This was published in the Western Journal of Medicine a while
back, but it explains the strength of our healthcare funding
system, which remains true today
TO THE EDITOR: The American Medical Association has reported that
over 40%of United States health care costs are directly
attributable to American self-indulgence, coupled with our polyglot
ethnic diversity and propensity to settle disputes with bullets.
Tobacco, intravenous drug use, unsafe sex habits, excess alcohol
and dietary fats, coupled with sedentary life-styles and
lackadaisical driving habits, ratchet up health costs while
Americans expect, nay even demand, that someone else pick up the
tab. Singapore has evolved a health insurance plan based on
individual responsibility, not rights and privileges.
Article 5 of the policy statement of Mr Yeo Cheow Tong, the
Singapore Minister of Health, reads: "Our medical system is based
on individual responsibility . . . no Singaporean has enjoyed or
expects to enjoy health services for free. When hospitalized he
pays part of the bill, more in a B class than in a C class ward.
His Medisave is his own money. This gives him the incentive to be
healthy, minimize his need for medical treatment, and save on
medical expenses."'
The individual Singaporean savings account, established in 1984 as
"Medisave," is a system the United States could well copy. Each
person contributes to his or
her own Medisave account-currently at 6% of income to meet future
medical expenses of the immediate family.
Article 35 of the Medisave government policy reiterates and clearly
defines the role of each citizen in terms of personal
responsibility for health. "Every Singaporean has the duty to stay
fit and healthy. A healthy life-style will reduce his chances of
falling sick. He should save up for future medical needs by
contributing regularly to Medisave. He should use his Medisave
prudently, by choosing the class of ward which he can comfortably
afford."
Adopting a Medisave system by US workers would dramatically
increase the nation's saving rate, currently at an all-time low
compared with competitors such as Japan and Germany. Invested
savings provide the capital necessary for economic growth. Such a
system would also establish in the minds of US citizens their own
individual participation in, and accountability for, paying for
their health care. The problems of the Scandinavian, British, and
Canadian health systems have shown that centralized government
control and administration of health care are unsustainable.
Eventually they all collapse in the face of unremitting and
escalating demands for more and more "free" care while the
countries' economies flounder under the weight and burden of taxes,
stifling job growth and economic expansion.
Medicine costs more because we can do more. People live. People
live longer. The people should have the final say in how each cent
of their health care is bought and paid for. Our government can
help by setting up tax-free medical savings accounts.
CHRISTOPHER LYON, MD, PhD
Fashion Island, Ste 402
1401 Avocado Ave
Newport Beach, CA 92660
West J Med. 1993 May; 158(5): 537.
