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An Accidental Experience with a Health System that Seems to Work
As I write this article, I'm seated in a hotel room across from the train station in Geneva, Switzerland. There's a slight, dull pain in my forehead from a two-inch line of stitches that are pulling together a gash that runs diagonally across my brow, thanks to a stumble on a high step on a sidewalk in the rain last night, that sent me flying airborne headfirst into a round metal lamppost.
I have been covering the Fourth Congress Against the Death Penalty sponsored by the United Nations and the international abolition movement, which brought together anti-death penalty groups from all over the world, and featured talks and workshops with a number of people, several from the US, who had spent years and even decades on death rows before being found innocent of the crimes that had put them there.
In view of their agonies and torments, my own little injury seems rather pathetic, but it did give me a chance, as the debate over how to deal with America's health care crisis drags on in Washington, to see in person the workings of a non-socialist model of health care--but one that controls prices and also mandates (that word that strikes terror into every Republican heart) that everyone buy insurance.
The answer is, it works pretty damned well!
When I got up from my sprawled position on the sidewalk and stood, there were gasps of horror from my companions as they looked at my gaping wound. Blood began pouring from it and refused to be stanched. I was walked back the block or so to the International Center where someone got out an emergency medical kit and cleaned me up a bit. Then an ambulance was called.
The three EMT guys in the ambulance competently and professionally checked me our for signs of a concussion, found none, and let me climb in back and sit. On the way to the hospital we discussed their work. The big difference between them and drivers in cities like New York, Los Angeles, or Philadelphia, where I've lived, is that they said they had almost never had to transport a gunshot victim. "We have a lot of knifings in the summer for some reason--usually drug related," said one EMT. "But no gunshot wounds."
But the big difference came when we got to the big public University of Geneva teaching hospital that they chose for my treatment. Exiting the ambulance, the men led me without stopping right past the intake and billing office, into the emergency room, where they brought me to the doctor in charge. She checked me out and, determining that I was not a serious case, dispatched me to the waiting room adjacent to the ER. It was equipped with free internet service, so I was able to contact my family back in the US while I waited.
Having been triaged into a low priority category, I sat for about an hour in what proved to be a clean, well-appointed ER operation. Unlike urban ERs I've visited over the years in the US, which tend to be controlled chaos, this place was calm and smooth-running. Maybe it's because there weren't police rushing in every so often delivering serious injured arrestees or victims. (Traffic here seems more orderly than what I'm used to too, plus there is a paucity of over-weight "muscle cars" and SUVs, so there may be fewer crash victims coming into the ER also.)
In any case my turn for treatment came soon enough. The doctor and a nurse did a careful job of sewing me up, pulling the wound together with two layers of stitches. Then they sent me on my way, with a letter of instructions to my American doctor about what they'd done, and when he should plan on pulling out the stitches.
On the way out, I passed through the billing room, where the nurse introduced me to a billing office clerk. My bill for the ER visit: $200.
Now that is probably between 400% and 900% less than what the same injury would have cost in an American hospital ER--and in an American ER, I might not have even been stitched up by a doctor. (A friend in Philadelphia from Puerto Rico who went to Temple University's public teaching hospital emergency room with a nasty case of the flu was given some aspirin and sent home a few years ago with a bill for $2000). Clearly the highly regulated private insurance plans that every Swiss person (including any non-citizen resident staying longer than three months) is mandated to buy (low-income people and the unemployed get subsidized), are keeping the hospital and doctor charges low.
One big difference between what is being offered up as insurance "reform" by House, Senate and President Obama, and what the Swiss have, is that every Swiss person buys a basic health insurance plan on which the Swiss insurance companies are barred from making a penny of profit. The insurance firms can offer highly profitable supplemental plans that cover amenities like private rooms, but they must also offer the basic plans at competitive rates. There is no "managed care"--the euphemistic term for the common American insurance plans that actually manage no care for enrollees. Patients can choose their own doctors and hospitals and don't go through medical gatekeepers to get authorized for treatment. They do have co-pays for treatment, but the total deductible outlay per person ranges from 300-2500 Swiss Franks per year (about $275-$2300) depending upon the plan chosen by the enrollee.
"Our insurance is not cheap, and it keeps getting more expensive," Evelyne Giordani, the coordinator of Lifespark, a Swiss-based anti-death penalty organization, told me. "But it is still a lot better than what you have to pay in the US."
