It hasn't been a good year for proponents of the US healthcare system.

In the past, when people asked tough questions about the state of privatised care, and the problems people have with their insurance companies - the industry would simply publish a few scarey stories about Canadians having to go to the US for treatment.

But the old tactics aren't as effective these days, since, thanks to the internet, Americans are able to compare stories from actual Canadians with the material the industry puts out. And guess what? Most Candadians love their system, and wouldn't trade it for all the executives in New York.

The movie Sicko didn't help matters. Now, even citizens who are insured feel insecure.

But appologists for America's corporate healthcare system have found a new template to "prove" private insurance can work! Behold: The bastion of healthcare capitalism: Singapore!

According the consulting firm Watson Wyatt Worldwide:

Singapore is generally acknowledged as having one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes. This is quite an achievement compared to most other developed countries.

... snip ...

The key to Singapore’s efficient health care system is the emphasis on the individual to assume responsibility towards their own health and, importantly, their own health expenditure. The result is a system that is predominantly funded by private rather than public expenditure.

They even have this handy-dandy chart to illustrate the point:

So, you see, private insurance can work... if only we give customers more choice and just trust the free market to bring down costs.

Huzzah! Fire up the PR machines!!!

What the article failes to do is provide details about Singapore's system for an objective analysis. Thankfully, I found one via the blog Economist's View.

According to the National Center For Policy Analysis - Singapore is hardly an example of free-market ideology. First, the system is mandatory.*

Second, it is subsidized heavily because the poor still can't afford the lower rates:

In 1992 the total amount of subsidized care in Singapore was approximately S$360 million, equivalent to 19 percent of the total health care expenditure, or 0.7 percent of GDP.

And third, most of the hospital care is through state facilities:

Eighty percent of hospital care is delivered in public facilities, and 75 percent of ambulatory service is provided by private practitioners. Twenty-six government-run clinics provide outpatient treatment, health screening, immunizations, diagnostic testing and pharmacy services for those who use the less-expensive public sector.

The Singapore system is a mixed system where the government covers the most expensive costs within its hospital system, and private coporations handle apsects where money can be made. (Otherwise known as the "Socialisation of risk, privatisation of profit.") The reason costs are held down isn't just because of the privatised elements, but a healthy dose of government regulation:

Singapore has a well-defined health care policy. The state actively manages all aspects of the medical system, from physician supply and education to price setting and service criteria. Such aggressive government intervention in the marketplace, which would probably be unacceptable to most Americans, is at least as important to the success of the Singapore system as is the individual savings mechanism.

In other words, Singapore's healthcare system looks more like a Medicare plan than a free-market system.

People who look to Singapore as a model for healthcare reform need to read up on the details. While it is true Singaporeians pay less for quality care, so do many things if you restructure the industry in a way that doesn't require the generation of profits.

Read counterpoint here.

Tags: healthcare, Singapore, Clinton, health insurance

* Note: In this respect, it is similar to Similar to Senator Clintn's recent health care proposal - only without subsidies and government controls on costs.