Pascal-Emmanuel Gobry explains at National Review Online why conservatives should balk when anyone — including a fellow conservative — suggests that the United States should adopt the health care system employed in another country.
I’m what some philosophers disdain as a “solutionist”: someone who believes that, whatever the problem, some great policy fix will make everything better. But when it comes to health care, the simple reality is that nobody knows what to do.
Conservatives have a simple dream when it comes to health care, and that dream has a name, and it is “Singapore.” And it is a beautiful dream. If Milton Friedman and Elon Musk sat down together to design a health-care system, it would probably look like Singapore’s. In outline, it’s very simple to understand: Everybody gets a health savings account, into which a portion of their paycheck is automatically deposited; from that health savings account, they can purchase catastrophic coverage. The elderly get a voucher for their choice of private insurance plans for age-related illnesses. The poor get top-ups to their health savings accounts and a special insurance scheme.
It’s got everything! It works the magic of health-care consumer choice that conservatives keep vaunting, and it really does keep quality up while bringing down prices. There’s just enough government intervention to make sure nobody falls through the cracks and everybody has basic coverage, but otherwise it’s pretty much a market-based system, and it works as magically as Conservative Apologetics 101 tells you market-based systems work.
Which is why conservatives should flee in terror when right-wing health-policy wonks like me start talking about Singapore. Because if there’s one thing conservatives (with their Burkean, Kirkian, Buckleyite deep understanding of the intractable complexity of human affairs and of the importance of culture) should instantly realize, it’s that the idea of importing a system from a highly homogenous, authoritarian, technocratically run urban nation of 5.6 million people to a continent-sized, fractious, ultra-diverse nation of more than 300 million people is a tragic farce. After all, America’s various government bodies and tiers rank from “alarmingly incompetent” to “you could not make this up” and our democratic governance structure virtually guarantees that any perfect-on-paper plan would be instantly captured by special interests.
