Milton Friedman?

[Kitsune]

I think this falls into politics but might not be quite right
Reason why is that I consider economics and politics to go hand in hand

Problem is that he is a favorite Libertarian "Big Gun"
From what I have been able to read, his ideas rally don't work in practice

Still, anybody have any suggestions for dealing with arguments?

[Ahriman238]

Posting some of his arguments might help. I google him and turn up a stack of spiffy, generally accurate quotes about the problems with out government. Oh, and one that he's for cutting taxes "under any circumstances and for any excuse, for any reason, whenever it's possible." Which isn't exactly a well-reasoned argument.

[Kitsune]

Lets start with this one
http://www.hoover.org/publications/hoov ... ticle/7298

or this one
http://www.slobodaiprosperitet.tv/en/node/504

I should add that in most economists I read, they try to use recent examples to show something working or not working
As far as I can tell, most of his examples are from centuries past and don't know if he is really working from data.

Many of his ideas appear to be failures
http://www.theguardian.com/commentisfre ... 16/post650

[energiewende]

Friedman is principally known for revolutionizing understanding of monetary and fiscal policy. This has worked pretty well at the very least in the sense of achieving their aims and being stable (low inflation and low interest rates are a comparatively recent phenomenon), and are generally also considered to be beneficial. Opponents may argue these policies contributed to the financial crisis and purists would argue that his ideas have been only ever partially implemented. Pretty much all modern monetary and fiscal work is built on his paradigm, including that of the New Keynesians who oppose many of his policy prescriptions.

Some decent approximation of Friedman's healthcare ideas were implemented in Chile and Singapore. As far as I know Chile does decent considering it's not really a developed country, while Singapore has one of the best ratios of outcome to expenditure in the world, arguably the best healthcare system in the world period. Although the youth and relatively good lifestyle of the population also help. I'd say Friedman's healthcare ideas soundly beat the US model and compete well with the best subsidised mandatory insurance and single payer models.

In the second link his main point seems to be that even the poor in free market countries live better than the vast majority of everyone everywhere else. This a true and sadly neglected fact, but not really a policy prescription beyond the obvious. His advocacy of free immigration, abolition of the minimum wage, and the existence of a welfare trap are all disputed but respectable, if not majority positions among economists.

I wouldn't take an attack article in a left wing newspaper as evidence for much of anything. What do you think Fox has to say about Keynes?


edit: I think I am wrong about Chile's healthcare system. They use his ideas for their pension system.

[K. A. Pital]

I don't really know why people rail so much about Friedman. Friedman is not a libertarian; he did not hold a consistent libertarian position and his stance on civil liberties (unlike that of the more orthodox libertarian thinkers) is pathetically weak. He's a typical monetarist. A mainstream person talking all mainstream right-wing points. Sure, his supporters and he himself probably had a soft spot for dictators, but that's pretty much the problem of every right-winger in America - they're so damn fascinated with leather, black boots and the like. You know... that stuff. Except not as a game but for real.

[Welf]

Milton Friedman was a great economist in some fields but often advocated terrible policy.

Lets start with this one
http://www.hoover.org/publications/hoov ... ticle/7298

This is one of the terrible policies I mentioned. Like in the next article Friedman has a very simplistic view of the world.

It's founded on the plausible concept that you yourself are the best person to make judgements for you. But when you think about it's less plausible.
Just think about what it takes to become a doctor. You study 5 or 7 years which includes some of the hardest exams in university, then have to do some time in practical training. So when you go to a doctor you will meet someone with maybe a decade of intense theoretical and practical training. And you have googled something the evening before. You can get to another doctor and get another diagnosis, and then to another one when those are not identical or even when they are, but that costs money. And since doctors form their own social group with similar interests you don't know if one would give you an honest diagnosis that differs from what the others say. That is a information asymmetry that leads to higher customers and will be only increased when a patient tries on his own to make a deal. And since sick people tend to be sick and feel pain and might even be afraid to die or suffer long term disability they are in the worst possible situation to make a deal.

This is were it gets useful to hire a specials and pool resources. Of course you then run into similar problems with insurance companies. You are not under concrete pressure to form a contract, but it's supposed to be a long term contract and the insurance company has better information and better means to get out of a contract. US insurance companies tend to make confusing and overly complex contracts so they can weasel out of them later. This happens everywhere where you don't have standardized contracts enforced by the government or another institution. For example the main use of commodity exchanges is that they offer standardized contracts. (It's no coincidence that Obamacare tries to establish just the same for health insurance). But at financial markets you have sellers and buyers at the same power so markets like that will be established naturally (and they sill prefer government rules to make the market places more save). In the health market this won't happen since consumers are too weak. This all leads to socialized medicine in some form since with a democratic process you can change the health insurance contract a population has effectively with itself with any election.

