Important, if limited, reforms contained in both the House and Senate bills include a prohibition on insurance companies denying insurance coverage based upon an applicant's pre-existing medical conditions. Higher premiums based on pre-existing conditions or on gender are also prohibited. (See "House, Senate bills diverge on details," Boston Globe, 11/9/09.) These may be the most noteworthy gains in the bills.
In a major victory for opponents of a woman's right to choose, however, the House bill bars any insurance plan subsidized by the government from offering abortion services. National Organization for Women president Terry O'Neill condemned this aspect of the bill, saying "The House of Representatives has dealt the worst blow to women's fundamental right to self-determination in order to buy a few votes for reform of the profit-driven health insurance industry."
O'Neill asserted that the Stupak amendment incorporating these anti-abortion provisions into the House healthcare bill was worse than the earlier Hyde Amendment, which, since 1976, has barred federal funding for abortions for low-income or other women. O'Neill explained that the Stupak amendment actually "[p[revents women receiving tax subsidies from using their own money to purchase private insurance that covers abortion . . . ." O'Neill called on President Obama "to refuse to sign any health care bill that restricts women's access to affordable, quality reproductive health care."
A single-payer system would function essentially like the popular Medicare program for seniors, but would be extended to cover all Americans. The actual medical care would still be provided by private doctors, hospitals and clinics, but payment would be through a single governmental agency, rather than through hundreds of private health insurance companies, each with their own rules of coverage, differing plans, and different forms.
Speaker of the House Nancy Pelosi had earlier reportedly allow a Congressional up or down vote on a single-payer healthcare bill as early as September. (See NY Daily News 7/31/09 report; The Hill, "Liberals will get single-payer vote on House floor," 7/31/09; and Healthcare Now, "Single-Payer Gets A Vote In House" 8/2/09.)
Swiss insurers cannot refuse to insure a person under the basic social health insurance plan, regardless of the person’s age or state of health, nor can they impose a waiting period or even require the completion of a health questionnaire. The insurance companies are not limited by these restrictions, however, when it comes to additional, supplemental health insurance coverage. (See Swiss Federal Office of Public Health, “FAQ – Requirement to take out insurance".)
According to the Swiss Federal Office of Public Health, health insurers must submit their proposed social health insurance premium rates for the following year to the Federal Office of Public Health, and the rates do not become effective until they are validated. ("FAQ -- Insurers and supervision") Moreover, under the Swiss system, "[h]ealth care prices are set each year after negotiations between insurance companies and medical providers. The fee schedule has to be approved by the Swiss canton (or state) governments . . . . Drug costs are also subject to price ceilings . . . . " reported The Dallas Morning News ("In Switzerland, everyone is insured, and businesses don't pay" 2/7/06).
For a detailed, but somewhat dated, look at the Swiss healthcare insurance system, see Uwe Reinhardt's 2004 article, "The Swiss Health System -- Regulated Competition Without Managed Care", distributed by the Journal of the American Medical Association. Reinhardt discusses the "tight government regulation" involved in the Swiss system, including price controlling features, and concludes that one can plausibly argue that this regulation is chiefly responsible for the high quality of medical care in Switzerland and, compared to the U.S., the relatively low cost system there.
For an interesting blog discussion about the Swiss system, apparently involving a number of people directly familiar with healthcare in Switzerland, take a look at the comments at healthinsurance.about.com.
Page last modified: 11/9/09