An alternative to “Don’t feed the animals.”

I just finished reading Lee Kuan Yew’s book, One Man’s View of the World. I read it because I knew a bit about how Lee had been instrumental in building Singapore into one of the best societies in today’s world.

Lee, who died earlier this year, was a conservative. I consider myself a liberal in the U.S. because I am concerned with inequality and poverty, and think that we should try to “find a more perfect union” than what we have. But Lee, I think has hit on ideas that our conservatives need to promote instead of just tearing down whatever the liberals do.

First of all Lee wanted people to be responsible for themselves. His basis was: every person is responsible for him or her self; every family is responsible for itself, and every generation is responsible for itself. But he also recognized that there are some who can’t pass these three steps and that the government plays a role.

With an unemployment rate less than 2% poverty does not play much of a role in Singapore. Healthcare is more of an issue. Most healthcare is paid for by the Medisave Fund, which is a patient controlled compulsory health savings account paid for by personal (8%—10.5% of salary) deductions. This is used for medical expenses until it grows to more than about S$35,000 when it can be used for other uses–a great incentive to develop healthy habits. Then there is MediShield, a catastrophic health insurance to cover true large medical emergencies. This is an opt out program but more than 90% of Singaporeans have accepted it. They are also helped by the government support of hospitalization which amounts to 80% in public hospitals, which also helps keep a lid on private sector costs. Health is seen as a public good and it is fitting that government play a role.

But that role realizes that giving someone something, as William Easterly argues in the case of foreign aid, makes them dependent. Conservatives recently have used the ‘Don’t feed the bears’ analogue, which belittles the humans involved. It is not helpful–and as Easterly shows it is not necessary. There are more than enough examples in foreign aid to humans creating dependency that we don’t need to rely on animals.

The point that both Lee and Easterly see, but that American conservatives don’t seem to, is that building people starts by empowering them. Lee made savings mandatory and Easterly argues for local decisions to direct aid. In these processes government is not the enemy–it is critical. But agents in government need to see what they are doing and shift their focus from beneficently giving to cooperatively helping.

Long ago Aaron Antonovsky looked at the things that seemed to contribute to healthy people. He saw a sense of control–over one’s environment, a sense of meaning–the environment made sense, and a sense of coherence–the person fit in the environment. Building people, making ‘a more perfect union’, and enhancing a population’s health begins here. It is not helped by providing a safety net that gives what is needed as seen by an outsider and at the same time reduces ones sense of self worth. Better is to empower them to make their own way.

Most often this choice is couched in the context of personal versus social responsibility. What I am saying here is that Republicans have a very good argument against the current manner of providing a safety net because it does promote some dependency. But blaming government and trying to reduce its size and role in caring for the population is not the answer. Shifting the role of government to empowering people is good policy and Lee and Easterly both provide good ways to do it.

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*Insurance is designed to pay for the unexpected crisis. Health insurance started that way in the U.S. but gradually, because the companies we work for were paying for it and getting a better tax break, it morphed into paying for it all. That means we have less interest in getting the ounce of prevention than if we were paying for some of those costs. Children we talk to about the dangers of drugs just say they’ll get a brain transplant if they burn theirs out. That’s why we think that Health Savings Accounts should be promoted by the government more; they put the individual back in a position of responsibility in making more choices in their health care. With Health Savings Accounts an ounce of prevention is worth a pound of cure.

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