Proposals for health care reform run the gamut, from consumer-driven solutions to a government-subsidized single payer system or “universal healthcare.”

There are many models worth considering, if we have the will to truly imagine a different kind of system. I recently traveled to Singapore and was intrigued by their approach. They spend 4 – 6 percent of their GNP on healthcare, the U.S. spends 16 percent, and we have similar life expectancy rates. Their government subsidizes access to basic, affordable healthcare at public hospitals and clinics, with consumers required to participate in paying for this coverage based on their income level. Consumers can also opt to pay for additional amenities and higher levels of service, such as private or semi-private hospital rooms versus multi-bed dormitory style wards. The result is access to quality medical care, including preventive and primary care, for all Singaporeans, including lower income groups, in an affordable government-subsidized model. For those who wish to pay more out of pocket, services and amenities are available in public and private facilities, at a cost.

Supporting access to primary and preventive care is key. ER overcrowding and costly medical interventions to treat advanced disease that should have been managed earlier are two of the unfortunate results of a system that prevents people from maintaining good health. Making sure everyone has the ability to get primary care check-ups, and diagnosis and management of early stage or chronic disease, would help decompress our emergency rooms, and even keep people out of hospital beds.

Any meaningful solution to health care reform must address the continuum of care. In the long run, dollars spent keeping people well could be dollars saved caring for complex, critical illness. And, who would argue that keeping people healthy is the right thing to do?


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