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Strong Swiss Support for a Single National Health Insurer

October 17, 2023

Summary: Switzerland if often cited as an example of how private insurance (highly standardized and not-for-profit) can achieve universal coverage. Yet, a recent poll found 3 to 1 support for a single national health insurer, and only 1 in 5 favor retention of private insurance.

Majority of Swiss want single national health insurer, survey finds
SWI Swissinfo
October 4, 2023

A majority of Swiss would support the creation of a single health insurer, rather than the multiple options currently available.

According to the online poll by the Ipsos Switzerland institute between September 27 and 29, 61.2% of the 800 respondents said they were in favor of a single health insurer. Some 21.1% were opposed and 17.7% had no opinion.

A majority of 58% also approved the idea of adjusting premiums according to income levels.

While respondents supported changes in the financing of compulsory health insurance, they rejected the idea of limiting benefits in exchange for paying a lower premium.

As for tackling costs, the left-wing Social Democrats have launched an initiative demanding that no insured person should pay more than 10% of their income on health insurance premiums. The text demands that federal and cantonal authorities contribute more to reducing premiums.

The Swiss have already twice refused the creation of a single national health insurer in popular votes.

Comment by: Don McCanne

There has been a popular drive in the United States to improve traditional fee-for-service Medicare and then expand it to include everyone in the form of a public single payer insurer. At the same time, a private version of Medicare – Medicare Advantage – has been heavily marketed with increasing sales in spite of evidence such as recently released by Physicians for a National Health Program that shows that these private plans are overpaid by more than $100 billion per year in patient and taxpayer dollars.

Those supporting the use of private insurance for national health programs often cite the Swiss system of compulsory private insurance. This argument could make some sense if the private insurers would make no profit on a truly standard universal insurance, as in Switzerland and other nations. But not if the private insurers profit from highly variable and inadequate insurance, as in the US. Moreover, based on the current poll, even in Switzerland support may be shifting to a single payer system, progressively financed. In a recent survey of what worried the Swiss most, health insurance premiums ranked first.

It may be that the Swiss have been observing the pathological U.S. markets of private health insurance and have decided that a health care financing system owned and administered by the people is really a better way after all. Importantly, the British have demonstrated that they must elect government stewards who are actually willing to fund their system fully enough to meet all of their health care needs. But what they don’t want to do is to cut the funds, hand them over to private administrators who then shunt whatever they can to billionaire healthcare investors.

If only we in the U.S. can learn from our own mistakes, dump private Medicare Advantage, and adopt a public single payer Medicare for All program. The Swiss seem to agree.

About the Commentator, Jim Kahn

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Jim (James G.) Kahn, MD, MPH (editor) is an Emeritus Professor of Health Policy, Epidemiology, and Global Health at the University of California, San Francisco. His work focuses on the cost and effectiveness of prevention and treatment interventions in low and middle income countries, and on single payer economics in the U.S. He has studied, advocated, and educated on single payer since the 1994 campaign for Prop 186 in California, including two years as chair of Physicians for a National Health Program California.

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