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.