Monday, March 22, 2010

America, Switzerland, and the scandalous 5%

Whew. The health-care bill passed. It isn't the complete overhaul we need, but at least it's a start. An editorial in today's New York Times rejoiced that, although "the bill does not quite reach full universality, ... by 2019, fully 94 to 95 percent of American citizens and legal residents below Medicare age will have coverage."

Something about that percentage sounded familiar, so I got out my copy of T.R. Reid's The Healing of America (an illuminating survey of health care in other developed nations) and turned to chapter 10, "Too Big to Change?" Acknowledging that revamping a nation's health care can seem overwhelming if not impossible, Reid tells how Switzerland did it in 1994.

The Swiss, he points out, have a lot in common with Americans. They spend "a good chunk of their federal budget maintaining an army." Their rate of gun ownership is higher than ours. They have a strong financial sector. And in the 1980s Swiss insurers, like their American counterparts, changed into for-profit institutions and began denying claims. Costs skyrocketed, bankruptcies increased, and an unacceptably high percentage of Swiss citizens began living without health insurance. The Swiss, who prize solidarity (that's a secular term for "love your neighbor as yourself"), decided that something had to be done.

Here's the shocker: the Swiss were moved to action in 1994 because five percent of their people were uninsured. Five percent was their starting point. They changed their entire system so those five percent could have health care.

We Americans have just taken step one toward reforming our broken health-care system. The media is hailing the health-care bill as "transformative," "landmark," "historic"--and it is indeed a major shift for a nation that has been resisting universal health care for a century. It is also inadequate.

Nine years from now, if all goes well, only five or six percent of our people will be without health insurance. Five or six percent--not a cause for rejoicing in Switzerland, but the shameful statistic that launched their health-care revolution!

So how did the Swiss achieve their goal of 100% coverage? By a narrow margin (there was a lot of opposition from the insurance and drug industries and much of the business community), they passed reform measures requiring insurance companies to operate as not-for-profit businesses and requiring all Swiss citizens to purchase insurance. Reid describes the result:
When I visited Switzerland a dozen years later, universal health care coverage was so firmly entrenched as an element of Swiss life that nobody seemed to oppose it anymore. Even M. Couchepin, the conservative businessman who became president, agreed. "Nobody would want to go back to the system before, when some people were locked out of the insurance," he told me. "We have a system now that means everybody, rich or poor, can have the best health care we can provide. It is accepted; it is working. We are happy that we made the changes in 1994."
Perhaps in another nine years, when only five or six percent of our people are uninsured, we Americans will have the courage and compassion to do more than nibble around the edges of our highly inefficient health-care practices. Perhaps by then we'll be as troubled as the Swiss were when five percent of their citizens lacked access to health care. Perhaps we will finally be ready to restructure our entire health-care system from the ground up.

At least now we're facing the right direction.


Beth Cook said...

Very well put,LaVonne. Isn't it amazing how quickly people adapted to the new Swiss system once they realized how it benefitted everyone? I hope that's what happens here. Someday, I hope we will look back at this time and wonder what all the fear and rage was about. I submit that the one's who are the angriest and most afraid are also the ones who are most in need of universal coverage.

Kathleen said...

Excellent analysis, as always. Thank you for pointing out Switzerland's story and comparables. It is so reassuring, exciting, relieving that "the better angels of our nature" came to the fore yesterday with the House vote. Let's hope that, as you state at the end, in a few years we will take care of everyone in society.

Lileonie said...

I only hope the Republicans can't carry through on their threat to work on a REPEAL; I must admit that scared me! I have a chronic illness, and every day I am grateful that I moved from the US all those long years ago, to the country that has one of the best health care systems.
Congratulations are in order for the US. I sent my most heartfelt congrats to all the American people.

Kim said...

I originally found your blog on Sojourners and I love your style.

Great article and I will be sharing it with many! Thank you so much for this fabulous insight...