Both Singapore and Switzerland have systems in which overall health-care spending is lower than it is in the United States but out-of-pocket health-care spending is higher. The shocking thing is this: So does practically every other country. A recent World Bank study finds that in the United States, only 20 percent of health-care spending comes in the form of out-of-pocket expenses paid by consumers. In Singapore, it is 88 percent and in Switzerland 72 percent. But even the single-payer systems of Canada and the United Kingdom feature more out-of-pocket spending by consumers, 49 percent and 53 percent respectively. How is it that in countries with “free” universal health care consumers pay more out of pocket than they do in the United States? The short answer is that treatment in single-payer systems tends to be kind of terrible, which is why a tenth of British subjects use private plans rather than the NHS. And a significant share of Britons who use the NHS must be turning to private care fairly often, since it is estimated that the typical medical specialist in the U.K. supplements his income by 50 percent moonlighting in private practice. In Canada, about 75 percent of people carry supplementary private insurance, and about 28 percent of all health-care expenditures happen in the private sector.

What that means is that health care in Singapore and Switzerland is less expensive because it is more expensive. And both countries enjoy superb quality of care.