Administration to support vulnerable populations. Eligibility for these programs is determined based on factors such as income, age, disability status, and family size. Each program is tailored to meet the specific medical needs of its target population, ensuring that essential health services are accessible to those in need. I wish more states would take after Indiana.
Conclusion
I really enjoyed the lecture by Dr. Sean Masaki Flynn. I had absolutely zero knowledge of Singapore’s amazing healthcare system beforehand. By integrating these principles, the U.S. could create a healthcare system that is more sustainable, affordable, effective, and overall better care at a lower cost for all Americans. I also liked learning that if the U.S. could adopt this system and take GDP spending on healthcare from 18% to closer to 5%, that 13% could go into funding other issues important to Americans, benefiting all citizens.