Another example of how simplistic Friedman's view is think about what he writes employer sponsored health insurance. It basically says that profit oriented employers would for some reason control less for costs if they have to pay for it and bear the risk. Wut? You can argue that employers might look for cheap health insurance if they have to pay it. But the article talks about too high costs. And when you have an employer taking care for the costs you have economies of scale and potential for specialization.

Funny it gets when he explains that the US has the lowest government share and the highest costs of western economies. He then explains what the advantages of socialist health care are and then brushes it aside shortly mentioning "waiting lines". Only a few paragraphs after mentioning that the US has worse results than other countries. But I guess standing in line beats living longer and healthier.

I also like how he explains that Medicare and Medicaid have a cost problem. Which they do. But of course he forgets to mention that private insurance in the US is doing worse.

or this one
http://www.slobodaiprosperitet.tv/en/node/504

Simplistic world view again. It's true that in simple models minimum wage increases unemployment for the poor. But more sophisticated models tell us that there are multiple equilibriums and a reasonable minimum wage can increase bottom income without destroying employment, and maybe even create some.

I should add that in most economists I read, they try to use recent examples to show something working or not working
As far as I can tell, most of his examples are from centuries past and don't know if he is really working from data.

Many of his ideas appear to be failures
http://www.theguardian.com/commentisfre ... 16/post650

Funny thing about the withholding tax; I didn't know that

[Kitsune]

Thanks for the help. . . .Does help a lot to understand what I am arguing against
Noted myself that his argument against socialized health care involved a lot of hand waving

[Alyrium Denryle]

Funny it gets when he explains that the US has the lowest government share and the highest costs of western economies. He then explains what the advantages of socialist health care are and then brushes it aside shortly mentioning "waiting lines". Only a few paragraphs after mentioning that the US has worse results than other countries. But I guess standing in line beats living longer and healthier.

It actually betrays a very deep lack of understanding in how those "lines" are formed. It is not "first come, first serve" in a socialized system. If you go into an Emergency unit with a temperature of 40 degrees celcius, you get seen before someone who comes in feeling Nausea, because a fever that high can cause neurological damage if left untreated. In socialized systems, your position in "line" is based on medical necessity, and after basic preventative care, it is effectively rationed based on medical necessity.

In the US system, healthcare is also rationed. But it is on the basis of ability to pay. The patient pool is decreased by pricing out 40 million people, and while emergency units use medical triage, anything longer term is scheduled on a first come first served basis, which necessarily entails that people who dont have the ability to afford treatment will wait longer (either as they raise the capital, or fight with their insurance company for prior authorization).

[PainRack]

Thanks for the help. . . .Does help a lot to understand what I am arguing against
Noted myself that his argument against socialized health care involved a lot of hand waving

Let's put it this way. The poster boy for Medical Saving Accounts, Singapore, does not believe in his philosophy.

No, seriously. Take a good look at any speech in Singapore, any analysis done by healthcare policy wonks. Well, actual ones anyway. Not a single person actually believes that the HSA reduces medical costs because singaporeans shop and choose.

What any libertarian has confused are two separate philosophies in Singapore healthcare thinking, although the confusion is understandable because they are mixed together in libertarian philosophy.

1. Competition is good and help reduces prices.
While we don't know about our current health Minister Mr Gan, the previous Health Minister Mr Khaw, one of two ministers most responsible for this concept fervently believe in this, with a speech given at the Asia Pacific Health conference about how competition help reduces prices, using LASIX as an example. He went on to talk about how he started more services to help people choose, to be better informed, such as the publication of median medical bills.

2. Rugged individuality/personal responsibility.
Any speech made by our ministers about this has been captured and viewed as libertarian. However, our own ministers view it quite differently. They simply view it as the transfer of costs from the public to the private, of how Government spending on healthcare has been reduced from 50% to less than 1/3. And that this is a "good" thin in terms of SUSTAINABLE healthcare spending.

When they talk about individuals being responsible for their health, they are not claiming that Medisave forces people to be responsible for their health, they're saying that people HAVE to be responsible for their health. And yes, they do subscribe to the question of healthcare moochers, of unlimited demand and etc......

