Singaporean Healthcare in the US

Could Singaporean healthcare, which is privatised but makes Europe look American in terms of efficiency, work in the US?
 
No, Singapore is a small and very homogenous city-state where blanket solution can work. The US is friggin massive and polyglot, so what works in one region mightn't work in another.
 
Do you know how the system works in detail? That's my thought too, but I don't really know the system...
 
Actually looking at it I'd say Singaporean healthcare doesn't seem that that different from the US' current model. It uses both government-offered public care and private medical care and insurance, but the vast majority of it sees to be private with the public side only covering a small portion. Though if we have a member in the community from there they'll obviously have more relevant info.
 
The system is getting problematic. Basically we've got compulsory public insurance but it has limits. It's not quite as bad as the American system but a lot of people are falling through the gaps. People who have chronic medical problems and no private insurance are getting hit the hardest- public insurance is enough to cover emergencies and one off things but essentially if you need have continuing care you need private insurance. Our public healthcare schemes are called Medisave and Medishield and this is how they work.

Here's an example clause: "[Medisave covers up to] $450 per day for daily hospital charges which includes a maximum of $50 for doctor's daily attendance fees". Fine and dandy for most things but if your fees happen to be higher than that you're going to have to top up with your own money. There's also a limit to how much is in your Medisave account (there's a certain base sum the government pays in and another percentage is deducted from your paycheck) and once that's gone it's all on you.

A caveat is that I'm not particularly clear about how the public healthcare system works because I've got comprehensive hospitalisation insurance. When I went in for my operation last Friday I signed one form which would debit a certain sum from my Medisave and another which would claim the bulk of my fees from my insurance. I think one advantage we have over the American system is that personal insurance isn't prohibitively expensive (my premiums are well under $1000/year) so if you're middle class you're ok- you aren't dependent on your employer necessarily.

The problem here, however, is the growing number of working class families supporting an aging population. If you're a factory worker, say, and your mother in law has diabetes there's a limit to what the government is going to give her so you have a lot of families of that sort in trouble since official government policy is that family members should be the first line of responsibility for each other. This might have worked back when people had 5 kids but nowadays it often means a middle aged couple (who may each be only children) shouldering the medical expenses of two sets of parents, themselves and their kids.

Basically in Singapore, if you can pay for it you can get world class treatment- but if your public insurance money runs out and you don't have private insurance you're screwed.
 

Hendryk

Banned
No, Singapore is a small and very homogenous city-state where blanket solution can work.
Flocc has already answered the question--indicating that even if the Singaporean system could be transposed wholesale in the US it wouldn't be all that much of an improvement--but here I'm focusing on your assumption that Singapore is homogeneous. It's not; it's an ethnically and culturally diverse place in which the government has deliberately sought to create a sense of national identity where there wasn't one a mere couple of generations ago.
 
Singapore is 74% Chinese, 13% Malay, 9% Indian (I think Flocc is in this group, a Karelian Christian IIRC) descent with 3% "other". Singapore has been described as the third China, it's the only country where Chinese constitute a majority of the population outside the Chinas themselves.

As for the US, Americans believe things quite passionately. They'd rather have a shit healthcare "system" than lose an iota of liberty by having one "foisted" onto them. While I find this attitude bizzare I can't help but admire their conviction.
 
Singapore is 74% Chinese, 13% Malay, 9% Indian (I think Flocc is in this group, a Karelian Christian IIRC) descent with 3% "other". Singapore has been described as the third China, it's the only country where Chinese constitute a majority of the population outside the Chinas themselves.

The Chinese population isn't homogenous- there's a huge split between the middle and upper middle, English speaking, largely Christian classes and the Mandarin or Dialect speaking, largely Buddhist/Taoist lower middle and working classes.

There's also a massive split between the Singaporean Chinese and the immigrant population of PRC citizens.

I'm from Kerala, not Karelia, btw :D The Indian population is similarly split, again between a middle and upper middle class largely of Tamils, Punjabis, Sindhis and Malayalees and a large working class Tamil population. Again, there's a growing Indian national population- there's been a massive upswing in Indian related events and so forth and the Singaporean Indian middle and upper classes seem to at the moment be actually reconnecting with upper middle class Indian society where they had previously been sort of but not quite socially connected to the Singaporean Chinese upper middle classes. This has actually been happening all over the world as the Indian diaspora reconnects with a growing India- I think my wife and I sort of exemplify this; she being an Indian national and I being third generation Singapore Indian. It should be noted that the Tamil working classes tend to have very few connections back in India and are pretty much left out of this process. There's a population of Indian and Bangladeshi labourers but they're here on contract basis and are largely ignored by the Singaporean Indians.

