Switzerland's example of universal healthcare
Published: 2009-11-01 19:05:34
Author: Doyle McManus | Los Angeles Times | October 18, 2009
So I used part of a vacation last week to head for the Swiss Alps to observe the system in practice.
Dr. Jean-Oscar Meile, 53, runs a tidy one-man practice in Melide, a suburb of Lugano in Switzerland's Italian-speaking south. He is quick to say he's not a spokesman for Swiss doctors, the government or anyone else. But he has about 1,000 patients, as varied as bankers, fashion designers, rural woodcutters and immigrant laborers.
"We've got a lot of problems," he told me last week. "Costs are going up. Nobody wants to pay for them. The politicians want us to drive a Mercedes, but they're only willing to pay for a Volkswagen. ... The system was better a few years ago, before there was so much regulation."
Still, he added, "I think we have the best system in Europe. All the American doctors I know complain about your system and are jealous of ours."
Here's how the Swiss system works: Everyone is required to buy basic health insurance from one of several private companies; the government subsidizes the cost for low-income families. Consumers can choose any insurer and go to any doctor -- more choice than most Americans now enjoy. The government prescribes what the policies will cover, sets the price and tells doctors what they can charge for every medical procedure. Doctors are free to do whatever they feel is called for, order up any test and prescribe any approved medication. But if a doctor's billings exceed the regional median by too much, he or she will get a "blue letter" -- a bill from the government demanding the return of some of those fees.
By world standards, Swiss medicine is very good. The average infant born in Switzerland can expect to live to almost 82, more than three years longer than the average American baby. Swiss patients don't wait long for treatment either. "If you need an MRI, I can arrange one tonight or tomorrow," Meile said. And they pay a lot less than we do. About 11% of the Swiss GNP goes to healthcare, against about 16% of ours. Per person, that worked out in 2007 to roughly $4,417 in Switzerland and about $7,290 per person here, according to the Organization for Economic Cooperation and Development.
That makes Switzerland's system a lot cheaper than U.S. medicine, but it's not cheap in the eyes of many Swiss. In fact, the Swiss pay out-of-pocket costs that are higher than the U.S. average. This year, the basic Swiss health insurance policy cost an average of about $3,800 per adult over age 25, with a deductible of about $300 for the year and a co-payment after that of 10% (up to a ceiling of about $700). Next year, the premium will rise by about 9%. Some employers pick up a big chunk of the premium, but not all.
The unrelenting rise in costs has been the single biggest disappointment in the Swiss universal coverage system, which was created by a landmark reform in 1994. To Meile and others, the basic reason is evident: The well-insured Swiss use a lot of medical care -- too much, in fact. They visit their doctors more frequently than Americans do. They often ask for tests or pharmaceuticals that they've heard about from friends. And nobody wants to tell them no.
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Published: 2009-11-01 19:05:34
Author: Doyle McManus | Los Angeles Times | October 18, 2009
Writing From Lugano, Switzerland
At least one country already has a healthcare plan roughly similar to the one President Obama and the Democrats have proposed, with universal coverage, a mandate that everyone buy insurance and a major role for private insurance companies: Switzerland.So I used part of a vacation last week to head for the Swiss Alps to observe the system in practice.
Dr. Jean-Oscar Meile, 53, runs a tidy one-man practice in Melide, a suburb of Lugano in Switzerland's Italian-speaking south. He is quick to say he's not a spokesman for Swiss doctors, the government or anyone else. But he has about 1,000 patients, as varied as bankers, fashion designers, rural woodcutters and immigrant laborers.
"We've got a lot of problems," he told me last week. "Costs are going up. Nobody wants to pay for them. The politicians want us to drive a Mercedes, but they're only willing to pay for a Volkswagen. ... The system was better a few years ago, before there was so much regulation."
Still, he added, "I think we have the best system in Europe. All the American doctors I know complain about your system and are jealous of ours."
Here's how the Swiss system works: Everyone is required to buy basic health insurance from one of several private companies; the government subsidizes the cost for low-income families. Consumers can choose any insurer and go to any doctor -- more choice than most Americans now enjoy. The government prescribes what the policies will cover, sets the price and tells doctors what they can charge for every medical procedure. Doctors are free to do whatever they feel is called for, order up any test and prescribe any approved medication. But if a doctor's billings exceed the regional median by too much, he or she will get a "blue letter" -- a bill from the government demanding the return of some of those fees.
By world standards, Swiss medicine is very good. The average infant born in Switzerland can expect to live to almost 82, more than three years longer than the average American baby. Swiss patients don't wait long for treatment either. "If you need an MRI, I can arrange one tonight or tomorrow," Meile said. And they pay a lot less than we do. About 11% of the Swiss GNP goes to healthcare, against about 16% of ours. Per person, that worked out in 2007 to roughly $4,417 in Switzerland and about $7,290 per person here, according to the Organization for Economic Cooperation and Development.
That makes Switzerland's system a lot cheaper than U.S. medicine, but it's not cheap in the eyes of many Swiss. In fact, the Swiss pay out-of-pocket costs that are higher than the U.S. average. This year, the basic Swiss health insurance policy cost an average of about $3,800 per adult over age 25, with a deductible of about $300 for the year and a co-payment after that of 10% (up to a ceiling of about $700). Next year, the premium will rise by about 9%. Some employers pick up a big chunk of the premium, but not all.
The unrelenting rise in costs has been the single biggest disappointment in the Swiss universal coverage system, which was created by a landmark reform in 1994. To Meile and others, the basic reason is evident: The well-insured Swiss use a lot of medical care -- too much, in fact. They visit their doctors more frequently than Americans do. They often ask for tests or pharmaceuticals that they've heard about from friends. And nobody wants to tell them no.
Full story