But here's the thing. The shift to a Medisave account 'might' be motivated by libertarian views, but by 1996, the government has clamped down on such as heresy and a failure in policy. Any healthcare analysis, and from this, the speeches our ministers made has been about restricting supply in the 90s, because they believe that increased supply leads to increased demand which leads to increased cost, based on what Hiao, a healthcare economist wrote. And it follows that the shift to a Medisave account was to restrict "demand" further, because it reduced the ability of people to demand more healthcare services.
No, not just from ability to pay, but from the fact that Medisave itself is a huge, rationing system. You can't use Medisave to pay for non standard treatment. You can't use it to pay for HIV meds. You can't use it to pay for a long list of things including outpatient costs until recently........ and in the public debate for expansion of Medisave to cover chronic diseases, Khaw, the poster boy of 'competition' and 'rugged individualism' in healthcare outright stated that he didn't want to expand Medisave because he didn't want Singaporeans to deplete their healthcare accounts.

In other words, the Government DECIDES how much healthcare you can spend with your own money.


The next time any Libertarian starts quoting Friedman and claiming Singapore shows that he works, point out that our government uses HSA as a huge rationing panel, a REAL death panel type mechanism. No, I'm serious.

Its only sometime in the 90s that we finally allowed people to use Medisave to purchase a vital, life saving drug with their own money, from their health saving account. Why? Because Medisave, is only intended for 'inpatient hospital' use, not outpatient. And HIV anti-retrovirals, is something you get from your doctor, in a clinic.

But hey, I mean, there's always delay in government healthcare policy, right? AIDs epidemic in 80s, healthcare reform in 90s, ten years for healthcare policy to be set is actually pretty fast in the normal scheme of things, especially once you realize effective ARV meds and science needs to be established first, then policy can react. Medisave as 3M system was set up only in 1990s anyway, so its just a delay hmmm?

Not when there's a limit of 550 dollars withdrawal per month and this includes any antibiotics used to treat oppurtinistic infections, created in 2002. And since ARV therapy costs 500 to 600 dollars a month, ignoring labwork and etc, and this ignores the cost of secondline therapy and etc needed when drug resistance set in....................
There's a huge world of difference in death panels, when its the government telling you no, we refuse to give you tax payer money to save your life and when its the government telling you no, we can't let you use your own money to save your life.


Ah well. In the grand overall scheme of things, arguing about how much a person can withdraw is a minor issue, because the average Singapore can't sustain 600 dollars worth of healthcare spending anyway but its a huge source of irritation everytime I see some libertarian crow about how Singapore HSA allows patients to 'compete' based on price and it gives them 'choice'.

[PainRack]

Friedman is principally known for revolutionizing understanding of monetary and fiscal policy. This has worked pretty well at the very least in the sense of achieving their aims and being stable (low inflation and low interest rates are a comparatively recent phenomenon), and are generally also considered to be beneficial. Opponents may argue these policies contributed to the financial crisis and purists would argue that his ideas have been only ever partially implemented. Pretty much all modern monetary and fiscal work is built on his paradigm, including that of the New Keynesians who oppose many of his policy prescriptions.

Some decent approximation of Friedman's healthcare ideas were implemented in Chile and Singapore. As far as I know Chile does decent considering it's not really a developed country, while Singapore has one of the best ratios of outcome to expenditure in the world, arguably the best healthcare system in the world period. Although the youth and relatively good lifestyle of the population also help. I'd say Friedman's healthcare ideas soundly beat the US model and compete well with the best subsidised mandatory insurance and single payer models.

No, no, it doesn't. Here's the thing.
We implemented Medisave in 1984, it was modeled in the 1983 health plan. Healthcare spending rose after that, to the extent that the then extremely fragile system was viewed as unsustainable.

In response to that, our healthcare economist said "healthcare financing is not a health system" and that "financing itself does not control costs", and shifted ENTIRELY over to supply side economics. Or restricting supply, because supply inflates demand.

Then in the late 90s and etc, when Minister Khaw took over, they shifted to competition as an idea to restrict competition. Yet, the splitting of the public hospitals in 2000 to become Singhealth and National Health Group had literally NOTHING to do with Medical Savings Account and to make matters even more interesting, the Ministry acknowledged that transparency and etc wasn't working to allow competition to work, so, they took the step of releasing a median hospital bill size so people could shop around. So even his vaunted idea of competition was found to be lacking, because healthcare lacked the mechanisms in other industries to allow competition and etc. The idea of opposing groups to drive innovation has been largely abandoned in favour of cluster based healthcare, we're still using competition to drive down prices and etc etc etc, but no more "battling units". Instead, healthcare will be decentralized and shifted towards the communities as much as possible, with an acute and community hospital in each cluster to provide community care and SGH and NUH will provide tertiary care. Of course, you can't abandon all the effort TTSH has made so they're going to continue their operations at tertiary care, beside, NHG is a private concern whose main shareholder just happens to be the government so yadda yadda yadda......

