Swiss reject single payer health care

Swiss voters on Sunday rejected a plan to ditch the country’s all-private health insurance system and create a state-run scheme, exit polls showed.

Some 64 percent of the electorate shot down a plan pushed by left-leaning parties who say the current system is busting the budgets of ordinary residents, figures from polling agency gfs.bern showed.

Going public would have been a seismic shift for a country whose health system is often hailed abroad as a model of efficiency, but is a growing source of frustration at home because of soaring costs.

“Over the past 20 years in Switzerland, health costs have grown 80 percent and insurance premiums 125 percent,” ophthalmologist Michel Matter told AFP.

There is more here, and for the pointer I thank Samir Varma.

Comments

Interesting. I wonder why the Swiss are reluctant to adopt single-payer. From what I've seen Switzerland has persistently higher healthcare costs than the single-payer European countries. Maybe it has to do with Swiss federalism?

Single payer is one way of doing cost-control. I think the question for countries like the US and Switzerland is "OK, if not single-payer, how are we going to control costs?" Are the right-of-center parties actually proposing any solutions?

"Single payer is one way of doing cost-control. I think the question for countries like the US and Switzerland is “OK, if not single-payer, how are we going to control costs?” Are the right-of-center parties actually proposing any solutions?"

What other sectors do you demand cost controls for? Why don't you call for cost controls across the board?

I'd go further -

Are left-of-center parties proposing any solutions for the myriad of diseases associated with aging?

Cahokia - the problem in health care is that, even with private insurance, the person who pays and the person who benefits are separated. So, docs and patients run up the bill, because they get all the benefit but little of the cost. Unlike restaurants or oil change places, where the same person pays & benefits. Unsurprisingly, we see huge cost inflation where 3rd parties pay for something on our behalf (health care, much of education), but not in consumer goods.

Does single-payer change this? Yes and no. Payer and beneficiary are still separate, but (in principle) the single payer has the bargaining power to lower prices paid to providers.

Payer and beneficiary are still separate, but (in principle) the single payer has the bargaining power to lower prices paid to providers. -

So do insurance companies. The "yes" part is something else. Something that you don't want to spell out.

Why should government be involved in health care at all? Every aspect of it, from medical schools to the last gasp in the emergency room is entangled with bureaucracy. Putting health care in an unregulated, free market context would lower costs dramatically, if that were actually the goal.

Putting health care in an unregulated, free market context would lower costs dramatically, if that were actually the goal.

The "concern" over health care costs always seems fundamentally immoral to me. We don't think it's ok to tell people they can't spend as much as they want on all sorts of other things. Education, food, model trains, etc. But when it comes to spending more money on trying to have a long and comfortable life, the left is up in arms.

If I can take my life savings and dump it into getting, say, a second Ph.D. or a lifetime supply of caviar, why should we submit to a command and control economy for health care to prevent us from spending our life savings on continued life?

MikeDC: "If I can take my life savings and dump it into getting, say, a second Ph.D. or a lifetime supply of caviar, why should we submit to a command and control economy for health care to prevent us from spending our life savings on continued life?"

You're operating from a fundamentally different set of starting principles than the left. To you, health care is no different than, as you say, education, food, model trains, etc. It's just another good/service to be produced and consumed. Therefore, government meddling in its economics is absurd and destructive.

To the left, health care is a human right: everyone is entitled to it regardless of economic means. Therefore, rationing the finite supply of it by ability to pay is fundamentally immoral. Hence, some degree of socialized provision and the attempt to ration it by need as assessed by committees of ostensible experts i.e. "death panels".

The debate over health care isn't truly over economics; it's over first principles.

And it isn't really a debate. No one thinks an old man who has exhausted his money has a 'right' to demand society supply him with model trains if he suddenly decides to take up that hobby. Yet no one seriously thinks he should be denied care if he doubles over in the street with a heart attack.

Yet no one seriously thinks he should be denied care if he doubles over in the street with a heart attack.

