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Singapore's Health Care System: A Free Lunch You Can Sink Your Teeth Into
Library of Economics and Liberty ^ | january 13th | bryan kaplan

Posted on 11/22/2008 1:46:23 AM PST by Halfmanhalfamazing

In The Undercover Economist, Tim Harford highly praised the health care policies of Singapore. But it wasn't until I read the section on health care in Ghesquiere's Singapore's Success that I realized how amazing the official numbers are. If the following is true, all the comparisons showing that the U.S. greatly outspends Europe without getting better health are beside the point, because Singapore makes Europe look like the U.S.:

The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970... Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States... It is true that such indicators are also related to the overall living environment and not only to healthcare spending. Nonetheless, international experts rank Singapore's healthcare system among the most successful in the world in terms of cost-effectiveness and community health results.

How does Singapore do it? Singapore is no libertarian health care paradise, but it does self-consciously try to maintain good incentives by narrowly tailoring its departures from laissez-faire:

>The price mechanism and keen attention to incentives facing individuals are relied upon to discourage excessive consumption and to keep waste and costs in check by requiring co-payment by users.

[...]

The state recovers 20-100 percent of its public healthcare outlay through user fees. A patient in a government hospital who chooses the open ward is subsidized by the government at 80 percent. Better-off patients choose more comfortable wards with lower or no government subsidy, in a self-administered means test.

I've heard a lot of smart people warn that co-payments are penny-wise but pound-foolish, because people cut back on high-benefit preventive care. Unless someone is willing to dispute Singapore's budgetary and health data, it looks like we've got strong counter-evidence to this view: Either Singaporeans don't skimp on preventive care when you raise the price, or preventive care isn't all it's cracked up to be.

More details on how Singapore's system works:

* There are mandatory health savings accounts: "Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions... Only approved categories of medical treatment can be paid for by deducting one's Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash..."

* "The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available."

* Private healthcare providers are required to publish price lists to encourage comparison shopping.

* The government pays for "basic healthcare services... subject to tight expenditure control." Bottom line: The government pays 80% of "basic public healthcare services."

* Government plays a big role with contagious disease, and adds some paternalism on top: "Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority."

* The government provides optional low-cost catatrophic health insurance, plus a safety net "subject to stringent means-testing."


TOPICS: News/Current Events
KEYWORDS: healthcare; hsa; hsas; medicine
Been out searching for examples of where medical healthcare savings accounts(HSAs) have been tried and work. This is so far what I've come up with in a few minutes.
1 posted on 11/22/2008 1:46:24 AM PST by Halfmanhalfamazing
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To: Halfmanhalfamazing
And this.

Health Savings Accounts Work

2 posted on 11/22/2008 1:47:14 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: Halfmanhalfamazing

Its hard to generalize with Singapore. They are, in general, very disciplined and orderly people. Remember they have extreme punishments for even mundane crimes with canings for vandalism and death for drug-possession.

They are also highly educated and can be expected to act rationally: i.e. their rate of obesity is far below the US’s.

HSA are a good idea in that they provide during extreme health crisis that can bankrupt families while aligning incentives to contain costs in the healthcare market. But people are irrational and the liberals have spread a culture of victimization. Pretty soon, we will have a case that prosecutes food companies for causing people to be fat and the floodgates will open once again to expanding the culture of victimhood.


3 posted on 11/22/2008 1:56:14 AM PST by DiogenesLaertius
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To: Halfmanhalfamazing

Its hard to generalize with Singapore. They are, in general, very disciplined and orderly people. Remember they have extreme punishments for even mundane crimes with canings for vandalism and death for drug-possession.

They are also highly educated and can be expected to act rationally: i.e. their rate of obesity is far below the US’s.

HSA are a good idea in that they provide during extreme health crisis that can bankrupt families while aligning incentives to contain costs in the healthcare market. But people are irrational and the liberals have spread a culture of victimization. Pretty soon, we will have a case that prosecutes food companies for causing people to be fat and the floodgates will open once again to expanding the culture of victimhood.


4 posted on 11/22/2008 1:56:46 AM PST by DiogenesLaertius
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To: Halfmanhalfamazing

This is indeed good news. Having the individual participate
in the cost and savings for their health care is
the basics of free market enterprise.

