Swiss Health Care Thrives Without Public Option
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By NELSON D. SCHWARTZ
Published: September 30, 2009
ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.
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Dominic Büttner for The New York Times
Dr. Gerlinde Schurter, center, with a patient and a nurse. She says regulators and insurers have fought to hold down costs.
Related
Incentives and Costs of the Swiss Government Model (October 1, 2009)
Times Topics: Health Care Reform
Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.
That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.
In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.
Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.
By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.
And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.
The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.
The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)
Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.
“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.
“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”
Since being made mandatory in 1996, the Swiss system has become a popular model for experts seeking alternatives to government-run health care. Indeed, it has attracted some unlikely American admirers, like Bill O’Reilly, the Fox News talk show host. And it has lured some members of Congress on fact-finding trips here to seek ideas for overhauling the United States system.
The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”
While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.
Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.
Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.
If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.
Similarly, the government health office also lowered reimbursements across the board for medical devices in 2006.
These are among the reasons health care costs consume 10.8 percent of gross domestic product in Switzerland, compared with 16 percent in the United States, the highest level of spending among industrial countries, according to the Organization for Economic Cooperation and Development.
Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.
Related
Incentives and Costs of the Swiss Government Model (October 1, 2009)
Times Topics: Health Care Reform
Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.
Direct comparisons are hard to make, however, because in the American system, employers and employees share the cost of premiums, which are also exempt from individual and corporate income taxes.
Nevertheless, Swiss citizens relish the lack of bureaucracy, especially compared with systems in Britain and Germany, even if their doctors grumble.
As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.
That is partly because the Swiss health insurers are not shy about using their muscle with physicians.
Pius Gyger, director of health economics and health policy at Helsana, the country’s biggest insurer, cannot suppress a smile when asked about the effectiveness of the so-called blue letters.
“If there’s something strange, we knock at the doctor’s door,” he said. “For doctors, it’s an incentive to treat economically, but often perceived as a threat.”
He estimates that only about 3 percent of doctors get the letters and that fewer than 1 percent actually have to return money. Still, Mr. Gyger said, “it’s an easy exercise for us and it has an effect.”
Despite pressure on general practitioners, hospital physicians like Edouard Battegay at the University of Zurich say universal coverage also lowers costs by reducing emergency room visits.
Indeed, his E.R. is as quiet and efficient as a Swiss watch, and he still expresses amazement at what he saw when he worked briefly in Seattle.
“I’ve seen things in the U.S. that I’ve never seen here; it was a state of disaster,” he said. “Chronic disease management is better here. If you don’t treat hypertension, you treat strokes. Not treating patients is expensive.”
And even Dr. Schurter — who says her income has been flat for the last five years — praises the virtues of the Swiss system for patients struck by catastrophe.
When her daughter was found to have leukemia seven years ago, “I never worried for a second how and if she’d get treatment and if it would be paid for,” she said. “All was granted as naturally as the air we breathe.
