Singapore health care; what’s not to like?

Here’s Matt Yglesias describing the Singapore health care system:

“” “The first tier of protection is provided by heavy Government subsidies of up to 80% of the total bill in acute public hospital wards, which all Singaporeans can access.”

“” “The second tier of protection is provided by Medisave, a compulsory individual medical savings account scheme … Singaporeans and their employers contribute a part of the monthly wages into the account to save up for their future medical needs.”

“” As best I can tell, these Medisave accounts are deposited into the Central Provident Fund, a government-run investment pool, rather than constituting private savings as we would understand them.

“” “The third level of protection is provided by MediShield, a low cost catastrophic medical insurance scheme” supplemented if like by private insurance called Integrated Shield plans and “Singaporeans must subscribe to the basic MediShield product before they can purchase the add-on private Integrated Shield Plans.”

“” “Finally, Medifund is a medical endowment fund set up by the Government to act as the ultimate safety net for needy Singaporean patients who cannot afford to pay their medical bills despite heavy subsidies, Medisave and MediShield.”

None of this sounds to me like anything American conservatives favor.

Compared to America’s health care system, this sounds like utopia.  Let’s take them one at a time:

Tier 1:  The big problem in health care in America is inefficiency.  Part of that has to do with deciding what health care to provide, and what not to provide.  But everyone seems to agree that when people get into traffic accidents they need to be patched up.  Even the uninsured are often helped in ERs.  So “acute care” seems a no brainer.  I gather that Singapore provides this service at very low cost.  Their government spends only 1% or 2% of GDP on health care.  Conservatives love that.

Tier 2:  Medical savings accounts are loved by conservatives, because they put the market to work.  Most of my health care expenditures have been a complete waste, but I made them because I was on OPM.  I mean I was using Other People’s Money.  In Singapore I would have saved that money.  I wouldn’t care if they put my savings into a Sovereign Wealth Fund, as I have lots of other funds I can gamble with.  And there is the EMH.

Tier 3:  Conservatives love catastrophic health insurance.  Indeed we believe non-catastrophic health “insurance” is an oxymoron.  It’s prepaid health care.  Would you buy auto insurance for an oil change or tune up or new tires?  Then why buy insurance for things like maternity care?  Is having a kid a “disaster” that has to be insured against?” If you think so, you shouldn’t be a parent.

Tier 4:  Some conservatives oppose any form of redistribution.  But I love the fact that after the Singapore government has set up a streamlined health care system with the right incentives, they can take care of the truly needy at a trivial cost.  In America our government spends a massive amount on health care, and for all that money we still have 45 million uninsured.  For any pragmatic utilitarian conservative, the Singapore system is so much better than the American system it’s ridiculous.

BTW, they live longer than we do, and also longer than Europeans, although health care probably has little or no impact on life expectancy, at least at the margin.

PS.  Many conservatives undoubtedly disagree with me, and would hate the Singapore system.  There are actually conservatives who defend our system of “private” health insurance, even though it is nearly as statist as the Soviet economy circa 1980.  I’m not fooled, America has no truly free market sector for health care, although plastic surgery comes close.  So if we can’t have freedom, let’s at least have efficiency.


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38 Responses to “Singapore health care; what’s not to like?”

  1. Gravatar of jknarr jknarr
    24. October 2013 at 06:17

    Government funding medicine is inversely proportional to government funding its military. You can have a NHS or a capable military, but not both. The UK as prime budgetary example.

    Also, it might work best to have a free competitive market in medical services. Now, we have insane prices set by oligopolies and government participation (in clear violation of the Sherman Act btw.)

    Normal prices, normal payment, normal market example: http://www.surgerycenterok.com/

  2. Gravatar of F. Lynx Pardinus F. Lynx Pardinus
    24. October 2013 at 06:29

    @jknarr I don’t understand your point–the UK has the 4th-largest defence budget, behind the US, China, and Russia. Are you arguing that the NHS is underfunded as a result?

  3. Gravatar of Matt McOsker Matt McOsker
    24. October 2013 at 06:31

    This sounds like the exact type of universal system conservatives would favor, and liberals hate any type of MSA/catastrophic system.

    I have never thought of universal insurance as unaffordable. The money is not the issue, but the supply and efficiency. If health expenses grow “too” much then NGDP goes up and your ratios never get that out of whack.

    Look at all the urgent care centers that have pooped up in recent years to offset expensive emergency room visits, and those centers supply “hours” that are convenient. The market does have a place.