You don't want to go there. Recall Whittaker Chambers' assessment of Rand's view of her opponents ("To a gas chamber, go!"). Only losers get sick or caught in industrial accidents, or so Ayn said.

http://aynrandcontrahumannature.blogspot.com/2007/10/that-winston-tunnel-scene-in-full.html

Why should government be involved in health care at all?

Because it has unpredictable spikes in expenditure that few people can plan for well. Insurance markets help some, but viable actuarial pools tend to exclude wide swaths of the public, generating social problems you have to address (if you're not an Objectivist moonie).

People with a sincere concern for others, the Shriners, for instance, are willing to spend their own money to help the less fortunate with medical problems. The less ethical left merely wishes to avoid paying for their own health care by pulling everyone else into a mandatory system. If their ideas were appealing coercion wouldn't be necessary but realistic souls have seen the fruit of other government/bureaucratic fiascos, mandatory ethanol, sugar tariffs, federal raids on guitar manufacturers and so on. Why wouldn't any sentient being be leary of a government program that dominates such a large part of the economy? If you need references on how effective government is just ask a native American.

@FUBAR007

Perhaps I fail the Turing test, but I honestly don't see how an honest starting point of "health care is a human right" leads one to an end point of "we must limit an individual's right to spend on his own health"

Rights are, almost by definition, lower bounds rather than upper bounds on human behavior. We all agree on a right to free speech, and to some extent I'm willing to subsidize the right of my fellow citizens to speak. But an interpretation of the right of free speech that limited my speech to the same as everyone elses' could only be described as Orwellian.

A right to health care should be no different. I can morally imagine (and to some degree support) a "right" to health that creates a relatively sensible national health care system. But a system that limits my personal consumption decisions "just because" is lunacy and obviously inimical to a right to health.

chuck,

This is what is frustrating about the right. They like to pretend to be virginal nuns during the day but at night sleep with anyone and everyone.

We hear over and over again that they don't think people should be 'coerced' to providing health care. Yet very simple question...a man doubles over with a heart attack in the street, what happens? Assume he has no serious money, no insurance and nearby charities are not able to help him. Everyone who is serious, everyone who has run for office in the US, everyone agrees he should be provided with medical care. Yet by definition if he is to be provided with care he cannot pay for then someone must be coerced somewhere down the line.

MikeDC

Perhaps I fail the Turing test, but I honestly don’t see how an honest starting point of “health care is a human right” leads one to an end point of “we must limit an individual’s right to spend on his own health”

Do single payer systems really do that? I understand the UK does allow individuals to have private insurance and use their own money to go above and beyond what the state system provides.... Medicare is essentially a single payer system yet there's a lot of spending that happens both with insurance and by out of pocket that is above and beyond that.

Because an undetermined percentage of mendicants will keel over on the street there is no other option than to coerce every citizen into giving up part of their income or wealth to support a specific industry configuration. This is when an MRI costs $400 in one clinic and $1500 in a clinic two miles down the road. You needn't have much experience with either the government or the health care industry to be skeptical of a sensible outcome for the average citizen in this scenario.

Boonton: "Yet no one seriously thinks he should be denied care if he doubles over in the street with a heart attack."

Don't be too sure about that.

That said, in practice, EMTALA has already taken care of this problem. The issue now is whether it's acceptable for such a person to incur massive debt paying for that care afterward in the event he doesn't have adequate insurance. The right says yes, it's acceptable; the left, at least implicitly, says no.

MikeDC: "Perhaps I fail the Turing test, but I honestly don’t see how an honest starting point of “health care is a human right” leads one to an end point of “we must limit an individual’s right to spend on his own health”"

Because there is a finite (although not fixed) supply of health care and, therefore, the distribution of it at any given time is to an extent zero-sum. There's only so much health care to go around. To put it another way, from a left-wing perspective, your "right to spend on your own health" is fine as long as you're not displacing someone else's rightful access to the base level of health care they need. That, then, gets into what constitutes "base level" and "need" which is an argument unto itself.

