Online Program

Is the swiss health care system a model for the United States?

Monday, November 4, 2013 : 12:50 p.m. - 1:10 p.m.

Claudia Chaufan, MD, PhD, Social and Behavioral Sciences, Institute for Health and Aging in the School of Nursing, San Francisco, CA
Both liberal and conservative commentators in the United States have suggested that the Patient Protection and Affordable Care Act (ACA) is similar to Switzerland's Federal Law on Health Insurance (LAMal) currently governing the Swiss health care system because both rely on an individual mandate and on private insurance. Liberals endorse the ACA, whereas conservatives critique it on the basis of this alleged similarity. However, both viewpoints assume that the Swiss model is successful and that the LAMal and the ACA are similar in meaningful ways. I challenge this assumption on the grounds that it overlooks the substantial inequities in access to care under the Swiss model, the historical links of the model with the sickness funds in Germany, which excluded for-profit insurers, and the daunting challenge of attempting to impose the government-regulated, nonprofit Swiss insurers' model of operation on giant, for-profit U.S. health insurance companies. I conclude that attempts to undermine, much less eliminate, U.S. health insurers' profits for medically necessary care, as the Swiss have done, will trigger no less ferocious resistance than would a fully publicly financed, single-payer system. I also conclude that the ACA may unravel in ways unintended, and even opposed, by its very designers. As employers confront ever-rising costs and retreat from offering coverage, and workers face the unaffordable underinsurance mandated by the ACA, popular outrage with the private-insurance model of financing care may usher in the changes in the political and ideological landscapes needed to establish a true, publicly financed National Health Program.

Learning Areas:

Provision of health care to the public
Public health or related public policy

Learning Objectives:
List key components of the Swiss model and of the ACA that set one apart from the other. Identify challenges to the Swiss model. Explain how the ACA may unravel and lead towards a National Health Program in the United States.

Keyword(s): Health Reform, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This is an area of research and interest in my work as a professor at UCSF.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.