Republicans are pushing for increased use of high-deductible health plans (HDHPs). 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 used HDHP successfully is Singapore. The 2020 Commonwealth Fund report summarizes the 3 components of Singapore’s system:
- MediShield LifeA universal basic health care insurance is mandatory for citizens and permanent residents and provides lifelong protection against large hospital bills and select expensive outpatient treatments. It was launched in 2015 to replace the opt-out catastrophic illness insurance scheme MediShield.
- medisaveA National Medical Savings Scheme helps cover out-of-pocket payments. Individual and employer salary contributions (8%–10.5% depending on age) to Medisave accounts are mandatory for all working citizens and permanent residents. These tax-free, interest-bearing (currently 4% to 5%) accounts can be used to pay for family members’ health care expenses.1
- medifund The government has a 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 costs onto individuals. The Straits Times reports:
New Integrated Shield Plan (IP) riders sold starting April 1, 2026, will no longer be allowed to cover the minimum deductible that patients must pay before coverage begins. IP holders with the new riders will also have to pay a larger portion of their bills, as the co-payment limit on their maximum out-of-pocket cash will double from the current $3,000 to $6,000. As a result, these new riders are expected to cost much less, with the Ministry of Health (MOH) estimating premiums to be around 30 per cent lower than existing riders with maximum coverage.
What are IP plans?
IP is an optional health coverage provided by private insurers on top of MediShield Life, usually to cover stays in A- or B1-type wards in public or private hospitals. With Medisave, premiums can be paid up to a maximum limit depending on your age. Today, about 71 percent of residents…[in Singapore]…or about three million people who have an IP.
There is also a maximum out-of-pocket spending limit of S$6000 in Singapore. The New York Times has a comparison of the health system and summarizes Singapore’s system as follows:
Singapore’s approach is unique. Basic care in government hospital wards is inexpensive, sometimes free, with more deluxe care available in private rooms for those paying extra. Singapore workers contribute about 37 percent of their salaries into mandatory savings accounts that can be spent on health care, housing, insurance, investments or education, with a portion being employer contributions. The government, which helps control costs, is involved in investment decisions in new technology. It uses wholesale purchasing power to reduce spending on drugs, controls the number of medical students and physicians in the country, and helps decide how much they can earn.
The cost of Singapore’s system is much lower than that of the US (4.9 percent of GDP versus 17.2 percent). Singapore does not release the same data as most other advanced countries, although it is widely believed to provide fairly good care at a lower cost. Others counter that access and quality vary, with wide inequalities between those at the top and bottom of the socio-economic ladder.
Do you think Singapore is a good model for the American health care system?
