>"Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised."
A socialised healthcare system forces government and the healthcare service to write and maintain policies that consider the health of the nation. Where as a private insurance based service doesn't.
The US opoid crisis is a perfect example of this. Many of those addicts in the US moved on from prescription opoids that they had been prescribed unnecessarily to streets heroin because there was little concern of the wider public health implications. In the UK getting a prescription for addictive strength opoid pain killers has long been near impossible because the healthcare system has to be careful not to create another problem in trying to fix the first one because it's their responsibility to fix it which also means Doctors are not motivated to meet the patients wants (e.g pain free) and only fulfil their healthcare needs. This is why the UK didn't go through the same crisis
So I say that life expectancy is a good measure of healthcare systems because it forces policy makers at all levels to consider the wider impact of public policy on public health.
Again, it's debatable, but as I continued in my comment, even when charitably accepting your premise, your argument loses its strength.
A fully socialized healthcare system is one of many implementations of universal healthcare in the developed world today, and you'll have to find an answer for why the most efficient system in the world is the one that just happens to rely the most on consumer-driven market mechanisms.
Perhaps but then you also have to consider that Singapore is such an outlier that maybe comparing with them is overlooking what universal healthcare system is more likely to really be possible to politically implement.
Chasing that vision of efficency that Singapore shines a light on likely only serves to distract from other universal systems that are more commonly provided that are more realistically achievable.
Singapore is so far off the scale close to Hong Kong that it suggests they have political, social, geographical conditions that can not be replicated.
That’s not what “outlier” means. If every country attempted to implement Singapore’s system, and only Singapore succeeded, then you would be correct that it is an outlier. Instead, other nations settled for different systems and are generally satisfied. There lacks a political will to move out of the local optima.
Singapore’s path to its current system wasn’t by accident. It tried an NHS style system, which failed due to overuse, then tried a US-style system, which failed for obvious reasons, and then settled onto the system it has today.
The US is in the unique position that someone else has tried this model and we have enough data to prove its superiority. There also appears to be enough political will to reform the current system. There’s no point in settling for local optima when we have more than enough information to be able to go all the way...
There’s actually no evidence whatsoever that it “cannot be replicated”, there is little about Singapore, geographically that uniquely lends it to such a system. Suggesting otherwise is just ignoring an inconvenient data point. You’re also conveniently ignoring Switzerland, the Netherlands, and Germany which have a significant degree of privatization in their healthcare systems. Pure socialization isn’t the only way, it’s not even the best way.
So then what are the friction points of the Singaporean healthcare model that prevents other countries from adopting it?
If it were a Bill up for a vote by politicians in the US then what issues would they have with it?
Also comparing healthcare costs of Germany, Netherlands, and Switzerland with the UK from the links I posted earlier clearly shows that socialised healthcare is more efficient.
The per capita cost in Germany ia 32% higher than the UK, Netherlands it is 28% higher, and in Switzerland it is a whopping 88% higher compared to the UK.
Even France and Greece which are more socialist than the UK and both also have national insurance schemes are much better value than their private counterparts.
> So then what are the friction points of the Singaporean healthcare model that prevents other countries from adopting it?
The friction points aren't necessarily with the model itself, the friction is strictly political will. Democracy doesn't always seek out the most objectively superior solution, it simply seeks out the solution that the people want. Strict gun control might be a "superior policy", but that doesn't mean that people in America want that. Similarly, people in Denmark don't really want to change their system, even if there exists a superior system in Singapore.
In contrast, the US is in a unique position in that there is growing political will to change the status quo system, and the Singapore model happens to be one of the few that enjoys bipartisan approval. Also uniquely, the fully socialized single-payer system couldn't even get majority support among the Democratic Party. Indeed, the current nominee was the guy who explicitly campaigned on "the public option" rather than a strictly socialized system.
> If it were a Bill up for a vote by politicians in the US then what issues would they have with it?
The GOP's proposed Fair Care Act[1] happens to make one key change that moves the US closer to parity with Singapore: namely easing the rule that requires one to enroll in a high-deductible plan in order to qualify for an HSA — so that even those on low deductible plans may take advantage of the HSA. The American HSA is similar to the Singaporean Medisave system, which is a pre-tax savings account for healthcare spending only, where the savings are invested in funds. With American HSA's, they are private custodial mutual funds. With Singapore's Medisave, the fund is the Singapore sovereign wealth fund.
The Fair Care Act may get buy-in from the Left if it includes universal catastrophic coverage (analogous to Singapore's Medishield), and also making HSA contributions compulsory, just like Singapore.
Indiana's government offers its employees what is widely considered to be superior health insurance[2], in which the state deposits funds into HSA's equal to the annual deductible. This is very similar to Singapore's Medisave + Medishield system.
Another proposal that enjoys generally bipartisan approval: Medicare Advantage For All. Medicare Part C, or Medicare Advantage, is the part of America's Medicare system that is working best. Medicare Advantage plans have lower costs, broader benefits, and better health outcomes than traditional, single-payer Medicare. Today, almost 40% of Medicare enrollees are in a Medicare Advantage plan, as opposed to traditional "single-payer" Medicare[3].
So the political will is there, and the empirical results are proven by one of the US's very own states (run by the GOP, no less).
> Also comparing healthcare costs of Germany, Netherlands, and Switzerland with the UK from the links I posted earlier clearly shows that socialised healthcare is more efficient.
> The per capita cost in Germany ia 32% higher than the UK, Netherlands it is 28% higher, and in Switzerland it is a whopping 88% higher compared to the UK.\
> Even France and Greece which are more socialist than the UK and both also have national insurance schemes are much better value than their private counterparts.
"Cheaper" != "More efficient". While you're right that the nations that provide "socialized healthcare" can have lower costs per capita — Germany, Netherlands, Switzerland, and Singapore all enjoy higher average life expectancies than Denmark, UK, and Greece. Switzerland & Singapore both enjoy higher average life expectancies than Denmark, UK, Greece, and also France. The goal of these systems is to get the most bang for our buck, not strictly to just spend the least.
This is why Singapore's system shines — it enjoys the lowest per capita spending while enjoying the best health outcomes.
I'll close by saying that Singapore tried the UK's system[4] (listen at 12:35). The US also has a UK-like single-provider healthcare system, the VA — and that's been an abject failure[5]. The fact that this failure was reproduced twice, independently, suggests that UK's success might be the "outlier" (to use your framing). In contrast, we are yet to see a failed attempt at replicating Singapore's system, and thus cannot yet conclude that it is some sort of an anomaly.
A socialised healthcare system forces government and the healthcare service to write and maintain policies that consider the health of the nation. Where as a private insurance based service doesn't.
The US opoid crisis is a perfect example of this. Many of those addicts in the US moved on from prescription opoids that they had been prescribed unnecessarily to streets heroin because there was little concern of the wider public health implications. In the UK getting a prescription for addictive strength opoid pain killers has long been near impossible because the healthcare system has to be careful not to create another problem in trying to fix the first one because it's their responsibility to fix it which also means Doctors are not motivated to meet the patients wants (e.g pain free) and only fulfil their healthcare needs. This is why the UK didn't go through the same crisis
So I say that life expectancy is a good measure of healthcare systems because it forces policy makers at all levels to consider the wider impact of public policy on public health.