She comments on why we can’t save medical costs like Singapore does. The answer is that Singapore did not get government “investment” that traps them in higher costs:
So here’s the problem with looking toward Singapore for cost control: We couldn’t do this even if we wanted to. Multi-bed wards pretty much disappeared from the U.S. after the 1970s. My father, who was a budget analyst in the New York hospital system, notes that this had two causes: first, commissions kept recommending private rooms over those noisy, unsanitary large wards. And second, any new beds you built could be paid for by filling them with Medicare patients at “usual and customary” fees. The result was a hospital-building boom, which is why virtually all hospitals are in new buildings, and why, outside of some emergency wards, you’ve probably never spent time in one of those long wards you see in black-and-white films. “American hospitals are rather like hotels,” I was once told by a British colleague who was defending the honor of the rather more spartan National Health Service.
Cost controls that are relatively easy to implement in advance — by, for example, not building shiny new hospitals filled with private rooms — become impossible once you’ve made certain investments. This problem also afflicts higher education. Say we decided, as a society, to go back to the college costs of the 1970s. We’ll fire all the extra administrators, and to hell with whatever it is they’re doing to promote diversity, improve admissions or direct student life. If their missions are critical, we’ll make faculty take them over and cut back on research. Cafeteria service will go back to the fare of my mother’s day (lamb patties and lima beans twice a week — she lost 20 pounds her freshman year, and she wasn’t heavy to start with). Want to get in shape? Go run around the track, because we’re closing the fancy gym.
We still wouldn’t reach the cost levels of the 1950s, because the buildings are still there. The grounds have to be maintained. Everything has more lights, and the buildings aren’t built to be warm in winter and cool in summer; they’re built on the assumption that they’ll be climate controlled. Frequently the windows can’t even be opened, so it’s going to get awfully stuffy in there unless you turn on the A/C. You can’t shut down the fabulous new fitness center and go back to using the old gym, because the old gym was probably torn down. Unless you want to invest billions of dollars in reconfiguring the nation’s campuses, they’re going to be inherently harder to operate than the campuses of yesteryear.
What I take away from this is that government “success stories” are writing the line “and they all lived happily ever after” before the story is really over. No wonder Keynes final answer (for his lucky generation) was that they would all be dead before the “long run” came.<>
