Somebody: Didn't you just hold up Singapore as a "First World service economy with reasonably free and fair elections"? Their health care system is arguably not much more progressive than what the Democrats are proposing, and is built around a system of health savings accounts, a basic universal catastrophic insurance program, and means tested subsidies. Nevertheless, it produces some of the best health outcomes of any large city in the world (and that's what Singapore should be compared to, since it's basically a modern day polis).