The Malay population, on the other hand, tends to have a lot of socioeconomic problems- drug use, teen pregnancy, unemployment and so forth. They actually exemplify a lot of the problems with the healthcare system since certain diseases (like diabetes) operate with genetic predispositions and Malays happen to be one of the racial groups most susceptible to this. Thus you have a lot of resentment towards a system that doesn't necessarily provide for sufferers of long term chronic illnesses which disproportionately hit the Malay population- whereas the Indians, for example tend to be prone to heart disease which means we have a tendency to drop dead with a bang- not really much in the way of medical bills- and the Chinese eat healthy and live forever :D
 
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Sorry Flocc, I just checked that thread where I found that little gem out and it was 18 months ago.
 
Sorry Flocc, I just checked that thread where I found that little gem out and it was 18 months ago.

No worries- the stats you quoted were correct but they don't tell the whole story. I thought I'd reveal a bit of the complexity behind the relatively simple-seeming "three races and a few others" breakdown.
 
Australia is like that too, but I get the feeling that vertical bonds of race and culture are stronger for most people than horizontal bonds of class and wealth, especially in adversity.

Except for the mega rich, those pricks stick together no matter what.
 
Plus on the grounds of cultural unity (or lack thereof), there are a large number (1-1.5 million, it varies) of temporary residents (Filipinos, Whites, ML Chinese) who are in S'pore for work. Their health-care is quite different from the local Singapore.

However, I must say that on the whole, (at least from my experience as a white expat) that the S'porean model seems to work quite well. Also on the average, S'poreans are generally better of than the average American, because of a lesser gap between the rich and the poor (at least among the non-immigrants). The aforementioned is from my experience though...
 
Plus on the grounds of cultural unity (or lack thereof), there are a large number (1-1.5 million, it varies) of temporary residents (Filipinos, Whites, ML Chinese) who are in S'pore for work. Their health-care is quite different from the local Singapore.

However, I must say that on the whole, (at least from my experience as a white expat) that the S'porean model seems to work quite well. Also on the average, S'poreans are generally better of than the average American, because of a lesser gap between the rich and the poor (at least among the non-immigrants). The aforementioned is from my experience though...

Things have changed over the last decade or so. There's growing income inequality and the strain is beginning to show. There's a lot of resentment about foreigners here on employment passes, especially those who get Permanent Resident status. The perception is that they get to enjoy most of the benefits of citizenship with few of the responsibilities. One major example is male Singaporean citizens losing out at work due to their annual national service commitments. This is generally not much of an issue for the upper middle classes but for people working on commission, say, or in service industry jobs (callcenters, say) it becomes a huge issue because in many cases employers at this level would rather simply hire a Filipino or a Malaysian who isn't potentially going to be out of the office for Army duty three weeks per year.

As a civil servant I'm securely insulated from these issues but they're a pressing concern for a large demographic.
 
Here's an example clause: "[Medisave covers up to] $450 per day for daily hospital charges which includes a maximum of $50 for doctor's daily attendance fees". Fine and dandy for most things but if your fees happen to be higher than that you're going to have to top up with your own money. There's also a limit to how much is in your Medisave account (there's a certain base sum the government pays in and another percentage is deducted from your paycheck) and once that's gone it's all on you.
Doesn't it make more sense to have people pay for the first 400 and then give insurance for everything above that? That'd be fair, equal, and mostly bearable for everyone.
 
Doesn't it make more sense to have people pay for the first 400 and then give insurance for everything above that? That'd be fair, equal, and mostly bearable for everyone.

See, this is why people are pissed off. With the current system the government hands you a a token sum and then claims "Well we've given you assistance- what are you whining about?"

This is also very much tied up with the class divide since the middle and upper middle classes can afford insurance and so aren't particularly affected. The ruling party is thus being seen as elitist and growing distant from the people- which is problematic since its rule has always depended on garnering the votes of the lower middle and working classes. The upper middle classes tend to have proportionately more swing voters.

Stuff like this is why the ruling party took a massive drop in the polls at the last election- especially after it came out the MPs have a secure pension plan when no one else in the country does. Pensions were eliminated in the 80s in favour of a lump sum fund which is funded by deductions for your paycheck and a government top up- no one knew the government had kept their own pensions.
 
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