I have an HSA. The experience of managing your costs
will, if nothing else, make you aware of the benefit of living a healthier life style.


5 posted on 11/22/2008 1:59:27 AM PST by ChiMark
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To: DiogenesLaertius

Come on now, americans are more disciplined than you give them credit for.

Keep in mind, they also had the comparison in there for Europe.


6 posted on 11/22/2008 2:00:35 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: ChiMark

Yeah. My main attraction to HSAs would be if everybody had them, that would make capitalism work and costs across the board would come down.


7 posted on 11/22/2008 2:01:33 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: Halfmanhalfamazing

Well you do understand, you have totally flubbed what the Democrats see government run health-care for. They have in mind more like the Cuban model, than a real effective model in mind -— Hoards of people lined up, waiting for their free pie, that never comes.


8 posted on 11/22/2008 2:17:46 AM PST by Tarpon (America's first principles, freedom, liberty, market economy and self-reliance will never fail.)
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To: Halfmanhalfamazing

it won’t work because it’s not “progressive” or “hope filled” and because HSA are counter to what socialists believe like bobble headed Barack.


9 posted on 11/22/2008 2:18:44 AM PST by MAD-AS-HELL (How does one win over terrorists? KILL them with UNKINDNESS)
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To: MAD-AS-HELL; Tarpon

That’s why I’m trying to fight all of this. Our best weapon is information. THe more that gets disseminated, the better.

We need to undermine this media.


10 posted on 11/22/2008 2:20:57 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: Tarpon


The Benefits of Socialism....
11 posted on 11/22/2008 2:24:30 AM PST by Kozak (USA 7/4/1776 to 1/20/2009 Requiescat In Pace)
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To: Kozak

That’s the Cuban health care system in action. Delivering quality care for all.


12 posted on 11/22/2008 2:28:14 AM PST by Tarpon (America's first principles, freedom, liberty, market economy and self-reliance will never fail.)
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To: Halfmanhalfamazing

good luck...trying to get this out which has been around since the early 90’s is like trying to surf the North Shore on glued together Styrofoam plates. We have a media that is hell bent on pushing anything democrat and anti free market/choice unless it’s about abortion.


13 posted on 11/22/2008 2:31:37 AM PST by MAD-AS-HELL (How does one win over terrorists? KILL them with UNKINDNESS)
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To: Halfmanhalfamazing

Singapore has no parasite class, here in the USA we have two: the uneducated illegal immigrants, and the ghetto underclass.


14 posted on 11/22/2008 2:35:31 AM PST by ikka (Brother, you asked for it!)
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To: ikka

” Singapore has no parasite class, here in the USA we have two: the uneducated illegal immigrants, and the ghetto underclass. “

You forgot the largest, most harmful, parasite class here in the ol’ USA — that one comprised of politicians, ‘journalists’ and the punditry, academics, union leaders, and ‘activitists’ and ‘community organizers’ of all stripes....


15 posted on 11/22/2008 2:45:49 AM PST by Uncle Ike (Sometimes I sets and thinks, and sometimes I jus' sets.........)
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To: Kozak
That's pitiful and sad, this guy probably worked like a dog, for his family, all his life.

Ending up in deplorable living conditions such as that is demeaning to say the least.


16 posted on 11/22/2008 2:57:47 AM PST by SouthDixie (We are but angels with one wing, it takes two to fly.)
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To: Halfmanhalfamazing; DiogenesLaertius
Its hard to generalize with Singapore. They are, in general, very disciplined and orderly people. Remember they have extreme punishments for even mundane crimes with canings for vandalism and death for drug-possession. ...... DiogenesLaertius

Come on now, americans are more disciplined than you give them credit for. ..... Halfmanhalfamazing

Well, we know one thing. There is at least one poster on this thread that has never spent a single hour in medical training in an American inner city hospital.

Drug abuse during pregnancy in an inner-city hospital: prevalence and patterns: ... Michigan Health Center (Detroit) implemented a policy of routine drug screening of all patients admitted to the hospital through the labor unit. ..... Urine samples were screened for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, and opiates. Nearly 27% of the urine samples tested positive for one or more of these substances.