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Thursday, October 01, 2009
The Swiss Health Care System
Swiss Health Model Gains Admirers ZURICH — Like every other the Swiss system involves some system is different from virtu- country in Europe, Switzerland trade-offs that U.S. consumers, ally every other country in the guarantees health care for all its insurers and health care provid- world,” said Regina Herzlinger, citizens. But the system here does ers might find hard to swallow. a Harvard Business School pro- not remotely resemble the model The Swiss government care- fessor who has studied the Swiss of socialized medicine often cited fully regulates drug prices and approach. by opponents of universal cover- fees for lab tests and medical “What I like about it is that age in the United States. devices. It also requires patients it’s got universal coverage, it’s Swiss private insurers are re- to share some costs — at a higher customer driven, and there are quired to offer coverage to all citi- level than in the United States — no intermediaries shopping on zens, regardless of age or medi- so they have an incentive to avoid people’s behalf,” she added. “And cal history. And those people, in unnecessary treatments. And there’s no waiting lists or ration- turn, are obligated to buy health some doctors grumble that cost ing like in the U.K. or Canada.” insurance. controls are making it harder Since being made mandatory That is why many academ- these days for a physician to in 1996, the Swiss system has be- ics who have studied the Swiss make a franc. come a popular model for experts health care system have pointed The Swiss government also seeking alternatives to govern- to this nation of about 7.5 million provides direct cash subsidies to ment-run health care. The Swiss as a model that delivers much of people if health insurance equals approach is also popular with pa- what Washington is aiming to ac- more than 8 percent of personal tients like Frieda Burgstaller, 72, complish — without the conten- income, and about 35 to 40 percent who says she likes the access that tious option of a government-run of households get some form of the private system provides. “If insurance plan. subsidy. In some cases, employ- the doctor says it has to be done, By many measures, the Swiss ers contribute part of the insur- it’s done,” said Burgstaller. “You are healthier than Americans, ance premium, but, unlike in the don’t wait. And it’s covered.” and surveys indicate that Swiss United States, they do not receive Still, along with lower costs and people are generally happy with a tax break for it. And unlike the the freedom to choose doctors their medical system. Switzer- United States, where the Medi- come bigger bills for individual land, moreover, provides high care program costs taxpayers patients. On average, out-of-pock- quality care at costs well below about $500 billion a year, there is et payments come to $1,350 annu- what the United States spends no special break here for the el- ally. That is well above the $890 per person. derly. average for the United States. And yet, as a potential model, “Switzerland’s health care NELSON D. SCHWARTZ
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The Swiss Healthcare System: A Model For The US
Swiss Health Model Gains Admirers
ZURICH — Like every other
the Swiss system involves some
system is different from virtu-
country in Europe, Switzerland
trade-offs that U.S. consumers,
ally every other country in the
guarantees health care for all its
insurers and health care provid-
world,” said Regina Herzlinger,
citizens. But the system here does
ers might find hard to swallow.
a Harvard Business School pro-
not remotely resemble the model
The Swiss government care-
fessor who has studied the Swiss
of socialized medicine often cited
fully regulates drug prices and
approach.
by opponents of universal cover-
fees for lab tests and medical
“What I like about it is that
age in the United States.
devices. It also requires patients
it’s got universal coverage, it’s
Swiss private insurers are re-
to share some costs — at a higher
customer driven, and there are
quired to offer coverage to all citi-
level than in the United States —
no intermediaries shopping on
zens, regardless of age or medi-
so they have an incentive to avoid
people’s behalf,” she added. “And
cal history. And those people, in
unnecessary treatments. And
there’s no waiting lists or ration-
turn, are obligated to buy health
some doctors grumble that cost
ing like in the U.K. or Canada.”
insurance.
controls are making it harder
Since being made mandatory
That is why many academ-
these days for a physician to
in 1996, the Swiss system has be-
ics who have studied the Swiss
make a franc.
come a popular model for experts
health care system have pointed
The Swiss government also
seeking alternatives to govern-
to this nation of about 7.5 million
provides direct cash subsidies to
ment-run health care. The Swiss
as a model that delivers much of
people if health insurance equals
approach is also popular with pa-
what Washington is aiming to ac-
more than 8 percent of personal
tients like Frieda Burgstaller, 72,
complish — without the conten-
income, and about 35 to 40 percent
who says she likes the access that
tious option of a government-run
of households get some form of
the private system provides. “If
insurance plan.
subsidy. In some cases, employ-
the doctor says it has to be done,
By many measures, the Swiss
ers contribute part of the insur-
it’s done,” said Burgstaller. “You
are healthier than Americans,
ance premium, but, unlike in the
don’t wait. And it’s covered.”
and surveys indicate that Swiss
United States, they do not receive
Still, along with lower costs and
people are generally happy with
a tax break for it. And unlike the
the freedom to choose doctors
their medical system. Switzer-
United States, where the Medi-
come bigger bills for individual
land, moreover, provides high
care program costs taxpayers
patients. On average, out-of-pock-
quality care at costs well below
about $500 billion a year, there is
et payments come to $1,350 annu-
what the United States spends
no special break here for the el-
ally. That is well above the $890
per person.
derly.
average for the United States.
