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How Single-Payer Advocates in the US can Learn from Switzerland’s Failure
2019-01-07 15:59:22
Oliver Smith

[메디컬리포트=Oliver Smith 기자]

Photo by: fil-magic via pixabay

Since Sen.Bernie Sanders shocked the nation with his impressive run for the Democratic presidential nomination in 2016, some of his policies have gained steam with Americans and their elected officials.Sanders’ proposal to overhaul the health care system by replacing the private insurance industry with a socialism-style Medicare-For-All single payer program has received support from a majority of congressional Democrats.In California, a single payer bill nearly became law.And advocates nationwide are using protests against the current attempts to repeal the Affordable Care Act as a simultaneous place to fight for a system where the federal government uses tax revenue to pay for each citizens’ medical costs.

In her paper “What Can US Single-Payer Supporters Learn From the Swiss Rejection of Single Payer?” Claudia Chaufan examines the 2014 Swiss referendum on Single-payer health care and its defeat by a wide margin.Chaufan argues that misinformation has led to the wrong lessons being taken from this vote and offers up an optimistic view for those who believe in single-payer healthcare systems in the United States.

After over 60% of voters rejected the Swiss proposal And only 39% voted in favor of it, “virtually all of these interpretations took results to mean a rejection of single payer (and concomitantly of government-run national health insurance) and a preference for a system of private insurers,” which Chaufan argues was a mistake.The mistake stands from 3 issues: the misinterpretation of the Swiss system, in particular, that it is almost exactly like the Affordable Care Act; the belief that the Swiss Healthcare System Is working fine; and that the referendum alone shows that the Swiss people prefer a private insurance industry.

According to Chaufan, the Swiss system differs from the American system in several critical ways.Most importantly, the Swiss government intervenes further into the insurance industry than the American government does under the ACA.Government subsidies available to Swiss citizens are far larger than their American counterparts have access to.Chaufan notes “the state offers full or partial subsidies to purchase insurance to more than 50% of the population—so more than 99% of the population is covered.The state also compels insurers to sell policies to everybody at the same price, irrespective of health status, medical history, gender, age, or location.”

Perhaps the most dramatic difference in direct governmental intervention is that “the state literally takes money away from companies that spend less in patient care and puts it in the hands of companies that spend more in patient care” by compensating companies whose patients cost more to insure by taxing companies with less expensive patients on their rolls.This balances out corporate revenue and ensures that no company needs to raise insurance prices or inconvenience patients to keep themselves afloat financially.It is hard to imagine most Americans accepting such equalizations, but they enable the Swiss system to function without catastrophic bankruptcies or price-gouging.

Chaufan includes a chart detailing other differences between the Swiss and American health care systems, which she argues are necessary to understand what lessons should come from the 2014 vote.The Swiss system does not allow insurers to charge elderly people more for service; the American does.The Swiss system caps  deductibles at roughly US$2500 for adults while the Americans can be charged any amount a company desires.While the US requires all insurance plans cover a list of “essential health benefits,” Swiss insurers are legally prohibited from profiting from the sale of their equivalent packages.

The Swiss system had been facing big changes leading up to the single payer referendum.Increased privatization pushed by wealthy lobbyists meant that “costs have continued to increase undeterred, making the system the third most expensive in the world, and leading an increasing number of residents to fall between the cracks” and dissatisfaction of the so-called “managed care” plans introduced by businesses led to more than 70% of Swiss voters denying their expansion in 2012.

Chaufan says that the lesson to be gleaned from the Swiss vote is that the flaws in its health care system which single payer advocates hope to overcome simply are not bad enough for the majority of voters.While the 2014 referendum was a 10 point swing in single payer’s favor from a similar 2007 referendum where 71 percent of people voted against the policy, not enough people feel squeezed by the insurance industry to change it.The author argues that “none of the single payer or other relevant referenda indicate that love of private health insurance is increasing.If anything, they lay bare the reality that even in the land of direct democracy, as in Switzerland, the attempt to achieve health care justice through a system of ‘competing private insurers’ is a delusion.”

The moneyed insurance interests who fought against the referendum should also be taken into account by US advocates, says Chaufan.She writes “The power of corporate propaganda matters because its self-serving interpretation can operate like a self-fulfilling prophecy,” especially in the United States where restrictions on companies campaigning for themselves are much looser.She fears those fighting for single payer may underestimate their power or “ retreat and accommodate to the boundaries of change as set by this corporate class.”

In summary, Chaufan says three key lessons should be taken from the Swiss referendum.That advocates must understand what the ACA does and does not so that they can propose real alternatives, that they must perform “ outreach to those sectors of society who do not have a voice, or whose voices are suppressed, or who do not think that their voices make a difference” and lastly “work on improving the political education of those we wish to reach, rather than investing in ‘improving the message.’”


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