There are only two basic elements in managing health care:
1. manage the demand for services
2. reduce the cost of supply

Singapore is using individual contribution to manage demand assuming that individuals will make responsible choices on health care - however not all individuals are capable of making those responsible choices.

Canada works to reduce the cost of supply by promoting walk-in clinics over emergency rooms for minor ailments, requiring a GP referral for specialist access and scheduling expensive equipment on a 24 hour basis (i.e. your lithotriptor appointment may be at 3:00am)and prohibiting prescription drug advertising. However in the face of unconstrained demand, costs continue to rise.

I beleive either model can be reaonably successful. Unfortunately the US seems intent on having both unconstrained demand, and avoiding any requirements that would limit the cost of supply - so it is difficult to see a solution.

I do not disagree with anything in your article, but also consider the following.
Two areas in America where costs are out of control are health care and college. It may be of benefit to look at what these two seemingly unrelated industries have in common. Both require fuel, electricity, food and paychecks to operate. None of this can be imported from cheap factories afar.
These industries, in my opinion, reflect the lost value of the U.S. Dollar. Until the dollar is fixed, all other cost saving measures will see a reduction in quality and service.

Agree with the effect of HSAs as a downward pressure on costs/prices of health care. I have in the past gotten a flu shot in my former tony suburb for $300. This included amin fees and severl other telephone-company-type costs. I was astounded.
Currently, I can go to a drug store for about $20. Last year I used the State Health Department in NM. THat was free. I was incredulous over that as well.
I have an HSA and pay out of pocket and can roll over my savings account. I shop. I price. I ask what the cost will be. Very simple way to save me money.

“If you subsidise it you will get more of it.” Al Gore.

This will be true of College, Health Care or Banking, or sugar or. . . . .

Many comment on healthcare systems assume that healthcare costs would go down if individuals had high out-of-pocket expenses, which would cause the to “shop around” for the lowest prices. Yet, there is little evidence that this is a feasible and successful approach.

Most of us go to one doctor and to any specialists to which our primary physician refers us. We would not be able to assess quality in relation to costs, even if prices were readily available, which they are not now.

Comparisons with other countries can be misleading. And Singapore is one of the few advanced healthcare system that have elements of “individual rsponsibility” and shopping around on price. But you are ignoring that Singapore has a primarily government subsidized and run system, and that the national government pays 80% of basic care (provided by government employees in government clinics. Government also pays catastrophic expenses for costly dideases, such as cancer. It mandates and regulates many aspect of the system, and basically controls many prices.

Here’s some details on how Singapore’s system works:

•There are MANDATORY health savings accounts: “Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions… Only approved categories of medical treatment can be paid for by deducting one’s Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash…”

•”The private healthcare system COMPETES WITH THE PUBLIC healthcare, which helps contain prices in both directions. Private medical insurance is also available.”

•Private healthcare providers are REQUIRED to publish price lists to encourage comparison shopping.

•The government pays for “basic healthcare services… subject to tight expenditure control.” Bottom line: The government pays 80% of “basic public healthcare services.”

•Government plays a big role with contagious disease, and adds some paternalism on top: “Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority.”

•The government provides optional low-cost catatrophic health insurance, plus a safety net “subject to stringent means-testing.”