The Swiss Alps, just like the Berkshires but different

Several reporters have compared the Swiss health care system to Obamacare after Switzerland’s recent vote to keep it, including the Washington Post: “Switzerland rejects single-payer, will keep its own version of Obamacare” and Vox: “Switzerland rejects single-payer in landslide, keeps its version of Obamacare.”

The similarities between the two systems are mostly superficial, both mandate people buy individual insurance. The differences, though, are huge. Obamacare is basically the Swiss system with all the important rules that make it work properly removed. Four of biggest elements Obamacare’s basic structure lack are:

  1. All basic health insurance in Switzerland is provided on a nonprofit basis, while the Affordable Care Act exchanges are full of for-profit companies.
  2. The premiums people are expected to pay for what is a good package is capped by the government to assure it is actually affordable for everyone. While the ACA provides subsidies for some low income people, it doesn’t provide this basic protection.
  3. The maximum allowed deductible/out of pocket allowed in Switzerland is a fraction of what is permitted on the Affordable Care Act exchanges, so that it actually protects people from serious financial problems if they get sick
  4. Most importantly, Switzerland uses an all-payer system to set a uniform price schedule. This helps control costs and reduce the administrative waste caused by hundreds of payers each negotiating individual prices with thousands of providers. It also stops the absurd practice of out-of-network providers extorting excessive payments from them.

While the Swiss health care system is not my favorite given its relatively high costs, it is infinitely better than system created by the ACA. They are only similar in the way a lame old donkey kind of looks like a thoroughbred race horse – if you squint really hard. To call the Swiss health care system a version of Obamacare is an insult to the work they have done over there and gives a false impression of what the ACA will accomplish.

Photo by James Jardine under Creative Commons license

Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at