That said, in practice, EMTALA has already taken care of this problem. The issue now is whether it’s acceptable for such a person to incur massive debt paying for that care afterward in the event he doesn’t have adequate insurance. The right says yes, it’s acceptable; the left, at least implicitly, says no.

EMTALA does not 'solve' the problem. If I double over in the street because I'm really, really bored, movie theatre owners are under no obligation to let me see a fun movie and then try to collect money from me afterwards.

EMTALA still 'coerces' people to provide medical care. Instead of shifting it to taxpayers (as Medicare/caid does) or a private/public partnership (Obamacare) it shifts it to hospitals and doctors.

The Swiss system has reputation for being the best on the continent. Perhaps the Swiss do not mind the cost that much and look at the NHS as an example of (not exactly cheap) disaster.

Note that there are more sophisticated treatments now than 20 years ago, so it is expected that the overall cost has grown.

Last but not least: in the same period, the Swiss economy has grown too. How much?

Well, 80% increase over 20 years is...something the US system would of killed to have. 4% a year is manageable. 7-10% a year increases might have resulted in reform, but in an age of expensive new medical toys, 4% isn't too bad.

80% increase over 20 years is approximately 3% per year compounded annually.

Even better - I knew it was less than 4%, but even a 4% is great. The US average was closer to 7.2% since 1990; only after the passage of the ACA (and the recession) is it even close to the Swiss rate (at about 3.8%). So even though our rate of increase is as low as it has been in a long time, it's still not as good as the Swiss average. And of course, they spend far less than the US per capita, and get better results.

"80% increase over 20 years is…something the US system would of killed to have"

s/would of/could have/

It seems to be more evidence that the Swiss are free people.

Suppose that "doing cost control" is a euphemism for "rationing."

Seems as if the Swiss majority opposes submission to control of an elite that would supervise ("One ring to rule them all.") their health care. It's not only about enhanced health care or cost-containment, single-payer is about control.

'Seems as if the Swiss majority opposes submission to control of an elite that would supervise '

No, the Swiss majority is perfectly content with the current framework that supervises the compulsory health care system - 'Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Swiss Federal Law on Health Insurance (ger: Krankenversicherungsgesetz (KVG); fre:' la loi fédérale sur l’assurance-maladie (LAMal); ita: legge federale sull’assicurazione malattie (LAMal)). It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.' http://en.wikipedia.org/wiki/Health_care_in_Switzerland

"Single payer is one way of doing cost control."

How is that exactly? By downgrading quality? By driving out excellent medical doctors and researchers? By rationing? By working the clay of the existing system into a mediocre shadow of itself?

Do, please, detail how?

"August 15, 1971. In a move widely applauded by the public and a fair number of (but by no means all) economists, President Nixon imposed wage and price controls.

The wage and price controls were mostly dismantled by April, 1974. By that time, the U.S. inflation rate had reached double digits.

While there were skeptics in August, 1971, there were a great many who thought "temporary" wage and price controls could cure inflation. By 1974, this notion was thoroughly discredited"

- http://www.econreview.com/events/wageprice1971b.htm

By rationing by committee. The current US system doesn't do much rationing at all given the lack of a price system. Single-payer is better than our current system (but pretty much indestructible once installed) but worse than some sort of price-based system (with subsidies for the poor and all that).

You wonder. I'll give you a hint. The Swiss don't like waiting and waiting for health care services.

And by the way, the Canadian single payer system has cost growth rates more than the US.

Cherry picking. Unless you are saying "Obamacare is working".

It is a fool me once, fool me twice situation.

The Swiss switch to mandatory private insurance and eliminating public health care to control costs because free market competition always lowers prices. Then they modified it to allow unlimited insurer profits, because the profit motive always reduces prices.

They can see the constant changing of health care systems around them to reduce prices, and see them all failing to reduce prices. Or costs.