*****

Military Medics Train for Combat at US Trauma Centers ...... In any armed conflict, military surgeons work close to the front lines, treating injured soldiers and civilians. But most military doctors are trained during peacetime and have seen few seen combat wounds, like those they are now treating in Iraq. .... The Pentagon came to realize that during the Gulf War, and has since formed partnerships with three inner city hospitals - in Baltimore, Miami, and Los Angeles. ... "We see a lot of gunshot injuries, including those from high velocity automatic weapons. So we do see situations very close to the military situation, patients coming with seven, ten bullets all over the body."

*****

17 posted on 11/22/2008 3:01:50 AM PST by Polybius
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To: MAD-AS-HELL

We’ve done a good job so far at undermining them.

All it requires is forum postings, emails, flapping your gums, and persistence.


18 posted on 11/22/2008 3:51:37 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: Polybius

I’d bet most of us haven’t had training in such a hospital.

But I doubt that the inner cities are totally representative of america.

Besides, all of that misses the point of the thread. So many of our current policies encourage irresponsibility. HSAs are just the opposite.


19 posted on 11/22/2008 3:58:09 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: DiogenesLaertius

Singapore comparisons: another problem trying to copy countries like Singapore is that they have much more homogeneous populations. The U.S. has a much more diverse population. Diverse populations tend to game the system.


20 posted on 11/22/2008 4:07:20 AM PST by rightklik
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To: Polybius
Polybius posted

” Urine samples were screened for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, and opiates. Nearly 27% of the urine samples tested positive for one or more of these substances.”

Marktwain replies:

A statement designed for propaganda purposes. Lumping in marijuana (cannabinoids) with the hard drugs renders the number meaningless.

*****

Polybius posted:

“We see a lot of gunshot injuries, including those from high velocity automatic weapons. So we do see situations very close to the military situation, patients coming with seven, ten bullets all over the body.”

Marktwain replies:

Another propaganda statement. “High velocity automatic weapons” is simply a propaganda phrase used to frighten the ignorant. America's murder rate is down.

Yes, we have a dysfunctional culture in many inner cities. They will respond to incentives. Giving them free health care without any incentives is sending the wrong message.

21 posted on 11/22/2008 4:14:43 AM PST by marktwain
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To: ikka
"Singapore has no parasite class, here in the USA we have two: the uneducated illegal immigrants, and the ghetto underclass."

DING DING DING! We have a winna!!!

Exactly why it would never work here.

22 posted on 11/22/2008 4:33:26 AM PST by libs_kma (F.U.B.O.)
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To: Halfmanhalfamazing

One item left out of the original article:

* In order to keep costs down, people who go to the Dr for treatment and are found not to be sick are caned without mercy.


23 posted on 11/22/2008 4:49:53 AM PST by TnGOP (Petey the dog is my foriegn policy advisor. He's really quite good!)
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To: Halfmanhalfamazing

As a Federal Government employee (Flame suit on), we are heavily encouraged to use the Health Savings Accounts. I haven’t up to this time, because it’s a use-it-or-lose-it type program. If you don’t spend it, it is taken away at the end of the year. It’s hard to predict what your needs will be from year to year, therefore hard to determine what amounts to contribute.


24 posted on 11/22/2008 4:56:54 AM PST by TnGOP (Petey the dog is my foriegn policy advisor. He's really quite good!)
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To: TnGOP
... we are heavily encouraged to use the Health Savings Accounts. I haven’t up to this time, because it’s a use-it-or-lose-it type program...

What you are describing sounds like a Flexible Savings Account (FSA). A Health Savings Account (HSA) is more like a 401k, any money lodged to the account remains yours. It can roll forward from year to year, building the balance. HSAs must be tied to a high deductible insurance policy.

25 posted on 11/22/2008 5:32:27 AM PST by evilC
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To: ikka
????? ~ Alas Singapore and Malaysia Both have a problem with illegal aliens ~ mostly from nearby poverty stricken, disease ridden Indonesia.

Besides being far wealthier than Indonesia they have a tradition of having "servants", and will do just about anything to make sure they have a good supply.

Both nations recurringly "send 'em back". The consequence is they never have to take care of an aging illegal alien population.

Life can be tough in the Orient!

