Flouncing to Singapore

From Wikipedia: Universal health care is implemented in all but one of the wealthy, industrialized countries, with the exception being the United States. It is also provided in many developing countries and is the trend worldwide.

John Stossel, writing at Independence Institute, states that the World Health Organization’s (WHO) ranking of the USA as 37^th in the world in health care is misleading. He said that ” The WHO judged countries not on the absolute quality of health care, but on how “fairly” health care of any quality is “distributed.” I respond by stipulating that Mr. Stossel is indeed correct. Anyone who can afford it can get top quality health care in the USA. The issue, John, is fair distribution. Whatever the solution to revamping our beleaguered health care system is, it will involve fairly distributing access to basic health care for all of us. The issue then, is the classic have’s vs. have not’s.

An ideal solution, one that would be acceptable to both the left and the right, would be one in which personal responsibility plays a role, while assuring access to all. That sounds nearly impossible until you consider that such a solution has been working in Singapore for over 20 years.

The Government in Singapore knew that they needed to revise their health care system so they did what many of us would do. They studied health care systems around the world and learned what was working and what was not. Then they implemented a system that put together the best elements from the various systems that they studied. Seems kinda logical, doesn’t it?

The aim was to give maximum responsibility and choice to patients, requiring them to spend their own money rather than that of government or insurers. At the same time, they needed to ensure that nobody faced catastrophic medical bills and that even the poor had enough money to buy medical care.

The solution was to require all citizens to maintain a savings account that can be used only for medical expenses. Achieving this savings was no problem, they simply reduced each person’s tax bill by $1,500 a year. This is roughly the cost, in taxes, of both the UK and the US public health systems. For people that pay less than $1,500 in a tax year, the government would contribute money to make up the shortfall. Since the system is compulsory, no adverse selection takes place, such as you and I face when we apply for insurance with private insurance companies.

The government then created cheap catastrophe insurance, which pays out only when a particular course of treatment is very expensive. You spend your money, from your compulsory savings account for your health care. You make your own decision about that health care, rather than having an insurance company or government agency make those decisions for you.

Your health-care savings would automatically go into a high interest bank account that would build up gradually throughout your life. For most people, medical bills are low in their younger years, so you could expect to have thirty thousand dollars in your account when you turn forty; more, if you’ve managed to keep your spending low and watched the money earn interest.

Thirty thousand dollars buys a lot of medical care, unless of course, you required a single, expensive procedure. In that case, the catastrophe insurance would restrict your expenses.

If you reach retirement age with money still in your medical savings account beyond some minimum, you can put the excess toward your pension. When you die, you can pass the savings along to your heirs. If you have a relative with ongoing medical problems, you can donate part of your savings to them.

At every point in your life you have an incentive to spend money only on health care that you feel is absolutely necessary. If you felt that the right treatment for you was a bit of preventative maintenance, that that would be your choice.

Clearly, with some imagination we can step back from out current failed system and think about how to fix it. The system I’ve just sketched out has been successful in Singapore for two decades. The typical Singaporean lives to the age of eighty and the cost of the system (both the public an private portions) is about a thousand dollars per person. That is less that just the cost of the bureaucracy alone in the United States.

Annually, the typical Singaporean pays about seven hundred dollars privately, compared to twenty-five hundred dollars for Americans. The government spends about three hundred dollars per person (mostly for the catastrophe insurance). This is about five times less than the British government and seven times less than the American government.

The debate in America seems to be stuck on a choice between government or market. As was mentioned in part one, both have their limitations. Fairness is not a function of the market, any market. The Singaporean solution recognizes the shortfalls of each. Their answer lies in a combination of the two working together to put the consumer in ultimate control of their own healthcare.

Singapore is ranked 7^th by WHO. Yes, John, it’s very likely that distribution was a huge factor in that ranking. Do I care that the Mayo Clinic may be the best in the world if I don’t have access to it? No, I don’t. I doubt that you do either.

You Mean... ME?

