Monday, July 17, 2017

Singapore Healthcare: Is it such a good model?

Khoo Teck Puat Hospital - Singapore

With Obamacare repeal talks ebbing and flowing in the States, conservatives mention Singapore ( as well as Scandinavian countries) as a role model for well-managed healthcare systems. But is the Singapore model really that good? The thing is:  Singapore is a really weird country, and generally its model will be difficult to apply to other countries -- especially one as massive and complex as the United States'.

Singapore is an island city-state, with 5 major hospitals which are largely government-owned 

Singapore healthcare system is centralized and mostly government-run, albeit with some private sector support.  Drug prices are controlled, as are doctors -- not entirely sure how it is compatible with conservative pro-business, free-market economics world view.  Hospitals also make non-trivial income from medical tourism: visitors from Indonesia, Malaysia, and China come to Singapore for medical care and vacation at the same time, and the hospitals charge them premium over the subsidized prices set for local citizens.

Unique location

Because of its geographic position in Southeast Asia, strategically located as a major trade hub surrounded by developing countries, hospitals in Singapore can source drugs relatively cheaply.

Singapore culture is also totally weird  

People don't drive that much, due to affordable high-quality public transport in the city state.  People walk everywhere, making obesity a non-issue.  There is no drug problem, as drug trafficking is punishable by death, a rule which is strictly enforced.  There is no guns whatsoever, despite the mandatory draft into the Singapore armed forces.  The young population is very health-conscious, and weekend biking is popular culture.  Air pollution can be a problem at times, mostly due to smog from forest fires in neighboring Malaysia and Indonesia.

Economics also matter  

The median Singaporean is also wealthier than the American.  In terms of GDP per capita, both countries are at about US$50k, but because of Singapore's small population (5.6m in 2016), there's just less poverty to deal with.

Main lesson:  things are easier when costs are lower

Singapore historians highlight their young, immigrant-welcoming demographics, and well-educated population.  Some also point to the country's sustainable healthcare financing system.  But the main point is that all of the factors above reduce healthcare costs.  And managing a healthcare system is that much easier when costs are lower, and buying powers higher.

Wednesday, July 05, 2017

Is the electric guitar dead?

A few thoughts on Washington Post's latest article on the woes of guitar companies:

  • An article about guitar spends so many paragraphs on Taylor Swift? I guess that's where we're at right now...   Also it's not all about Clapton or BB King; there are younger guitar gods around: Derek Trucks and Gary Clark Jr. are probably around my age.  Also worth mentioning, musicians dont need to be Eric Johnson-calibre talent to make cool stuff; I respect guys like Ed Sheeran who writes music prolifically and can lead a full-length concert with just his Martin acoustic and loop pedal (no band!). 
  • Millennials don't like/can't afford to spend money in general, thanks to (among others) student loans.  Not just a guitar problem, but look at decline in home ownership. Declining interest in golf. And so on. 
  • Speaking as a terrible guitarist, it's really hard to justify buying a $3,000 American Fender when I can spend $400 (or $200 used!) on something Indonesian-made that sounds just as terrible on my hands. And I reckon 95% of guitar buyers are probably not good players.
  • Music nowadays feels more about the production that about playing instruments, with software such as Ableton and Garage Band. Which makes me respect for musicians and vocalists who really spend the time honing their skills -- people like Mark Tremonti, whose riffs I can probably never play, not even one.