    IMO I would love to adopt the Singapore model and provide a universal plan.

  4. Gravatar of Benoit Essiambre Benoit Essiambre
    24. October 2013 at 06:43

    It always weirds me out when you call yourself a conservative because I consider myself staunchly liberal and agree with 99% of what I read here. I am also under the impression that most of the liberals I know would be more in agreement with this blog than conservatives who see any kind of money creation as a big government move equal to stealing their money through inflation.

    At least if both liberals and conservatives can identify with this blog it means there is still hope in the pursuit of sensible monetary systems around the world.

  5. Gravatar of Wonks Anonymous Wonks Anonymous
    24. October 2013 at 06:47

    Scott usually calls himself a “right-wing liberal”.

  6. Gravatar of W. Peden W. Peden
    24. October 2013 at 06:59

    “I’ve often heard conservatives and libertarians praise Singapore as, broadly speaking, a model of health care policy that they embrace. Words like “free market” often get thrown around in this context.”

    I’d be interested if Matt could give a single example of someone who (a) says they like the Singapore system and (b) say that it’s a totally free-market system. Until he does that, given I know no-one who answers to that description, he’s just arguing against a strawman.

    Even someone like Herman Cain, when championing the Chilean system, never said “The Chileans have a free market system”. If Cain wasn’t so silly, I doubt that any other US conservatives or libertarians were so silly.

  7. Gravatar of Morgan Warstler Morgan Warstler
    24. October 2013 at 07:08

    What is weird is the Matty so grossly misunderstands cons.

    Speaking of which, the way for cons to modify Obamacare, and have it turn out exactly like SIngapore:

    http://www.morganwarstler.com/post/64032782980/there-is-no-reason-for-conflict-in-modern-gop-1

  8. Gravatar of ssumner ssumner
    24. October 2013 at 07:09

    Benoit, Wonks is right that I consider myself a right wing liberal. It’s liberals like Krugman that define classical liberals like me (or Tyler Cowen) as conservatives. That’s how I’m viewed by most liberals. But you are right, I’m not actually a conservative, and didn’t call myself one in this post. (I implied it, but only because people like myself and Cowen were some of the bloggers Yglesias was probably referring to. So it wasn’t misleading)

  9. Gravatar of sam sam
    24. October 2013 at 07:10

    The Singaporean system works because Singapore is full of Singaporeans.

    A system with some redistribution and government-funded catastrophic coverage will work just fine in Singapore, because most people compulsively save money and few people are making bad life decisions.

    Singapore has an illegitimacy rate of less than 4%, and a savings rate of almost 40%.

    The United States has a savings rate of less than 4%, and an illegitimacy rate of almost 40%.

    In Singapore, no matter how generous the system may be, few people will have recourse to it and it will remain solvent.

    In the United States, no matter how stingy the system may be, so many people will have recourse to it that it will bankrupt the nation.

    Quod licet Singapore non licet bovi.

  10. Gravatar of TravisV TravisV
    24. October 2013 at 07:13

    AMAZING graphs!! 🙂

    Richard Koo: I Can’t Find Anyone To Refute My Argument That America Is In A ‘QE Trap’

    Read more: http://www.businessinsider.com/koo-says-no-one-can-refute-the-qe-trap-2013-10#ixzz2ieXE37Ux

  11. Gravatar of TravisV TravisV
    24. October 2013 at 07:15

    Morgan,

    What did you think of this ambitious post from Yglesias?

    http://www.slate.com/blogs/moneybox/2013/10/23/how_to_fix_everything.html

    Which of his proposals do you dislike the most?

  12. Gravatar of Matt R. Matt R.
    24. October 2013 at 07:18

    Laser eye surgery is close to a free market as well. I know that prices have actually fallen for laser eye surgery over time and I wouldn’t be surprised if the same is true for plastic surgery. I don’t think that is a coincidence.

  13. Gravatar of benjamin cole benjamin cole
    24. October 2013 at 07:32

    “Conservatives” and the GOP support a huge, Soviet-style federal health program for 22 million Americans. It is called the VA.
    Not just public funding, but federalized doctors, nurses, administrators, facilities. In fact, the VA is communism in action.
    Never heard anyone say the VA should be eliminated and vets given vouchers…
    Funny how ideology conveniently evaporates…

  14. Gravatar of jknarr jknarr
    24. October 2013 at 07:37

    FLP — I’m saying that all governments have budget constraints, and choices have to be made. Take a look. The UK has some fantastic data. Medical and defense spending are some 75% r-square negatively associated since NHS came on-line.