People want choice but low costs, but given higher prices means better quality results... they want to use high priced services to get lower costs.

And economists, engineers, marketeers constantly explain the paying a higher price will cost less.

Buy the high priced car which will carry you in luxury for two decades and a million miles, pointing to the 80s Mercedes classic with a million miles.

So, customers want the private sector to lower cost by giving them choices of higher priced services. The customer is always right. Government eliminating choice is bad, but government needs to prevent insurers from eliminating their choices.

No one is willing to say TANSTAAFL: high cost or less choice, pick one, not both.

I guess things will change in Switzerland as well.

You know, a lot of immigrants with - uhmmm - another perspective on those kind of issues.

People should self-insure more, and just buy catastrophic insurance. After all, if you don't have insurance for routine things, you will both be more careful and do preventive medicine (lifestyle changes, like eating less and exercising more), which will cut down on costs.

Here in the PH I self insure. I am out of Obama Care since my premiums shot sky high, despite being healthy, since I am a small business owner. You don't need insurance here when routine medical care costs about $15 a visit and it's pretty decent service for basic stuff. Cut US health care costs by outsource US medical care by allowing medical tourism (current against the rules for US Medicare), and/or importing more foreign doctors.

Canadian healthcare costs are rising just as fast as America's.

Without the corresponding innovation and choice.

While massively expanding the public sector, it's unions and their ability to hold the taxpayer hostage. Case in point the 4 month teachers strike that just ended in BC, in part because the govt agreed to union demands for a several thousand dollar for new teachers even though there is a huge number of graduating teachers chasing fewer jobs.

Should read "several thousand dollar signing bonus."

Yes, a teacher's strike in one province proves that Canadian Health Care is less innovative and as expensive as American.

Attention world: changing how something is financed does not change how much it costs.

To reduce costs, you must either squeeze consumers with less care, or squeeze providers with lower payments. At the moment, medical innovations tend to increase costs rather than decrease them.

It is so irritating that costs are somehow a major issue when these programs are proposed, then go completely out the window when they are passed. Remember all the wonderful cost savings we were going to get from Obamacare?

The answer: it went back into Ezekiel Emmanuel's fevered imagination when he realized that nobody else was willing to die at 75 just because they were getting more expensive.

(Ah, but what if you never build the facilities in the first place? No upfront costs, no costs of care, and no need for denial when there's no care available -- the holy trinity of single payer cost savings.)

The old procedures constantly get more expensive too. That's why it's "healthcare inflation." There isn't much actual medical progress right now. Pharma companies are slashing spending on R&D because nothing is paying off. We're going broke trying to eke out tiny improvements. So the idea is we might as well just switch to single-payer and use monopsony/price controls to control costs.

There is a "Great Healthcare Stagflation."

Why do the old procedures get more expensive? Baumol's Cost Disease tells us their cost should follow income growth. I'd suggest that they should get slightly cheaper with time too, as what was once new, cutting-edge, and very specialized becomes old and routine. Laser eye surgery is a prime example of this.

Increased demand vs decreased supply.... In other words increased proportion of sick elderly vs decreased proportion of working age population...add in slow capacity growth and there you go

Actually, how something is paid for CAN change how much it costs, especially in healthcare. And your point about "innovations tend to increase costs rather than decrease them" is a prime example. If providers are paid on (traditional) retrospective reimbursement, then why not use the fancy new gadget that you can use to pad your bill? But if providers are paid on prospective reimbursement (diagnosis of congestive heart failure? here's $18,000, the average to treat that condition, have fun) then they will invest in cost-saving technology. Googlescholar "Weisbrod, Quadrilemna", this was all known 20 years ago.

Likewise, a single payer has much greater bargaining power than fragmented private insurers - that's why Medicare will pay less for the same procedure than private insurers. This has older data, but the more recent reports haven't broken out Medicare:http://voices.washingtonpost.com/ezra-klein/IFHP%20Comparative%20Price%20Report%20with%20AHA%20data%20addition.pdf

Okay, VTProf, yes, then you have answered the question I had, that is how "single payer is one way of doing cost control."