26 posted on 11/22/2008 5:46:45 AM PST by muawiyah
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To: rightklik
Singapore comparisons: another problem trying to copy countries like Singapore is that they have much more homogeneous populations. The U.S. has a much more diverse population. Diverse populations tend to game the system.

Singapore actually has a very diverse population.

27 posted on 11/22/2008 5:46:45 AM PST by MyTwoCopperCoins
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To: rightklik
Singapore has a rather mixed population ~ starting with the Chinese. They drive from just about every identifiable language and ethnic group in China.

Then there are the folks from India, SE Asia, United Kingdom, .....

It may well be more mixed than the USA, but not by much.

America and Singapore were once part of the British Empire you know. No "racial purity" there Fur Shur!

28 posted on 11/22/2008 5:49:45 AM PST by muawiyah
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To: Halfmanhalfamazing
But I doubt that the inner cities are totally representative of america.

Inner-city slum "values" and behavior, like drug use, illegitimacy, shacking up, ghetto dress styles and music, etc. are increasingly becoming mainstream. You can find these wonderful things in rural areas and affluent suburbs today.

29 posted on 11/22/2008 5:59:41 AM PST by hellbender
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To: hellbender

See post 2. HSAs seem to be working here in the US wherever tried.

So the Singapore reference might be better than some want to consider.

No matter where humans come from, where they’re at, or what their goals, most of us aren’t really all that different. I learned that when I saw Iraqis with smiles and purple fingers.

Big government doesn’t work. But this does seem to.


30 posted on 11/22/2008 6:41:17 AM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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To: Halfmanhalfamazing
By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970... Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States... How does Singapore do it?

These comparisons are always specious, because none of these places are absorbing hundreds of thousands of illegal immigrants every year.

31 posted on 11/22/2008 6:52:42 AM PST by denydenydeny ("Banish Merry Christmas. Get ready for Mad Max.."-Daniel Henninger)
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To: Uncle Ike

” Singapore has no parasite class, here in the USA we have two: the uneducated illegal immigrants, and the ghetto underclass. “

You forgot the largest, most harmful, parasite class here in the ol’ USA — that one comprised of politicians, ‘journalists’ and the punditry, academics, union leaders, and ‘activitists’ and ‘community organizers’ of all stripes....

******************************************************************

The modern socialist state is far more diverse than you think - within its political ecosystem are found parasites, to be sure, but those you enumerate seem to be occupying more of the predator and scavenger niches.

It’s more holistic this way. ;^)


32 posted on 11/22/2008 6:56:38 AM PST by headsonpikes (Genocide is the highest sacrament of socialism.)
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To: DiogenesLaertius
Good points.

It's also worth noting that Singapore can't possibly serve as a valid point of comparison on a national level simply because it's barely a "country" as we would understand it.

Singapore is a city-state, which means it doesn't have to cope with one of the factors in most countries that affect vital statistics: rural health care, and all of the difficulties that come with it (mainly lack of timely access for emergency care).

For a valid comparison, Singapore would have to be compared to a typical urban area in the U.S. When you eliminate any consideration for crimes related to personal and social dysfunction (crime, drug abuse, etc.), I would venture to guess that Singapore would be no different than most U.S. cities when it comes to the standard of health care.

33 posted on 11/22/2008 6:56:49 AM PST by Alberta's Child (I'm out on the outskirts of nowhere . . . with ghosts on my trail, chasing me there.)
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To: TnGOP
That's an FSA you've got, not an HSA.

One of the defining characteristics of an HSA is the person's ability to build up a pile of cash over a long period of time to pay for future (undetermined) medical expenses.

An FSA is ideal for short-term, recurring medical expenses (if you're already being treated for a chronic condition, for example, that requires expensive prescription drugs).

34 posted on 11/22/2008 7:00:12 AM PST by Alberta's Child (I'm out on the outskirts of nowhere . . . with ghosts on my trail, chasing me there.)
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To: Halfmanhalfamazing
"HSAs would be if everybody had them, that would make capitalism wor.....

Very funny.


We be not working, cause of....um...GM and shi*t...and, um, can't find no job...and, um,...akchewly I be need'n disability payment on acount of my back....So..YOU GOT TO PAY FOR ME!