And note that even here, in 1990, we acknowledged that Medisave on its own was incapable of meeting healthcare needs(and beside, Medisave was only allowed for hospital inpatient use) and we revamped it to include 3Ms, and then later, Elder Shield.

Which is essentially a government basic catastrophic health insurance and then targeted government aid, as well as a government disability insurance.

And we now recognize that even here, its inadequate and in 2013, we announced that the 'public option' will henceforth be mandatory, with subsidies given to those who won't be able to afford the premiums.......

[Guardsman Bass]

Friedman tended to make arguments that were superficially appealing and reasonable once you accepted his premises, but which tended to be problematic when you got into the deeper details. One of his favorite points to make was about how the Gilded Age was a glorious period of not only commerce, prosperity, and innovation, but of philanthropy - with the implication that this was destroyed by the rise of the New Deal and "dependency" on the government by the poor. But that was it - he never really went into the argument as to whether this rise of private charity actually was a sufficient panacea for the social ills of the period, most likely because it wasn't when you looked into it. Conditions for a huge segment of Americans were appalling, and private philanthropy was merely a bandage on a gaping wound - it's not coincidence that this period led to the rise of the first national social welfare programs in the US.

He did get a few things right. I don't entirely agree with his views on occupational licensing, but he makes some good points about how it's often the groups themselves looking for special licensing regimes, not their customers (especially if their proposals "grandfather in" previous practitioners as opposed to making everyone follow the rules). He was right about the gas lines in the US being a result of the Nixonian price freezes, and how they went away once those price freezes were removed. And he was right about how the Federal Reserve in the 1930s did an absolutely incompetent job in responding to the Great Depression.

[Kitsune]

With regards to Singapore, it sounds like your statement is that antivirals are not available to aid's patience?
I hope I am misunderstanding you?

[UnderAGreySky]

A lot of people consider Paul Krugman and Milton Friedman to be on opposite side of the economic spectrum. This isn't strictly true, but they do hold (or in the case of Friedman, held) differing opinions on what to do in a recession caused by the lack of demand.

With that out of the way, here's Krugman writing a nuanced biographic article on Friedman the economist, Friedman the policy entrepreneur and Friedman the ideologue:

Milton Friedman played three roles in the intellectual life of the twentieth century. There was Friedman the economist’s economist, who wrote technical, more or less apolitical analyses of consumer behavior and inflation. There was Friedman the policy entrepreneur, who spent decades campaigning on behalf of the policy known as monetarism—finally seeing the Federal Reserve and the Bank of England adopt his doctrine at the end of the 1970s, only to abandon it as unworkable a few years later. Finally, there was Friedman the ideologue, the great popularizer of free-market doctrine.

Did the same man play all these roles? Yes and no. All three roles were informed by Friedman’s faith in the classical verities of free-market economics. Moreover, Friedman’s effectiveness as a popularizer and propagandist rested in part on his well-deserved reputation as a profound economic theorist. But there’s an important difference between the rigor of his work as a professional economist and the looser, sometimes questionable logic of his pronouncements as a public intellectual. While Friedman’s theoretical work is universally admired by professional economists, there’s much more ambivalence about his policy pronouncements and especially his popularizing. And it must be said that there were some serious questions about his intellectual honesty when he was speaking to the mass public.

Friedman’s work on consumption behavior would, in itself, have made his academic reputation. An even bigger triumph, however, came from his application of Economic Man theorizing to inflation. In 1958 the New Zealand–born economist A.W. Phillips pointed out that there was a historical correlation between unemployment and inflation, with high inflation associated with low unemployment and vice versa. For a time, economists treated this correlation as if it were a reliable and stable relationship. This led to serious discussion about which point on the “Phillips curve” the government should choose. For example, should the United States accept a higher inflation rate in order to achieve a lower unemployment rate?

In 1967, however, Friedman gave a presidential address to the American Economic Association in which he argued that the correlation between inflation and unemployment, even though it was visible in the data, did not represent a true trade-off, at least not in the long run. “There is,” he said, “always a temporary trade-off between inflation and unemployment; there is no permanent trade-off.” In other words, if policymakers were to try to keep unemployment low through a policy of generating higher inflation, they would achieve only temporary success. According to Friedman, unemployment would eventually rise again, even as inflation remained high. The economy would, in other words, suffer the condition Paul Samuelson would later dub “stagflation.”

