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AAHPN  October 2009

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Subject:

Re: From Richard Saltman

From:

"Jost, Timothy" <[log in to unmask]>

Reply-To:

Jost, Timothy

Date:

Mon, 5 Oct 2009 11:31:04 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (141 lines)

I published a piece on the Swiss system in the Times prescriptions blog a couple of weeks ago.  http://prescriptions.blogs.nytimes.com/2009/09/18/health-care-abroad-switzerland/
Two salient concerns are 1) Switzerland has the most expensive health care system in Europe and by some measures has had the most rapidly growing costs.  It is odd that this would be the model the US should follow and 2) ny understanding is that even with its heavily regulated system, there is still a good bit of risk selection going on in the Swiss system.  As risk selection is one of the major issues we are trying to address, Switzerland is again perhaps not the best model.  It does have great mountains, however,
Tim

Timothy Stoltzfus Jost
Robert Willett Family Professor
Washington and Lee University School of Law
Lexington, Va. 24450
540 458 8510
fax 540 458 8488


-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Maynard, A.
Sent: Monday, October 05, 2009 11:27 AM
To: [log in to unmask]
Subject: Re: From Richard Saltman


Well put Richard !
Uwe Reinhardt published a nice piece on this in JAMA some years ago
Just love the notion of Gary Becker as the proponent of regulation!
I guess next up they will want the Dutch system which is also "slightly" 
regulated!!
Keep smiling!
Alan :-)

Adam Oliver wrote:
> ---------------------
> Swiss health insurance companies are in fact for-profit, however by law
> they cannot earn a profit on the basic health insurance policy. Where
> they do earn (substantial) profits are in selling supplemental health
> insurance policies, as well as in "cross-selling" other form of
> insurance (life, liability, etc) .
>
> What is essential about the Swiss approach is that these private
> for-profit insurers are heavily regulated by the federal government, and
> that it is this regulation that protects the public interest. For
> example, Swiss health insurers cannot build a new building for
> themselves without obtaining government permission - since a new
> building will increase their cost basis.
>
> In essence, the Swiss approach treats private health insurers as a
> public utility - a model that many economists despise as cost-raising
> and innovation-suppressing, but which seems to work reasonably well in
> the Swiss political, geographic (26 quasi-independent cantons), and
> historical context.
>
> For the Swiss model to work in the US, there would have to be a dramatic
> increase in regulatory interference from the federal government with the
> day-to-day pricing, benefits, staffing, operational-infrastructure, and
> of course profitability of US health insurers. This, combined with an
> expansion of Medicaid  to cover 100% of income eligibles, could go a
> long way to combining the security, certainty, and cost stabilization
> that the majority who have private insurance are demanding, with an
> extension of coverage to many lower income citizens who currently lack
> coverage.
>
> Of course, both components of this strategy are highly controversial in
> the US context, which is fundamentally different politically,
> geographically, and institutionally.  Much more importantly, both
> componenets would be very expensive, at a time when state governments
> (who pay 45% of Medicaid) are being forced to contract their current
> services dramatically and the federal government is running
> unprecedented, utterly unsustainable, currency-debasing deficits.
>
> Please access the attached hyperlink for an important electronic communications disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>
> ------------------------------------------------------------------------
>
> Subject:
> RE: Is the Swiss Health Care System a Good Model for the US?
> From:
> <[log in to unmask]>
> Date:
> Mon, 5 Oct 2009 15:57:04 +0100
> To:
> <[log in to unmask]>, <[log in to unmask]>
>
> To:
> <[log in to unmask]>, <[log in to unmask]>
>
>
> Swiss health insurance companies are in fact for-profit, however by law they cannot earn a profit on the basic health insurance policy. Where they do earn (substantial) profits are in selling supplemental health insurance policies, as well as in "cross-selling" other form of insurance (life, liability, etc) .
>
> What is essential about the Swiss approach is that these private for-profit insurers are heavily regulated by the federal government, and that it is this regulation that protects the public interest. For example, Swiss health insurers cannot build a new building for themselves without obtaining government permission - since a new building will increase their cost basis.
>
> In essence, the Swiss approach treats private health insurers as a public utility - a model that many economists despise as cost-raising and innovation-suppressing, but which seems to work reasonably well in the Swiss political, geographic (26 quasi-independent cantons), and historical context.
>
> For the Swiss model to work in the US, there would have to be a dramatic increase in regulatory interference from the federal government with the day-to-day pricing, benefits, staffing, operational-infrastructure, and of course profitability of US health insurers. This, combined with an expansion of Medicaid  to cover 100% of income eligibles, could go a long way to combining the security, certainty, and cost stabilization that the majority who have private insurance are demanding, with an extension of coverage to many lower income citizens who currently lack coverage.
>
> Of course, both components of this strategy are highly controversial in the US context, which is fundamentally different politically, geographically, and institutionally.  Much more importantly, both componenets would be very expensive, at a time when state governments (who pay 45% of Medicaid) are being forced to contract their current services dramatically and the federal government is running unprecedented, utterly unsustainable, currency-debasing deficits.
>
>
>
> ________________________________________
> From: Anglo-American Health Policy Network [[log in to unmask]] On Behalf Of Starfield, Barbara [[log in to unmask]]
> Sent: Monday, October 05, 2009 10:02 AM
> To: [log in to unmask]
> Subject: Re: Is the Swiss Health Care System a Good Model for the US?
>
> I also believe that Swiss health insurance companies are non- profit.
>
> ----- Original Message -----
> From: Anglo-American Health Policy Network <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Sent: Sun Oct 04 19:40:06 2009
> Subject: Is the Swiss Health Care System a Good Model for the US?
>
> FYI Gary Becker's blog which might be of interest to some of you
>
>
>
> http://www.becker-posner-blog.com/archives/2009/10/is_the_swiss_he.html
>
>
>
>
> Is the Swiss Health Care System a Good Model for US? Becker
>
>
> The Swiss health care system has several important properties that I (and many others) have been advocating should be incorporated into any reform of the US health care system. One major advantage of the Swiss system is that employer-provided health care does not receive any special tax breaks, whereas the US system is built on these tax breaks. As a result, only a rather a small fraction of Swiss health care is obtained through employment. Mainly, Swiss families buy health care on their own, so that, unlike in the US, their health insurance does not reduce their incentives to change jobs because job changes do not endanger their health coverage. Unfortunately, probably due to union pressure, Congress is not planning to eliminate this tax break for employer-provided health care. Indeed, many Congressmen want to increase the pressure on employers to provide health care to their employees...
>
>
>
>
> Please access the attached hyperlink for an important electronic communications disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>
> This e-mail message (including any attachments) is for the sole use of
> the intended recipient(s) and may contain confidential and privileged
> information.  If the reader of this message is not the intended
> recipient, you are hereby notified that any dissemination, distribution
> or copying of this message (including any attachments) is strictly
> prohibited.
>
> If you have received this message in error, please contact
> the sender by reply e-mail message and destroy all copies of the
> original message (including attachments).
>   

!SIG:4aca105a134015189324131!

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