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.