|
 Published
Monday, February 11, 2008
 Print
Friendly Version Email
This
Swiss can teach us about health plans
by Stephen Butler
Last week's ski trip to Zermatt in the Swiss Alps gave me ample
opportunity to quiz the Swiss on their country's health plan --
a timely subject considering that here in this country, health
insurance is a domestic concern second only to the economy in
the minds of voters.
So what have the inventors of numbered secret bank accounts and
Swiss Army knives managed to cobble together in the way of a national
approach to health care?
My waiter at breakfast spelled it all out for me. For what amounts
to $145 per month, he receives total health care. At a doctor's
office or hospital, he pays nothing. The $145 is the same for
everyone regardless of age. There are no pre-existing condition
issues that stand in the way of coverage.
The quality of care, in his experience, was superb and he knew
of no one who had any complaints. The Swiss national system seemed
like a more successful approach than the one cited by my caddie
in Scotland a year ago who, in describing the British program,
said, "The system is a good one, but it doesn't work."
My primary concern in pursuing this information is a reflection
of what I see as the greatest threat to the retirement security
of our nation's middle-age folks.
By far the largest cause of personal bankruptcy today is not
credit card deadbeats but people who fall through the cracks of
the health care system with no insurance.
These are people like us with plenty of assets from a lifetime
of saving, but a changing job situation can leave any one of us
uninsured while being hit with a major health problem.
I know of a cancer survivor whose drugs alone cost $8,000 a month.
They are worth every penny, but who without insurance could afford
that kind of expense without liquidating most of what they own?
Just around the corner lurks a major battle between the current
health care system and the elected officials who are proposing,
in a variety of forms, solutions to the problem.
In simple terms, we all now pay for the uninsured because they
go to the emergency room. The total cost of operating the hospital
-- including care for these people -- becomes the starting point
for determining what health insurance premiums cost for the rest
of us.
Anyone who thinks they don't pay for coverage "because my
employer pays the whole monthly premium" is operating under
a common delusion. That premium has doubled in the past five years,
and the extra money would otherwise have shown up in bonuses and
salary increases. Health insurance premiums are part of everyone's
total compensation. We each pay every dime of what our coverage
costs regardless of who writes the check.
It is definitely true that any attempt at universal coverage
will lead to some level of rationed care.
However, that condition exists today in the current system. Virtually
all current health insurance companies operate phone banks whose
employees are trained to approve treatment before payment will
be granted.
Bonuses in some cases are based on how much they can disallow.
Any of us thinking we can just demand the vaunted American world-class
treatment like the shah of Iran came here to receive hasn't had
a recent experience of the system.
Frankly, if care is rationed, I would like to see it result in
reduced premiums.
By comparison, the purpose of today's rationed care is to open
the door to obscene insurance company profits that, a few years
ago, made it possible to pay one insurance CEO more than $1 billion.
A handful of executives at Blue Cross received a total of $250
million when their merger took place.
For practical reasons, it would make sense to preserve the insurance
industry while paying tax dollars to subsidize the cost for everyone.
Then, establish what would amount to a public utility commission
to see that the industry operates in the best interests of the
public.
All the money currently spent on advertising and marketing could
be better spent on reduced premiums and better service. If I understand
the recent MIT study, the net annual cost to cover all of the
current uninsured would be $145 billion. Coincidentally, we currently
consume about 145 billion gallons of gasoline per year in this
country. We could kill several birds with one stone with a dollar-per-gallon
tax on gasoline -- like those clever Swiss have long since figured
out.
In fact, their tax is about $3 per gallon, and every car and
truck in Zermatt is electric. They have bitten the bullet.
|
