The U.S. spends more on its healthcare system than any other country in the world but significantly less on social programs that improve health in lower income populations. Data show social determinants of health (clean water, safe communities, healthy food) contribute to better health and lower costs for health care. Our system is widely regarded as an exceptional sick care system where the latest technologies and approaches are used by hospitals and physicians to treat the sick and injured.
- In your first post:
- Describe one foreign healthcare system. How is it financed? Describe insurance coverage. Compare the outcomes of care, costs and other related statistics to the United States.
- Do you think one is better than the other? What are some ways the United States should improve or reform the healthcare system?
- What role do you think the federal government has in providing Americans with health care?
- Respond to at least two classmates’ posts, preferably those whose opinions you disagree with.
The healthcare system I looked into is the Singaporean healthcare system. It is a mixed system of private and public The system is driven by 3 pillars of philosophy. First, the country is determined to create a healthy population through preventative care and promote healthy lifestyle practices. Second, the country also looks at healthcare as a shared responsibility with the people and the government. Lastly, it is built off of 3M’s, that is Medisave, Medishield, and Medifund. Part of the responsibility the government assumes is taking control of healthcare services and highly subsidizing public healthcare. Costs of premiums, and what is subsidized are mostly dependent on age and income. The system is partial to people who are older as the costs will mostly shift onto young, high earners to keep costs low for the elderly.
Medishield is a mandatory universal basic healthcare insurance with the purpose of covering catastrophic care. It is a high deductible plan of $1-3,000 and a coinsurance of 3-20%. The premiums can range from $15-68 and pays up $100,000 annually with lifetime coverage. Medisave is a national medical saving scheme. It is designed to help pay for out-of-pocket costs. Workers and their employers contribute 8-10%, depending on age and is also mandatory. It is a tax-exempt account that also has an interest rate of 4-5%. Medifund is a federal safety net to help citizens who cannot cover their out-of-pocket expenses when they deplete Medisave.
Some differences in cost to the US are pretty great. The average cost of a bypass surgery is about $130,000 while in Singapore it is $18,000. The fact that the Health saving account offers an incredible 5% interest and everyone has to do it, all the money in these accounts can pay for all healthcare spending, public and private, for the next 5 years. In comparison to the US, it would only sustain 13 days. Singapore has an average life expectancy of 83 years and health expenditure as a share of GDP was about 6%. The US average life expectancy is 78 years and health expenditure as a share of GDP was about 18%. For 2021, WHO international ranked Singapore’s healthcare system 6th with the US at 37. I will say personally and I may be bias, but I question a ranking that has the US at 37, but Cuba at 39. Nonetheless, I think it’s hard to definitively say that Singapore’s healthcare system is better than the US, although there are blatant problems that the US has right now. What makes it difficult is the population size of only 5.7 million to 328 million in the US. The founding philosophies of the US are also fundamentally different. Citizens in Singapore are willing to give up freedoms and defer a lot more control to the government to have lower costs. They have a lot more trust in the government, where this country was founded on the idea that government should not have too much power. Singapore price controls medical services, what is available, the technology that can be used, and even how many medical professionals are required. Although I am hesitant to give more deciding power to a government, somethings that I do like the Singaporean government does is require people to invest into a health savings fund. I like the idea that healthcare is a shared responsibility and I think people need to actively prepare themselves financially in some way. The fact that these accounts yield a 4-5% interest is incredible. It beats inflation while bank accounts in the US give an empty 0.08%. Saving money is losing money. The fact that the Singaporean government controls food imports with mandates such as reducing their sugar content to 12% at a minimum is wonderful. In the US, we allow food additives that are deemed harmful to our health but are banned outright in other countries.
I think the government’s role is more of coddling or enabling. I am not saying to get rid of social programs and the aid that people are getting, but an estimated 38.5% of the federal budget is spent on Medicare and Social Security. This is more than double what is spent on the military. It would be political suicide if someone proposed a budget cut to these programs, but as it was stated in the lesson, there is not enough funding going to social programs that have data showing these are much better alternatives in lowering costs and making the population healthier and happier. It doesn’t seem like the government has much interest in making people financially independent and healthier for the long term as this would make less people dependent on federal programs. The ACA also seeks to expand who is eligible for Medicare and Medicaid, which means even more spending and reliance on these programs.
Canada is one of the foreign countries that has a universal healthcare system. All Canadian citizens and permanent residents can apply for public health insurance at no cost. Canada is publicly financed or funded through federal, provincial, and territorial taxations (Government of Canada, 2019). The federal government in Canada provides cash assistance to each province and territory per capita basis. However, the health insurance coverage such as insurance plan, benefits, and delivery approaches may vary in each province and territory. Fortunately, all Canadian citizens and permanent residents may receive medically necessary services such as physician visits, hospital services, or emergency medical services at no charge. The United States spends the most on healthcare compared to other countries including Canada. According to OECD data, the United States spends 17% of the gross domestic product (GDP) while Canada only spends 10.8% in 2019 (Santhanam, 2020). Despite this spending, the United States still has poor health outcomes compared to Canada. For instance, the United States has a lower life expectancy and higher suicide rates than Canada. In 2017 data, the United States has 78.6% life expectancy and 13.9% suicide rates while Canada has 82.0% life expectancy and 11.8 % suicide rate (The Commonwealth Fund, 2020). The United States has also a higher rate of chronic diseases, obesity, and hospitalizations. Overall, the United States has worse health outcomes and shorter life expectancy than Canada.
In my perspective, Canada’s universal healthcare system is better than the United States healthcare system. All Canadians are covered with health insurance at no cost regardless of their social and financial status while most Americans usually get insurance coverage through their employers and pay more for health insurance. Although the United States passed the Affordable Care Act (ACA) in 2010 that requires most Americans to acquire health insurance, many of the citizens do not qualify for this government insurance and remain uninsured. For instance, the working poor usually do not qualify for Medicaid because they are earning above the federal poverty level to qualify for the program but too little to afford the health insurance in the marketplace.
The United States must improve or reform the healthcare system for Americans due to rising medical costs. Some ways that the United States should improve or reform the healthcare system is to offer affordable coverage and/or provide universal healthcare coverage for Americans. Offering affordable coverage and/or providing universal healthcare coverage will help more Americans to obtain health insurance. Due to the rising cost of medical care, many individuals remain uninsured. According to the American College of Physicians, the United States needs a healthcare system that provides care for all Americans (Tanne, 2017). All Americans should receive essential health benefits packages such as primary care, preventive care, chronic management services, and other medical emergency services regardless of their social and health status. This will not only improve the quality of life of many Americans but also reduce health disparities and protect them from catastrophic healthcare costs.
One role the federal government has in providing Americans with healthcare is to ensure access quality of care for vulnerable populations. For instance, the elderly, children, minorities, underinsured, disabled individuals, and socioeconomically disadvantaged must acquire high-quality medical care and essential health benefits. The federal government is responsible to regulate equal access to healthcare for all Americans. This will help Americans to receive adequate access to medical care to prevent chronic diseases and decrease healthcare expenditures.
Government of Canada. (2019, September 17). Canada’s health care system. https://www.canada.ca/en/immigration-refugees-citi…
Santhanam, L. (2020, August 31). How Canada got universal health care and what the U.S. could learn. https://www.pbs.org/newshour/health/how-canada-got…
Tanne J. H. (2007). US needs universal access to health care, American College of Physicians says. BMJ : British Medical Journal, 335(7632), 1228. https://doi.org/10.1136/bmj.39423.499560.DB
The Commonwealth Fund. (2020, January 30). U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? https://www.commonwealthfund.org/publications/issu…