Would You Buy The Swiss Health Care Plan?
Buy it as an idea, I mean.
I did -- effectively -- when I stopped working at a company and went freelance in my 20s. I chose a non-profit HMO that was supposed to only go up in price with one's age. Once you were in, you were in -- there was no dinging you with higher fees because you got sick.
I thought it was prudent to get in in my 20s -- both so I would be personally responsible and covered if something terrible happened to me healthwise, and so I could get in on the pricing of a young, healthy person.
Well, "Affordable" care ruined my previously affordable care; now I can't afford it and I certainly can't afford to use it, with the now huge deductible. (I don't have enough money at the end of the year to qualify for Obamacare -- though I never wanted other people to pay for me -- and they don't give you a choice of paying a little more and getting Obamacare. It's either Medi-Cal or paying what millionaires pay.
Well, I can't afford to lose my doctors or prescription setup as I could through Medi-Cal (which I never wanted anyway...other taxpayers paying for me...yuck) so my healthcare is financially eating me alive. Sucks, especially after being personally responsible as a 20-something.
Anyway, a digression.
The Swiss seem to do what I tried to do for myself. Bruce Yandle writes about it at AIER:
Consider the Swiss approach to health care. First, every person is required by law to purchase basic health care insurance from a private insurance company, of which there are some 80 in number. The premiums vary across the 26 Swiss cantons; In 2017, the individual average payment per person was $450 per month. Any payment in excess of 8 percent of income was tax deductible.Once insured, the policy holder has it for life, at the original annual premium, and can go to any doctor in Switzerland. There aren't many impoverished Swiss, but they receive a state subsidy that pays for the insurance. The Swiss also have taxpayer-supported emergency room services, making it something of a blended system.
Of course, the United States isn't Switzerland, not by a long shot. In 2017, the Swiss population stood at 8.4 million people. Swiss per-capita GDP was just over $80,000, compared with just under $60,000 here. In 2014, Switzerland had just a half-million people living under the poverty line, or 6.6 percent of the population. In the United States, the 2014 share was 14.8 percent. It's an exceptionally wealthy, smaller country.
Even so, some version of the Swiss health care approach may deserve consideration. After all, it works, at least in the eyes of the Swiss people. And rather than a one-sized-fits-all approach, the program is loaded with opportunities for people to pick and choose coverage from private firms that have to compete to satisfy patients.
As far as overall costs, in 2017, Switzerland spent $8,009 per capita for health care, second highest among the 36 Organisation for Economic Co-operation and Development countries. The United States was number one, at $10,224, or about 28 percent more than the Swiss.
Now, what does this have to do with the U.S. approach to automobile liability insurance?
Think about how people are compensated when they and their property are harmed in auto collisions. Do we have a national auto insurance plan? A system paid for with taxes so that everyone gets covered? High insurance taxes for rich people and no tax at all for the poor?
No. Our auto insurance system--like the Swiss health care program--is determined by each of the states.
47 of our 50 states require those who own an automobile to purchase insurance coverage from private providers. The required coverage varies, and people in each state can choose the insurance they will purchase. Three states--Arizona, New Hampshire, and Virginia--do not require coverage, but heavily incentivize people to buy it in other ways.
Somehow, it works! And there is no national debate about how to deal with the auto insurance crisis. Maybe it is time for one of our aspiring presidential candidates to refresh the health insurance debate. Health care might be a different animal, but not so different that we can't pay attention to a few lessons that are right in front of us.
One problem with this, Switzerland is relatively small. I'm guessing that money has a relatively uniform value across Switzerland. The US is huge. $450/mo in Pampa, TX has a completely different value than $450/mo in New York, NY.
This is one of the major problems with minimum wage in the US. A minimum wage in New York or LA that provides a minimal living for the poor makes the middle class in Pampa and many other places unemployable.
Doing things like auto insurance, where you are required to have it but no minimum cost is set, works better. But then you run into the politics of the situation. If Obamacare only mandated people have catastrophic insurance it would have worked and been well liked. But it didn't. The Democrat party wants national control of health care (and many other industries). They weren't willing to mandate minimum coverage. They wanted everyone to have maximum coverage. Well that doesn't work. We can't afford it. That people in DC are so out of touch that what they think is affordable and minimal is completely unaffordable is yet another issue.
Ben at January 12, 2020 5:57 AM
But $165k in Dallas is a universal standard of potential wealth!