How did Friedman reach this conclusion? (Edmund S. Phelps, who was awarded the Nobel Memorial Prize in economics this year, simultaneously and independently arrived at the same result.) As in the case of his work on consumer behavior, Friedman applied the idea of rational behavior. He argued that after a sustained period of inflation, people would build expectations of future inflation into their decisions, nullifying any positive effects of inflation on employment. For example, one reason inflation may lead to higher employment is that hiring more workers becomes profitable when prices rise faster than wages. But once workers understand that the purchasing power of their wages will be eroded by inflation, they will demand higher wage settlements in advance, so that wages keep up with prices. As a result, after inflation has gone on for a while, it will no longer deliver the original boost to employment. In fact, there will be a rise in unemployment if inflation falls short of expectations.

At the time Friedman and Phelps propounded their ideas, the United States had little experience with sustained inflation. So this was truly a prediction rather than an attempt to explain the past. In the 1970s, however, persistent inflation provided a test of the Friedman-Phelps hypothesis. Sure enough, the historical correlation between inflation and unemployment broke down in just the way Friedman and Phelps had predicted: in the 1970s, as the inflation rate rose into double digits, the unemployment rate was as high or higher than in the stable-price years of the 1950s and 1960s. Inflation was eventually brought under control in the 1980s, but only after a painful period of extremely high unemployment, the worst since the Great Depression.

By predicting the phenomenon of stagflation in advance, Friedman and Phelps achieved one of the great triumphs of postwar economics. This triumph, more than anything else, confirmed Milton Friedman’s status as a great economist’s economist, whatever one may think of his other roles.

The article is long, of course, but worth reading. You could say it's biased towards Krugman's point-of-view, but he's frank about it, and I don't personally see any malice in his criticisms wherever they may be.

[Guardsman Bass]

That was a good read, and it's appropriate that Krugman was the one to write it - I saw a video where another prominent economist compared to Krugman to Friedman (both are Nobel Prize Winners). I especially thought this was interesting, but sadly not surprising:

What’s odd about Friedman’s absolutism on the virtues of markets and the vices of government is that in his work as an economist’s economist he was actually a model of restraint. As I pointed out earlier, he made great contributions to economic theory by emphasizing the role of individual rationality—but unlike some of his colleagues, he knew where to stop. Why didn’t he exhibit the same restraint in his role as a public intellectual?

The answer, I suspect, is that he got caught up in an essentially political role. Milton Friedman the great economist could and did acknowledge ambiguity. But Milton Friedman the great champion of free markets was expected to preach the true faith, not give voice to doubts. And he ended up playing the role his followers expected. As a result, over time the refreshing iconoclasm of his early career hardened into a rigid defense of what had become the new orthodoxy.

[PainRack]

With regards to Singapore, it sounds like your statement is that antivirals are not available to aid's patience?
I hope I am misunderstanding you?

Its....... not as bleak as that, but the costs of ARV therapy means that many people receive what would be considered substandard care in Western countries.

http://www.afa.org.sg/act/27/3.htm

The argument is that HIV is not curable, hence, public subsidies isn't forthcoming and Medifund, our third pillar which ensures that anybody who needs healthcare receive 'some', says its not productive to cover the full costs of HIV meds, because its not curative.(emphasis on some, as opposed to EFFECTIVE. Which is laughable. Right, give a person an asthma inhaler, but don't give him the spacer because its a 'luxury' item, and since he can't use the inhaler properly, you just wasted the inhaler. For the want of a nail............)

My argument was against the belief that somehow, Singapore Medisave Account is a triumph of patient choice. HIV meds are the perfect example of how this is NOT. I mean, one could potentially argue how withdrawal limits protects against frivolous spending in other examples, say for example, Hyperbaric oxygen therapy. The withdrawal limit of 100 dollars per treatment means that the average cost of 5,200 dollars, a person has to pay 3,200 dollars out of pocket for a treatment that heals chronic wound faster and has a significant impact on reducing the risk of amputations.
http://www.singhealth.com.sg/NR/rdonlyr ... sofmed.pdf
I mean, its still 'additional', since its not part of basic care. And basic wound care is effective at reducing the risk of amputations. And you can purchase additional insurance which covers these gold plated treatments. But HIV? Nope. At least, none as of 2007 anyway. The last 6 years might have seen some changes on that front.

That nonsensical paragraph in Tim Hartford Undercover economist? Pure fiction. You can't use Medisave for a shiasatu massage, only for approved treatments, which HELPS to weed out the woo.
http://www.moh.gov.sg/content/moh_web/h ... cture.html
Well. Some:D

But the limits on withdrawals impose a hard limit on a person ability to pursue treatments, something that everyone has ignored. Yes, MSA itself impose a limit because its dependent on a person resources and etc etc etc, but by adding an additional withdrawal limit, it limits the person ability to pursue further treatment. The idea that Singapore Medisave gives patients the ability to choose is just........ absolute farce.