    (I’d suggest that you may be misled by absolute spending levels. Versus GDP could be helpful for you.)

    Clearly, when the government takes on the fiscal responsibility over people’s bodies, sacrifices have to be made. Let alone the fact that the NHS is a dump, and that anybody with any means immediately runs to private doctors.

    Time and again, citizenry are bamboozled into thinking that “Oh, socialized health care will be the same, just with different people paying.” No. The level of service changes, apparently drastically.

    But, not to worry, we’ve seen it before. It’s just another recessional of a world power: internal imperialism replaces external imperialism.

    http://www.ukpublicspending.co.uk/spending_chart_1950_2015UKp_13c1li001mcn_10t30t

    Obamacare is a Rube Goldberg machine that is not designed to last, but to be replaced by USNHS. Government medicine distorts markets and produces bad outcomes? Give them more market-distorting power, of course! Priceless.

  15. Gravatar of Patrick R. Sullivan Patrick R. Sullivan
    24. October 2013 at 08:32

    ‘ I mean I was using Other People’s Money. ‘

    Until your premiums get raised, that is.

    But, if we went the Singapore way would we have to accept the canings too?

  16. Gravatar of mbka mbka
    24. October 2013 at 08:34

    Well according to the Singapore Ministry of Health website that Matt copied his text from verbatim, Singapore spends 4% of national income on health care. And that low number is in part due to the fact that Singapore was until now a very young country that kept on importing a lot of very young people, keeping dependency ratios low – and health goes with demographics.

    I have the usual problem with these kinds of comparisons. The underlying assumption is always that one could somehow adopt that part of a policy that one likes while everything else stays the same. But it isn’t the same. The country isn’t the same, the culture, the history, the politics, the demographics, the expectations of what should be covered.

    SOME Americans would love SOME aspects of the Singapore system but I doubt that a majority would like the whole of it. It’s a matter of cultural habits that have formed. Take for example that Singaporeans must by law care for their ageing parents. I don’t think the US would somehow institute this kind of law to save social security from bankruptcy. Or in terms of health coverage – 45 Mio Americans may be uninsured but the other 200 Mio have an often very high standard of coverage and treatment with no means testing. I doubt that these 200 Mio would all like to scale their coverage back to some basic, catastrophic insurance type with high co-payments and means testing.

    So all this discussion somehow misses the point – Americans want exactly what they have. Only cheaper. And that isn’t going to happen.

  17. Gravatar of Randomize Randomize
    24. October 2013 at 08:42

    I have to disagree in regards to leaving regular maintenance expenses up to the individuals for one simple reason: The need for these procedures is involuntary. There is no morale-hazard when it comes to paying for your diabetes meds; it doesn’t matter if it’s OPM or your own hard-earned cash that pays for your asthma inhaler. These illnesses are often luck-of-the-draw and it makes no sense from an economist’s standpoint to sentence an individual to a lifetime of expenses for which he or she had no choice in the matter. Bad eye sight? Same deal. When exactly was it that you chose to need glasses?

    Even beyond that, the preventative care makes sense from both a morale hazard standpoint and at the bottom line. Birth control? Not many women chose to have vaginas and it’s very, very easy to argue that preventing unwanted pregnancies is a public good – the avoided cost of welfare expense of a single kid in a poor family could buy hundreds of IUDs or decades of pills.

  18. Gravatar of Tom Brown Tom Brown
    24. October 2013 at 08:56

    What’s not to like? Obama has the power to absolutely ruin it for any conservative: all he has to do is praise it… then it would be tainted. It would be “ObamaSingaporeCare.” 😀

  19. Gravatar of Matt McOsker Matt McOsker
    24. October 2013 at 09:23

    W Peden – The republicans proposed and passed MSA’s (HSA’s) with catastrophic coverage. The Democrats have routinely opposed these.

    Morgan – could not agree more on your post.

    -The other Matt

  20. Gravatar of johnleemk johnleemk
    24. October 2013 at 10:09

    mbka,

    “So all this discussion somehow misses the point – Americans want exactly what they have. Only cheaper. And that isn’t going to happen.”

    Exactly. Americans want their fancy ass prepaid health plans (that they for whatever reason delude themselves into calling “insurance”), and they don’t want to deal with the consequences of these prepaid plans.

    Randomize,

    “The need for these procedures is involuntary. There is no morale-hazard when it comes to paying for your diabetes meds; it doesn’t matter if it’s OPM or your own hard-earned cash that pays for your asthma inhaler.”

