Why the US doing such a poor job at healthcare
Growing up my dad had two rules for my siblings and my career choices: dont do something where people shoot at you, and dont go into medicine. The first one is for rather obvious, but the second, not so much. My dad is a private practice gastroenterologist in Tulsa. He always takes the time to note how much the government screws him over, and how it is only getting worse. I used to just think he was complaining about the government like the good republican he his, but I began to understand his complaints when I worked at a bank in their healthcare lending division this summer. I got to see the actual reimbursement rates, restrictions, and directions that Medicare and other government programs established. I was able to see that doctors were actually putting in more hours and effort for less pay than they had around 1999 not accounting for inflation. This is certainly anecdotal evidence to this problem, but it stands to reason that the increased government influence in medicine has led to less efficiency, and satisfaction for both patients and doctors. I believe the speaker did a great job explaining how this can be remedied by the use of free market mechanisms as in Singapore. The two things that I want to reflect on is the brilliance of forced savings, and the instance on including free market tools in any government policy.
Forced to make good decisions
People are great at managing money until you actually ask them to do it. Many people understand that they must live below their means and save for the future. No-one can work forever so you have to plan ahead. Unsurprisingly though, as mentioned in the talk, a huge majority of people across many different economic classes are living paycheck to paycheck and dont have the necessary funds for a small emergency. It seems to be an unwritten law, that there will always be something more urgent to spend ones money on instead of save. This is the brilliance of the plan implemented in Singapore. They aren’t asking you if you have the capacity to save. There is no discussion of whether you have the room to save money in your budget. They simply mandate savings. *Although this seems like a huge amount of government overstep, It seems to be the best alternative as long as you believe that hospitals should be required to help everyone that comes in their doors. If hospitals are going to be required to take in people that cannon pay, it results in the government stepping in. So yes, although there is a significant amount of government action in this plan, it doing a good job of ensuring that there is the majority of the freedom to the individual.* Instead of the government just paying for things whenever, you are actually using your tangible savings. As of now, in America it feels like there is no affect on you. All costs just come out of some large unnamed government account. I think this gives it more ownership and free market pricing incentives than the government covering the bill like social security.
Always have skin in the game
Continuing on the theme of free market incentives, I loved the way Singapore always makes sure you have skin in the game. Even in their insurance policies and social safety nets, they make sure you are choosing wisely when it comes to cost of treatment. I thought it was remarkable the difference this can make. The example of going to the ER or urgent care when there is a difference of eight thousand dollars worth of price difference illustrates how much that choice can be worth to a health payout system. That seems to be the biggest issue in Americas system now. We haven’t insisted that the person on the hook for the decisions that they make, if even partially. However, the system implemented by Whole Foods was a really exciting reintroduction to these types of ideas in America. It showed how not only do people make better health cost decisions, but they also save the issuing company a huge percentage on the cost of covering their employees. With healthcare being such a remarkably large percentage of GDP, I believe that free market concepts and responsibilities must be added back. I agree whole heartily with the speaker that not only should we be looking for ways to follow Singapores example at the public level, but also in private enterprise. So that in the future, perhaps I will be recommending my kids to go back into medicine where the government is the one driving inefficiency.