About Singapore…

UPDATE: When you’re done reading this post, go read this and this.

Man, this has been a week. Just a few days ago, I wrote about how Singapore has been a go-to for many of my more conservative colleagues, who think it’s a much more market friendly alternative to the ACA. I think that many of them underestimate how much “government” there is in the system. Today, all that is a bit irrelevant, because Singapore announced that however much government is involved, it’s not nearly enough (emphasis mine):

Singapore’s Prime Minister Lee Hsien Loong announced a number of policy adjustments on Sunday evening in areas such as medical insurance and education, outlining a strategic shift in his approach to nation building.

Individuals must still do their best, but the community and government must do more to reduce the pressures on individuals, he said at the annual National Day Rally.

In one of the key changes announced in the evening, Lee said that the government is revamping the country’s medical insurance system to move towards universal and life-long coverage.

Hoo-boy. What kind of changes can we expect? You don’t think they’ll look anything like Obamacare, do you? Let’s get out our scorecards.

The coverage of MediShield, a low-cost basic medical insurance scheme, will no longer stop for people who turn 90.

A “Medicaid expansion”! Check.

It will also be expanded to include even those with pre-existing illnesses.

Guaranteed issue! Check.

The benefits will be increased so patients will pay less out of their own pockets.

Less cost-sharing! Check.

There will be no choice to opt out under the scheme, which is to be renamed MediShield Life.

A stronger mandate! Check.

The premiums will likely be higher, but Lee said the government will step in to help those who cannot afford it.

Rate shocks! Increased subsidies! Check and check.

He also singled out the pioneer generation, in their late 60s and above. The government will create a Pioneer Generation Package to help pay for their MediShield Life premiums.

A new entitlement program! Check.

It’s almost as if Singapore doesn’t realize that it’s supposed to eschew all of these things so wonks can point to some system somewhere that hews to a more market-based health system. Don’t they understand what they’re supposed to do?


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