35 posted on 11/22/2008 7:07:51 AM PST by Leisler ("Give us the child for 8 years and it will be a Bolshevik forever. " Lenin)
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To: Alberta's Child

People like to dream dreamy dreams and then you go bringing up all that reality stuff.

Killjoy.


36 posted on 11/22/2008 7:09:26 AM PST by Leisler ("Give us the child for 8 years and it will be a Bolshevik forever. " Lenin)
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To: rightklik
Singapore comparisons: another problem trying to copy countries like Singapore is that they have much more homogeneous populations. The U.S. has a much more diverse population. Diverse populations tend to game the system.

Let's also not forget that it's a heck of a lot easier to manage or control a healthcare system for a population of less than 5 million than it would be for a population like in the U.S. of over 300 million. Most healthcare systems that the democrats like to quote from are from countries with populations which have considerably less population, such as Canada or the UK or anywhere else.
37 posted on 11/22/2008 7:24:04 AM PST by adorno
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To: TnGOP
* In order to keep costs down, people who go to the Dr for treatment and are found not to be sick are caned without mercy.

Now that would be counterproductive. Wouldn't the caning then require medical care for the victim, at perhaps more cost than the original reason for the visit?
38 posted on 11/22/2008 7:28:24 AM PST by adorno
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To: ikka
The parasite class..the uneducated illegal immigrants..

These people from Mexico are getting a bum rap. For the most part they are young and are beneficially employed. IMO, (ouch) the parasites are those who game the system, because they have coverage. This includes a medical system that run up the prices, because the system pays for just about anything.

Way back, when companies started medical benefits they thought it would be 'nice' to add drug coverage. After all, ~$50 a year coverage per employee wasn't all that much, in that it would attract and keep good workers.

The drug companies not being stupid, figured if a customer was willing to pay initially ~$1.00 per pill and the company ~$1.00, then why not charge $2.00?

Upshot is that the market is is determined by what the customer is willing to pay, and the 'customer' now includes the government. This flaw has snowballed through out the system and is a bigger problem than immigrants and the 'ghetto' unemployed.

39 posted on 11/22/2008 7:49:21 AM PST by duckln
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To: long hard slogger; FormerACLUmember; Harrius Magnus; hocndoc; parousia; Hydroshock; skippermd; ...
Socialized Medicine aka Universal Health Care PING LIST

FReepmail me if you want to be added to or removed from this ping list.


40 posted on 11/23/2008 7:24:54 AM PST by socialismisinsidious ( The socialist income tax system turns US citizens into beggars or quitters!)
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To: Halfmanhalfamazing

HSAs are not a good idea if you’re living paycheck to paycheck, because there is no money left for a HSA.

With rents skyrocketing, you can easily spend 50% or more of your take-home pay to live in a safe neighborhood. Add to that the skyrocketing costs of everything else and a chronic illness or two that you have to buy meds for/see doctors for/have periodic testing for and you’re eating Campbell’s Soup for dinner each night with no money left for a HSA.

Or a 401K or an emergency savings acount for that matter.


41 posted on 11/23/2008 8:53:04 AM PST by JavaJumpy
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To: AdmSmith; Berosus; Convert from ECUSA; dervish; Ernest_at_the_Beach; Fred Nerks; george76; ...
The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970... Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States...
Maybe Singapore doesn't have Maury Povich broadcasts.
42 posted on 11/23/2008 3:43:04 PM PST by SunkenCiv (https://secure.freerepublic.com/donate/_______Profile finally updated Saturday, October 11, 2008 !!!)
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To: JavaJumpy

It’s gotten to the point that all of this stuff is a self fulfulling prophecy.

Government is begetting government, and the costs that government is incurring is begetting more costs.

Here, perhaps this will explain to you what I mean:

http://www.cchconline.org/privacy/hmoart.php3

Healthcare, education, energy, and more. All of these things have one thing in common, especially when you are talking about costs.

Government is the cause of the problem.

I think they intentionally screwed it up so that they could blame the market then take it over totally.

That’s exactly what they did in this mortgage crisis. Now Paulsen has dictatorial powers.


43 posted on 11/23/2008 4:30:16 PM PST by Halfmanhalfamazing (There is no "rich". There is only "the hiring class".)
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