You say, " ... a single payer has much greater bargaining power than fragmented private insurers – that’s why Medicare will pay less for the same procedure than private insurers."

So, that is the same thing that Nixon tried to control inflation in 1971. (http://www.econreview.com/events/wageprice1971b.htm)

The hugely powerful, and one desperately hopes, incorruptible, government uses that enormous power to shape the cost of things. This power, naturally, squishes down on inflated costs, yes, but at the same time it necessarily distorts quality, supply and many other good things that go into excellent health care.

Using a bludgeon to nail in a small brad type nail gets the nail in alright, but ruins the surrounding structure at the same time. And, then, you pretty much no longer even would want the brad nail in that broken down, destroyed, wall.

At this pace of growth, I'd say the system is unsustainable. I doubt making it all public would solve the problem but there's no doubt that changes are in need.

And about that health-care cost curve: The New Commanding Heights, Arnold Cling and Nick Schulz, National Affairs, Summer 2011.

http://www.nationalaffairs.com/publications/detail/the-new-commanding-heights

Switzerland, much like Germany, already has 'single payer' - if by that you mean that health care providers are required to follow billing standards that are legally binding. In other words, none of the wonderful variability of the American health care system - 'In the District, George Washington University’s average bill for a patient on a ventilator was $115,000, while Providence Hospital’s average charge for the same service was just under $53,000. For a lower joint replacement, George Washington University charged almost $69,000 compared with Sibley Memorial Hospital’s average of just under $30,000.' http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/

In reality there is far less variability in what is paid for similar procedures in similar care settings in the US. Payers actually pay pretty consistent amounts for similar stays. Hospital "charges" are like infomercial retail prices that no one pays--and no, the uninsured don't pay list charges either.

In reality, the differences are much larger than the DC example - 'Imagine walking into a hospital and being charged more than $10,000 for a blood test to check your cholesterol level. And going to another hospital in the same state and being charged $10 for the exact same blood test. That’s what a team led by a University of California San Francisco researcher found when it looked at the prices California hospitals charge for 10 common blood tests.

Researchers studied charges for a variety of tests at 160 to 180 California hospitals in 2011 and found a huge variation in prices. The median charge for a basic metabolic panel, which measures sodium, potassium and glucose levels, among other indicators, was $214. But hospitals charged from $35 to $7,303, depending on the facility. None of the hospitals were identified.' http://www.washingtonpost.com/news/to-your-health/wp/2014/08/15/a-10000-blood-test-yes-really/

The Swiss were not worried about health care costs per capita, at least not directly. The question was on the divergence between average health care costs per capita and the average price of the compulsory sickness insurance premiums. For short, health care expenses have grown in the last 15 years, but insurance primes have grown even more.

http://www.caissepublique.ch/argumente/

The concern has some basis since the (cheapest) compulsory insurance premium do not cover a lot of important things. Ambulances are not covered. You may chose the cheapest insurance that includes only your "family" doctor, but if you see anyone else the reimbursement is smaller.

All this mess might have a rational explanation like miscalculations of costs by actuaries has required a price update, however the lack of information for the public has eroded the trust on private insurers.

This does not mean what is implied by the excerpt. Switzerland is so far from a totally free market, private health care system that the change would have a minimal impact. The benefits of single payer have largely already accrued to the system through strong regulation.

The Swiss get nearly-free drugs from the US, and still can't keep healthcare costs down?

Surely there is a cabal of CEOs that Krugman can blame this on?

'The Swiss get nearly-free drugs from the US, and still can’t keep healthcare costs down?'

The sounds of laughter coming from Basel are probably not loud enough to reach your ears. (Roche being the 3rd largest, and Novartis the 5th largest pharma companies in the world - http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies) The Swiss know how to milk their customers even better than their cows.

