By Evan Falchuk
Blogging from Switzerland this morning.
American news reports and blogs in the last few weeks have talked about how the Swiss health care system can be a model for our own. The Swiss system includes many components of what is being debated in Washington. For example, there are no exclusions for pre-existing conditions, an individual mandate, and, according to the New York Times, a cost per person far less than that of the United States. It also doesn’t have a “public option.”
So is it a model for reform in the United States?
For starters, you can’t simply transplant the health care system of one country into another one. Each country’s system has developed in the unique circumstances of that country’s political and medical culture.
For example, the Swiss have no Medicare-type system for the elderly, who must buy insurance like everyone else. According to some experts, they also have a very different set of expectations of what they want from their health care system. Americans, it seems, are far more demanding, and have a much higher expectation that death can be staved off or avoided if only appropriate care can be delivered. And these are just a few of the more important differences.
It’s not really the point, though. No one in Washington is talking about importing Switzerland into the United States.
There is much that can be learned from the experience of health care and health insurance in other countries. The trouble is, the reform debate in the United States has revolved around a series of political maneuvers designed to get a particular bill or another passed, or not. The substance of reform, buried in the thousands of pages of legislation produced by the House and Senate has become secondary. And, as far as anyone can tell, what’s in these bills an enormous collection of changes to our health care and health insurance system that may or may not fit together, that may or may not address the issues they are meant to address, and may or may not be what Americans – or even their representatives – mean them to be.
But whatever the legislation will be, one thing is clear. Our representatives in Washington, of both political parties, have spent more time behind closed doors or on TV jockeying for political position than they have learning about the experience of health care systems outside of the United States.
So, yes, there is a lot we can learn from the health care systems of other countries. But the truth is that one of the uniquely American aspects of the U.S. system today, and the one we will have tomorrow, is we like to try to do things our own way. It’s a recipe for creating a new system that’s just as strange and confused as the old one.