Well, of course, many Americans have some of their insurance premium paid for by their employer--an arrangement which American businesses actually like and have lobbied to keep, knowing that they are just paying for it with money that they aren't paying in higher wages. (Workers only think they are not paying when the premiums are covered as a benefit, all or in part, by the employer.) American employers actually like being the health insurance provider because where the Swiss, like their fellow Europeans with more socialist-style or single-payer style health systems, aren't tethered to their jobs by the serf-like bonds of health insurance, most Americans have to worry that if they quit, get fired, or go out on strike, they and their families are then left at the mercy of the health care industry. That in fact is a major reason American workers are so much more docile and cowed by management than are their European counterparts.
So all in all, the Swiss have it pretty good. They've got excellent health care, available to all. They aren't being held for ransom by employers. They have complete freedom of choice of physician, hospital and course of treatment. The have reasonable costs for their care. And they are still only collectively spending just over 10% of GDP per year on health care. That's more than the next most costly country, Canada, which devotes 9% of GDP to health care with its single-payer Medicare-for-all type system. But it's still a far cry from the staggering 17.5% of GDP that gets pumped into the medical industrial complex in the US, where nonetheless 40 million Americans remain left out of the system, with no ready access to medical care at all.
The one place where Swiss health care and American health care have something in common is ambulance service. While my care in the hospital was incredibly cheap, my bill for the ambulance ride was $730, which is about what I expect it would have cost me in the US (maybe a little less). One difference though--most of that bill would be covered in Switzerland. I'm less confident about getting reimbursed by my Blue Cross plan, though. They'll probably figure out some way to weasel out of paying for it.
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38 Comments so far
Show AllBoth progressives and conservatives scream in outrage about "mandated" insurance. Yet it is a sound idea. The idea of spreading the risk among as large a pool as possible (everyone) is sound ("Everybody in, nobody out"). It is, in fact, one of the main features of the bill HR676, or Expanded and Improved Medicare for All.
HOWEVER--this is very important-- it is only a sound idea when the insurance is NON-PROFIT, either in a government system (like Medicare) or in a Swiss-type system, in which basic health care is paid for by strictly non-profit and highly regulated companies.
Actually MANDATED should be used in the USA
about PRIVATE insurance . Americans are MANDATED by capitalism to BUY private insurance and give up an arm and a leg for the privilege of being ROBBED.....MANDATED by the USA's good'ol Capitalism.
so there! Mandated , governed, enforced upon, enslaved, order to obey and pay up,
BY THE PRIVATIZERS .
Interesting point. We have the option of paying through the nose for private insurance or opting out, which is basically choosing to die if we get a serious illness. Talk about a Hobson's choice!
The hell with mandated--it should just be automatic. You get your card when your born or become a citizen. Should be government supplied like education, police and fire departments, infrastructure, etc. All paid for through taxes.
Obamacare's individual mandate is a one-way street. While the IRS will fine you if you do not buy private insurance, there is no mandate that the private insurance provide adequate coverage or prevent you from going bankrupt.
This is an excellent article and a fairly good argument for Single Payer if you ask me.
I must point out to Dave that they do spend about 11.5% on healthcare and its rising as he said. They also have advantages we do not.
The first being a homogeneous population thats over 94% European so their health problems are pretty much the same.
Second, they have a very tightly controlled immigration policy and identification methods.
Third they have the economy of scale without the penalty of large size. The country is small, 15,940 square miles as opposed to my state which has 268,820 square miles. And their population is less than a third of my states.
This is not to say that we cannot adapt their system if we chose to, but that the cost would be far higher for us. I suspect we would have to spend more GDP than we do now.
Consider Dave's experience, how many more people come to the US than go to Switzerland?
I found the fact that the EMT's admitted the knifing instances startling.
>>The first being a homogeneous population thats over 94% European so their health problems are pretty much the same.
In order to support the assertion that a more homgenous population leads to lower health care costs you have ot demonstrate that this Universal. You can not pick out a single country having lower costs and then link it to a homogenous population.
Canadas population is less homogenous then that of the USA. We have lower health care costs. That does not prove that a less homogenous population will see lower costs.
Germany , France and Great Britain are all examples of countries with diverse populations. Yet all have lower Health Care costs. Japan has one of the most homogenous populations in the world and lower costs.
To be blunt, what you seem to suggest is that those of "European Extract" are just naturally healthier.
I am going to suggest Ethnic origins have little to do with the "added costs" to a health care system. I am going to suggest it has far more to do with POVERTY and the fact that in the USA those of "Color" tend to be poorer.
