Republicans are pushing for increased use of high deductible health plans (HDHP). HDHPs have increased over time, from 29% of all employer health plans in 2021 to 33% of all employer health plans in 2025.
One country that has successfully used HDHP is Singapore. A 2020 Commonweath Fund Report summarizes 3 components of the Singapore’s system:
MediShield Life, a universal basic health care insurance, is mandatory for citizens and permanent residents and provides lifelong protection against large hospital bills and select costly outpatient treatments. It was launched in 2015 to replace MediShield, an opt-out catastrophic illness insurance scheme.MediSave, a national medical savings scheme, helps cover out-of-pocket payments. Personal and employer salary contributions (8%–10.5%, depending on age) to MediSave accounts are mandatory for all working citizens and permanent residents. These tax-exempt, interest-bearing (currently 4% to 5%) accounts can be used to pay for family members’ health care expenses.1MediFund is the government’s safety net for needy Singaporeans who cannot cover their out-of-pocket expenses, even with MediSave.
Since the 2020 report, Singapore is shifting even more cost over to individuals. The Straits Times reports:
New Integrated Shield Plan (IP) riders sold from April 1, 2026, will no longer be allowed to cover the minimum deductibles patients have to pay before insurance kicks in. IP holders with the new riders will also need to pay a larger portion of their bills, as the co-payment cap on their maximum out-of-pocket cash will be doubled from the current $3,000 to $6,000. As a result, these new riders are expected to cost a lot less, with the Ministry of Health (MOH) estimating premiums to be about 30 per cent lower than those of existing riders with maximum coverage.
What are IP plans?
An IP is optional health coverage provided by private insurers on top of MediShield Life, typically to cover stays in A- or B1-type wards in public or private hospitals. Premiums can be paid for with MediSave up to a cap based on your age. Today, around 71 per cent of residents…[in Singapore]…or about three million people, have IPs.
Singapore does have a S$6000 out-of-pocket maximum as well. The New York Times has an health system comparison an summarizes Singapore’s system as follows:
Singapore has a unique approach. Basic care in government-run hospital wards is cheap, sometimes free, with more deluxe care in private rooms available for those paying extra. Singapore’s workers contribute around 37 percent of their wages to mandated savings accounts that may be spent on health care, housing, insurance, investment or education, with part of that being an employer contribution. The government, which helps control costs, is involved in decisions about investing in new technology. It also uses bulk purchasing power to spend less on drugs, controls the number of medical students and physicians in the country, and helps decide how much they can earn.
Singapore’s system costs far less than America’s (4.9 percent of G.D.P. versus 17.2 percent). Singapore doesn’t release the same data as most other advanced nations, although it’s widely thought that it provides pretty good care for a small amount of spending. Others counter that access and quality vary, with wide disparities between those at the top and bottom of the socioeconomic ladder.
Do you think Singapore is a good model for the US health care system?
