Friday, September 28, 2007

How The Swiss Do Health Care

Everyone knows our health-care system, superior as it is in so many ways, is too expensive, too bureaucratic and wasteful. Basically, we hand over about $2.2 trillion each year to hospitals, insurance companies and government paper-pushers -- and then we let them micromanage our health care like we are helpless babies, not rational consumers.

Everyone also knows by now that Canada’s “free” national health care system -- like its sibling socialistic systems in Britain and France -- is a just another Big Government fraud. So can any wealthy, modern country get health care right without resorting to socialism? Yes.

You never hear it touted by the media but Switzerland uses market forces, not government rules and red tape, to create a private, affordable, high-quality health-care system for its 7.5 million citizens. And it spends 40 percent less per capita than we do. Sen. Tom Coburn, an Oklahoma Republican, a fervent fiscal watchdog and a practicing physician, knows all about the Swiss system. Much of his proposed health-care reform bill -- the Universal Health Care and Access Act -- is modeled on it. Coburn’s plan, a major overhaul that can be found at, is complicated, controversial and in no danger of becoming law anytime soon, if ever.

The bill's key elements include achieving universal health-care access by using tax credits to pay for individual or family insurance, phasing out reliance on employer-based insurance, allowing people to choose their own doctors and health insurance and stressing preventive care.

On Wednesday, Sen. Coburn explained why he likes the Swiss system, which operates sort of like our car insurance: You must buy health insurance but you can choose among many plans from many private companies. Since every Swiss is covered, Coburn said, there is no cost-shifting -- i.e., no hidden subsidizing of those who don't have insurance at all or don't have enough. Cost-shifting costs Americans about $250 billion a year, Coburn said. Ending it would save a family of four about $4,000 a year.

Another virtue of the Swiss way, Coburn said, is that it has fostered a range of innovative insurance products. For example, there are five-year policies that reward customers with lower and lower rates if they do the preventive things the company asks. A third virtue, he said, is a national high-risk pool that all insurance companies contribute to that essentially protects companies from suffering heavy losses in a given year.

Fixing America's health care won't take more money, said Coburn, who notes we already "pay too much. ... One out of every $3 we’re spending today didn’t go to help anybody get well and doesn’t prevent anybody from getting sick." "What we need to do is we need to start changing our paradigm to prevention instead of treating chronic disease. That’s what has happened in the Swiss system, and that’s why their costs are not going up."

Switzerland is tiny and doesn't have our social problems. But Coburn says its consumer-driven approach -- which is transparent to consumers in price and quality -- would work here. Coburn knows markets aren't perfect. But he knows why the Swiss system works so well: "It forces people to shop, it forces people to make decisions. ... The point is, markets work -- if, in fact, we’ll trust them."


NHS rationing rife, say doctors

Rationing of NHS treatments is becoming more widespread, a survey of GPs and hospital doctors suggests. Doctor magazine asked readers about rationing. Of 653 answering questions on consequences, 107 - 16% - said patients had died early as a result. More than half - 349 - said patients had suffered as a result. This compared with one in five in a similar survey conducted nine years ago. The government said decisions had to be made on which treatments to provide.

The magazine asked 12,000 of its readers a variety of questions with between 473 and 857 replying to each one. Doctors said more debate was urgently needed over what should and should not be rationed. They reported not being allowed to prescribe drug treatments including smoking cessation drugs and anti-obesity treatment. They also reported that local NHS trusts had been placing restrictions on fertility treatments, obesity surgery and a host of minor operations, including those for varicose veins.

The magazine said the findings of the latest poll showed rationing was becoming more widespread. A similar survey nine years ago showed that a much smaller proportion - one in five, compared to half - were aware of patients who had suffered due to rationing.

Rationing has become a sensitive subject in the NHS. Independent advisory body, the National Institute for Health and Clinical Excellence, makes recommendations on new, expensive treatments. But with limited budgets, local trusts are often forced to cut back on other treatments to keep pace with the recommendations. Many experts fear the situation will get worse with increasing demands on the health service made by the ageing population and expected advances in medicines.

Richard Vautrey, deputy chairman of the British Medical Association's GPs committee, said: "There is not much honesty and openness about this. "The NHS could spend whatever you gave it, but it obviously works with a limited budget so we urgently need to have a debate about what can be provided. "Trusts are already being forced into this but the political parties are not talking about it."

And Dr Michael Dixon, chairman of the NHS Alliance, which represents NHS trusts, added: "Rationing is the great unspoken reality. "The only people who refuse to mention the 'r-word' are the media and the politicians, who continue to want to promise everything for everyone in order to win elections."

A Department of Health spokesman said it was not trying to avoid the issue. "The NHS has received an unprecedented funding boost in recent years but finance is not endless and hard decisions will always have to be made about which treatments to provide." But he added: "Doctors and nurses make these clinical decisions with patients - not managers or politicians."


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