And yet, as a potential model,
“Switzerland’s health care
NELSON D. SCHWARTZ
ZURICH — Like every other
the Swiss system involves some
system is different from virtu-
country in Europe, Switzerland
trade-offs that U.S. consumers,
ally every other country in the
guarantees health care for all its
insurers and health care provid-
world,” said Regina Herzlinger,
citizens. But the system here does
ers might find hard to swallow.
a Harvard Business School pro-
not remotely resemble the model
The Swiss government care-
fessor who has studied the Swiss
of socialized medicine often cited
fully regulates drug prices and
approach.
by opponents of universal cover-
fees for lab tests and medical
“What I like about it is that
age in the United States.
devices. It also requires patients
it’s got universal coverage, it’s
Swiss private insurers are re-
to share some costs — at a higher
customer driven, and there are
quired to offer coverage to all citi-
level than in the United States —
no intermediaries shopping on
zens, regardless of age or medi-
so they have an incentive to avoid
people’s behalf,” she added. “And
cal history. And those people, in
unnecessary treatments. And
there’s no waiting lists or ration-
turn, are obligated to buy health
some doctors grumble that cost
ing like in the U.K. or Canada.”
insurance.
controls are making it harder
Since being made mandatory
That is why many academ-
these days for a physician to
in 1996, the Swiss system has be-
ics who have studied the Swiss
make a franc.
come a popular model for experts
health care system have pointed
The Swiss government also
seeking alternatives to govern-
to this nation of about 7.5 million
provides direct cash subsidies to
ment-run health care. The Swiss
as a model that delivers much of
people if health insurance equals
approach is also popular with pa-
what Washington is aiming to ac-
more than 8 percent of personal
tients like Frieda Burgstaller, 72,
complish — without the conten-
income, and about 35 to 40 percent
who says she likes the access that
tious option of a government-run
of households get some form of
the private system provides. “If
insurance plan.
subsidy. In some cases, employ-
the doctor says it has to be done,
By many measures, the Swiss
ers contribute part of the insur-
it’s done,” said Burgstaller. “You
are healthier than Americans,
ance premium, but, unlike in the
don’t wait. And it’s covered.”
and surveys indicate that Swiss
United States, they do not receive
Still, along with lower costs and
people are generally happy with
a tax break for it. And unlike the
the freedom to choose doctors
their medical system. Switzer-
United States, where the Medi-
come bigger bills for individual
land, moreover, provides high
care program costs taxpayers
patients. On average, out-of-pock-
quality care at costs well below
about $500 billion a year, there is
et payments come to $1,350 annu-
what the United States spends
no special break here for the el-
ally. That is well above the $890
per person.
derly.
average for the United States.
And yet, as a potential model,
“Switzerland’s health care
NELSON D. SCHWARTZ
Thousands Of Jobs Will Be Lost As Saturn Comes To An End
Saturn’s end likely as Penske walks away
By Tom Braithwaite in Washington and Bernard Simon in Detroit
Published: October 1 2009 00:45 | Last updated: October 1 2009 00:45
Penske Automotive Group, the listed dealership chain, walked away from a deal to acquire General Motors’ Saturn unit on Wednesday in a decision that spells the end for the brand and threatens thousands of jobs.
Penske, founded by former racing car driver Roger Penske, said it was pulling out of the acquisition, which was agreed in June and due to close by Thursday, because of doubts about its ability to secure a long-term supply of vehicles.
EDITOR’S CHOICE
In depth: Car industry in crisis - Sep-29
GM bankruptcy documents - Jun-02
Audio slideshow: History of General Motors - Jun-01
GM had agreed to supply Saturn vehicles for a period but Penske was ultimately unable to conclude a follow-up deal with another manufacturer.
“This is very disappointing news and comes after months of hard work by hundreds of dedicated employees and Saturn retailers who tried to make the new Saturn a reality,” said Fritz Henderson, chief executive of GM, in a statement.
GM set up Saturn in the 1980s as a response to the challenge posed by Japanese imports. The brand operated relatively independently, and has sold more than 4m vehicles since 1990. However, its sales decline has been worse than the average at GM during the recession.
