How often had you heard that “every other developed country has single-payer health insurance”? So often that I have lost count. How often have you heard that those single-payer health systems provide superior health care at lower costs? Again, so often that I have lost count.
Yet when you actually start to dig around, you discover that there is a wide range of health care systems in other developed countries — and many of them are not single-payer at all, at least in the way that Britain or Canada is.
Singapore, for example, has a mandatory savings system called Medisave, similar in purpose to the Health Savings Accounts that Americans are encouraged (but not required) to open. And while the Singapore government does pay for basic health care, it also allows patients to spend their own money to upgrade their hospital rooms. It also offers optional catastrophic health insurance. Not American-style, but definitely not single-payer.
Singapore also works aggressively to control behavior-related medical costs in a way that would lead to hyperventilating lawsuits in America. Homosexual sex is still an imprisonable crime in Singapore — hence, relatively low AIDS rates. Singapore is also the world’s top executioner, at least partly because various drug dealing charges carry the death penalty.
It’s a pretty controlling place — they only recently legalized chewing gum. I suppose if we were prepared to exercise that level of control over our population, we could also get our health care costs down.
Germany is another country often touted by the single-payer advocates, but it isn’t single-payer, either. About 92 percent of the country has health insurance that private employers are required to provide, with peculiarly enough, civil servants and the self-employed using private health insurance (which is apparently mandatory). Surprisingly, 0.3 percent of the German population is not insured at all: either the very rich and those so poor that the government directly provides health care.
What about health outcomes? It is very easy to assume that America is typical of developed nations, and thus our high mortality rates must be because we lack single-payer health insurance. We really aren’t demographically typical — some of those differences are genetic and some are behavioral.
Obesity is a major factor in determining mortality in morbidity rates, and Americans are more likely to be obese than people in other developed countries (although Britain is catching up fast). For example, 33 percent of American women are obese, compared to 19 percent of Canadian women. Is this cultural or genetic?
It may be both. In the U.S., 35.7 percent of blacks are obese, compared to 23.7 percent of non-Hispanic whites and 28.7 percent of Hispanics.