The Switzerland universal health care solution using insurance companies - do we want it?
There is a right wing pro corporate, pro-insurance industry, pro "competition" Harvard Professor, Regina Herzlinger, who says http://www.economist.com/people/displaystory.cfm?story_id=9254081 in her book "Who Killed Health Care?" that we need a national universal health care system which requires individuals to buy health insurance, with help in the form of tax breaks for all, and subsidies for the poorest. She wants multiple levels of quality in the mandated you must buy under the law insurance policies, with the same policies made available to the sick and the healthy at the same price (called having ""risk-adjusted" policies in the market place") with hospitals free to charge what they like so they can offer new services as the market demands. She throws into the mix a law being passed that requires "transparency of price and quality" - how that is to be accomplished without mandated coverages for each allowed level of risk policy is something I do not know, and calls the whole thing by the same term that is used by the GOP to sell the end of employer based health insurance and replacement by the savings accounts called HSA's - namely "a consumer-directed approach".
While at first blush one would say that this approach would only work for the healthy and wealthy, it is actually the approach of the Swiss http://www.oecd.org/document/47/0,3343,en_2649_201185_37562223_1_1_1_1,00.html and that system was reviewed by the OECD and WHO in 2006 and found to perform well in terms of health outcomes and health of the population.
It of course sucks in terms of cost - being 30% more costly as a percentage of GDP than the average of the OECD countries who do not have insurance companies involved via selling policies for basic care of the population. Plus the difference is growing rapidly larger as health cost inflation in Switzerland over the prior 14 years was 60% higher each year on average (the Swiss spending 11.5% of Gross Domestic Product (GDP) on health in 2003, against the OECD average of 8.8%, with the cost having increased steadily in Switzerland over the past 14 years, rising by 2.4% of GDP between 1990 and 2004, well above the OECD average increase of 1.5%). It also causes Switzerland to short change preventive care, spending only 2.2% of its health spending on disease prevention and health promotion compared with an average of 2.7% for all OECD countries. WHO found that fee-for service or by number of bed days did not provide strong incentives to increase cost efficiency and recommended changing to a fixed price by the pathology for hospital inpatient care, with family doctors as gatekeepers to the specialists.
Despite the "risk adjusted" system that moves the cost of the sick over all insurers via a "risk exchange" (what we would call reinsurance) the Swiss still have insurance companies trying to avoid coverage of those they deem "high risk", Plus there is no quality of care incentives built into the system, nor do they did not push the use of nonpatented drugs (such as generics) so as to reduce the cost of drugs. The result is high out of pocket costs. lack of rural care, and regressive premiums by income class relative to the other OCED countries.
So as expected the open-ended insatiable fee-for-service sector grows the cost faster under the Swiss system while the only real competition is in who can avoid individuals at high-risk while also limiting actual cash outlays for any services covered via searching for "pre-existing" exclusions, despite the "risk exchange system".
Now the Professor does have some ideas that might work - such as a specialized hospital concept - so we can not just toss her thoughts in the trash. But I certainly hope that her ideas are not what the GOP tries to sell as the "market based" universal health solution.
What I also fear is that bipartisanship (Obama), or getting something doable (Hillary) will make the fact that the insurance industry has said they endorse the Switzerland approach into an argument that convinces Democrats to support the Swiss idea.