The sale of Saturn, part of a process to prune GM’s brands down to a core four, was expected to save 13,000 jobs at Saturn and its 350 dealerships. The cost of closing the brand will fall to GM, which is majority owned by the US government.
The bleak outlook for the dealers, who had been expected to be saved by Penske, comes as members of Congress are pressing both GM and Chrysler to reduce dealer closures that were already planned as part of the companies’ restructuring.
“I am pleased that both sides have put forward proposals and have agreed to work toward a solution,” Steny Hoyer, leader of the Democrats in the House of Representatives, said after a meeting that took place before the Saturn decision was announced.
Combined, the US and Canadian governments now own 72.5 per cent of GM and 10 per cent of Chrysler. The governments have lent the two companies a total of about $75bn and in spite of a pledge by the Obama administration to adopt a hands-off approach, Congress does not necessarily share that view when under pressure to save jobs.
“We all want to reach a non-legislative solution, which can only happen by reaching a deal that is reasonable and fair to both sides,” said Mr Hoyer.
By Tom Braithwaite in Washington and Bernard Simon in Detroit
Published: October 1 2009 00:45 | Last updated: October 1 2009 00:45
Penske Automotive Group, the listed dealership chain, walked away from a deal to acquire General Motors’ Saturn unit on Wednesday in a decision that spells the end for the brand and threatens thousands of jobs.
Penske, founded by former racing car driver Roger Penske, said it was pulling out of the acquisition, which was agreed in June and due to close by Thursday, because of doubts about its ability to secure a long-term supply of vehicles.
EDITOR’S CHOICE
In depth: Car industry in crisis - Sep-29
GM bankruptcy documents - Jun-02
Audio slideshow: History of General Motors - Jun-01
GM had agreed to supply Saturn vehicles for a period but Penske was ultimately unable to conclude a follow-up deal with another manufacturer.
“This is very disappointing news and comes after months of hard work by hundreds of dedicated employees and Saturn retailers who tried to make the new Saturn a reality,” said Fritz Henderson, chief executive of GM, in a statement.
GM set up Saturn in the 1980s as a response to the challenge posed by Japanese imports. The brand operated relatively independently, and has sold more than 4m vehicles since 1990. However, its sales decline has been worse than the average at GM during the recession.
The sale of Saturn, part of a process to prune GM’s brands down to a core four, was expected to save 13,000 jobs at Saturn and its 350 dealerships. The cost of closing the brand will fall to GM, which is majority owned by the US government.
The bleak outlook for the dealers, who had been expected to be saved by Penske, comes as members of Congress are pressing both GM and Chrysler to reduce dealer closures that were already planned as part of the companies’ restructuring.
“I am pleased that both sides have put forward proposals and have agreed to work toward a solution,” Steny Hoyer, leader of the Democrats in the House of Representatives, said after a meeting that took place before the Saturn decision was announced.
Combined, the US and Canadian governments now own 72.5 per cent of GM and 10 per cent of Chrysler. The governments have lent the two companies a total of about $75bn and in spite of a pledge by the Obama administration to adopt a hands-off approach, Congress does not necessarily share that view when under pressure to save jobs.
“We all want to reach a non-legislative solution, which can only happen by reaching a deal that is reasonable and fair to both sides,” said Mr Hoyer.
Thousands Of Jobs Will Be Lost As Saturn Comes To An End
Saturn’s end likely as Penske walks away
By Tom Braithwaite in Washington and Bernard Simon in Detroit
Published: October 1 2009 00:45 | Last updated: October 1 2009 00:45
Penske Automotive Group, the listed dealership chain, walked away from a deal to acquire General Motors’ Saturn unit on Wednesday in a decision that spells the end for the brand and threatens thousands of jobs.
Penske, founded by former racing car driver Roger Penske, said it was pulling out of the acquisition, which was agreed in June and due to close by Thursday, because of doubts about its ability to secure a long-term supply of vehicles.
