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>The problem is, the economies that have strong government actor working on behalf of consumers (either in the form of regulation, or a public corporation that

>The problem is, the economies that have strong government actor working on behalf of consumers (either in the form of regulation, or a public corporation that competes in the market too) are actually affected less. I don't see any evidence for that. A couple counter-examples: Singapore and developing countries like India and China have more market based healthcare systems than Western Europe and the US, and spend far less on healthcare as a percentage of GDP. India and China are making significant gains in life expectancy, but that may be explained away by the fact that they're starting from a lower level. Singapore however has a higher life expectancy than European countries. The US is the outlier, with approximately half of healthcare spending being private, yet spending a very high percentage of GDP on healthcare. But I would argue that much of this 'private' is quasi public, as it's a manufactured outcome as a result of significant intervention by state and federal governments, like tax incentives for employers to provide healthcare through large insurance companies, and state mandates requiring health insurance to be comprehensive. The fields of medicine in the US less subsidized via these kinds of interventions; cosmetic and laser eye surgery, have seen prices increase at below the rate of inflation. The key is that people pay out of pocket for cosmetic and laser eye surgery: http://healthblog.ncpa.org/why-cant-the-market-for-medical-care-work-like-cosmetic-surgery/ http://healthblog.ncpa.org/why-cant-the-market-for-medical-c... The government intervention in the private US healthcare system encourages exactly the opposite. Also with respect to US healthcare spending, it's worth mentioning the US is a higher income country than other OECD countries, and there seems to be a trend toward healthcare spending as a percentage of GDP increasing with level of wealth, independent of all other factors. The US does have a more capitalised healthcare system, with more diagnostic equipment and advanced treatment centres for things like neonatal care. Often not mentioned is that the US has some of the best cancer survival rates in the world. Mind you, the US is definitely suffering from the cost disease in healthcare, but the relatively higher wealth level of the US may explain the difference with Europe.

taneq 9y ago
> A couple counter-examples: Singapore and developing countries like India and China have more market based healthcare systems than Western Europe and the US, and spend far less on healthcare as a percentage of GDP. I think this is far more to do with the fact that they're developing countries than the economic structure of their healthcare systems.
- Jabanga 9y ago
  I mention that possibility in the very next sentence and also point out that Singapore has a higher life expectancy than EU countries.
redy 9y ago
It's also worth noting Singapore is certainly not a market-based system. Singapore's healtcare efficiency is completely the result of mandatory saving programs, a government funded insurance scheme for the poor and strict price controls[1]. As for China frankly I don't think anybody would seriously want to replicate what passed for healthcare in China. It's disturbingly common for patients to die because they cannot afford even routine surgeries in China. [1] https://en.wikipedia.org/wiki/Healthcare_in_Singapore#Funding https://en.wikipedia.org/wiki/Healthcare_in_Singapore#Fundin...
- Jabanga 9y ago
  Singapore's healthcare system is more market based than the EU's, and other than the guarantee of government coverage (despite spending much less per capita on its public healthcare program than the US), than the US's. The mandatory health savings accounts are not redistributive. Each account is funded by the individual that makes use of it. And the individual decides how much to spend out of it, and with which provider, so it turns the individual into a price-conscious consumer. In the US, leftists would call such a program 'regressive' and a form of privatisation. So for the reasons mentioned, I think it's reasonable to suspect that the relative efficiency of Singapore's healthcare system is due to the greater role that market forces play in it.
  - redy 9y ago
    I suspect that this is not the case and I can't find anybody else that seriously argues this. Singapore's efficiency is due to price controls and government coverage of the poor [1] and mandatory saving (in that order). Calling Singapore a market-based system is very misleading. Remove the price controls and remove the coverage for the poor and I guarantee you that you'd see the same runaway costs that the US knows all too well. This isn't exactly rocket science and I don't see how you can call a market where the government strictly controls the prices [2] and compels participation to be a "free market" or "market based." (Then again, because health providers are compelled by law to provide their services to the poor even though the poor cannot pay it's pretty clear that there is no such thing as a modern market-based health care system. This is essentially an oxymoron.) [1] http://www.slate.com/blogs/moneybox/2012/07/30/you_contain_health_care_spending_with_price_controls.html http://www.slate.com/blogs/moneybox/2012/07/30/you_contain_h... [2] http://www.thenational.ae/world/southeast-asia/singaporean-health-care-balances-free-market-principles-with-pragmatic-intervention http://www.thenational.ae/world/southeast-asia/singaporean-h...
js8 9y ago
I am not all that familiar with Singapore's health care, but just a cursory look at Wikipedia reveals that it's not really that much market-based, it looks quite similar to most European countries, really. > there seems to be a trend toward healthcare spending as a percentage of GDP increasing with level of wealth This can be expected under my model, too. The monopolistic prices depend on the demand curve, which depends on the level of wealth.
- Jabanga 9y ago
  Private spending constitutes a larger portion of healthcare spending in Singapore than in the US. Also, much of that private spending is out of pocket: https://thehearttruths.files.wordpress.com/2013/10/slide4-1.jpg https://thehearttruths.files.wordpress.com/2013/10/slide4-1.... Which is very unlike the US, where, as a result of government intervention, spending through insurance companies is the norm.