    The point of insurance is to guard against the risk of large expenses that you cannot reasonably anticipate. Nobody can reasonably anticipate their home burning down, which is what creates a market for home insurance.

    I agree healthcare is a little different, which is why I am open to government provision and/or tight regulation of medical insurance (i.e., catastrophic insurance, not fake American “insurance”). But the governing principle is the same: we all run the risk of incurring large expenses without warning or any chance to plan for them, which is why the smart thing to do is to buy insurance to guard against those risks. Birth control pills and doctor’s check-ups are not large, impossible-to-anticipate expenses. There is no reason to get an insurer to pay for them any more than there is for my car’s insurer to pay for my oil changes.

    “These illnesses are often luck-of-the-draw and it makes no sense from an economist’s standpoint to sentence an individual to a lifetime of expenses for which he or she had no choice in the matter.”

    Tell that to all the socialised healthcare systems who require copays for check-ups and other similar regular easy-to-anticipate expenses.

    “Even beyond that, the preventative care makes sense from both a morale hazard standpoint and at the bottom line.”

    So why shouldn’t my auto insurer be paying for my oil changes? Doesn’t that help their bottom line so they don’t have to pay for towing and repairs when my car breaks down?

    I’m not saying preventive care for the poor shouldn’t be subsidised. I’m simply saying I see no reason to subsidise preventive care for all. And even if we subsidise it for all, it’s simply infeasible to reduce the cost-sharing burden on consumers to zilch. Most socialised healthcare systems maintain copays for regular care and sometimes catastrophic care too (the NHS with its utterly free care is the exception, not the norm).

    You can predict you’re going to have sex; you should buy your own birth control. If you can’t afford it, that’s one thing. But there’s no reason the government should be covering, or requiring “insurers” to cover, birth control for every citizen irrespective of their economic standing.

  21. Gravatar of Collin Collin
    24. October 2013 at 10:37

    One question about Singapore

    Is having a kid a “disaster” that has to be insured against?” If you think so, you shouldn’t be a parent.

    Is this one reason why Singapore has amongst the lowest fertility/birth rate? I do wonder if we moved more to conservative free market healthcare, would the birth rate take a drop? For how great Singapore generally is, how come very few people have more than 1 or 2 kids?

  22. Gravatar of myb6 myb6
    24. October 2013 at 13:33

    Given the below-market price-fixing, I’ve always been curious how they clear the market; does the price-fixing only apply to services with inelastic demand? I could see the most acute care being pretty inelastic. My efforts to find out more have failed- anyone have any pointers?

    I don’t think the people claiming Straw-Man are being very fair: google “Singapore health system” and go through the first three pages, I see Cowen, Forbes, AEI, Freedom Works.

    Of course those organizations aren’t the same as the conservatives in power, but that’s sorta Yglesias’ point. To duplicate Singporean health care, pragmatic utilitarians would have to convince Tea Party types that market-dominating publicly-run acute care facilities, savings mandates, sovereign wealth funds, and means-tested subsidies are all good ideas. Have fun with that.

    If you’re looking for balance, I think it’s also pretty hard convincing hard-left types that Singapore is the way to go. Technocratic efficacy doesn’t usually fit well in left-right pissing contests.

  23. Gravatar of Tom Tom
    24. October 2013 at 16:27

    Ben,

    Yep. my dear old dad who is your typical tea party guy loves him some VA.

  24. Gravatar of ssumner ssumner
    24. October 2013 at 17:41

    Sam, It would not work as well here as in Singapore, but it would still be a vast improvement over our current system.

    Matt, Good example.

    Ben, Good point.

    Patrick, I suppose I’d prefer a caning to prison (but they have prisons in Singapore too.) I’m not a fan of their drug laws.

    mbka, Americans only think they want it because they don’t see the cost. Merely taking away the tax subsidy would dramatically lower the demand for health care. If you offer people $10,000 a year more in take home pay in exchange for switching to catastrophic they’d do so in a heartbeat. But companies are not allowed to do that, because they can’t offer the extra income on a tax free basis.

    It’s like saying the French have a cultural preference for short working hours. They didn’t when their taxes were lower.

    Having said that, I agree the politics of switching would be daunting, but mostly because providers would (correctly) realize the 18% of GDP would shrink sharply. BTW, demographics explain only a small share of that difference.