Anyone who has been reading my blog posts, all one of you, knows that I’m certainly not angry about anything. As hard as it is to believe, my other reader called a recent post “so angry”? Can you imagine? Where do they come up with this stuff?

I guess they think I’m angry because the soon-to-be-former Administration, fueled by fanatical right-wing zeal, has run our country into the ground with a needless war, over a Trillion dollar projected budget deficit, hateful anti-gay referendums, trashed our economy, trampled our right to privacy and taken away our freedoms in the name of freedom (huh?), placed themselves above the Geneva Convention by torturing prisoners and going to the mat to defend that “right”, maniacally supporting Israel no matter what they do, failing to get Bin Laden, radicalizing more Muslims toward terror and last but certainly not least, doing everything they can think of to lead us toward self-fulfilling their dangerous apocalyptic prophecies/fantasies. Angry? What’s to be angry about?

Case in point; I am no longer angry about the tithing I was forced to pay to the Mormon Church when I was nine. It was pointed out that nine year olds don’t really have anything that doesn’t actually belong to their parents. The same person said that they teach their children to give some of their money to charity to learn the joy of unselfishness.

So if, as was just pointed out, it isn’t really theirs anyway, what did they learn? Ignoring the arrogant assumption in that statement that if the money doesn’t go to the Mormon Church, then it isn't charity, I'll point out that I do give to charity. I also did when I was nine, but I’m not asking for any of that back, since I did it that with my own free will. It’s interesting that they jumped on the tithing comment when the point of the post was really that we need to start taxing churches.

Then I’m told that I need to meet some of the true Holy Men, the ones who believe in the one true God, then all will become right in my Universe. Interestingly, not ALL are Mormons, though the teller has never met one who wasn’t Mormon, but he’s told they exist. I quote, “If you'd take the time to know these people too, you'd quit debating the morality of this that and the other and join their cause.”

Holy cow, why do I even bother with people who think like this? First, I’m not debating the morality of anything. My moral compass is very clear, no need to debate that. Of course, this comes from the assumption that we cannot have a moral compass without God or some “holy man” to give it to us. No, I have not debated morality, but rather, I have spoken out when my government does outrageously immoral things.

Insert deep sigh here. I’m not sure why I bother writing these posts. There are so many stinkin’ bloggers around and they/we all think that they/we have something to say. I’m not sure why any of us subject ourselves to this, All that ever comes of any of it is that those who agree tell us how smart we are and those who disagree tell us how messed up we are. Do hearts and minds ever get changed? I doubt it.

When my wife reads these posts or hears of some of my email exchanges, it is always followed with a heavy sigh and a groan, even though she generally agrees with my point of view. She knows what I’m still having trouble reconciling; that it’s all really rather pointless. I know that too, but there’s that other little voice in my head, the one of my great grandchild asking, “Why didn’t you do something before it came to this?”

“I tried honey, I really did, but everyone thought Global Climate Change was just an Al Gore PowerPoint thingie to get Government money under the guise of research. I spoke out but they kept making wars, kept spending beyond our means and overpopulating a planet that was already stretched to its limits. I guess the planet showed them in the long run, I was just hoping there would be something left for you. I tried and failed, but at least I’m not angry about it.”

Twenty One Day Salute

Wow, it's been quite a year. It's been quite an eight years too. Strange as it may seem, especially if you've read some of my other writing recently, I'm actually optimistic about 2009, both in my personal life and in the world at large. No, I don't have my head in the sand, not at all. You'll have to trust me on that one.

Since life is nothing if not a contradiction, let me now say the future looks pretty bleak. Even an economic dummy like me can see that the coming depression has only begun. The signs of global climate change are, quite literally, all around us. The Bush administration's assault on our constitutional rights and their apparently successful attempts to insulate themselves from being held accountable, have left our Government in shambles. We're fighting war on two fronts with Chinese money. We're short on soldiers and long on debt because of it. No, I'm no Pollyanna.