taneq 9y ago

> A couple counter-examples: Singapore and developing countries like India and China have more market based healthcare systems than Western Europe and the US, and spend far less on healthcare as a percentage of GDP. I think this is far more to do with the fact that they're developing countries than the economic structure of their healthcare systems.

Jabanga 9y ago
I mention that possibility in the very next sentence and also point out that Singapore has a higher life expectancy than EU countries.

redy 9y ago

It's also worth noting Singapore is certainly not a market-based system. Singapore's healtcare efficiency is completely the result of mandatory saving programs, a government funded insurance scheme for the poor and strict price controls[1]. As for China frankly I don't think anybody would seriously want to replicate what passed for healthcare in China. It's disturbingly common for patients to die because they cannot afford even routine surgeries in China. [1] https://en.wikipedia.org/wiki/Healthcare_in_Singapore#Funding https://en.wikipedia.org/wiki/Healthcare_in_Singapore#Fundin...

Jabanga 9y ago
Singapore's healthcare system is more market based than the EU's, and other than the guarantee of government coverage (despite spending much less per capita on its public healthcare program than the US), than the US's. The mandatory health savings accounts are not redistributive. Each account is funded by the individual that makes use of it. And the individual decides how much to spend out of it, and with which provider, so it turns the individual into a price-conscious consumer. In the US, leftists would call such a program 'regressive' and a form of privatisation. So for the reasons mentioned, I think it's reasonable to suspect that the relative efficiency of Singapore's healthcare system is due to the greater role that market forces play in it.
- redy 9y ago
  I suspect that this is not the case and I can't find anybody else that seriously argues this. Singapore's efficiency is due to price controls and government coverage of the poor [1] and mandatory saving (in that order). Calling Singapore a market-based system is very misleading. Remove the price controls and remove the coverage for the poor and I guarantee you that you'd see the same runaway costs that the US knows all too well. This isn't exactly rocket science and I don't see how you can call a market where the government strictly controls the prices [2] and compels participation to be a "free market" or "market based." (Then again, because health providers are compelled by law to provide their services to the poor even though the poor cannot pay it's pretty clear that there is no such thing as a modern market-based health care system. This is essentially an oxymoron.) [1] http://www.slate.com/blogs/moneybox/2012/07/30/you_contain_health_care_spending_with_price_controls.html http://www.slate.com/blogs/moneybox/2012/07/30/you_contain_h... [2] http://www.thenational.ae/world/southeast-asia/singaporean-health-care-balances-free-market-principles-with-pragmatic-intervention http://www.thenational.ae/world/southeast-asia/singaporean-h...

js8 9y ago

I am not all that familiar with Singapore's health care, but just a cursory look at Wikipedia reveals that it's not really that much market-based, it looks quite similar to most European countries, really. > there seems to be a trend toward healthcare spending as a percentage of GDP increasing with level of wealth This can be expected under my model, too. The monopolistic prices depend on the demand curve, which depends on the level of wealth.

Jabanga 9y ago
Private spending constitutes a larger portion of healthcare spending in Singapore than in the US. Also, much of that private spending is out of pocket: https://thehearttruths.files.wordpress.com/2013/10/slide4-1.jpg https://thehearttruths.files.wordpress.com/2013/10/slide4-1.... Which is very unlike the US, where, as a result of government intervention, spending through insurance companies is the norm.