Is the Swiss Healthcare System a Model for the United State - PowerPoint Presentation

Slide1

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 FranciscoSlide2

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, employment-based 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 coverageSlide3

‘Similarities’

SwitzerlandMajor reform=ACA, 2010 Retains commercial insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditionsUnited StatesMajor reform=LAMal, 1996Retained commercial health insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditionsSlide4

The Illusion of Similarity

SwitzerlandMajor reform=ACA, 2010 Retains commercial insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditionsUnited StatesMajor reform=LAMal, 1996Retained commercial health insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditionsSlide5

LAMal

(est. 1994)

MANDATORY PURCHASE OF HEALTH INSURANCE

Guaranteed Quality

Comprehensive Coverage

Cost Containment

Solidarity/Equality

SWISS RESIDENTS (99.9% OF POPULATION)99.9% of population

Out of pocketpayments (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)MANDATORY BASIC INSURANCE PLANRegulated @ the national levelCovers 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

TXSupplemental Insurance-dental, vision, private rooms (88% pop.)$ PROFIT $Source: OECD Review of Health Systems, Switzerland, 2011Insurance Companies(80 to choose from) NO PROFIT!!Risk Equalizationinsurance 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 incomesSlide6

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 onHigher deductibles lead to increasing out of pocket expenses (foregone care for low-income groups); Restricted networks lead to access problemsHigh costs – only lower than U.S. & Norway (11.4% of GDP), including higher administrative costs due to multiple payersMajor premium price variations between cantons & regressive pricing (same for all income levels)IN COMMON: RELIANCE ON PRIVATE FINANCING!!Slide7

Is the ACA really

“Swissified” Health Care?!....Slide8

FOR PROFIT Health Insurance mandatory requirement to obtain health insuranceAffordable Care Act

Source: Kaiser Family Foundation, 201330 Million LeftoverUndocumented ImmigrantOpting outExchanges/MarketplaceIndividual MandateEmployer MandateAffordable CoverageIncreased QualityReduced Costs

10 broad categoriesDoes not apply to all plans? ESSENTIAL HEALTH BENEFITSIncreasingly ‘consumer-driven’ (i.e. more out of pocket)

Very poor>65 yrsVeteranAmerican IndianPUBLIC PLANS

GOVERNMENTEmployer Coverage, (FTE & business >50 people)Subsidies < 400% FPLSelf Employed/Small Firm Employees

Low incomeMiddle incomeHigh incomePUBLIC OPTIONSlide9

The reality

United StatesBuilds on commercial insurers, tied to employment, income or ageInsurers CAN MAKE PROFIT from medically necessary coverage (skimpy & no national standard)RESTRICTED PROVIDER NETWORKS (‘PREFERRED PROVIDERS’) IS THE NORMVERY FEW COMPARATIVE SHOPPRICE 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!)SwitzerlandBuilds on long history of social insurance – coverage no longer tied to employment, income or ageInsurers 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 poolNo price discrimination by age, immigration status, etc. Slide10

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 SwissThe fallacious debate and spin obscure real problems and undermine search for real solutionIf the goal is universal, equitable health care, we need a real National Health PlanSlide11

What to do?

Educate ourselves, family, friendsJoin the single payer Medicare for All movementConnect the dots (with other public policy issues – war-making)Demonstrate!Slide12

Thank you!

My appreciation to my colleagues atPhysicians for a National Health Program, for their years of struggle to achieve health care equity for the American people