Unfortunately for the bureaucrats, truth is that excellent health care does not fit into the entitlement model. Say all you will about the different mechanisms, but you are creating a very different product. Even the esteemed brainiac of the ACA, Ezekiel Emmanual, had to admit that there really should be a limit to how long a person lives ... or as it will most likely evolve, be allowed to live.

Sicko? Yep.

Thinking of this makes me wonder how anyone can believe that the state, peopled by human beings just as corruptible as those in the private sector but with less oversight, should be handed the reins of an entire sector of the economy?

A quote from the Business Insider article:

"Of course we can criticise a lack of transparency by some insurers, but state control isn't going to solve such problems,"

Read more: http://www.businessinsider.com/afp-swiss-voters-reject-shift-to-state-run-health-insurance-2014-9#ixzz3EiAvwTig

Yes, indeed, state control will absolutely not SOLVE such problems. Amen.

'Yes, indeed, state control will absolutely not SOLVE such problems.'

You do realize that the Swiss health care system is state controlled through the Swiss Federal Law on Health Insurance, right? Insurance companies, for example, are mandated to act like this - 'As far as the compulsory health insurance is concerned, the insurance companies cannot set any conditions relating to age, sex or state of health for coverage. Although the level of premium can vary from one company to another, they must be identical within the same company for all insured persons of the same age group and region, regardless of sex or state of health. This does not apply to complementary insurance, where premiums are risk-based.'

There is also the point about 'official tariffs' - basically, an official rate is set for treatment (in a similar fashion to how this works in Germany, one can broadly assume), and that official rate is covered by insurance. No one expecting to be paid by a health insurer can charge more than the official tariff, however - the insurance company will reject the extra amount, and have the full power of 'state control' backing its refusal.

http://en.wikipedia.org/wiki/Health_insurance#Switzerland

The insurance companies in the US are in control of the reimbursement figures. So there as similarities. And as a physician I know has asked, "in what other profession does the reimbursement for the same services go down from year to year?" And, the doc, the ever vilified docs are already being squeezed.

prior_approval, my point was that putting more power to big government may look pleasant, but just may make things more expensive and less available.

For example, right off, the first thing is that adding a - thicker - layer of bureaucracy to the health care system immediately raises costs, no? I just must repeat the idea from Milton Friedman: "Is it really true that political self-interest is nobler somehow than economic self-interest ? You know, I think you’re taking a lot of things for granted. Just tell me where in the world you find these angels who are going to organize society for us ? Well, I don’t even trust you to do that." http://martinkronicle.com/2010/05/16/milton-friedman-where-are-these-angels/

One can complain about many things about the Canadian healthcare system, but *higher* bureaucratic costs would not one of them. A substantial part of the savings of the Canadian system (which was about 1/2 - 2/3 the cost for equivalent care) came from the savings in not having to negotiate the American insurance system. I've heard that the bureaucracy in the more US system can end up being 20% of total medical costs. I find this hard to believe, but at least two of the Canadian doctors that I know that returned from sojourns in the US medical system cited the cost of the American billing bureaucracy as a major reason for their return.

prior_approval, so if Swiss pharma are milking the consumer do you then see single payer as a solution to that type problem?

This suggests that big government, oh, so corruptible, big government, that of the $400 hammer, $1000 toilet seats, overly expensive junkets and other pork barrel profligacy, can be trusted to correct excesses?

The interesting thing is that pharma as a group are regulated and under the oversight of big government. Once big gov has the reins, from where will any oversight come then?

Just because I am a conservative, it doesn't mean that there are no big government conspiracies to consolidate power over health care.

Swiss drug prices are already centrally negotiated so single payer would do little. Of course the government is wary of squeezing pharma too much considering how important an industry it is but single payer would change little if anything

Ha, the swiss system is heralded as a 'model of efficiency' not because it has particularly low costs or particularly good outcomes when compared to state run healthcare systems in the first world, but because it is 'all private', and because of ideological pre-commitments neo-liberalism US economists tout only tiny examples like Singapore and Switzerland to demonstrate that markets can work despite providing bad outcomes at enormous cost in the US, while other larger and more significant successes like Japan, Canada, or all of Western Europe get marginalized and criticized.

while other larger and more significant successes like Japan, Canada, or all of Western Europe get marginalized and criticized.

