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Health care reform efforts in U.S. should learn from Swiss experience

Instead of dashing off to Copenhagen last week to headline Chicago's ultimately unsuccessful bid to host the 2016 Olympics, President Barack Obama should have gone to Switzerland to learn about that country's health care system.

In Switzerland, every citizen has coverage and is required to buy a basic health insurance policy. The government establishes coverage details, but it doesn't run the health care system; the mandated insurance is sold by private companies.

To control costs, without a government-run program, the Swiss government requires that private health insurance companies offer the basic health insurance policies as a not-for-profit operation. Other health insurance policies, offering higher-level coverage and supplemental features, are sold by the companies in a for-profit environment.

In the current health care reform debate in the United States, health insurance companies have applied political pressure and spent tens of millions of dollars in lobbying to kill the so-called "public option."

Increasing numbers of health policy experts believe a better approach would be to follow Switzerland's path and mandate that the private companies offer the basic coverage on a not-for-profit basis. This approach is part of the solution that has allowed Switzerland to provide universal health coverage, while spending a significantly smaller percentage of its domestic economy on health care than is spent in the United States.

Switzerland also controls costs through some regulation over prices for drugs, lab tests and medical devices. Health care consumers in Switzerland also are required to share a larger portion of their health care costs, and this is intended to discourage unnecessary treatment.

To help with these costs, lower- income citizens in Switzerland are provided subsidies if health insurance costs exceed 8 percent of income. This subsidy is available to people of all ages; there is no separate system for older people, such as Medicare.

To help control drug costs, the Swiss system requires a 20 percent co-pay for brand-name drugs, while a reduced co-pay of 10 percent applies to cheaper generic drugs.

Still, controlling health care costs remains a challenge in Switzerland, as elsewhere, and additional reforms are expected in 2012.

Heath care spending in Switzerland amounts to 10.8 percent of gross domestic product. While this percentage is higher than some other European countries where the government's role in health care is larger, it is still well below the 16 percent of GDP spent in the United States on health care.

And while Swiss health officials report that they are working on additional reforms to help slow the growth of health care spending, the country has seen health care spending increase by just 2 percent a year over the past decade. That figure is less than one-third of the annual rate of increase in health care spending in the U.S.

Little official health care talk coming out of Washington mentions the Swiss system, but some members of Congress have visited there and Switzerland's system is gaining more fans in the U.S.

The 1994 reforms that Swiss voters narrowly approved to provide universal coverage require everyone to buy insurance, make basic health insurance a not-for-profit product and charge more for nongeneric drugs was opposed by health insurance companies and drug makers. Today, those industries remain profitable, and the Swiss generally are satisfied with their health care system.

With drug makers and health insurance companies supporting current reform plans in the U.S., it's apparent that those industries have cut sweetheart deals with the White House and have enough influence over Congress to block real cost-control efforts. The fact that "Harry and Louise" ads now support reform plans suggests that corporate interests have gotten what they wanted.

Switzerland's health care system is not perfect; no country's health care is without critics. But the United States should follow the reforms that have worked in Switzerland.

So far, Obama and Congress appear to be doing the bidding of powerful insurance and drug industries, shielding them from the financial impact of significant cost controls. This appears to be a political calculation to allow something called health reform to become law, but it will fall short of real reform.

The outcome will please health insurance companies and drug makers who see increased profits in current reform plans, but it will fail to bring America's spending on health care in line with other countries'.

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