Spend enough time thinking and reading and talking about the state of the U.S. health care system and someone will inevitably point overseas. Is the answer to be found in Germany? In France?
One popular flavor is Swiss, because the Swiss system, like ours, is market-oriented. The Swiss have to buy insurance, but the government kicks in a subsidy if the premium exceeds 10% of one’s income. All insurance is private, but all the companies have to offer the same basic benefits package, on which they are not allowed to make a profit. (They can profit on supplemental insurance, though.) Competition among insurance companies helps keep costs down, as do price controls on hospitals, doctors, and especially pharmaceutical companies.
The Swiss report being happy with their system, and they should be. Although they spend less of their GDP on health care than we do, their outcomes are better. Their life expectancy is higher than ours, and their infant mortality rate is far lower.
So why don’t we go the Swiss route? Well, for starters, the population of Switzerland is 8 million; the population of the U.S. is about 300 million. But it’s not just a question of size: by every metric, Switzerland’s population is wealthier and healthier. They’re more active and less overweight.
Switzerland’s great health outcomes, in other words, seem to have more to do with its population and less to do with health insurance or health care.
The simple truth is, no matter how much we’d like to find the answer ready and waiting in another country’s health care system, we’re not going to.
But we may find good questions. What do these places do well? What are they doing that we’re not? What are we missing?
In this case, we might ask ourselves: If starting with a healthier population improves outcomes, should we be putting less money and time into health insurance reforms and more into prevention of disease and promotion of healthy lifestyles? And are we prepared as a nation to address poverty and economic disparity—issues that have an enormous impact on population health?
Dave, I think your comment and analysis is right on. Our problem is not only the size of our population but the diversity of the population. We don’t have a population of all blond, blue eyes people. We have to come together on the issues without being called a racist.