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Turning Swiss

Kevin Drum predicts the future:

The current bills pretty clearly move us along the path toward a Swiss system — not my first choice for a model to follow, but certainly better than what we have now — and I don't think that the existence of Medicare as a separate part of that really stands in the way. A single comprehensive system for all would probably be better and more efficient, but it's hardly an absolute precondition. My own guess is that a decade or two from now, we'll basically have Medicare for the elderly and the Swiss system for everyone else.

That sounds right to me. If conservatives were really as high on the Swiss (and Dutch!) systems as they occasionally claim, however, they would have done more to embrace Wyden-Bennett, which folded Medicaid into the private, Nordic-style system. That seemed a pretty good trade for supporters of private insurance, but it wasn't one they ended up championing.

By Ezra Klein  |  November 17, 2009; 12:50 PM ET
Categories:  Health of Nations  
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Comments

Unless I'm missing something here, "Nordic" isn't the word you're looking for.

Posted by: eleander | November 17, 2009 12:56 PM | Report abuse

Personally, a big market of insurance plans that I could choose from sounds pretty good... provided that none of the choices are particularly bad. One way or another, we'll have to accept a lot more regulation of the insurance market than anything proposed.

In Holland and Germany, providers, insurers and the government all sit down and negotiate rates. There are strict, comprehensive rules for what's covered. They also adjust for their risk pools through redistribution between the plans from healthier pools to the more sickly. The inner workings might be byzantine, the business model is around ensuring that people get the care they demand at a competitive price. Sounds like a good way to stack the incentives.

If the system's going to remain mostly private, and if I'm going to have to buy from it, I want some choice in the matter. I want to be able to walk away from a company that doesn't do right by me, otherwise, what's the point in leaving it to companies at all?

Right now, my employer's menu of plans offers about as much choice and timeliness as I'd have shopping for cars in East Germany, circa 1983. I thought that's what we were trying to avoid in the first place by not making the whole thing public.

Posted by: itstrue | November 17, 2009 1:30 PM | Report abuse

"A single comprehensive system for all would probably be better and more efficient, but it's hardly an absolute precondition."

The necessity for a single system for all may not be evident to Kevin Drum but it is indeed a precondition for long term sustainability.

The reason universal healthcare systems work is precisely because *everyone* has a vested interest in their success...and recognizes that truth. A fragmented financing model in which selected populations are protected from changes that would result in better care and financial stability for all is a recipe for statemates.

Posted by: Athena_news | November 17, 2009 2:26 PM | Report abuse

"That seemed a pretty good trade for supporters of private insurance, but it wasn't one they ended up championing."

You are right but I suspect you are thinking of the wrong "they". Liberal supporters of health care reform painted the argument as a binary choice between single-payer and exchanges with a public option. Instead of proposing some variation of the German or Dutch system -- which would have been far more palatable to almost everyone -- they have pushed the idea that some sort of "public option" insurance company will transform the insurance market and somehow control the actual costs of care.

Liberals have persisted in this position in spite of the fact that, while there are myriad examples of all-payer and individual payer models that are successfully delivering *universal* coverage through private insurers, no one can cite a single example anywhere of this public insurance company scenario working as envisioned. It's definitely "uniquely American".

Now we have people who call themselves progressive, thowing stones at reform opponents when they themselves never considered any other options that might have saved us all from another decade (or more) bankrupting medical expenses.

For a different take on what we might have had, see Uwe Reinhardt's blog post from April:

http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model

Posted by: Athena_news | November 17, 2009 2:36 PM | Report abuse

actually many of us conservatives LOVED Wyden-Bennett and it was championed in the SFC by Senator Ensign of all people. The problem was that Senators Kerry, Bingham argued against it as anti business and anti labor (even though its not) and eventually was pushed aside by Senator Baucus on a technicallity of scoring.

Its a wonder when 10-15 years pass after this reform who will be to blame if and when it fails.

Posted by: visionbrkr | November 17, 2009 2:59 PM | Report abuse

"In Holland and Germany, providers, insurers and the government all sit down and negotiate rates. There are strict, comprehensive rules for what's covered. "

The competitive market in those countries is also a fairly narrowly-defined sandbox.

"Liberal supporters of health care reform painted the argument as a binary choice between single-payer and exchanges with a public option."

Can you document that claim? It feels like a strawman to me.

Posted by: pseudonymousinnc | November 17, 2009 4:43 PM | Report abuse

The Swiss system barely works for the Swiss. It will not work in the US with our large number of uninsured, huge economic disparities, and lack of strong social safety net. We need to be able to squeeze every last dime of inefficiency out of our system in order for it to be affordable. For that to happen, the federal government has to have authority to cut out middlemen and set rates.

Liberals may have made a strategic error by not pushing the administered rates concept from the beginning. The problem is it's hard to explain--especially to Americans who are steeped in free-market propaganda. Then you had Jacob Hacker saying, at least initially, that administered rates was not important. Don't get me started about about Father Jacob.

Posted by: bmull | November 17, 2009 5:21 PM | Report abuse

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