You are right, there is nothing about Switzerland demographically that would suggest they could operate their system more cheaply than the US could. Switzerland almost certainly has an older population than than the US.
I would add that Geneva is hardly ethnically unified. Because of the large UN operation there, the small city is awash in people of all races. Looking at the population in the area around the train station where my hotel was located, which is fairly central, I felt like I was back in New York City, surrounded by people of all skin tones, speaking spanish, urdu, arabic, turkish, and various African languages.
And in any event, it's ridiculous to assume that because you have a primarily European population it will be more healthy. As the above writer notes, it is class, not race, that affects health.
Dave Lindorff
Visit Dave Lindorff's website at www.thiscantbehappening.net
dlindorff
What I find ridiculous is the notion that you can take a system used in a small country and transfer it to a large one without the tight controls it has and expect to have the same level of care for anywhere near the same cost.
That kind of thinking reminds me of the democrats health care plan.
I suggest you reread what I said. You believe its easier to apply a system to a population that is larger, spread over a far greater area, a population that has not assimilated to the larger society as the Swiss demand you do and are not as predisposed to follow your directions?
If it were as easy as you two seem to think, whats the problem? We just adopt the Swiss system tomorrow and save 5% of GDP and everyone is covered with excellent health care. That is what you both are saying. I just don't buy it, the problems are enormous.
That's just nonsense.
It's axiomatic that the larger the risk pool, the cheaper overall care becomes.
If you think that caring for the few genetic diseases that are peculiar to particular ethnic groups is a significant factor in health care costs, you're speaking from total ignorance. Yes people with African genes are more predisposed to sickle cell anemia, but they are also, by the very same genes, less vulnerable to melanoma and other skin cancers. The same can be said for every ethnic genetic ailment. For every vulnerability, there is a benefit.
Dave
Visit Dave Lindorff's website at www.thiscantbehappening.net
GwNorth
To be blunt, I was thinking of different illness's that afflict different ethnic groups. I doubt the Swiss have much problem with Sickle Cell Anemia. If you check medical stats you'll find that each ethnic group has different problems other than the ones we all share.
Canada has a population just a few million larger thasn my state.
France is only three times its population.
GB the same.
Frankly I'm surprised you don't see the difference in applying a system used in very small areas in small population's to a very large country with a population more than three times the size of all these combined.
"Canadas population is less homogenous then that of the USA."
I don't know how you see that, but in any case Canada is such a small country, I don't see a comparison concerning the point I was trying to make. Perhaps we are considering the same thing, but in different aspects.?
>>Canada has a population just a few million larger thasn my state.
France is only three times its population.
GB the same
You show a profound inability to understand statistics and the concept of per capita spending. Just as "African Americans" might be more prone to certain diseases so too are "White Americans".
The size of population is immaterial when measuring per capita spending. What is material is the percentage of the population that is of a different ethnic origin in a given population sample.
Canada is a larger country then the United States of America. The ethnic makeup is more diverse then it is in the United States of America. Per capita spending means EXACTLY that.
Consider the fact that the USA has 10 times the population of Canada. They have a MURDER rate per capita between 4 times and 5 times higher. This is not a function of population size as it measured on a per capita basis.
Our PER CAPITA spending on health care should in theory be HIGHER then that of the USA given we are a larger country in size and given we are more ethnically diverse. Our per capita spending is half the cost of yours. Thus one can only conclude that per capita spending on health care has little to do with ethnic makeup.
>>Third they have the economy of scale without the penalty of large size. The country is small, 15,940 square miles as opposed to my state which has 268,820 square miles. And their population is less than a third of my states
Let us reemphasize this.
Canada is around 15 TIMES the size of Texas. Canada has a population that is larger then your State of texas. Canada STILL spends less per Capita on health care then TEXAS and gets far better outcomes in virtually every measurable statistic.
Geographical land mass certainly adds to health care costs but here Texas has a distinct advantage over Canada (Much Smaller) and still fares far worse.
"268,820 square miles" means Texas
..... is that you, Thomas More / Henry8 / Horsus Assicus ??
If this misfortune had overcome Mr. Lindorff while visiting the United Kingdom, he would have had no bills.
Yes, that's correct. The British system is actually a state-run one, with docs on salary, much like our VA.
I actually favor such an approach, or a Canadian-style single-payer approach, both of which are cheaper to run than the Swiss system.
