The Right and Left on Switzerland

Several studies have found that the most egalitarian health care system in the whole world is the Swiss system. So during the debate over HillaryCare and ever since, it’s always been a mystery to me why  our friends on the left  have talked about the German system, the French system, the Canadian system — anything but the Swiss system.

Then Regi Herzlinger discovered that whatever its faults, the Swiss system looked relatively good – individual ownership of insurance, portability, competition, private sector institutions, etc. More recently, Doug Holtz-Eakin and Avik Roy endorsed the Swiss system as the ideal reform. Aaron Carroll counters with all of the many ways government intervenes in Switzerland.

Here is Austin Frakt taking the opportunity to complain that he and Aaron get no respect. Here is Matt Yglesias claiming that Doug and Avik have surrendered to the left. Here is more about what just about everybody thinks about Switzerland. At this post of mine and in the comments you can discover what just about every conservative think tank thinks about health reform in general – if that interests you.

Bottom line: the Swiss system is managed competition and it doesn’t work any better than managed competition works for federal employees or for state employees or any better than it will work in the ObamaCare exchanges. This is much ado about nothing.

Comments (7)

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  1. Ken says:

    I think the Swiss system is better than Obama Care.

  2. Tommy says:

    Regardless of how well a system works in another country, it can almost never be copied exactly in another. In this case, it seems perhaps the system doesn’t work that well. And it seems we have copied part of it. Hmmmmmm…

  3. Buster says:

    I like the Swiss health care system. But, I also agree that managed competition doesn’t work. The whole idea that the Swiss government can intervene in the insurance market to force perceived socially-desirable outcomes is naive. There needs to be another way to subsidize older, sicker enrollees without trying to force younger, healthy enrollees to pay more than their expected costs of coverage. Basically, require everyone to have an HSA. Require young people have high-deductible plans with most of their premium dollars funding an HSA. Require older people to pay risk-adjusted premiums; but allow them to have lower-deductibles if they’re willing to pay more for them. Provide a tax credit so everyone gets the same subsidy. Allow people to make foolish choices. Don’t require hospitals to treat all who show up at the Emergency Room door.

  4. Greg Scandlen says:

    This gets tiresome. The Swiss system would work great here — if we were all Swiss. The U.S. is nothing like Switzerland. Just one example (that no one will talk about) is the large and growing Latino population. Latinos for the most part don’t share a cultural grounding in the merits of insurance coverage. They understand paying cash to get a service. They don’t understand giving large amounts of money to an insurance company in the hope the insurance company will eventually pay for the service.

    This sensibility s not confined to recent immigrants. I have a friend who is a mortgage broker. When his sister developed cancer he and all his siblings took out second mortgages on their homes to pay for her care. They provided as much nursing care as they could themselves. One woman quit her job to be available round the clock.

    Because of this, some 40% of Latinos are uninsured. The state-by-state rate of uninsurance correlates almost perfectly with the penetration of Latinos. They aren’t wrong, they just do things differently than the Anglo population.

    Policy wonks can’t fathom how culture and religion affect values. They view us all as cardboard cutouts that conform to their cultural bias.

    John, your proposal is the only one that is able to account for these cultural differences. Don’t relent on it.

  5. Angel says:

    Wait a minute, lots of studies have shown how well the Swiss system works…but it doesn’t work any better than Obamacare because of some elements of managed competition? If we solely allow the individual to have HSA and manage their own health care, that seems pretty egalitarian to me…right? However, the concept being overlooked is that not everyone is equal when it comes to health. Some people are born with life-long diseases they need care for on a long-term basis, expensive care at that. HSA’s and insurance companies try to avoid these circumstances, but then what about the individual? Subsidies come to mind, but if there is anything other than government involvement, what would it be? Charities? Those won’t always be reliable, nor will religious institutions.

  6. Mulligan says:

    +1 Greg.

  7. H. James Prince says:

    For those who argue that the U.S. should implement the Swiss model using the argument that “because it works there it must work here”, I now call out your use of the following logical fallacies:
    The Fallacy of Composition: that what is true for the parts is also true for the whole. If it works for Switzerland, it must work for other countries.
    The Fallacy of Division: something true of a thing must also be true of all or some of its parts. If the Swiss system works, then it will work here.

    For those of you who argue against HSAs because they will not work in some cases falls victim to the Nirvana Fallacy – that there exists a perfect solution.