Monday, August 17, 2009

Swissify America!

I was going to comment on the Swiss health care system one of these days, in light of the ferocious debate going on in the US, but Paul Krugman beat me to it. As most of our past visitors know, we are big fans of the Swiss system and have long thought it would make a smart model for the US. To summarize it in short: every resident is required to have a minimum level of coverage, insurance companies (all private) have to make certain plans available and must accept all applicants, and the government provides assistance to families who need it. Finding a reasonable health care plan was surprisingly one of the easiest things to do here (considerably easier than getting access to the laundry). There were many companies from which to choose, even at the lowest level of coverage, and the policies were easy to compare. We chose the cheapest option possible and have received excellent (and, I might add, very high-tech) care. We have not one complaint (though my teeth are annoyed we did not add dental). Just my two francs' worth.


Kathy said...

I've thought about this too. So much is at stake in the US, including recovery from the recession. What a difference affordable health care and availability of micro (business) loans would make to thousands of the under- and unemployed.

I have yet to test drive the care or the insurance here. Of course we have it, we just haven't had a chance to use it.

On the one hand, the Swiss model seems like a good fit for the US. But for the model to work, you need some additional elements, and I would love to know more how the Swiss handle the following.

1. Insurers cannot exclude coverage based on 'pre-existing' conditions. Per Krugman this is the case in Switzerland.

2. Insurers cannot cherry pick which diagnoses to cover. They must all cover at least a core set of diagnoses/treatments. It appears that the required insurance in Switzerland is subject to this kind of regulation. Individuals can purchase additional coverage beyond this (for example, dental). Is that correct?

3. Pharma costs must be controlled either by regulation or by giving government the ability to bargain on behalf of customers. How do the Swiss control drug costs, or do they?

4. Incentives for good care and diagnosis. My husband has a colleague here who has a serious but (apparently) difficult to diagnose condition and has not received any treatment yet, despite trying one doctor and two hospitals.

Swiss Ms. said...

Kathy, thanks for your thoughtful comments. I do not know the answers to your questions but they have been good food for thought.

We have found it hard to compare the quality of care to that offered in other countries due the many cultural differences playing into diagnosis and treatment. Fortunately, we've not had to deal with any serious health problems while living here so our experience is admittedly limited. I've received excellent, conscientious care for my preexisting condition but would be seriously disheartened to find unwillingness or inability to diagnose/treat a new problem. I'm not sure how excellence is encouraged here, or in any other country for that matter.

I do appreciate that the insurers are required to accept you and that, even at a very basic level, they will cover everything (to my knowledge) over a certain deductible amount. Compared to private insurance I had to arrange for myself as an independent contractor in the US, this coverage is a much better value – certainly a much lower deductible at a lower premium, anyway. We were surprised by how many other options/levels were offered here; I'm sure this would be appealing in the US.

Regulating the cost of pharmaceuticals seems very complicated to me. I am not sure how to resolve the fact that uncontrolled drug prices in the US help subsidize (among other things) the continued research and innovation of old and new drugs, something that clearly benefits the rest of the world. I think this is the case, anyway. Our current plan does not cover prescriptions; I pay more than I did when I had employer insurance but less than I did when I had my own coverage. I guess there is some price control but I do not know how or how much.

Keep us posted if you learn more about how things work around here in the meantime!

Kathy said...

I found some additional detail on the topic and posted in on my blog.

Kathy said...

Also, the coworker who was having a problem getting diagnosed went back to one the providers and they fell all over themselves trying to make it right. He's getting treatment and improving.