Is the Swiss Healthcare System a
Model for the United States?
Physicians for a National Health Program
Boston, Novermber 2013
Claudia Chaufan, MD, PhD, University of California San Francisco
The Massachusetts health reform more or less
follows the Swiss model; costs are running higher
than expected, but the reform has greatly reduced
the number of uninsured. And the most common
form of health insurance in America, employmentbased coverage, actually has some “Swiss” aspects:
to avoid making benefits taxable, employers
have to follow rules that effectively rule out
discrimination based on medical history and
subsidize care for lower-wage workers. So where
does Obamacare fit into all this? Basically, it’s a plan
to Swissify America, using regulation and subsidies
to ensure universal coverage
‘Similarities’
Switzerland
Major reform=LAMal, 1996
Retained commercial health
insurance policies
Individual mandate
“Affordable” plans with
“essential” coverage
No discrimination on preexisting conditions
United States
Major reform=ACA, 2010
Retains commercial
insurance policies
Individual mandate
“Affordable” plans with
“essential” coverage
No discrimination on preexisting conditions
The Illusion of Similarity
Switzerland
Major reform=LAMal, 1996
Retained commercial health
insurance policies
Individual mandate
“Affordable” plans with
“essential” coverage
No discrimination on preexisting conditions
United States
Major reform=ACA, 2010
Retains commercial
insurance policies
Individual mandate
“Affordable” plans with
“essential” coverage
No discrimination on preexisting conditions
Supplemental
Insurance
Solidarity/Equality
Cost Containment
MANDATORY PURCHASE OF HEALTH INSURANCE
Regulated @ the national level
MANDATORY BASIC
INSURANCE PLAN
-dental, vision, private rooms
(88% pop.)
Covers all TX’S and DX’S
prescribed by a licensed
provider for both IN & OUT PT
care, certain medications and
medical goods, a # of hours of
home & LT care, and (some)
complementary TX
SWISS RESIDENTS
Insurance Companies
(80 to choose from)
Out of pocket
payments
(99.9% OF POPULATION)
99.9% of population
Risk Equalization
insurance co.’s pay
into the same pool
Subsidies
-1/3 of pop.
-50% discount of premiums
for children/young adults
-maternity care exempt
-income-based for lower
incomes
(1CHF=$1.08)
-Premiums vary per Canton
-Deductible CHF 300/year (Mx.
2,500)
-Max. co-insurance: CHR 700
/year
-Hospital daily rate CHF15
-No age discrimination. 26 and
above= same price
(Age categories: 0-18; 19-25)
Source: OECD Review of Health Systems, Switzerland, 2011
Guaranteed Quality
Comprehensive
Coverage
So…what’s the problem???
Managed care plans (i.e. restricted provider networks) becoming more
common (‘popular’) & insurance companies providing ‘incentives’ (e.g.
lower premiums vs. higher deductibles) to sign on
Higher deductibles lead to increasing out of pocket expenses (foregone
care for low-income groups); Restricted networks lead to access problems
High costs – only lower than U.S. & Norway (11.4% of GDP), including
higher administrative costs due to multiple payers
Major premium price variations between cantons & regressive pricing
(same for all income levels)
IN COMMON: RELIANCE ON PRIVATE FINANCING!!
Is the ACA really
“Swissified” Health Care?!....
mandatory requirement to obtain health insurance
10 broad categories
Does not apply to all plans
ESSENTIAL HEALTH
BENEFITS
Increasingly ‘consumer-driven’
(i.e. more out of pocket)
High
income
Very poor
Middle
income
American
Indian
Employer Coverage,
(FTE & business >50
people)
Self
Employed/Small
Firm Employees
Veteran
Subsidies
< 400% FPL
Exchanges/
Marketplace
Undocumented
Immigrant
>65 yrs
PUBLIC PLANS
30 Million Leftover
Opting out
Increased Quality
Reduced Costs
Low income
Source: Kaiser Family Foundation, 2013
Individual Mandate
Employer Mandate
Affordable Coverage
The reality
Builds on long history of social insurance
– coverage no longer tied to
employment, income or age
Insurers CANNOT MAKE PROFIT from
medically necessary coverage (very
generous & national standard)
All insurers must offer plans THAT
INCLUDE ALL PROVIDERS
EVERYBODY CAN COMPARATIVE SHOP
(even if most do not!)
PRICE CONTROLS! (same service, same
price)
Large pool overseen by government -risk equalization, healthy/sick same pool
No price discrimination by age,
immigration status, etc.
Builds on commercial insurers, tied to
employment, income or age
Insurers CAN MAKE PROFIT from
medically necessary coverage (skimpy &
no national standard)
RESTRICTED PROVIDER NETWORKS
(‘PREFERRED PROVIDERS’) IS THE NORM
VERY FEW COMPARATIVE SHOP
PRICE CONTROLS ANATHEMA! Service A
can sell at whatever price!
Financially fragmented – ‘profitable’
patients in private plans, ‘unprofitable’
in public plans (increasingly privatized)
Price discrimination by age. EXCLUDES
UNDOCUMENTED IMMIGRANTS, VERY
POOR (‘HARDSHIP EXCEMPTIONS!)
Conclusions
• The ACA is NOT a ‘version’ of LaMAL – doesn’t “turn US
into Switzerland” (Paul Krugman) 
• LaMAL has problems – may even not be working for
the Swiss
• The fallacious debate and spin obscure real problems
and undermine search for real solution
• If the goal is universal, equitable health care, we need
a real National Health Plan
What to do?
• Educate ourselves, family,
friends
• Join the single payer
Medicare for All movement
• Connect the dots (with
other public policy issues –
war-making)
• Demonstrate!
Thank you!
My appreciation to my colleagues at
Physicians for a National Health Program,
for their years of struggle to achieve
health care equity for the American people