Lessons from Swiss Healthcare Reform and the Great Society

 

By Dr. Pat Herndon

 

The next most expensive disease and trauma care system is the Swiss, seen as portion of median family income, portion of GDP/GNP, etc.  And, its one of the most recently created "nationalized" systems.  The Swiss government has tightly regulated the private underwriters of their universal disease care access system, and forced private underwriters to be *functionally* and legally non-profit.  Most western social "democracies", and Pacific (rim) Tiger nations are experiencing proportionately rising disease care costs, no matter how they are organized, financed, regulated or owned, because of rising penetration of new and dramatically more expensive medical technologies and the consumer *expectations* of such miracles of technology.  Parenthetically, where is the evidence of benefit in disease population studies or to herd health of these new and expensive technologies driven by consumerism?  There's ample evidence of increased harm to the consumer.

A lesson to be learned about starting up massive public programs in the US like the Great Society programs of LBJ from the middle 60s is that it takes decades for these programs to absorb start up costs,.....and to reach the levels of effectiveness and efficiency that only a public owned and operated massive program can reach, that private programs can never reach.  It took near four decades for most of the Great Society programs to begin to reach any level of efficiency, and because, in part, of the limited populations addressed, they are still struggling to achieve attainable levels of effectiveness.  Of course, there have been countervailing political and social forces in this social institutional evolution all along, obstructing.  The private, non-profit underwritten Swiss access to disease care system is only about 30% more financially efficient than ours, and it's less than two decades old.  So, the Swiss are still dealing with start up costs, still dealing with an inherently less efficient and effective privately owned system, and now dealing with the same rising technology costs that everyone is dealing with in developed and developing countries with some sort of a national system of access.  The Swiss are not dealing with universal access to disease and trauma care for a population like in the US that is well over 300 million residents, plus the cultural diversity that exists in the US.

Previously, I have projected some of the reasons why the current enacted legislation in the US will obstruct even incremental modifications of this unregulated public windfall for private medical underwriters in the US for at least a decade, if not more.  Incrementalism on a bad and obstructive law many decades after the fact doesn't look like a very viable strategy to me.  So, what can we learn from the Swiss example and the Great Society example about how we should proceed from where we are now with this new "historic" legislation?  Yeah, Joe, it is a BFD!

Dr Pat