Successes at what? Life expectancy at ages 60, 70, 80, and 90 are virtually identical in the U.S. and Britain.

Successes at spending substantially less to obtain substantially similar results.

Life expectancy is about as blunt a tool as I can imagine to measure a person's health. According to the OECD Better Life Index, Americans self-rate their health higher than any other country.

http://www.oecdbetterlifeindex.org/topics/health/

The Japanese and South Koreans are so unhealthy by this weird subjective measure that you are on board with only because it legitimizes what you believed already. Having for less heart disease, obesity, higher mobility, and longer lives are negatively correlated with health. WHO KNEW. You know the mental gymnastics that communist sympathizers in academia have to go through to deal with the enormous humanitarian failure of the soviet system? If you wondered how anyone could be so dumb look in the mirror.

Tyler should change the headline:

Switzerland votes to retain Obamacare by rejecting single payer.

I wasn't so creative with the headline, as this is the theme of the Vox article:
http://www.vox.com/2014/9/29/6864201/single-payer-switzerland-failed

Spoken like an ideologue.

Well written like a partisan, anyway. ;)

Both the original article and the vast majority of commentary here is crawling with errors and misconceptions.

1) According to the article, Switzerland has the "wolrd's best figures for life expectancy and infant mortlity." No. Try Japan for life expectancy.
'
2) Nearly everybody here is going on and on about how Switzerland's health care is system is "totally private," albeit sort of like Obamacare. No. Latest figures have that only 40% of the spending for health care in Switzerland is private. A majority is public. This discussion has been one of the least well informed ones I have seen here in quite some time.

Nearly everybody here is going on and on about how Switzerland’s health care is system is “totally private,” albeit sort of like Obamacare. No. Latest figures have that only 40% of the spending for health care in Switzerland is private. A majority is public.

But pre-PPACA, that was basically true of the United States as well. The USA spent in 2008 8.5% of GDP on private health care expenditures, and 7.4% on public expenditures. So over 40% of the pre-Obamacare spending for health are in US was public, the numbers aren't that different.

If the pre-Obamacare similar numbers for the US were 46.5% of spending for health care public, it would not be surprising if after full implementation the number was a majority or higher. (There are a few different ways to count things; for instance, I'm not sure if the common numbers treat the tax deduction for insurance premiums as a public "tax expenditure" on healthcare.)

Plus the life expectancy figures vary by source. The WHO does indeed rank Japan first, but the OECD says Switzerland, so at best you're splitting hairs there....

http://www.keepeek.com/Digital-Asset-Management/oecd/economics/oecd-factbook-2014_factbook-2014-en#page238

Overall 40% of US health spending may be public but that varies a lot by demographics. Over 65 it is almost all public spending. For working age people, though, it is almost entirely private unless you're talking about those on disability or the very, very poor.

This would be radically different from a system that, say, required everyone to buy private insurance but the gov't picked up 40% of the tab. The US actually has a mix of different systems within it's health system ranging from pure private voucher type system (Obamacare's exchanges) to single payer (Medicare/caid, the VA, the military etc.)

I think if voters believed that Obama's health care law would give us an identical health care system as Switzerland with the same outcomes at the same cost, nearly everyone would be on board with the plan.

The problem is that we just don't trust him, or Congress or anyone in our government to get it right. They've f***ed up on so many other projects that we just aren't willing to trust them to deliver timely, affordable high quality health care.

The VA system and its many scandals [http://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014] is a classic example of this.

For whatever reason, the US government just isn't very good at providing certain public goods.

Wait, somebody asked them? What is wrong with the Swiss? Couldn't they just elect an Italian or something to make this decision for them?

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