Health care is again moving to center stage in this election year. A year ago the Trump Administration released a respectable report (“Reforming America’s Healthcare System Through Choice and Competition”) but neither Democrats nor Republicans have shown much interest in it since no major legislation can pass both House and Senate. Accordingly the Trump Administration has been confined to making changes in insurance and tax regulations, and proposing price controls to reduce pharmaceutical costs (which the 2018 plan rejected.)
On the Democratic side, Sen. Bernie Sanders has championed “Medicare for All”, which on close inspection translates to “Medicare for Nobody”; Sen. Elizabeth Warren has floundered trying to clarify her version of universal coverage; Pete Buttigeig is promoting a government insurance company as a “public option”; former VP Joe Biden promises to expand and improve Obamacare; and Michael Bloomberg is running ads telling us that he worked wonders in health care as Mayor of New York.
One key Sanders talking point is “the U.S. is the only country in the developed world without a government-run universal health care coverage.” There is certainly something to be learned from examining health care policies in such countries as the Netherlands, France, Switzerland, Japan, and Sweden, plus the problem-plagued Canadian and British models. But by far the most interesting and successful model is Singapore.
In 1955, ten years before this city-state became independent, its British colonial masters instituted the Central Provident Fund. Every Singaporean is required to pay 20% of wages, matched by the employer, into the Fund. This is the equivalent of the U.S payroll taxes for Social Security and Medicare (15.3%), plus the cost of the employer’s medical plan, plus a large contribution into the employee’s HSA, HRA, FSA, or 401(k).