    Randomize, You said;

    It doesn’t matter if it’s OPM or your own hard-earned cash that pays for your asthma inhaler.”

    My asthma medicine costs $800 a year, but I only buy it because I can use OPM. I would not buy it otherwise, even though I can easily afford it. Sure, some illnesses are the luck of the draw, but so is everything else in life–talent, family background, looks, smarts, etc. You have catastrophic insurance to take care of the huge inequities, and you trade off some smaller inequities in exchange for more efficiency on the smaller expenses.

    Your analysis is actually a better argument for taxing height (which is completely deterministic) than asthma medicine, which is only partly pre-determined. But no one advocates taxing height.

    Collin, I doubt insurance has much impact on birth rates. They are lower in Germany and Italy than the US, despite more universal health insurance.

    myb6, It’s pretty clear Yglesias was talking about conservative intellectuals, not voters. Voters don’t even know about Singapore. Most Americans couldn’t find it on a map.

  25. Gravatar of ChrisA ChrisA
    24. October 2013 at 20:26

    As others have noted, the success of the Singapore system may have something to do with the residents of Singapore. We have a nice natural experiment with Hong Kong, since genetically we have a similar population but Hong Kong has a health care system similar to the one in the UK, basically free health care at no or minimal cost. Load on the system is managed with queuing and quality so richer folks (as in UK) go to the vibrant private sector. HK spend about 5% of GDP on health care, of which about 50% is Government spend. Outcomes are excellent, with one of the highest life expectancy and excellent (4th in world) first year survival rates. I think the more general learning from Singapore and Hong Kong is that genetic factors play a huge role in health care outcomes and differences in funding mechanisms do not make a big difference in health care outcomes.

  26. Gravatar of ssumner ssumner
    25. October 2013 at 05:29

    Chris, I agree that spending has little impact on life expectancy.

  27. Gravatar of Floccina Floccina
    25. October 2013 at 06:54

    Conservatives love catastrophic health insurance. Indeed we believe non-catastrophic health “insurance” is an oxymoron.

    I think that companies that call their low deductible health plans insurance should be prosecuted for fraud. They are abusing the word “insurance”. They can call it a health plan.

    Singapore’s system seem much better than ours but is healthcare spending there rising significantly faster than GDP?

  28. Gravatar of Floccina Floccina
    25. October 2013 at 07:16

    BTW here is my very conservative healthcare plan:
    The state would provide insurance to all Americans but the annual deductible would be equal to the family’s trailing year adjusted income minus the poverty line income (say $25,000 for a family of 4) + $300. So a family of 4 with a trailing year adjusted income of $30,000 would have a deductible of $5,300. A family of 4 with a trailing year adjusted income of $80,000 would have a deductible of $55,300. Middle class and rich people could fill the gap with private supplemental insurance but this should be full taxed. This would encourage the middle class and rich, who are generally capable people, to demand prices from medical providers and might force down costs. They could opt to pay for most health-care out of pocket while the poor often less capable would be protected.
    It is not a perfect plan but it might help. Some deregulation of health-care would also help the poor gain access. The gauntlet that Doctors have to run these days to get to practice seems like an anachronism in today’s world. Let smart people get to practice medicine after on the job training. Let the medical businesses decide who is qualified to practice medicine. 12 years of training to tell if my child has an ear infection is overkill and reduces access to health-care for the poor.
    Another benefit of my plan is that it would encourage capable Americans (the rich and middle class) to be a counter weight politically against the providers.

  29. Gravatar of MP MP
    25. October 2013 at 07:52

    Yglesias is conflating “conservative” intellectuals (several of whom talk about Singapore because they do favor elements of its model) and the rank-and-file (most of whom probably would object to many of the elements he lists, if they knew about them). I assume he’s obscuring the difference deliberately to make a cheap partisan point, because he’s too smart to do it by accident. A bit disappointing, since he’s usually someone I can respect, even when I disagree.

    Also, Floccina, very interesting, simple plan. I’ll definitely be thinking about that for a while.

  30. Gravatar of Randomize Randomize
    25. October 2013 at 09:34

    Dr. Sumner,

    You said:

    “My asthma medicine costs $800 a year, but I only buy it because I can use OPM.”

    My asthma medicine costs about the same but don’t buy it even though I could use OPM. Now that we’ve proven anecdotal evidence is garbage, we can move on 😛

    “Your analysis is actually a better argument for taxing height (which is completely deterministic) than asthma medicine, which is only partly pre-determined. But no one advocates taxing height.”

