Back in Singapore

I've been remiss posting to my blog this week. I think all the back and forth travel of the last few weeks wore me out. I've battled fatigue all week, and yesterday, after having a good night sleep, I still needed a two hour nap in the middle of the day to finally feel fully rested.

The big concern for this week was whether our son would decide to arrive early. Our doctor has adamantly explained that our daughter is not welcome in the delivery room, so if my wife went into labor when I was not around, we had to find someone to stay with her. Our building offers a babysitting service at $15/hour. However, they require a 24 hour notice and a two hour minimum. I didn't think the minimum would be an issue. The 24 hour notice definitely would be. I tried to swing a deal whereby I would pay the two hour minimum to have someone on call, which they would keep if we never used them and would be a bonus if we did. They countered with paying someone to be present for the full time I was gone - 96 hours, at the full rate. Not interested in paying $1,000 for a babysitter we did not need, I did not peruse this option. Luckily, one of our new neighbors agreed to watch our daughter, if needed, until I arrived. We didn't need to partake of their hospitality.

I continue to read extensively. This week I finished two books on discovering and using economics in everyday life. For example, using theories of economics to identify which queue at the grocery store will move the fastest. Ultimately, economic theory helps to determine policies and procedures at work (or in government programs) that create the appropriate incentives for the behavior you desire. People typically act rationally to serve their own self-interests, so you have to structure programs in recognition of this tendency so that self-interest aligns with corporate interest.

A corollary to these readings is learning more about our health care situation. There are so many myths about how great, but expensive, US health care is vs. the rest of the world. The US system contains $1,000 per person just for administration - secretaries, insurance processing, etc.! Here is the reality: per person, the US spends more than any other country in the world with no proof of additional quality. And not just a little bit more - at least double, often triple.

The theory is that this is okay because we have better care. What defines better care? Probably most effective to look at common measurements - longevity, infant mortality, quality of life. When comparing the US data on these categories with other countries, our claim for "the world's best care" falls hollow. Many countries spending less per person surpass our statistics.

The system achieving the most value? Singapore. Singapore's publicly funded system spends the equivalent of $752 per person to cover the entire population - less than just the administration portion of the US costs. Unlike the British or Canadian system, they also do not have long wait times to see a doctor. Singapore has designed a system exactly they way I would have. Blending personal responsibility (cost) with protection from catastrophe.

The British and Canadian system has long lines for one simple reason - when something is free, the laws of supply and demand dictate demand will always be more than supply. If you did not have to pay for a car, how many would you own? So, people use services they don't actually need. Singapore addresses this situation by requiring everyone to pay for the care they receive out of their pocket, up to a certain amount each year, based on their ability to pay. So, a person earning $100,000 a year will have medical expenses cap at $5,000 while a person earning $20,000 a year will cap at $1,000. Once expenses exceed this amount, the government picks up the rest. Of course, they still decide what they will cover (heart surgery, yes, breast augmentation, no), but there is no discussion on who (young vs old).

The anti-public health care groups in the US focus on perpetuating fear and myth - death councils, government ineptitude, uncontrolled cost. All they are really demonstrating is their own laziness. Inaction is easy. We pay them for action. The private sector solution is not working. It is expensive and does not cover everyone. We can be lazy - or, for many Congressman, just believe that the Rapture will occur before we ever have to address it - or, we can solve the problem by looking at successes around the world. Singapore is a good place to start.

Odds and Ends

Living the life of a bachelor again reminds me why so many of us leave it for the confines of marriage. The most difficult part is the meals - eating alone. It's tough to go out to a restaurant: "Table for one?" They don't like it either. Wastes a perfectly good table. The like us to eat at the bar, with all the other lonely castoffs. At least I know mine is temporary.

I've been meaning to get around to a few things on my blog, and now is as good a time as any. I try not to get too political here - I have a different blog for that - because this is my story about living abroad. My recent medical experiences in both Jakarta and Singapore have provided timely insight into a current national debate in the US, and I've now decided, after much internal debate and consideration, that I am in favor of some type of nationalized health care.

I'm a free-market capitalist to the core. Any economist worth his degree, however, will admit that, in the interests of efficiency, the government has to take on some roles. For me, those roles have been limited to: educating the populous, protecting the populous (police, fire, military), providing reliable transportation (roads), regulating (minimally) commerce, and negotiating internationally. I will now add providing basic health care to the population to my list of essential government functions.

Anyone who has had a baby recently and viewed their insurance payout information knows how expensive it is. Nearly $10,000 if you have an epidural and a vaginal delivery. In Singapore, if we had to pay it out of pocket, the cost would be $1,400, including three nights in a private room. My endoscopy, which my father tells me can cost well over $2,000 in the US, had a total cost, including filling my prescriptions, of $500. The procedure itself was just $300.

Health care costs in the US are out of line. Much of this is due to the fact that doctors have to carry malpractice insurance that costs them $100-$200k per year. They have to earn $200,000 just to cover their premiums. It's obvious to me why small towns no longer have doctors. They can't make enough money to cover their premiums, pay their office expenses, and still earn a living.

Another major contributor is the amount of relatively healthy people who visit the ER for a cold. ER's are required by law to not turn anyone away. They can't deny someone treatment for not having insurance. When these people don't pay their bills, the hospitals have to make up the cost somewhere - so they take from people with insurance. If everyone has insurance for basic needs - annual check ups, annual colds; and everyone has catastrophic insurance for major medical like severe car accidents, this problem goes away. We also would still have an auto industry and more small businesses.

Everything in between those two extremes - basic, preventive care and catastrophic injury (like amputation) - would need to be covered by private insurance. Viagra, Ritalin, xanax - those would all be covered by private insurance.

If third world nations are able to keep medical costs low, I would think the US could do a better job. My advice to Obama: Think big, start small, start now.

Tomorrow I'll post on the other topic - career management.