4 ms·

Can you explain? Why higher taxes? Can't it be a mixture of private enterprises replacing some equivalent public institutions from the Swiss setup? Even non-pro

by robertk 10y ago

Can you explain? Why higher taxes? Can't it be a mixture of private enterprises replacing some equivalent public institutions from the Swiss setup? Even non-profits if you can reach critical mass on tithes, cf effective altruism. Seems doable if you have good rhetoric and get a movement going.

sleavey 10y ago
Doesn't it come down to the argument about whether a private company can run a service (on behalf of society) more efficiently than the government itself? The article makes this pretty clear - $3,000 for giving birth in a Swiss hospital plus much better care, or $30,000 for bare minimum care in the US. I very much doubt it costs more to run hospitals in the US - even with the liberal lawsuit culture. It's more likely in my mind that the Swiss government holds insurers and hospitals to a higher standard, and enforces more protection for the insured, than in the US. (I'm no expert though)
- jerven 10y ago
  Not an expert but this is the system in general The Swiss system is somewhat fixed prices (TarMED etc) for care provided. This changes every so often. However, hospitals and doctors do charge for extras not related to primary care e.g. private hospital room, choice of Dr and hospitals. Secondly, insurers are not allowed to dispute charges by doctors for primary care (things covered under LaMAL). In the US medical staff spends a lot of time talking to insurers before starting treatment about payment, this practically does not happen here. A doctor prescribes or does, the insurer pays no discussion (or very, very rarely). Insurers thus compete by getting the best customers and extra's for those with money, as well as reducing their own costs. Also every one is insured, you can choose your own insurer if you don't one is picked at random for you. Every year you can change insurance (cancel in November to change in new year). For tourists or the first 3 months that you live here the state covers. Each Kanton/State has at least one public hospital, if you don't have extra insurance this is where you will be treated. To a good standard just nothing experimental. These hospitals are very focussed on their costs. i.e. they will schedule similar operations on the same day. As a patient you will get whatever dr is assigned to the operation. If you have expensive insurance you can ask for a specialist. This costs extra! Of course there are many private hospitals in CH, however they compete for the rich patients who can pay for the luxury. These hospitals actively move care to the public ones when they can get away with it.
- gregmac 10y ago
  > $3,000 for giving birth in a Swiss hospital plus much better care, or $30,000 for bare minimum care in the US I still find both of these numbers insane. In Canada, I paid $40 to upgrade to a private room because we had to stay overnight. To be fair though, my benefits from work already paid $60 to go from the free 'ward' (4 people) room to semi-private (2 people). Had we not stayed it would have cost $0 -- that includes a private delivery room, delivery by a midwife we had been seeing for a few months, the midwife coming to our house at 4am before we went to the hospital, any emergency intervention by nurses/doctors (if needed, thankfully we didn't), plus the midwife coming to our house a few times for follow-ups for the first few weeks. It's the same cost ($0) to get a OB/GYN except delivery is by whoever is on call (not necessarily your doctor), and early pregnancy and follow-up care is by your regular family doctor at their office. Oh yeah I also had to pay for parking, that was like $30.
  - jacobush 10y ago
    Scandinavian countries. And the UK, for now.
- secabeen 10y ago
  > $3,000 for giving birth in a Swiss hospital plus much better care, or $30,000 for bare minimum care in the US. A normal birth in the US without complications is not going to cost $30k to the family. (It might cost $30k in nameplate price, but we know that insurance companies don't actually pay that.) We had a home birth in California for $4k total, and the standard charge for Global Maternity Fee (including the birth, and all visits to the doctor throughout the pregnancy) is under $5k. Even if you add a night or two in the hospital to that, it's not going to be $30k. It can get higher with a C-Section, which are too common. All that said, the average cost to a family of a pregnancy is $3,400. That's not that different from Switzerland. http://www.dailymail.co.uk/femail/article-2352687/How-cost-giving-birth-U-S-TRIPLED-1996-9-775--thanks-expensive-fees-epidural-placenta-removal.html http://www.dailymail.co.uk/femail/article-2352687/How-cost-g...
acqq 10y ago
> Can't it be a mixture of private enterprises replacing some equivalent public institutions from the Swiss setup? In short: no. Private institutions always just want to maximize profit, there has to be enough of the ideal of working for the common good.