    As much as I appreciate your Rush reference, nobody is talking about taxing height because height disparity isn’t causing widespread poverty. Health disparity, on the other hand, causes exactly that.

    Johnleemk,

    “You can predict you’re going to have sex; you should buy your own birth control. If you can’t afford it, that’s one thing. But there’s no reason the government should be covering, or requiring “insurers” to cover, birth control for every citizen irrespective of their economic standing. Etc.”

    Let’s be clear that when it comes to “insuring” regular expenses, what we’re really talking about is cost pooling. Insurance agencies, in this case, are being used as convenient administrators of cost pools. As for birth control in particular, it’s clearly been a while since you were a teenager. Just saying, with a cocktail of hormones, drugs, and alcohol flowing through their systems, sex happens and there’s not always time to drive to the store. If it were up to me, we’d be handing out birth control pills on their school lunch trays. So you say that we should only subsidize birth control for the poor? That’s a fair argument and it would work well in tandem with the ACA since there’s already a mechanism for determining poverty that could be leveraged.

  31. Gravatar of simplicio simplicio
    25. October 2013 at 11:58

    I’m not sure there’s really that much difference between “other people’s money you can use for medical items” and “money in a forced savings account you can only spend on medical items”. Either way, the incentive is to overspend on medical care. After all, all that money sitting in that account is only useful if you figure out a way to spend it.

    Plus, Yglesias’s post doesn’t really address what happens to poor people with non-acute problems. If someone without money in their account gets diabetes, and can’t afford insulin, what happens? They could wait, and eventually toes will start falling off, and it will be acute enough they can go to the gov’t hospital, but obviously that’s not ideal either for the patient or for the gov’ts bottom line (since apputating toes costs a lot more then giving someone insulin). So what happens if someone’s account runs dry and they don’t make enough to cover treatment from their usual income.

  32. Gravatar of ssumner ssumner
    26. October 2013 at 06:48

    Floccina, Interesting ideas. It’s hard to overstate the importance of eliminating the tax deduction for health care, and also the barriers to entry.

    Randomize, You have not proved anything about “anecdotal evidence,” and I’m afraid your poverty argument misses as well, as I favor universal health care coverage, including catastrophic.

    Simplicio, I don’t follow, I’d be much more careful with money in an HSA, and I assume others would as well.

  33. Gravatar of Please Stop Comparing Health Insurance to Car Insurance | The American Conservative Please Stop Comparing Health Insurance to Car Insurance | The American Conservative
    30. October 2013 at 02:31

    […] it a day. I first encountered it in some Cato Institute literature at college in the mid-’90s and came across it again a couple days […]

  34. Gravatar of Please Stop Comparing Health Insurance to Car Insurance | Tony Johnson Please Stop Comparing Health Insurance to Car Insurance | Tony Johnson
    30. October 2013 at 03:55

    […] day. I first encountered it in some Cato Institute literature at college in the mid-’90s and came across it again a couple days […]

  35. Gravatar of Please Stop Comparing Health Insurance to Car Insurance Please Stop Comparing Health Insurance to Car Insurance
    30. October 2013 at 06:04

    […] it a day. we initial encountered it in some Cato Institute novel during college in a mid-’90s and came opposite it again a integrate days […]

  36. Gravatar of Please Stop Comparing Health Insurance to Car Insurance – United Americans Please Stop Comparing Health Insurance to Car Insurance - United Americans
    30. October 2013 at 15:41

    […] it a day. I first encountered it in some Cato Institute literature at college in the mid-’90s and came across it again a couple days […]

  37. Gravatar of Owen Venn-Brown Owen Venn-Brown
    30. October 2013 at 17:26

    The elephant said to the flea..”That’s really neat. Teach me to jump like that.”
    Singapore is an island 704 square kilometres or 272 square miles, a little less than a quarter of the size of Rhode Island which is 1214 square miles. Its population is roughly 50% Chinese, the next biggest ethnic group is Indian, the rest being indigenous Malay. It has a per capita GDP of about US$51,709, slightly larger than USA. Traditionally, Chinese families tend to have great respect for and to care for their elderly much more than do Westerners. The Health Care of Singaporeans probably does not translate to a large, diverse nation like USA.

  38. Gravatar of Browsing Catharsis – 10.25.13 | Increasing Marginal Utility Browsing Catharsis – 10.25.13 | Increasing Marginal Utility
    21. February 2015 at 19:27

    […] -Scott Sumner, “Singapore health care; what’s not to like?“ […]

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