Healthcare in Freedom Land

The new Heritage Freedom Index ranks Hong Kong #1 in the world for economic freedom. Yet the libertarian paradise also has universal, mandatory, single-payer health insurance, cushioned by flexible and widely available private insurance.

Click here to read all of David Frum's blogposts from China.

The new Heritage Freedom Index ranks Hong Kong #1 in the world for economic freedom.

So I thought I'd use my hours of jetlag-induced sleeplessness to swot up on how the libertarian paradise provides health coverage.

The Hong Kong system is built upon a foundation inherited from Britain: a National Health style single-payer system. Funded by tax dollars, and lots of them, the basic Hong Kong health system extends coverage to all through a system of publicly owned and operated hospitals.

This reliance on hospitals is outdated. A Hong Kong citizen hit by a bus is rushed to a government-run hospital, given advanced care, and released without charge. Nice deal. Primary and preventive care is not handled so well - mental illness very poorly - and so Hong Kong citizens who can supplement their government basic care with private insurance.

The sort of person whom a visiting foreigner meets will of course all have private insurance of some kind or another. Yet despite the growth of the private medical sector, government still spends 60% of all the territory's health dollars, a lower ratio than in Canada or most European countries, but well higher than the U.S. at 51%.

One-sixth of all government spending is spent on health care, and that figure is sure to rise in the years ahead as

1) Citizen pressure forces governments to recognize that health care means more than just hospital care;

and

2) as native-born Hong Kong medical workers press to raise their wages up to the levels received by the expatriate doctors who staff the private insurance system.

I won’t make any bold predictions of the future - I have only grasped the roughest idea of the Hong Kong present - but if there's a bottom line, it's this:

The world's freest economy has universal, mandatory, single-payer health insurance, cushioned by flexible and widely available private insurance. It's not a perfect system, but it does deliver the 5th longest life-expectancy on earth (almost 3 more years of life expectancy than the U.S. system), and significantly superior infant mortality. And I think we can safely acquit the people of Hong Kong of any interest in socialism whatsoever.