EDITOR’S CHOICE
In depth: Car industry in crisis - Sep-29
GM bankruptcy documents - Jun-02
Audio slideshow: History of General Motors - Jun-01
GM had agreed to supply Saturn vehicles for a period but Penske was ultimately unable to conclude a follow-up deal with another manufacturer.
“This is very disappointing news and comes after months of hard work by hundreds of dedicated employees and Saturn retailers who tried to make the new Saturn a reality,” said Fritz Henderson, chief executive of GM, in a statement.
GM set up Saturn in the 1980s as a response to the challenge posed by Japanese imports. The brand operated relatively independently, and has sold more than 4m vehicles since 1990. However, its sales decline has been worse than the average at GM during the recession.
The sale of Saturn, part of a process to prune GM’s brands down to a core four, was expected to save 13,000 jobs at Saturn and its 350 dealerships. The cost of closing the brand will fall to GM, which is majority owned by the US government.
The bleak outlook for the dealers, who had been expected to be saved by Penske, comes as members of Congress are pressing both GM and Chrysler to reduce dealer closures that were already planned as part of the companies’ restructuring.
“I am pleased that both sides have put forward proposals and have agreed to work toward a solution,” Steny Hoyer, leader of the Democrats in the House of Representatives, said after a meeting that took place before the Saturn decision was announced.
Combined, the US and Canadian governments now own 72.5 per cent of GM and 10 per cent of Chrysler. The governments have lent the two companies a total of about $75bn and in spite of a pledge by the Obama administration to adopt a hands-off approach, Congress does not necessarily share that view when under pressure to save jobs.
“We all want to reach a non-legislative solution, which can only happen by reaching a deal that is reasonable and fair to both sides,” said Mr Hoyer.
By Tom Braithwaite in Washington and Bernard Simon in Detroit
Published: October 1 2009 00:45 | Last updated: October 1 2009 00:45
Penske Automotive Group, the listed dealership chain, walked away from a deal to acquire General Motors’ Saturn unit on Wednesday in a decision that spells the end for the brand and threatens thousands of jobs.
Penske, founded by former racing car driver Roger Penske, said it was pulling out of the acquisition, which was agreed in June and due to close by Thursday, because of doubts about its ability to secure a long-term supply of vehicles.
EDITOR’S CHOICE
In depth: Car industry in crisis - Sep-29
GM bankruptcy documents - Jun-02
Audio slideshow: History of General Motors - Jun-01
GM had agreed to supply Saturn vehicles for a period but Penske was ultimately unable to conclude a follow-up deal with another manufacturer.
“This is very disappointing news and comes after months of hard work by hundreds of dedicated employees and Saturn retailers who tried to make the new Saturn a reality,” said Fritz Henderson, chief executive of GM, in a statement.
GM set up Saturn in the 1980s as a response to the challenge posed by Japanese imports. The brand operated relatively independently, and has sold more than 4m vehicles since 1990. However, its sales decline has been worse than the average at GM during the recession.
The sale of Saturn, part of a process to prune GM’s brands down to a core four, was expected to save 13,000 jobs at Saturn and its 350 dealerships. The cost of closing the brand will fall to GM, which is majority owned by the US government.
The bleak outlook for the dealers, who had been expected to be saved by Penske, comes as members of Congress are pressing both GM and Chrysler to reduce dealer closures that were already planned as part of the companies’ restructuring.
“I am pleased that both sides have put forward proposals and have agreed to work toward a solution,” Steny Hoyer, leader of the Democrats in the House of Representatives, said after a meeting that took place before the Saturn decision was announced.
Combined, the US and Canadian governments now own 72.5 per cent of GM and 10 per cent of Chrysler. The governments have lent the two companies a total of about $75bn and in spite of a pledge by the Obama administration to adopt a hands-off approach, Congress does not necessarily share that view when under pressure to save jobs.
“We all want to reach a non-legislative solution, which can only happen by reaching a deal that is reasonable and fair to both sides,” said Mr Hoyer.
An Innocent Man Executed In Texas And The Governor Is Running A Giant Cover-Up
http://www.huffingtonpost.com/2009/09/30/cameron-todd-willingham-t_0_n_305653.html
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