Furthermore, the very real problem of fund depletion, one that's ignored by libertarians, is one that's constantly on the minds of Singaporean politicians. Its why those withdrawal limits exist. Its why despite lobbying from the medical profession for 3 years, its only now that the ministry is saying, ok, let's consider whether one can use Medisave to pay for outpatient imaging.

So, one of the pillars for outpatient care, the ability to take an MRI or a PET CT imposes significant costs for patients, who can't possibly afford the 800 to 1 thousand dollars said MRI and PET CT costs as outpocket.

Its also why the ministers always say that one must be adequately insured. But only Shield plans can be paid for using funds in your Medisave account. Any other insurance used to pay for outpatient imaging ,a comprehensive medical insurance isn't generally available and are usually offered through MNCs as part of their medical benefits. Or in other words, paid out of pocket.


In summary, the only choice Medisave gives you, is what kind of catastrophic insurance you wish to purchase, the basic Medishield, or enhanced Shield plans given by the government, and it helps to 'buffer' various medical costs. Anything else libertarians attribute to it is sheer nonsense.

It doesn't control costs. The 80s showed it and that's why we have limits on medical devices and physicians.
It doesn't allow you to choose your treatment for the 'most' effective care. The fact that the government steps in to control costs and publicly release medical bills so as to help patients choose a cheaper choice shows that.
It doesn't really increase your ability to improve access to healthcare options in the modern era, it did, back in the 80s and early nineties, but the advances in outpatient care, decentralisation to community care and non institutional care has severely outpaced reforms to our public health financing system.

[Kitsune]

I have a feeling that Singapore may come up in future discussions.
I hope that I might your posts unaltered
Look, Singapore is doing likely about as well as it can with the resources it has but it is not some shining beacon to use as a blunt instrument.

[PainRack]

I have a feeling that Singapore may come up in future discussions.
I hope that I might your posts unaltered
Look, Singapore is doing likely about as well as it can with the resources it has but it is not some shining beacon to use as a blunt instrument.

Singapore has achieved amazing cost controls. However, what every libertarian somehow seems to ignore is that Singapore didn't do it with Medisave. We did it with a huge amount of government regulations and subsidies, while tampering off demand and using targeted aid to ensure people get the care they need. This on top of the fact that our healthcare industry is a strange mixture of government owned, privately run hospitals for secondary care.

Right now, if the US really wants to follow Singapore, what would have happened is that a public option insurance immediately comes into being .... You don't even have to do much. Simply allow anyone to enroll into Medicare and retain Medicare Advantage. Boom. You have one third of the public healthcare financing of Singapore pops into existence. Are the libertarians willing to do that?

And of course, its odious how libertarians harp about medical savings account while ignoring the fact that its a MANDATORY savings account. You know.... Taxation.......... say, like Social Security? The sole difference between Social Security and CPF is that CPF will pay you returns based on how much money you put in.

The last portion, Medifund is just another name for Medicaid. Well, a relatively less comprehensive version of it since eglibility might be different, I'm not a social worker.

Odd how all of these are just rightwing examples of Democrats ideas ,aren't they? No fancy 'voucher' system, although we do have something similar, in the sense that the government will give every citizen a CPF/Medisave top up every few years(incidently close to election year) No fancy 401k or tax deferred Health Savings account. No 'privatisation" of Social security.

And lol. Obamacare taxes medical devices= overregulation? I'm sure that's infinitely less regulation than government licenses on medical devices.

Its odd that everytime you see a Friedman or libertarian harp about how Obamacare is dooming the nation but Singapore shows a new way, they all fucking ignore just how Singapore is the very antithesis of their propaganda claims.

A death panel deciding not to give you treatment using tax payer money is infinitely less odious than a panel claiming that you can't use every single cent you have to get treatment. At least, NICE and etc are rationing a public resource, not your OWN money.
And the costs of HIV treatment similarly shows the bankruptcy of a MSA in terms of achieving healthcare. The disease hits people when they're relatively young, meaning that their savings is small when compared to other diseases like heart disease. Its a 'chronic' disease(if you get effective treatment), but one that costs almost a thousand dollars a month to treat(depending on stage etc etc etc).
Without some form of government aid, patients find their available funds wiped out. Which is what happened to Singaporeans PWA.

At least with hepatitis infection, the costs of managing it is offset by the fact that lamivudine is on the standard medication list, ensuring that it receives a hefty public subsidy that ensures out of pocket costs are 'relatively' low.


Lastly, our system works for Singapore, because our out of pocket costs are low. Our system is being threatened by rising costs. Now, the same is true for the US, but their out of pocket costs are already insanely high. An MRI here costs around 900 dollars. What's the equivalent cost in the US?

