The Cure That Works--How to Have the World’s Best Healthcare--at a Quarter of the Price
Background of Healthcare Systems
Dr. Sean Flynn talks about how we have created a system in healthcare that is unhealthy for the patients and also the doctors. This system with long lists of patients, excessive hours, and salary issues discourages young professionals that may have qualified if they tried from being doctors. There are things that we can implement in order to improve this thing that we spend 18% of our gross domestic product on every year. If these were enacted we could save 13% of our GDP and use that money previously spent on healthcare on solving pension issues, fixing underfunding Medicaid, infrastructure, etc. This model of 13% less GDP is based on how Singapore budgets its healthcare. I do question whether this system could scale up to a country the size of the United States, but Dr. Flynn claims that this can occur because of its decentralized nature of it. One of the main differences between these two countries’ systems is that the market-based system in Singapore is the payment between you and the doctor versus in the United States third-party transactions take place for payment from insurance companies or the government.
U.S. Healthcare Before 1940
Every hospital had a charity board before 1940 and some people would be treated for free. In the same way, prices were adjusted by small-town doctors because they knew the financial states of their patients. The government then nationalized everything in time of way during 1940 in order to direct things toward the military. The new government price controls, wage controls, and them controlling where good go was discouraging to the population. At this time, free health care was discovered by Kaiser which brings him employees from all over because of this incentive. This created competition and almost everywhere was offering free healthcare. These examples show how decentralized healthcare used to exist in the United States. Now, most are done through insurance billing. Dr. Flynn makes the valid point that this makes the system unresponsive to the needs of their patients because they are not the ones paying the office or hospital. I agree that this discourages a relationship and creates an attitude of nonchalance. However, I don’t see Dr. Flynn's correlation between free healthcare in war times because of frozen wages and how that would apply today. As he mentions, this is partly because of the tax code.
Three M’s
Singapore has an acronym called the 3 M’s that stands for MediSave, MediSheild, and MediFund. This leads to great retirement and saving up for health issues in the future. Here in America health saving isn’t mandatory. While I agree that mandatory health savings would ideally solve a lot of crises in our country, this couldn’t be practically applied in my opinion. Our American attitude of freedom and independence doesn’t line up even with the way that companies like Whole Foods put money into health savings. People get panicked when they don’t have complete and total control of their income.
Seeing Prices in Advance
One aspect of Singapore’s healthcare system that is admirable and part of the reason it is so successful is that it creates a competitive market. Prices are published as well as data on the quality of procedures done. Citizens can now compare and contrast who and where they want medical procedures performed at. Consumers now have a choice when in countries like the U.S. there is no competitive pressure to make things better price or quality-wise. But this choice is necessary when there are no third-party transactions.
The Problem with Free
When things are free to all, demand skyrockets. Dr. Flynn mentions this which leads me to wonder how much these diminishing returns weigh against the benefits. When all is free it changes many dynamics during the choices in life. This is why paying 10% creates a much better system with competitive pressure and cheaper choices. However, they still have a social safety net in Singapore by providing grants when citizens truly cannot afford something they need. This is something America could benefit greatly from, and it would relieve medical stress from many citizens already faced with enough pressures of their own. However, I do wonder if applying a system like this in a country such as the U.S. would only work as well as systems like Medicare and Medicaid do. Practical application on a larger scale is hard to predict if the same outcome will occur. Dr. Flynn kept saying that he had examples of how these Singapore practices would work in the U.S. but never presented any, which leaves me still questioning.