Dr. Flynn’s talk introduces a new style of health care that does not involve third party insurance companies or a single-payer system like universal health care systems. Instead, his ideal for health care is based off of Singapore, which relies on encouraging a free market within healthcare and incentivizing people to spend less money while simultaneously incentivizing providers to increase quality while decreasing costs. I think this method of health care would work very well in the United States and would be a welcome departure from our current health care system which is arguably very exploitative and definitely very expensive.
Current Health Care in the United States
The health care system in the United States, as Dr. Flynn explains it, is a third party payer system. Health care companies are not dealing directly with a consumer with regards to cost, so they have little incentive to provide the best care beyond a moral obligation. Additionally, costs are not expressly shown, but rather negotiated after a procedure. This means that customers often do not know what price they will be paying when they receive health care. Overall, the United States health care system has driven prices up and quality down, leading health metrics such as infant mortality rate to lag behind those of other countries. Particularly in systems where health care is entirely covered, like Medicare, patients have no preference about the cost of a procedure and often simply go to the nearest location. This unnecessarily drives up costs. Meanwhile, in the case of voluntary procedures, prices are listed in advance, quality improves, and cost decreases. Dr. Flynn argues that by adjusting the rest of the United States health care to be more like the way voluntary procedures (which are not covered by insurance) are operated and more like the way Singapore operates, the United States would drastically decrease the amount of money spent on health care.
Health Care in Singapore
In Singapore, the health care system is run as essentially a free market. People pay for their own health care, so they are incentivized to shop around for higher quality and lower prices based on their priorities. The primary issue this has the potential to create is that some may not be able to afford health care for a variety of reasons, but Singapore addresses this issue very well. They require health savings for every working person because, as Dr. Flynn points out, people are often very bad at planning ahead with the average American only being prepared to pay for an unexpected cost of about $400. This means that often, people are able to pay for their own health care, especially at the drastically lower prices in Singapore. However, sometimes emergency may lead to people being unable to pay for the entirety of their medical expenses. The example Dr. Flynn uses is of a child developing a form of cancer with very expensive treatment. To solve this problem, Singapore has a grant system that allows people to apply for help with health care expenses if they cannot afford them. Through these mechanisms, less than 5% of the Singapore GDP is spent on health care (as opposed to almost 20% in the United States).
Problems with United States Implementation
The first of my concerns with implementation in the United States is also addressed by Dr. Flynn: Americans would likely see forced health care savings as an additional tax. While Dr. Flynn describes this as a barrier to implementation, I see it as a slippery slope towards lack of financial freedom. It is true that people are bad at saving money, but the solution to that problem, in my opinion, is not forcing them to spend their money in a particular way. I worry about what the next essential that people are required to save for may be. In my opinion, this means that the Singapore health care system would not be as effective in the United States, but it doesn’t take away the lessons we can learn from Singapore in order to improve our health care system. The second concern is that an expensive procedure may not be impossible to obtain in Singapore, but it can certainly drastically impact your socio-economic status and quality of life. If an upper middle class family in Singapore has a child requiring the expensive medical care described by Dr. Flynn, they may be able to afford most of it, and it is certainly a good thing that the child won’t be left to die if they cannot afford all of it, but they are also at risk to spend the majority of their money and find themselves in poverty because of this devastating health event. I believe a middle ground may be the best implementation for the United States that addresses these issues while keeping the integrity of Singapore’s system.
A Possible Compromise
Dr. Flynn talks a lot about the Whole Foods employee insurance plan which was similarly used by Indiana for Medicare. I believe I am in agreement with Dr. Flynn in saying that this is the most beneficial way Singapore’s system can be applied in the United States. This is something of a compromise between the Singapore system and the universal health care systems in which there is a flat deductible rate that a person must pay themselves, and then after that amount health care is entirely covered. It was shown by Whole Foods and in Indiana that this leads individuals to spend about 35% less on health care and incentivizes people to “shop around” for good deals. In the case of Whole Foods and Indiana’s Medicare system, people were given a certain amount of money each year to pay for health care, and anything they didn’t spend was theirs to keep. This type of system allows room for debate on whether people should have different deductible amounts based on their income or whether people will be given money to cover their deductible, and I am not entirely sure where I fall on these details. However, I do believe this solves both problems I have because it does not force large savings for health care onto the American population, and more key, it means there is no potential that an expensive health event will drastically change your quality of life.