A health system that the public are happy with? Look at Switzerland.
Swiss health care is a blend of public and private, free to those who need it but with extra options for those who can afford them. Would it work here?
Lots of people liked my Times article on Switzerland's canton system as the model for localism in the UK, and many have been asking me if other parts of the Swiss system would be good for other countries to follow too. I can think of one right away: Switzerland's healthcare system.
It's many years since I looked at this in detail, but Switzerland's healthcare system is fundamentally a compulsory insurance system – like the compulsory insurance system we have in the UK for our car insurance. You have to insure yourself or your family for a basic package of healthcare services. The premiums are the genuine price for that insurance, and are not related to income. You can shave off some of the cost of those premiums by taking a higher excess – meaning that if you do need treatment, you will pay more out of your own pocket. A typical policy might cost a family £2,000-£3,000 a year, but if you can't afford that, the state steps in by paying the premium for you. There is also a state-funded disability benefits programme.
The insurers are competitive, but they are not allowed to make profits on these basic healthcare package policies. However, most people also buy voluntary top-up policies, on which the insurers can make a profit. These provide services that are not covered in the basic package – things like dentistry, the use of a private room in hospital, eyeglasses, newer medicines, or alternative medicines. There is a mixture of publicly run and privately run hospitals to choose from, but you can also join an HMO-style managed care system, which actually provides your care, rather than having insurance that enables you to shop around between different providers.
Many commentators think that the Swiss system is the world's best. The care is as good as any in America but because there is much more competition and much less regulation, the cost is significantly less – though, like everywhere, premiums have increased considerably over the past decade or two. But the bottom line is that the system is very popular with the Swiss population, who consider it both good and fair, and seem to have no desire to change it very much.
A health system that the public are happy with? Now that would indeed be a good model for us all.
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