I am merely writing about my rather impressive experience with the Swiss system, because a number of "reformers" in the Democratic government here are pointing to it is the "best" model, because it remains based upon a private insurance model. However, as I point out, it's a model that, unlike the various proposals put forward by House, Senate and White House, requires provision of a basic plan for all that must be offered at no-profit by the insurance firms. That's a huge difference.
Dave Lindorff
Visit Dave Lindorff's website at www.thiscantbehappening.net
The system in the Netherlands is also based on mandated private insurance.
There are no prescription charges, unlike England.
Fortunately I live in Wales where these have been scrapped.
Why hasn't the US invaded the UK to stamp out the communists and bring democracy to the UK? Wellpoint executives could each be pulling down twenty million per year instead of ten if we INCLUDE AN INDIVIDUAL MANDATE when we bring democracy to the UK.
"That in fact is a major reason American workers are so much more docile and cowed by management than are their European counterparts"
But Dave, in the land of the free, home of the brave, we don't allow reality to interfere with our delusions. So your point is moot!
"my bill for the ambulance ride was $730"
I think I'll start up an ambulance service and charge half the rate! Ooops! In the land of the free, the invisible hand of the health insurance cartel will refuse payment!!
The irony is HILARIOUS!!!
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This of course offered by someone who probably could not describe where Switzerland is without consulting a map, and then, no doubt, only with considerable difficulty.
Visit Dave Lindorff's website at www.thiscantbehappening.net
Your links are just noise - like your post. They prove nothing. Everyone here is already aware that there are websites exist pushing the official conspiracy theory.
The Swiss system is definitely better than ours, but there are better choices out there in other countries. Remember the Swiss system is the second most expensive in the world.
I doubt our .gov can pass meaningful controls over our health insurance gangsters so mandating the purchase of health insurance in the US probably wont bring down costs.
My point is not to say the Swiss have the ideal system. It's to point out that even in a country that has always rejected socialist ideas, they've managed to come up with a system of health care that is miles away better than what we have here in the US. The key is that they've taken the profit out of the provision of basic insurance--something that none of the plans on offer currently in DC--not in the House, the Senate or the Obama version--dares to do.
The problem, in otherwords, is not that solving the health care crisis is complicated, it's that our political system is so in hock to the corporate interests that there's no way to pass any legislation that impinges on corporate profits.
Dave Lindorff
Visit Dave Lindorff's website at www.thiscantbehappening.net
While an exchange student in Boston I suffered a nasty and complicated arm fracture in an accident and decided to fly back to Germany for treatment. Two lengthy surgeries, a total of five weeks in a hospital and 6 months of daily physical therapy cost $3500 (in 1989). In the US chances are I'd become a cripple, both financially and bodily.
Thanks for the great ideas. There are so many! To broaden the pool, everyone must purchase insurance, with subsidies as required. (What happens when your unemployment expires, or your job is making coffee part time at the WaWa? Is there enough money?)
No one can be denied insurance for pre-existing conditions, and recission would not be allowed.
The Swiss twist of a basic non-profit plan for everyone sounds good. Add in one set of rules for the basic plan to minimize the paperwork and back and forth between Docs and insurance company claims analysts. Individuals and employers could add for-profit goodies as they like, and some would be taxed.
Medicare would be better policed for bogus billings from deceased dctors, renting $100 devices at $20/month for 10 years and other silly stuff.
Throw in tort reform to protect Docs from ruinous malpractice rates. (You must have heard about malpractice lawyers preferring to try Docs in Philly instead of Bucks or Montco.) There are so many good ideas!
Obama, Congress and the CBO should come up with an actuarially defensible plan and push it through. A good plan would not stifle medical and Pharma R&D. As a 50-something who has been insured for my entire life, but probably facing an employment gap between now and medicare eligibility, it works for me.
(BTW, did you hear Lower Bucks Hospital is bankrupt?)
Not that I wish the author further harm, but I'm looking forward to a follow-up report if Dave gets clocked in the noggin by a baton-wielding Philly cop at the airport upon his return.
Unless he sensibly wrapped that "Mumia" book he's carrying in plain brown paper, it'll be like trying to whisk past a hungry piraña with a dangling bucket of chum. Apparently he got away with it when departing-- but luck has since deserted him.
