Matt Yglesias published a really good article yesterday, What Do Conservatives Like About Health Care in Singapore? He’s confused, you see, because he actually knows something about the Singapore healthcare system. And based upon that, conservatives ought to hate it because it is a far more intrusive and “socialistic” system than Obamacare. In fact, like almost all countries outside the third world, Singapore has a healthcare system that liberals would gladly exchange Obamacare for.
This is nothing new. Conservatives are always talking about some other country’s healthcare system. It doesn’t matter what it is. Back in February, Aaron Carroll wrote, I Don’t Think the Swiss Health Care System Is What They Think it Is. That was about how the conservative healthcare wonks (such as they are) were all excited about Switzerland. For example, Douglas Holtz-Eakin and Avik Roy wrote, “While most Americans view their healthcare system as ‘free-market,’ Switzerland actually has the most market-oriented healthcare system in the West.” But alas, no. So I guess the next in line is Singapore.
All this is grasping at straws. As I’ve noted before, the Republicans really screwed up when they decided that their very own healthcare reform idea was too liberal. For some, I’m sure this is a good faith effort to find a way out of the corner they’ve painted themselves into. But mostly, it is just yet more cover. “We hate Obamacare. Let’s repeal it and then we’ll get that Swiss system. Or Singaporean. Or…” The weird thing about it is that they really think if they ignore our country’s healthcare problems long enough they will just go away. Eventually they are are going to have to face the problem, but in the meantime people are dying.
In the case of Singapore, the confusion seems to be that conservatives think that it is based upon Health Savings Accounts (HSA). These are the Holy Grail of conservative healthcare reform. The idea is that an individual buys a catastrophic insurance policy with, say, a $2,000 deductible. Then they put money in a special non-taxed savings account for a total of $2,000 per year. Then they pay for their medical treatment out of the account up to the deductible. If they don’t meet the deductible, they get to keep what is left over in the account. Thus, people won’t just run to the doctor, because they have an incentive. It really is the ultimate libertarian policy: perfect in theory, useless in practice.
Well, it turns out that part of Singapore’s healthcare system is called “Medisave, a compulsory individual medical savings account scheme.” But it isn’t really an HSA. It is more like Social Security, “Singaporeans and their employers contribute a part of the monthly wages into the account to save up for their future medical needs.” Yglesias explains, “As best I can tell, these Medisave accounts are deposited into the Central Provident Fund, a government-run investment pool, rather than constituting private savings as we would understand them.” Aaron Carroll sums it all up nicely:
What this means is conservatives will continue to call for anything but. They are willing to consider any healthcare system, as long as it absolutely positively cannot be done here. So even if Singapore had the perfect libertarian Holy Grail of healthcare, it would be abandoned as soon it became an actual bill in Congress. Conservatives only want perfection and that only exists in their minds. From a practical standpoint, that means they want to do nothing. Everything else is bloviating.