Crid at January 12, 2020 6:50 AM
I’m good with this. It has supports for the poor. You can’t lose your insurance just because you have the nerve to get sick. The premiums are similar to what I get through my employer.
I could have more freedom to change jobs or start my own business. Now I’m pretty much tied to my employer because if the insurance.
Jen at January 12, 2020 8:10 AM
Why the HELL are you calling health care programs INSURANCE?
They are NOT.
And to use the auto insurance biz... wow, so close, so far.
Don't pay for treatment you don't get. Don't go without treatment anywhere because you're not signed up for a plan mandated by the government. Free employers from accounting for employee plans. QUIT paying government officials to tell you that the plan works if paperwork is filled out. QUIT paying tens of thousands of administrators who have nothing to do with treating you.
In short, throw out EVERYTHING you have been told in that pack of lies called "the Affordable Care Act". Repeating what doesn't work does not fix this.
Radwaste at January 12, 2020 8:17 AM
Switzerland is also a relatively homogenous country culture-wise - without the identity politics and fractures that characterize current American society.
As long as politicians exploit class envy, play identity politics, and stoke fear with claims that under any type of pay-your-own-way system, the rich will have care and the poor will die in the streets, the United States cannot develop a sensible healthcare delivery system.
Conan the Grammarian at January 12, 2020 8:24 AM
The Swiss system sounds very similar to what we have here except for this part:
Once insured, the policy holder has it for life, at the original annual premium, and can go to any doctor in Switzerland.
I don't see how that can work with inflation and everything.
I had good insurance before Obamacare. Now it has a high deductible to the point I would almost consider it catastrophic.
The Former Banker at January 12, 2020 9:03 AM
Paying for health care in this country is a mess. If you feel like doing an experiment, ask your sawbones who much an MRI costs. Just an MRI and a analysis thereof.
I bet he can't answer that. Not specifically. He might can tell you how much Medicare Medi-Cal will pay for one. If you talk to the staff members who do billing, they can look it up, after asking this question: which insurance are you using?
Why is that important? because a premium plan will pay more than an OK plan, which pays more than the government does. And because the government generally pays less than the cost of the MRI, the premium users pay more, the OK plan user pay a bit more. In the end, the costs are met and the MRI operator doesn't go out of business.
The only single payer I support is the person who gets the treatment. That is an immediate check on playing games with prices, like charging a boatload of money for some aspirin. You become invested in the cost when you're spending your own money.
I R A Darth Aggie at January 12, 2020 11:01 AM
No, the auto insurance status quo doesn't work.
More than 40% of the people on our roads don't have insurance, even in states that make it mandatory. In particular, illegal aliens drive in large numbers, have no licenses, and couldn't get insured if they wanted to. (But police in sanctuary states have a policy of always letting them go -- including after a hit-and-run.)
And the vast majority (70%+) of those who do have auto insurance have only the minimum required (15k/30k/5k in California, numbers which haven't been raised since I got my license 45 years ago!) I doubt if any state even comes close to requiring amounts that would actually pay the victim's losses in a serious wreck. I suggest new minimums of X/2X/X, where X = the price of a median new car to be adjusted annually from car sales figures.
The reason there is no serious movement to change this bad situation is that lawyers make big bucks from the unjust status quo, so naturally they pay high-powered lobbyists to keep it the way it is.
jdgalt at January 12, 2020 11:41 AM
You can't necessarily go to any doctor you like. Many plans limit you to using health care in your canton. Cantons, size wise, are comparable to counties in eastern seaboard states.
In addition, there are public hospitals and private clinics, and your basic plan doesn't cover doctors in private clinics. You can get a complimentary insurance that covers private clinics.
There are two types of plans, as well... see any doctor you like at any time plans, or get a referral from your primary care plans, the second being cheaper.
Also, you don't have it at the original cost for life. That's blatantly untrue. Our premiums rise every year.
Switzerland is not really that homogenous... there are four native cultures which speak completely different languages, not to mention the high numbers of foreigners that live here.
NicoleK at January 13, 2020 11:26 AM
Good point on the canton/county issue NicoleK. there are many counties here in the US where there are no doctors. Typically because there are almost no people that live there.
On the homogeneity, compared to the US yes Switzerland is very homogeneous. I agree it isn't like children of the corn. But compared to the variation across the US Switzerland is more or less uniform.
Ben at January 14, 2020 4:25 AM
I mean, if you think Germanic, French and Italian cultures are uniform then sure...
NicoleK at January 14, 2020 10:37 AM
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