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Health Alert!

Professor Jurg K. Siegenthaler. American University

An unusual summer hit, Michael Moore's documentary "Sicko", on the United States' broken health insurance system, has moved health up the political agenda.

But even before that, experts had surmised that next to the Iraq war and perhaps immigration, healthcare problems would figure prominently in next year’s election campaigns. After watching the movie, one would certainly hope so.

Michael Moore’s critical approach, involving comparisons of health protection in France, Britain, Canada, and Cuba, came in for some outraged commentary by the established powers in American health care. He was being too selective, anecdotal, and not properly serious, as if these commentators had not themselves long mastered a misleading discourse of stereotypes (“socialized medicine,” “health rationing”).

So it was fortunate that, at the same time, the Organization of European Cooperation and Development (OECD) came out with its report 2007 Health Data, which allows an objective review of where each country stands.

The United States and Switzerland share some key statistics, for example high health expenditure as a share of Gross Domestic Product (GDP): 15.3 per cent and 11.6 per cent respectively, with nine per cent being the OECD average. Also, in both countries a relatively low proportion of the health cost is financed by public sources: 45.1 per cent and 59.7 per cent respectively; the OECD average is 72.5 per cent.

But when it comes to the results of these expensive systems, the two countries look rather different: In the US, there are fewer physicians per capita than in most other OECD countries, fewer nurses, less gain in life expectancy over the past decades, less decline in infant mortality, and the highest obesity rate anywhere.

On all these indicators, Switzerland performs better than average. The exceptions are the indicators for smoking and drinking, where Switzerland’s public health programs are less developed than those in the US.

Health insurance

With such unimpressive results from a system which is costly, the American people are obviously looking for improvement. What is so frustrating in the present situation is that not everybody has health insurance coverage.

Whether one can rely on help with doctors’ or hospital expenses depends on employment, indeed an employer’s willingness to carry a health insurance plan. Almost 50 million Americans do not enjoy that protection.

Thus most politicians promise steps toward “universal coverage,” a condition that is, of course, taken for granted in the rest of the developed world. Will that be enough? Michael Moore, for one, does not think so. He shows that even Americans with health insurance get let down by their healthcare providers.

So a look across the Atlantic is rewarding and should be mandatory. There is little awareness among the American public, and even among experts, about the solutions other countries have found.

A health economist I recently watched on TV did mention the Swiss system, but did not recognize that it was not employment-based. Even though the Swiss health insurance coverage is expensive, it rests on life-long, obligatory, membership in a sickness insurance fund, a non-profit insurer that pays for doctors, drugs, and hospitals. Thus coverage is universal. The funds are regulated by the government and receive public subsidies on behalf of citizens who cannot afford the full premiums.

A single payer?

The Swiss solution, however, has not advanced to instituting a “single payer,” that is, one public entity that collects the premiums and pay healthcare providers.

Plans to reduce the number of insurers have met with considerable resistance. Just this March, Swiss voters rejected a proposal for a single health insurance company, with premiums based on ability to pay.

In the US, the staying power of insurance companies, as well as combinations of insurers and providers like health maintenance organizations (HMOs), is even more formidable. Only one presidential candidate has embraced a single-payer health insurance proposal. Yet lowering the administrative costs is where substantial savings would lie.

To strike an optimum balance between people’s needs, system capabilities, and future requirements (especially for an aging population!) calls for ingenuity. A full battery of experts have spoken on how to accomplish the task, and the people are ready. Now it needs the unusual political will and savvy of a president as policy reformer to make it a reality.

Don’t just take my word for it. Writing on how to fix the broken primary care services, Debra A. Geihsler, a prominent healthcare executive, argues in the Boston Globe: “The healthcare community has to act quickly but there needs to be a president, backed by Congress, who will overhaul the system.”

It has been rumored that the party who brings the American people affordable universal health insurance, as a right, will stay in power for a generation. Maybe the Democrats should try.

By Jurg Siegenthaler

The views expressed in this column are not necessarily those of swissinfo.

Every month retired professor, Jurg Siegenthaler, compares and contrasts aspects of life in Switzerland with that of his adopted homeland, the United States.

He emigrated to the United States from Switzerland in 1967, and is now a retired university professor living close to Washington, DC. He is a graduate of Bern University (Dr.rer.pol., 1966).

His fields of teaching and research encompassed economic history, social theory and social policy analysis. Throughout his career, he has maintained close comparative research interests in the US and Switzerland.

He is associated with the Institute for Socio-Financial Studies, a research non-profit that has done a lot of work improving financial literacy at the community level.

Since his retirement, Jurg Siegenthaler has broadened his involvement in community organizations and in the arts. He is married and lives with his wife Linda in Silver Spring, Maryland.

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