[UnderAGreySky]

Quick question, you said an MRI costs $900 - is that Singaporean dollars? That would make it US$750 according to Google. Still sounds insanely high. I got a knee MRI done in Mumbai, albeit in 2005, for The equivalent of US$100.

[Kitsune]

As far as MRI, it seems to not be tied in with the actual cost
http://www.washingtonpost.com/blogs/won ... in-france/
In France, an MRI costs $280 while in the United States costs $1080
In Japan (another source), MRI in Japan cost $100 and in the US, up to $3000

[Simon_Jester]

MRIs require one or more skilled technicians working for... I don't know, an hour? Two? The cost of paying the technician would be factored in. Also, MRI machines are long term capital budget items which are relied upon to bring in a steady stream of funds for the hospital; in the US this may result in inflated costs because of the usual factors in US health care.

[PainRack]

Quick question, you said an MRI costs $900 - is that Singaporean dollars? That would make it US$750 according to Google. Still sounds insanely high. I got a knee MRI done in Mumbai, albeit in 2005, for The equivalent of US$100.

Sorry, job hazard, I was thinking about an MRI brain which costs more.

http://www.moh.gov.sg/content/moh_web/h ... apore.html

An MRI knee costs around 400 Sing dollars.

MRIs require one or more skilled technicians working for... I don't know, an hour? Two? The cost of paying the technician would be factored in. Also, MRI machines are long term capital budget items which are relied upon to bring in a steady stream of funds for the hospital; in the US this may result in inflated costs because of the usual factors in US health care.

Actually, there's also the cost of having a radiologist read the film. Which is where IT plays a role. Everybody is outsourcing this to people in India and etc, where labour costs are cheaper. And bonus! They work different hours than the US, so, you get people grinding away at what to you is the middle of the night to give you your radiological report.

[Kitsune]

MRIs require one or more skilled technicians working for... I don't know, an hour? Two? The cost of paying the technician would be factored in. Also, MRI machines are long term capital budget items which are relied upon to bring in a steady stream of funds for the hospital; in the US this may result in inflated costs because of the usual factors in US health care.

Doesn't explain why they are less than 1/3 the cost in France as the United States

[PainRack]

Actually, talking about inpatient bills brings another matter to mind. Has any libertarian pointed out that Singapore has another mean of reducing the cash burden on Medisave, thus reducing the risk of fund depletion? Namely. Public subsidies. Go into a C class ward and you have 80% of your hospital bill paid for by the government(well, the actual formula is way more complicated but that's public funding for you.)

Seriously, look at the difference worldviews can bring.

This is slate.
http://www.slate.com/blogs/moneybox/201 ... ut_it.html
It describes the system accurately.

http://www.theatlantic.com/business/arc ... em/254210/
Hmm, the atlantic somehow miss out everything else except government health insurance and most importantly, MSA!!!!?!?!?!?!

Odd that our own health minister claim that its health insurance that's the most important.
http://www.healthxchange.com.sg/News/Pa ... ry-$8.aspx
Unfortunately, the original post by the Health Minister on the MOH blog is no longer searchable but he essentially stress how important it was that one gets Medishield, enhance it with Shield plans and then obtain private supplemental insurance on top of that.

Medisave only mention was that along with all of the above(and the fact that he has a bloody Civil servant healthcare benefit which he doesn't mention), he paid only 8 dollars out of pocket for his heart bypass surgery, with the thousand of dollars excess fee paid for by his Medisave account.

Well, at least the Atlantic is a newspaper. The real libertarians get things even more wrong.
http://www.freedomworks.org/blog/breean ... -singapore


Now, the actual economists and health policy wonks get things less wrong.
http://www.amazon.com/Affordable-Excell ... Excellence

The odd thing is how Haseltine can describe the same mechanisms and methods, but somehow think that 'competition' is what keeping prices low, although even here, he's noting that its the competition of government owned(albeit privately run) hospitals that are acting as price controls by setting baseline prices. So, just like how Medicare set baseline prices in the States then..........

I have no idea whether Haseltine book is still free on Kindle but it provides an accurate description and history of our success.
What it fails in is in his conclusions.
http://www.brookings.edu/~/media/press/ ... ncepdf.pdf

Our own healthcare policy wonks, doctors who have worked in the system disagree.
http://www.todayonline.com/singapore/wh ... are-system

Unfortunately, I can't find the link to Dr Lin website, a healthcare policy wonk who released a book refuting Haseltine arguments.....

