What? Shouldn’t health care cost less? Isn’t that the chief focus of the whole national debate over Obamacare and its alternatives? Kevin D. Williamson explains for National Review Online readers why the 2010 federal health care reform law misses the boat, if the goal is a reduction in overall health care costs.
The problem with health care in the United States is that it does not cost enough.
First, some relevant points of comparison. There are many ways to do government-supported health care, but, if you took the popular American political debate as your sole source of perspective, you’d think that there were only three: the British National Health Service, the Canadian single-payer system, and the wildly dysfunctional dog’s breakfast we have just created and nicknamed Obamacare. But there are other models that are useful to examine, not necessarily because we want to replicate them in the United States but because they help to illuminate the underlying institutional failures that all of us, progressive and conservative alike, are interested in ameliorating: the remorseless price inflation in both health insurance and health care itself, uncertain access to care for the poor and for some of the middle class, and the heavy burden that rising health-care expenditures place on both household and government finances.
Williamson examines health care in Singapore.
There is no such thing as free health care anywhere, and in Singapore there is not even the illusion of free health care: Everybody pays for doctor visits, hospital stays, insurance premiums, etc. And because the Singaporean government deducts 6 to 9 percent out of your paycheck to deposit in a tax-exempt, interest-bearing, heritable health-savings account (HSA), almost everybody has the ability to pay the relatively high co-pays and other out-of-pocket expenses that characterize the Singaporean system. It is not a free-market utopia; to the contrary, it is very interventionist, with subsidies, price controls, and the HSA mandate, but there is a strong element of consumer choice and incentives for thrift.
What about the Swiss?
Switzerland has a very different kind of national health-care system, one with more than superficial similarities to the Affordable Care Act regime: an individual mandate with profit controls on insurers (which are not allowed to profit at all on the most basic health-insurance plan), price controls, coverage mandates, etc. Premiums run on average just over $1,000 a month for a family comprising two adults and two minor children. And like the Singaporean system, it is characterized by relatively high out-of-pocket costs: the highest of any OECD country, in fact. …
… What that means is that health care in Singapore and Switzerland is less expensive because it is more expensive. And both countries enjoy superb quality of care.
