is routinely ranked as having one of the best healthcare system in the world (WHO 2000 study Singapore ranked 6th, U.S. was ranked 37th). It's universal healthcare
The cost of providing world best medical care for everyone in Singapore, costs per person what Americans spend on administration alone - not doctors, drugs, surgeries or real health care - just what Americans spend on managers and secretaries. And yet, for this price, they get one of the best healthcare systems in the world in return. Amazing. Economists love it, here's some excerpts from The Undercover Economist -
The United States relies upon private health insurance to provide much of the financing for medical costs. This is unusual: in Britain, Canada, and Spain, for example, health-care costs are largely paid for by the government. In Austria, Belgium, France, Germany, and the Netherlands, medical costs are paid for by a system of "social insurance": it is compulsory for most people to buy insurance, but insurance premiums are tied by law to income rather than to the risk of a claim.
The United States system makes it voluntary to buy insurance, and premiums are linked to risk, not to income. But these market-based premiums, beloved of many Americans, do not seem to be delivering health care that makes them happy. A recent survey revealed that only 17 percent of respondents in the United States were content with the health-care system and thought no substantial reforms were necessary. Why the discontent?
The superficial reasons are simple enough to describe: the system is hugely expensive, very
bureaucratic, and extremely patchy. The expense first: US health cares costs a third more, per person,
than that of the closest rival, super-rich Switzerland, and twice what many European countries spend.
The United States government alone spends more per person than the combination of public and private
expenditure in Britain, despite the fact that the British government provides free health care for all
residents, while the American government spending program covers only the elderly (Medicare) and
some of the marginalized (Medicaid). Most Americans worry about health-care costs and would be
stunned to discovered that the British government spends less per person than the American
government but still manages to provide free health care for everyone. In fact, if you figure in the costs of
providing health insurance to government employees and providing tax breaks to encourage private
health care, the US government spending on health care, per person, is the highest in the world.
Bureaucracy next. Researchers at the Harvard Medical School found that the administrative costs of the
US system, public and private, exceed $1,000 per persons. In other words, when you count all the taxes,
premiums, and out-of-pocket expenses, the typical American spends as much on doctor's receptionists
and the like as citizens of Singapore and the Czech Republic spend on their entire medical care. Both
places are countries with health outcomes very similar to those in the United States: life expectancy and
“healthy life” expectancy (a statistic that distinguishes a long healthy life and a long life plagued by years
of severe disability) are a shade lower in the Czech Republic than in the United States; and in Singapore
they are a little higher than in the United States. The costs of US bureaucracy is also more than three
times the $307 cost per person for the administration of the Canadian health system, which produces
noticeably superior health outcomes.
Then there is the patchy coverage of the system. Health insurance is usually packaged together with a
job, which reduces the efficiency of the labour market; workers are hesitant to quit their jobs without
lining another job up first for fear of being uninsured. Worse, 15 percent of citizens have no insurance
coverage of any kind – which should be a stunning statistic for the world's richest economy, but probably
isn't because it has been lamented for so many years. Compare it to Germany, where 0.2 percent of the
population has no coverage, or to Canada or Britain, where everyone is provided for by the government.
Given what we have learned from George Akerlof and his lemons, the troubles of the US health-care
system should be no surprise. We should expect a voluntary private insurance system to be patchy. A
few people who have more pressing costs than health insurance (for example, the young poor, who have
little money and rightly expect that they are unlikely to become seriously ill) will drop out of the system.
As a result, health insurance companies, needing to cover their costs, will raise the premiums for the
average client, driving out more and more people. Unlike the very stark lemons model, the market does
not completely collapse; this is partly because many people find that the risks of having to pay for
medical treatment are so worrying that they're willing to pay substantially more than an actuarially fair
premium. As a result, the process of unravelling stops, but not before many people have been excluded
from the system.
Thanks to Spence and Stiglitz, we should also expect insurance companies to devise ways to get
around this lemons problem, but that although the solutions may be effective they will probably also be
wasteful. The huge bureaucratic burden of the US system is one of the results, as insurance companies
struggle to monitor the risks, behaviour and expenses of their customers. The clunky linkage of health
insurance with jobs is another result: at first sight, there is no reason why a job should come with health
insurance, any more than it should come with a house or free food. Employees are frequently forced to
buy the health insurance that is packaged with their job. This packaging compels the healthiest members
of society to buy insurance packages and so come cheap: health-care plans are not chosen by their
beneficiaries, who would aim to get the ideal coverage for the right price, but by human resource
managers with other priorities, such as making their own lives easy with a “one-size-fits-all” bulk
purchases. The result is likely to further wasteful spending.
Not every drawback of the US health-care system should be blamed on Akerlof's lemons problem. Even
without the difficulty of inside information, the system of insurance is problematic, because patients are not always able to choose their treatment. With the insurance company picking up the bill, choosing the
appropriate treatment is always going to be something of a matter of negotiation. When you ask
somebody else to pay for your health care, don't be surprised if you don't get exactly what you would
have chosen yourself