Map of life expectancy at birth from Global Education Project.

Tuesday, August 17, 2010

Ask a stupid question . .

You might get an intelligent answer.

Cheng Tsung-Mei for Health Affairs interviews Thomas Zeltner, former health minister for Switzerland. (You can't read this part except you can, because I'm reproducing it here.) The Swiss adopted a system in 1996 that's something of a model for the PPACA, only better, because poor people don't get second-class coverage.

Cheng: Many Americans bristle at the idea of being mandated to purchase health insurance and see it as a violation of their individual freedom. The Swiss are known for jealously guarding their individual freedom, too, yet they accept their own mandate to have adequate health insurance. As one such freedom-loving Swiss individual, would you defend the Swiss mandate?

Zeltner: That’s easy.We will not let people suffer and die when they need healthcare. The Swiss believe that in return, individuals owe it to society to make provision ahead of time for their health care when they fall seriously ill. At that point, they may not have enough money to pay for it. So we consider the health insurance mandate to be a form of socially responsible civic conduct. In Switzerland, “individual freedom” does not mean that you should be free to live irresponsibly and freeload from others, as you would put it.

Cheng: What if you do not have a job or are poor? How do you own up to the mandate then?

Zeltner: If you do not have a job, then, obviously, there are two options. Either you’re very rich or on a pension, and you don’t need public assistance. Or you’re poor—in which case you will get a subsidy from the government to help pay for the insurance.

There. Would that be so difficult for Democratic politicians to say?


Anonymous said...

Yes, the Gvmt. (tax payer) will pay 100% of the insurance premiums if you cannot pay. In Switz.

Estimates vary, as it depends what you count (fancy ramps to the hosp? Police ambulance? Federally funded Gov. program for experimental cancer treatment? Helicopter save paid by an association? Free wheel chair from the disability insurance...that one is a ball of wax...etc. etc.) but basically it judged that private persons pay, in the form of insurance payments to ‘private’ (heavily gvmt regulated) cos., between 60 and 75% of total ‘health costs’.

The rest is paid either in the form of stipends to those who cannot pay, or for all varied things such as mentioned before. That means, of course, that in some places, 50% of the pop. is getting payments from social services to pay ‘health care’ private insurance.

The personal responsibility thing is totally overrated, imho.

If you are poor, you may get 100% paid, or 50% paid, or even less. (I know one guy who gets 20%.) That is, you must be registered and in the hands of social services, open up yr budget, etc. You have to show clean hands, good faith.

Basically what Switz. did was to outsource, and mandate, control, insurance.

Employers pay nothing, that includes state/union/ etc. employees. Nothing, ever.

Cantons, aka states in a federation, pay nothing as well in the official structure, though they do pay a lot through social services - social services are not there to pay health care, they are there to up the family budget, may pay your rent, pay for you to take a course, get educated. Or pay for taxis twice a month if you are blind. Or, in some case, for therapy if you are freaking out, etc. Or for a home aid for an elderly Alz. patient, etc. That is why is so hard to figure out the ‘health’ care part: and anyway, what is health care and what is not?

In this scheme, health care is just one onerous part of family expense, not treated separately. (it would cost too much to do those calcs.) Illegal immigrants can get health care as well (another topic.)

Now, this is not my favorite model, by far. But it suits the Swiss, who have voted many many times not to touch or change this system. Despite the fact that cost rise every year.

I have to add, that the model of ‘social aid’ was, in Switz. slowly changed from investing into both ‘health’ (e.g cheap clinic, lower payments for the poor, or staggered payments, free dental care for the poor, etc.), ‘housing’, ‘supplementary education’ (etc) to simply supporting the individual / families.

For ex. what in the US would be Section 8 housing hardly exists anymore. Individuals are just supported in the ‘free market’. They can’t eat, or pay the doc, the tax payer chips in.

The right and the left agreed to this slow change, in part for ‘social harmony’ (in a housing bloc one family may be living off aid, the other is a condo owner with a mercedes in the garage, in the very same building) and in part because running special programs for one section of the pop is discriminatory and very costly. It just seemed to suit everyone.

That is all well and fine as long as extravagant med. costs can be paid, in one way or another.


Cervantes said...

Thanks Ana. It seems that you basically went as far as you could and did the best you could given a political environment in which a publicly sponsored program wasn't possible. I think the hope many people have had with the reform in the U.S. was that at least it could be a step toward a Swiss system, but that very much remains to be seen.

Meanwhile, I hope y'all will take it a step further and get that public option in.

Anonymous said...

yes, C that is exactly it.

But things are moving. 3 (or 4, 5, it is all a bit tentative) Swiss-German cantons have now gotten together 6 months ago and are discussing the possibility of ‘doing their own insurance’ - all together, not separately- cutting out the insurance cos. These prelim discussions have gotten wide support and interest from other cantons, have been reported in the press (page 10 or 29) and on TV (2 mins.) And the national “AMA” supports such efforts, has done since forever.

The underlying crux is moving ‘health care’ from the ‘commercial’ sector in law (liberal profession, free contract - any contract between private persons must be allowed and honored - private insurance, etc. - it is right there in the Constitution!) to the ‘state funded‘ slot, on par with, for ex, education, and ‘elder care‘ (state pension like Social Security, homes for the elderly, Gvmt. disability insurance, also part of ‘health care’ etc.) which has since 30 years of course become inextricably entwined with health care. (Elder care is a total mess.)

Personally, I simply wonder what would happen if a canton just decided to do it.