Obamacare and Singapore: a comparison

10/23/2013 06:00:00 PM
They all have Obamacare, but with slightly more socialism.
Matt Yglesias takes on a common conservative refrain about how much better Singapore's healthcare system is than Obamacare. You can read Yglesias piece to learn the essentials of how Singapore's system actually works, and why it's nothing like anything American conservatives advocate for.

I strongly suspect that what's going on here is that conservatives like the idea of Singapore's MediShield, and are ignoring all the rest. MediShield is described as a "catastrophic" health insurance plan. Conservatives like the idea of catastrophic insurance because it preserves the incentives of the market place: you pay all routine expenses out of pocket, meaning that you won't over-utilize routine care, but you also have insurance so that if you have a catastrophic incident like a gun-shot wound, you won't go bankrupt either. Yglesias points out that MediShield does not stand alone: it is part of a centralized regime of mandates and subsidies which finance the rest of your medical bills--in addition to paying MediShield premiums, you are required to pay a large percentage of your income into a centrally-managed "MediSave" fund which covers your allegedly "out-of-pocket" medical bills, you are required to pay taxes which subsidize up to 80 percent of hospital bills, and, on top of all that, you pay taxes into Medifund, a social insurance program covering all other medical costs for the poor.

Yglesias quotes the Singapore health ministry:
"The third level of protection is provided by MediShield, a low cost catastrophic medical insurance scheme"
The use of the term "catastrophic" would appear to be a misnomer, at least by American standards. The deductible for a MediShield plan is no greater than \$1,614.86 USD (adjusted at exchange rate) and will pay 80 to 90 percent of your bills over the deductible limit and 20 to 30 percent of bills under the deductible limit, according to the Singapore health ministry. Far from being catastrophic, that sounds like pretty generous insurance to me.

You can see some of the plans I found on healthcare.gov below the fold. Unfortunately they aren't saying anything at all about deductibles and co-pays for each individual plan, other than this generic statement:
It's hard to compare the generosity of Medishield plans to Obamacare without Obamacare premiums and copays, but I will do so by a circuitous rout. The cheapest Obamacare catastrophic plan is \$1433.04 per year. Assuming a fairly typical 20 percent loading cost and that the plan is calibrated to pay 60 percent of your annual healthcare expenses, that means your expected annual expenses are \$2985.50. I checked and it turns out all the plans work out to expected costs near \$3,000 per year. At this level, Singapore's MediShield would fund around 62.4 percent of your average annual expenses, barely more generous than the minimum required coverage under Obamacare.

In other words, Obamacare is Singapore, except with fewer mandates and more role for private markets, things that conservatives generally prefer.

Monthly Obamacare premiums after the jump:
Here's what I found for an Ohioan less than 50 with no dependents:

  1. Catastrophic plans:
  2. Bronze plans (can anyone tell me how these are different than catastrophic plans? or why they cost more than silver plans?):
  3.  Silver plans:
  4. Gold plans:
  5. Platinum plans:
Eugene Tham 11/29/2013 08:31:00 PM
Actually, given that Medishield premiums are less than 500 dollars annually and cap at 1.1k for the elderly of 86-90 yrs old, that a huge difference in cost.


I'm guessing the real difference comes from the fact that Medishield only covers hospitalization bills, whereas US health insurance covers basic medical bills such as visiting the doctor in a outpatient setting.