by robertk 10y ago

sleavey 10y ago

Doesn't it come down to the argument about whether a private company can run a service (on behalf of society) more efficiently than the government itself? The article makes this pretty clear - $3,000 for giving birth in a Swiss hospital plus much better care, or $30,000 for bare minimum care in the US. I very much doubt it costs more to run hospitals in the US - even with the liberal lawsuit culture. It's more likely in my mind that the Swiss government holds insurers and hospitals to a higher standard, and enforces more protection for the insured, than in the US. (I'm no expert though)

jerven 10y ago
Not an expert but this is the system in general The Swiss system is somewhat fixed prices (TarMED etc) for care provided. This changes every so often. However, hospitals and doctors do charge for extras not related to primary care e.g. private hospital room, choice of Dr and hospitals. Secondly, insurers are not allowed to dispute charges by doctors for primary care (things covered under LaMAL). In the US medical staff spends a lot of time talking to insurers before starting treatment about payment, this practically does not happen here. A doctor prescribes or does, the insurer pays no discussion (or very, very rarely). Insurers thus compete by getting the best customers and extra's for those with money, as well as reducing their own costs. Also every one is insured, you can choose your own insurer if you don't one is picked at random for you. Every year you can change insurance (cancel in November to change in new year). For tourists or the first 3 months that you live here the state covers. Each Kanton/State has at least one public hospital, if you don't have extra insurance this is where you will be treated. To a good standard just nothing experimental. These hospitals are very focussed on their costs. i.e. they will schedule similar operations on the same day. As a patient you will get whatever dr is assigned to the operation. If you have expensive insurance you can ask for a specialist. This costs extra! Of course there are many private hospitals in CH, however they compete for the rich patients who can pay for the luxury. These hospitals actively move care to the public ones when they can get away with it.
gregmac 10y ago
> $3,000 for giving birth in a Swiss hospital plus much better care, or $30,000 for bare minimum care in the US I still find both of these numbers insane. In Canada, I paid $40 to upgrade to a private room because we had to stay overnight. To be fair though, my benefits from work already paid $60 to go from the free 'ward' (4 people) room to semi-private (2 people). Had we not stayed it would have cost $0 -- that includes a private delivery room, delivery by a midwife we had been seeing for a few months, the midwife coming to our house at 4am before we went to the hospital, any emergency intervention by nurses/doctors (if needed, thankfully we didn't), plus the midwife coming to our house a few times for follow-ups for the first few weeks. It's the same cost ($0) to get a OB/GYN except delivery is by whoever is on call (not necessarily your doctor), and early pregnancy and follow-up care is by your regular family doctor at their office. Oh yeah I also had to pay for parking, that was like $30.
- jacobush 10y ago
  Scandinavian countries. And the UK, for now.
secabeen 10y ago
> $3,000 for giving birth in a Swiss hospital plus much better care, or $30,000 for bare minimum care in the US. A normal birth in the US without complications is not going to cost $30k to the family. (It might cost $30k in nameplate price, but we know that insurance companies don't actually pay that.) We had a home birth in California for $4k total, and the standard charge for Global Maternity Fee (including the birth, and all visits to the doctor throughout the pregnancy) is under $5k. Even if you add a night or two in the hospital to that, it's not going to be $30k. It can get higher with a C-Section, which are too common. All that said, the average cost to a family of a pregnancy is $3,400. That's not that different from Switzerland. http://www.dailymail.co.uk/femail/article-2352687/How-cost-giving-birth-U-S-TRIPLED-1996-9-775--thanks-expensive-fees-epidural-placenta-removal.html http://www.dailymail.co.uk/femail/article-2352687/How-cost-g...

acqq 10y ago

> Can't it be a mixture of private enterprises replacing some equivalent public institutions from the Swiss setup? In short: no. Private institutions always just want to maximize profit, there has to be enough of the ideal of working for the common good.