Introduction: America’s Healthcare Paradox
America spends more per capita on healthcare than any other country—yet it ranks poorly in many health outcomes. In The Cure That Works, economist Sean Masaki Flynn lays out a bold and data-driven case for why the U.S. healthcare system fails and how a smarter, simpler model can save money while improving outcomes. His solution? Borrow from the best parts of Singapore’s healthcare system—a hybrid model that combines market incentives with universal coverage.
Flynn is not advocating for more government bureaucracy or full-scale privatization. Instead, he champions a consumer-driven, transparent, and incentive-based healthcare model where individuals have real skin in the game. He believes this could drive down costs, increase quality, and expand access—without the trade-offs found in socialized systems or the inefficiencies of America’s current model.
Part 1: What’s Wrong with U.S. Healthcare?
Flynn begins by unpacking the core problems of American healthcare:
- Lack of price transparency: Patients often don’t know what services cost until they get the bill. Even providers don’t know the prices.
- Third-party payer distortion: Because insurance (often employer-based) pays most costs, patients have little incentive to shop around or question treatments. This creates what economists call moral hazard—overconsumption and waste.
- Misaligned incentives: Hospitals, doctors, and insurers often benefit more from providing expensive treatments rather than the right ones.
- Administrative bloat: Complex insurance rules, coding requirements, and regulatory red tape lead to ballooning administrative costs—up to 25%–30% of U.S. healthcare spending.
- Employer-based insurance trap: Tying insurance to employment causes “job lock” and coverage loss when people change jobs, retire, or get sick.
The result is a system where costs rise relentlessly, innovation is stifled, and patients are disempowered.
Part 2: Singapore’s Model—The System That Works
Flynn turns to Singapore—a wealthy, modern city-state that spends only about 4% of its GDP on healthcare but ranks near the top in outcomes like life expectancy, infant mortality, and patient satisfaction.
How does it work?
- Mandatory Health Savings Accounts (HSAs):
Citizens are required to set aside part of their income in personal accounts (called Medisave), which they use to pay for routine medical expenses. This makes patients cost-conscious and encourages smart spending. - Catastrophic Insurance:
The government provides catastrophic insurance (called MediShield Life) to cover serious illnesses. This keeps out-of-pocket expenses manageable in emergencies without undermining personal responsibility. - Price Transparency & Competition:
Hospitals and clinics post prices and compete openly. Government-owned hospitals compete with private ones. This fosters price discipline and efficiency. - Means-Tested Subsidies:
The poorest citizens get government help, but wealthier individuals pay their own way. This preserves equity while encouraging self-reliance. - Hospital Autonomy:
Even public hospitals operate as independent entities with budget responsibility and incentives to control costs.
Part 3: Flynn’s Prescription for America
Flynn proposes a “Singaporean-style” overhaul adapted for American realities. The core elements include:
1. Universal Catastrophic Coverage
Every citizen would be enrolled in a high-deductible insurance plan funded by the government—protecting against ruinous costs while encouraging responsible behavior.
2. Mandatory Health Savings Accounts (HSAs)
All working individuals would contribute to HSAs (with employer or government support as needed). These funds would be used for routine care, incentivizing patients to shop for value.
3. Transparent Pricing
Hospitals and providers would be required to post standard prices, allowing consumers to compare and choose wisely—much like any other industry.
4. Public Hospital Competition
Government-owned hospitals would be decentralized and incentivized to compete on cost and quality, like in Singapore.
5. Portable Coverage
Insurance would no longer be tied to employment. Your HSA and insurance would follow you throughout your life, just like a 401(k).
Key Arguments in Favor of Flynn’s Plan
- Efficiency Through Competition: Patients spending their own money (within HSAs) make smarter, more informed choices.
- Lower Administrative Costs: Simplified billing and price transparency reduce paperwork and overhead.
- Freedom of Choice: Consumers, not bureaucrats or insurers, choose their care providers.
- Equity and Sustainability: Government support is targeted, while the majority pays their own way.
- Long-Term Viability: Incentivizing prevention and value leads to better population health and lower costs.
Criticisms and Counterpoints
Flynn addresses some common objections to market-based reforms:
- “Won’t people avoid care if they have to pay for it?”
HSAs are designed to cover care with saved funds, and catastrophic insurance ensures no one goes bankrupt. - “Aren’t free markets bad for healthcare?”
Flynn argues that most inefficiencies in U.S. healthcare result from a lack of market dynamics, not too much of it. - “What about the poor and elderly?”
Subsidies and safety nets remain part of the system, but Flynn argues they should be targeted, not universal giveaways.
Conclusion: A Smarter Way Forward
Flynn’s thesis is compelling: America doesn’t need to spend more on healthcare—it needs to spend smarter. The solution isn’t socialized medicine or unfettered capitalism, but a consumer-focused hybrid that empowers patients and promotes efficiency.
The book stands out for its clarity, real-world examples, and actionable solutions. Whether or not one agrees with every aspect of Flynn’s prescription, The Cure That Works is an urgent call for reform and a valuable contribution to the healthcare debate.
