Today, in the United States there is a heated debate on Obama's health care bill and on whether mandatory health insurance is constitutional or not. Here in Switzerland people are required to buy a health insurance. More especially, every person living and working in Switzerland is obliged to buy a basic sickness insurance, public or private.
It is true that it is important for a country (government) to feel secure that all its residents have access to health care and that there is a concrete framework that stipulates how things work on this issue. But what kind of framework? All people paying the same is a just framework? Equality means applying the same rules to different people? Or instead is it more just to set up flexible legal provisions sensible to the peoples' different socio-economic conditions?
The argument presented by the supporters of the current regime is that the healthier parts of the Swiss society should bear the economic cost of the less healthy ones. I agree that this is a solid argument. But if we get into the details, there are some socio-economic and generational objections. Should a young unemployed person pay the same monthly fee with a middle-aged (less healthy) person who has been working and receiving a respectable salary for decades? Should somebody with a salary of 3,500CHF per month pay the same as somebody with, for example, a salary of 15,000CHF?
Institutionally speaking, there is a system of financial assistance for those who need it. But, it is not responsive, and the amount of this assistance is a fraction of the total monthly fees. You have to wait several months before you receive this assistance. And another thing is the rise of prices. I am not aware of any state regulation that determines the percentage of this increase in the monthly fees. Each insurance company decides on this percentage and informs its clients one month in advance!! For this year there were insurance companies who imposed on their clients a 4% raise, whereas others a 12%!
I give you the example of my case, which might not be the most representative one. I am unemployed and thanks to my previous part-time working experience, I have the right to receive an unemployment benefit of 1,600CHF per month. With the raise in the health insurance prices, I actually pay 302CHF per month, the same amount a friend of mine, (55 years old with a very comfortable financial situation), is paying. Way over the 8% of my "salary". Apart from that, paying this money does not mean that I am fully financially covered, because I have to pay also the first 1,000CHF of any treatment I'll get (except for the dentist). This means, that I need to have a sickness bill of more than 1,000CHF per year in order to have the right to be reimbursed!!! And guess what, I don't think a healthy person of 30years will ever need to pay 1,000CHF for treatment.
I am not a specialist on Swiss health care, and I am aware of the positive things of the Swiss case. Regina Herzlinger, a Harvard Business School professor, argues that "there are no intermediaries shopping on people’s behalf" and that "there’s no waiting lists or rationing".
However, I believe that there is always a possibility for improvement and flexibility. Switzerland, therefore, will not only be proud of the quality of health care, but also of its cost.
D.S.
It is true that it is important for a country (government) to feel secure that all its residents have access to health care and that there is a concrete framework that stipulates how things work on this issue. But what kind of framework? All people paying the same is a just framework? Equality means applying the same rules to different people? Or instead is it more just to set up flexible legal provisions sensible to the peoples' different socio-economic conditions?
The argument presented by the supporters of the current regime is that the healthier parts of the Swiss society should bear the economic cost of the less healthy ones. I agree that this is a solid argument. But if we get into the details, there are some socio-economic and generational objections. Should a young unemployed person pay the same monthly fee with a middle-aged (less healthy) person who has been working and receiving a respectable salary for decades? Should somebody with a salary of 3,500CHF per month pay the same as somebody with, for example, a salary of 15,000CHF?
Institutionally speaking, there is a system of financial assistance for those who need it. But, it is not responsive, and the amount of this assistance is a fraction of the total monthly fees. You have to wait several months before you receive this assistance. And another thing is the rise of prices. I am not aware of any state regulation that determines the percentage of this increase in the monthly fees. Each insurance company decides on this percentage and informs its clients one month in advance!! For this year there were insurance companies who imposed on their clients a 4% raise, whereas others a 12%!
I give you the example of my case, which might not be the most representative one. I am unemployed and thanks to my previous part-time working experience, I have the right to receive an unemployment benefit of 1,600CHF per month. With the raise in the health insurance prices, I actually pay 302CHF per month, the same amount a friend of mine, (55 years old with a very comfortable financial situation), is paying. Way over the 8% of my "salary". Apart from that, paying this money does not mean that I am fully financially covered, because I have to pay also the first 1,000CHF of any treatment I'll get (except for the dentist). This means, that I need to have a sickness bill of more than 1,000CHF per year in order to have the right to be reimbursed!!! And guess what, I don't think a healthy person of 30years will ever need to pay 1,000CHF for treatment.
I am not a specialist on Swiss health care, and I am aware of the positive things of the Swiss case. Regina Herzlinger, a Harvard Business School professor, argues that "there are no intermediaries shopping on people’s behalf" and that "there’s no waiting lists or rationing".
However, I believe that there is always a possibility for improvement and flexibility. Switzerland, therefore, will not only be proud of the quality of health care, but also of its cost.
D.S.
3 comments:
One question you need to address is what this obligatory insurance buys.
If it is as basic as you imply then probably it is safe to assume that it is fair, as regardless of financial situation what you get is what you pay, thus indicating that if you want something in the higher end of care and protection you should dig deeper in your pockets. It's equality rests in the fact that both of you (you and your richer friend) get the same minimum healthcare worth for your money -you are equal at the low end.
It's inequality lies in that you have different income bases.
It is also equal in that you get coverage from day one and fairer than other systems since you can shop around for the best plan/price.
Another question is what is the role of the employer, is it the sole responsibility of the worker to buy insurance?
Also who guarantees that the above mentioned minimum is there, are there uninsured people and what are the state's provisions apart from the assistance you mention?
Indeed it is an interesting issue internationally (and has been for me for a while these past few years dealing with it) as there are a few better systems around but definitely more worse.
Thank you Stelios.
You are right about the minimum standard. And exactly, it is about the basic coverage. The minimum standard is the stipulation that the fees should not be higher than 8% of one's salary. However, 8% percent of 3,500 is different (no...t in absolute sum) from the 8% for someone who has much higher salary. You need a gradual percentage. And you are also right that you do not shop around. You only shop around for your family doctor who is the one suggesting you where to go after him or her. This does not mean also that you get the best price though! Surely, my point of view is about the debate of what is equal, and how some systems which are considered as being perfect, they have still some issues to contemplate upon!! It's an interesting debate!! :-)
As far as the other conditions that you mention, such as the state assistance or the employers' assistance. It's been a long time since the provisions concerning the employers' contributions have been revoked. An exception, for the canton of Geneva at least, is the police force. Employees in the police have their health care paid by the state of Geneva. But this is an exception. Concerning the state assistance, it's limited to up to 80CHF per month, one fourth or one fifth, of the overall monthly fees. Actually there is a debate to increase the amount of this assistance.
I agree with you Damianos. I think it is unfair that a single woman or man with 3 children and working at 60% is paying the same for her/his health insurance than someone like Daniel Vasella or Oswald Grübel.
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