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Through Matt Yglesias he writes: “If you imagine America with no guns, less booze, much less drugs, and radically less driving, our public health outcomes would soar.” But at the same time health care costs would plummet. You mention valid reasons why we might think about adjusting tax policy, but unless I’m not understanding your argument, you haven’t provided any reasons why this is the best first step instead of other options that have widespread political support, such as allowing customers to import cheaper medications from abroad.Changes to the FDA approval process don’t even require political will, but only a decision on the part of the Executive Branch to uphold the law in a different way.For example, it would be easy to streamline the approval process for bio-similars even further than it already has been. RPLong, Because it’s the biggest single problem, by far.
* Singaporeans are far healthier than Americans with 3% who are obese compared to 35% of Americans, which adds a fourth major strain on health care costs.
Klein makes a reference to this toward the end of the article but without the details that show how stark the differences are.
But the lower overall prices make them much less exposed to health costs than both patients and employers inside the American system — which suggests to me that Americans have at least as much incentive as Singaporeans to try to use their power as consumers to cut costs. There are restrictions against patients signing contracts making it more difficult to sue for malpractice.
The fact that that hasn’t worked is, I think, a reason to believe we’ve gotten the lesson of Singapore’s health system backward. There are restrictions on importing foreign drugs, even foreign generics.
Americans, by contrast, have their care paid for by insurers and employers and the government, and so they have little incentive to act like shoppers and push back on prices. (It’s worth noting that, on average, Singaporeans are richer than Americans, so the issue here is not that we have more money to blow on health care.) I think he’s overstating the case here (I find that even many of my small health expenses are heavily subsidized) but there is some truth to what he says here.
And I think this points to the necessary first step in health care reform—getting costs down.
I’m curious as to why you think tax policy is the first step toward getting a better health care system. First, if you want less of something, tax it; if you want more, subsidize it (got milk? By making employer-provided health insurance tax deductible (Your employer gets a tax break on its portion of Social Security and Medicare taxes), government has encouraged employers to use employee-pre-tax money to purchase insurance in the employee’s favor. By the way, he said “the first step toward getting there is cutting costs” and tax policy is a major driver.
There are many ways to improve the system, and a good number of them would have widespread political support among the American population and would make tangible positive impacts on the system. This advantage is not available to that part of the population not covered by employer plans. Getting government out of the subsidy business is necessary to begin moderating government-driven health-care inflation.
Indeed Klein’s basic argument is that the Singapore system is actually a pretty effective health care regime, but it would be hard to implement in America because the cost of health care is so much higher here.
But this leads to what I see as the one major blind spot in Klein’s article: Singapore’s system is probably better designed in terms of how consumers spend their own money.