[Simon_Jester]

MRIs require one or more skilled technicians working for... I don't know, an hour? Two? The cost of paying the technician would be factored in. Also, MRI machines are long term capital budget items which are relied upon to bring in a steady stream of funds for the hospital; in the US this may result in inflated costs because of the usual factors in US health care.

Actually, there's also the cost of having a radiologist read the film. Which is where IT plays a role. Everybody is outsourcing this to people in India and etc, where labour costs are cheaper. And bonus! They work different hours than the US, so, you get people grinding away at what to you is the middle of the night to give you your radiological report.

I treat a radiologist as a "skilled technician" in this context, but yeah. Again, what it comes down to is that different countries have hugely different requirements for their MRIs. You get very different pricing in a place where radiologists' time is cheaper, or where the machines are being run at cost to pay off their operating costs over their (long) lifetime, than you do where the time is expensive and the machines are major moneymakers for the hospital.

[PainRack]

Ah, I found the post.
http://mohsingapore.sg/2010/10/keeping- ... as-strong/

Health insurance, as a protection against hospitalisation (MediShield) and severe disability (ElderShield), is an important pillar of our 3Ms health financing framework. It makes sure that all Singaporeans have access to high quality healthcare. They are like our umbrellas for rainy days, or thunderstorms, or even typhoons. That is why I spend time reviewing these umbrellas and fixing them periodically to make sure they are strong and can withstand any calamity.

After several reforms to MediShield and ElderShield, the macro picture looks good. 88% of all Singaporeans are now protected by MediShield and its coverage is still growing. We have been particularly effective in reducing the % of uninsured young Singaporeans, from 45% in 2007 to 17% in 2009, through reaching out to them in schools. Among the MediShield policyholders, 58% have topped up with a private shield plan for hospitalisation in Class A and private hospitals. After the 2008 MediShield reform, we have raised the MediShield payout from 56% of large hospital bills to 66%, a 10%-point increase. This has saved patients hundreds and sometimes thousands of dollars, in out-of-pocket expenses.

Meanwhile, subscription to ElderShield has increased from 789,000 in 2007 to 906,000. Few Singaporeans now opt out of ElderShield, when they cross 40. Among the ElderShield policyholders, 19% have topped up with private ElderShield supplements, to enjoy a higher payout. In my recent bypass surgery, my hospital bill was largely paid by MediShield and a private Shield supplement. Medisave took care of my co-payment of the bill. My out-of-pocket expense for the hospital bill was $8 only; yes, no typo here. But good umbrellas also need regular servicing and strengthening. Yesterday, I had an informal lunch dialogue with all the health insurers, to review the state of our umbrellas. I wanted their ideas on what else we could do, to make the umbrellas stronger. Several ideas were floated, especially in extending MediShield to include mental illness, congenital illness and neonatal treatment. There were also comments on raising the claim limits on outpatient cancer care, so as to relieve the burden on cancer patients.

For the ElderShield, there was discussion on how to raise the monthly basic payout from $400 and to extend the payout period beyond 6 years. We also had a good discussion on how to incentivise Singaporeans to adopt healthy living seriously. There was a good chat on how to discourage over-charging, and how to take advantage of the lower cost providers overseas. Over a healthy vegetarian meal, we had a productive exchange. It will help shape our ideas on what else to do to keep our healthcare umbrellas strong - See more at: http://mohsingapore.sg/2010/10/keeping- ... SRwqt.dpuf

http://mohsingapore.sg/2010/10/keeping- ... as-strong/

Note here that the emphasis is on ADEQUATE insurance, not a single talk whatsoever about health saving account other than the fact that it paid for his excess. Medishield is a high deductible plan. Based on further clarifications, the 25 thousand dollar bill was split so 5k paid out of Medisave, 20k paid out from Medishield. BTW, since the real problem with a HSA is about fund depletion,
http://www.moh.gov.sg/content/moh_web/h ... miums.html
The average Medisave balance for our elderly is 5 thousand dollars(late adoption, most of our elderly are poor with median incomes then of 500-1000 etc etc etc). So, if a 60 year old male HAD the same CABG procedure, his Medisave account would have been wiped out.
Sure, we would then have proceeded on to the Medifund portion, selling of the house to pay for bills and etc etc etc, but hey, Libertarians don't ever talk about this, eh?

There is an earlier post about Medisave, but he's talking about Obamacare and Mackey article/Wholefood Health savings combined with high deductible and how Singapore has a similar system to WholeFoods and how it should still continue.

Note that we're hailing as a victory that over 90% of Singaporeans are insured and that the number of our young Singaporeans uninsured is only 17% as opposed to 28% for the US. Not Medisave is the most important pillar and that it forces personal responsibility.