It'll be a great opportunity to "compare and contrast". ;)
· Yr Obd't Servant
Dave Lindorff's emphasis upon those insurance companies which deal with health care in the United States should be non-profit is echoed by two terrifically written books which deal with this subject. One books deals primarily with the issue of health care and is entitled The Healing of America: A Global Quest For Better, Cheaper, and Fairer Health Care by T. R. Reid. In his book Reid journeys to about a half dozen other countries [including Switzerland] to find out why those nations can afford to implement very efficient and productive health care systems at a fraction of what it costs in this country. The other book only devotes a chapter or two to this topic but offers compelling reasons why health care in European countries is far superior to that of the United States which spends about $7,200 per capita on health care and yet only manages to rank 37th by the WHO in terms of quality health care. This book is the highly recommended Europe's Promise: Why Europe Is the Best Hope In An Insecure Age by Steven Hill.
One thing that it amazes me never gets brought up in this discussion of "how much is this going to cost us" is the fact that we are being gouged not just once for health care, but MULTIPLE TIMES. Think about this: You are paying for auto insurance. That includes medical care in case of an accident. What about home owner's insurance? It has a medical clause in it in case of accident or injury. Workman's comp covers you at work in case of injury or accident. I'm sure there are others.
If we had a single payer system, the savings on those plans could possibly pay for a large part of the single payer plan. As it is, we are getting shafted not once, but at LEAST three times. Then, ad in the paper pushing that makes this SEEM like a necessary way to go, and you've got some real savings if you eliminate that.
Insurance companies don't provide medical treatment. Not a single aspirin. And in fact, their very model of existence is to NOT pay for that single aspirin. And then people wonder why that headache just won't go away. Get rid of the insurance companies, once and for all, and that headache will go away.
Exactly. They are completely unnecessary middle men who take 30% off the top. Many, many billions of dollars that should go to health care. And this is the system that both parties are intent on preserving.
Agreed. I have been advocating for some time that we take these arguments to right-wing sites so that alternatives to their talking points can be seen by people who read, but do not necessarily post.
I'm willing to bet that a total bill of just about $1,000 is still out of reach for many Americans right now.
The only way a single-payer (seemingly preferred to the Swiss non-profit system by most healthcare professionals) system is going to pass in America is by fixing and expanding Medicare. For its problems now (the increasing co-payments, no real dental or vision care) it is a popular program. Funding could come from cutting the obscene Pentagon budget.
Makes for a simple rallying point: Medicare for All!
Gary
"From cell phones to computers, quality is improving and costs are shrinking as companies fight to offer the public the best product at the best price. But this philosophy is sadly missing from our health-care insurance system."
-- John Shadegg
"American employers actually like being the health insurance provider because where the Swiss, like their fellow Europeans with more socialist-style or single-payer style health systems, aren't tethered to their jobs by the serf-like bonds of health insurance, most Americans have to worry that if they quit, get fired, or go out on strike, they and their families are then left at the mercy of the health care industry. That in fact is a major reason American workers are so much more docile and cowed by management than are their European counterparts."
Don't I know. In about 7 months I'll be 62. I would really like to retire early. Sure as heck don't want to wait until I'm 66. I've worked since I was 15! Damn, I'm so tired of the grind! But,to feel comfortable, I would like to have some type of health insurance that isn't sky high, though I have not had any major health problems in my life. (I use "alternative" medicine and try to eat "right". It works for me. But, say I break my leg or have a heart attack. Somehow, I don't think herbs or poultices will take care of those cases).
Trish
Yes, millions of us boomers are delaying or cancelling retirement from our family wage jobs solely to keep our relatively affordable employer-sponsored medical insurance.
For each one of us delaying or cancelling retirement there is another young American being deprived of a family wage job. If Obama was serious about improving job prospects for young Americans he would change medicare eligibility from 65 to 55. Its hard to believe that so many young Americans love Obama considering how he is burning them.
Dave Lindorff's experience and the discussion here confirms the wisdom of reading asap the recent book by T.R. Reid called =The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care=. Check your library. This note is from someone who lived in Canada more than 30 years.
Thanks for this article. The way civilized countries deal with health care is rarely discussed or described in this country by the MSM and the people fighting over how best to protect the profits of insurance carriers. That's why the battle is being lost.
If this accident happened in the USA, it would most likely have produced a lawsuit. A routine "slip-and-fall," as lawyers call it. The first question to come up in settlement discussions would be the size of the medical bills. Same with medical malpractice cases. Tack on the attorneys' fees, debit the insurance company, pass the cost on to liability policy holders, and you've got yourself a free market system. Want tort reform? Enact Medicare for all.