Paul Krugman writes that "'Consumer-based' medicine has been a bust everywhere it has been tried." That would probably come as a surprise to the state employees of Indiana where an HSA/catastrophic insurance program has saved the government money and increased worker take home pay while maintaining access to high quality health care. It would probably come as a surprise to the people of Singapore where the several enormous consumer-driven programs have helped the country achieve access to high quality health care at a fraction of the GDP that the US pays.
That doesn't mean there aren't legitimate questions. The Indiana-style program seems to work well for some populations but perhaps not the elderly (though that doesn't mean that a government single-payer FFS system is the only alternative.) While there are things to learn from Singapore it probably wouldn't make sense for a much larger, more diverse, more dispersed population to adopt the entire package of Singapore policies. Even moving in a more consumer-oriented, the government will still have a crucial role supplying subsidies (whether direct subsides, tax subsidies, or forced savings) and in some ways an even larger role in regulation (especially in enforcing price transparency.) Neither Indiana, nor Singapore offer a one-size-fits-all answer to our health care policy problems - though we ought to try to learn what we can. We should also never forget that Paul Krugman will never let his integrity get in the way of whatever narrative he is pushing.
h/t Megan McArdle