Good news though, is on the horizon. We only need survive twenty one more days without another major setback and hope is on its way. I'd like to believe that our new President will wave his magic wand and restore all of our rights, fix the climate and our economy, and while he's at it, bring back the 2300 + US soldiers and 98,000 + civilian casualties in Iraq. Maybe Santa Obama can bring me a new motorcycle too. Obviously, that's not going to happen.

No, it's not going to be easy to undo the damage that Bush has done and so much of it will never be undone. We can't bring back the dead, for example. It's unimaginable that this guy sleeps at night knowing that over 100,000 human beings are dead because of his arrogant insistence on a needless war. He says he sleeps very well.

Now I hear Bush is working on his legacy, expecting to walk away unscathed, believing that history will judge his holy war as the right thing to do. This is why religion is so dangerous. Silly me, I thought we hung people for treason?

See how hard it is not to digress, even when I'm trying to write an optimistic piece? I wasn't happy when Bush overthrew our legitimate Government in 2000 but in my worst nightmares I could never have guessed just how badly he could mess the world up. I know rash statement like that take away from my credibility but how is it not a coup when he loses the election and becomes President anyway? And how can manufacturing evidence to gain support for the War in Iraq, resulting in all those aforementioned deaths, be anything less treasonous? What traitor has ever damaged the US more than Bush? Do I sound pissed. HELL yes!

Alright, alright, back to the optimism. We finally have a President-elect with an IQ higher than mine. That's not a brag folks, we need someone a whole lot smarter than me to deal with this mess. Unlike Bush, I can form complete sentences all on my very own, but that doesn't make either of us geniuses.

While President Obama won't have that magic wand, he does seem to have a firm grasp on our challenges and a determination to take them on. I'd love to see a more liberal lean to his Presidency but let's be real, we won't get anything done that far from the center, at least not right now. I fully expect things to get worse before they get better. No, my optimism is not of the Pollyanna variety so much as my belief, or maybe just hope, that there is a 'better" to follow. Through the lens of the last eight years, that would be a very radical change and it's about as optimistic as it gets these days.

On the personal front, I'm very concerned about what will happen as the economy continues to plunge. My self-employment situation is certainly vulnerable. I'm working full time for one client while I prepare to find others before the full time project is finished. Meanwhile, my client's business is down 40% from a year ago and that seems to be the norm in the industry. Finding new clients is always hard and will be even harder now. When I do find clients, getting paid may well be a bigger problem than in the past. Obviously, you can see my optimism, right?

My personal finances aren't all they could be but they could be a lot worse. Since my wife's income is assured, at worst, we won't lose our house, whatever happens in the economy... I think. That puts us well ahead of an awful lot of the country so I'll count my blessing and hope to minimize the damage when things get worse, as they inevitably will. Thankfully, my motorcycle is paid for so it's safe too. How can I not feel good about that? So I hope to survive the worse part on our way to the better part. Hey, it's a depression folks, I'll take that.

Most of my extended family will be okay too, I hope. My mother has a secure income, my daughter is doing well and works in a profession unlikely to get the worst of the hard times to come. My wife's children will survive, even if they need some help from us. They're young and resilient. We have our first grandchild on the way. I've finished my book and it's on the internet and getting good reviews from readers. I hope to see it published soon. So yes, I do see good things ahead.

I don't remember any time in my life when what was happening politically seemed so directly relevant to my own personal situation. I guess that's what happens in depressions. I remember some pretty hard times for everyone in the 70's and I've had some personal hard times of my own that I hope never to repeat, but this is on a whole new scale for those of us who weren't around for the last depression.

I generally have little faith in the intelligence of American voters so I am amazed that at this time, when it was so important, somehow, the right candidate was not only present but elected. It's nothing short of a miracle, given our voting history and the choices we typically have to vote for.

That, my friends, in the face of these terrible times, is the source of my optimism. Maybe I should call it guarded optimism and that may be as good as it gets these days.