Are the Swiss ready for single payer?
The Dangers of Undermining Patient Choice: Lessons for Europe and Canada
A joint project with Galen Institute, and International Policy Network October 2006
Institute for Policy Innovation
The U.S. is once again embarking on a national debate over health care reform, and many people want the country to embrace a system similar to those of Europe or Canada. This study includes nine papers from a number of economists and health policy experts from those countries. What these experts expose are governments micromanaging the health care system: imposing price controls, limiting access to prescription drugs, hindering research and innovation, and cutting government health care budgets. As a result, patients face long waiting lines, often go untreated, or treated with old and outdated technologies.
Swiss Health Care: A Clockwork Model that Fails to Keep Promises
By Alphonse Crespo, M.D.
Switzerland’s pluralist social health care system stems from constitutional articles voted in 1890 guaranteeing access to adequate health care for all.
This goal was achieved by a delicate blend of social insurance, private enterprise, oligopoly and competition in which the government played a subsidiary role and where wide autonomy was left to the cantons. Limited government intrusion, strong and innovative health industries, reputable medical schools and a market economy spared by two world wars gave quality care to all levels of society for many decades.
The Promise Denied.
But efforts for health care reform that began in 1960, pushed for an increased regulatory and redistributive function of the state.
Social-democratic reformers finally got their way in 1994 with the creation of the Federal Law of Insurance against Sickness (LAMal), which established compulsory insurance and appointed insurance providers with wide regulatory powers.
Possibilities for Reform.
A constitutional initiative launched in 2004 by trade unions and the socialist party called for a single national insurance provider and for insurance premiums pegged to personal income. This proposal that would abolish some 90 existing sickness funds was rejected by Parliament, but the issue will be taken to referendum vote in 2007. Deep public dissatisfaction with sickness funds and current polls reflect a readiness to accept a single insurance provider as a lesser evil.
Comment:
By Don McCanne, MD
The producers of this report are supporters of the free market in health care, with its current incarnation as consumer-directed health care.
As expected, the report is saturated with anti-government rhetoric, containing their requisite criticisms of universal systems. Still it is a report worth reading since it is important to understand the rhetoric of the opponents of national health insurance, and it also does identify some genuine weaknesses of other systems, even if biased, distorted and sometimes false.
Only the United States spends more on health care than does Switzerland.
With an individual mandate to purchase insurance, choosing from 90 different sickness funds, the Swiss are looking for relief. It is a sign of the times that these free market advocates acknowledge that the Swiss seem ready to “accept an (equitably funded) single insurance provider as a lesser evil.”