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Comment by jeofken | Hacker News Reader

When I moved from a country with public, so called “free” healthcare (Sweden) to one with private health care (CH) where I’m a customer rather than a “user”, I was blown away. I can see a doctor tomorrow, I can select which language (maybe higher chance to find a Swedish-speaking doctor here ngl), there are not the crazy bureaucracy and endless hours waiting in a phone queue, and I’m welcomed to my doctors office with a cup of coffee. Being a customer rather than a nuisance is great! It’s like upgrading from waiting in line for a Trabant to getting a Volvo! My health insurance here is also cheaper than the one I paid in Sweden (technically tax to the Region/Län).

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Let's not call the Swiss healthcare "private" or the US Americans will get the wrong impression. Yes it's offered by private companies but here is where the "private" stops - it's mandatory for starters, no free market as the very strict rules they must follow are written in law, primes and services are also controlled by the state... As for the experience, without knowing the Swedish system I can tell that the phone queues we have them too (depending on which provider you got, you might get usable online support), and the family doctor can be an ass just as well.

>Let's not call the Swiss healthcare "private" or the US Americans will get the wrong impression.

As others have told you, you are wrong. The Swiss system is almost identical to that of the US post-Obamacare, albeit with 100% mandatory enrollment (as in, the local canton picks a plan and sends you the bill) as opposed to the US's system in which a tax penalty is levied.

>no free market as the very strict rules they must follow are written in law, primes and services are also controlled by the state

Just where do you think the prices for plans on the various US states' exchanges come from? Out of thin air? Yes, insurance companies have some leeway, but not as much as you think.

What made me wrong was probably the fact that, although almost identical, for the end-user the two systems couldn't be more different. With all my critics, in Switzerland it quite works, while from the US is hear plenty of horror stories. So either private here is not private there, or I'm biased by what I read here and elsewhere about the US healthcare.

20% of the horror stories you hear are from young people who decided they don't need to sign up for health insurance then get in trouble.

60% (and, really, the 20% above and 20% below too) are from those upset that the US system isn't "free" because, as I wrote elsewhere, all they know of to compare with are the "free" UK and Canadian systems, so the whole world outside the US must be "free" and thus anything that isn't 100% "free" is fascism by billionaires, or something. When, really, the UK and Canadian systems are more aberrations than the US's is.

The remaining 20% are more like complaints about how different plans cover different things, or finding a doctor that accepts their plan, or unexpected difficulties with changing plans; that is, procedural issues. I don't mean to say that they are insignificant—I'm experiencing the last one myself—but they don't get the Internet mobs riled up as much as they get about the injustice of not having 100% "free" healthcare like "the rest of the world".

You just haven't been paying close enough attention. Our health care system in the US sucks.

Are you going to try to defend the completely fictional numbers that end up on US hospital bills? And how those numbers drive the insurance protection racket? And how they'll say "but nobody pays that", when 1) ABSOLUTELY some people do end up paying full chargemaster rates, and 2) even a small fraction of chargemaster is usually a multiple of the actual cost of providing health care services

I'm living in Swiss but originally from the Netherlands. What you in CH call phone queues wouldn't even be noticed in other countries in the EU. Waiting lists? Same story. In NL it can take many months or even a year before you can be seen by a specialist. Maybe that specialist needs an X-ray taken? Make another appointment with the radiologist and start waiting again.

Often I get the feeling here that people in CH don't realize how good they have it ..

That's because in the Netherlands everyone is equal. You're treated according to medical needs. Doctors don't care that you are a very important Google developer. They read your chart and know that you can wait. It's battlefield triage in Dutch hospitals. I find it hilarious that people think that they put you on list you for shits and giggles.

You're totally free to find a private clinic in Singapore (but let's face it most people who think they are affluent don't quite have the money for that and Google isn't forking over the money because you're not that important).

Why should anyone have to wait for medical care? Sounds like a broken system to me. Prioritizing who gets through a bottleneck isn’t equality.

Well ressources are not infinite. And in such conditions I would rather prioritize by need rather than by mean.

Dutch people with enough money who don't want to be on a waiting list, go abroad for medical treatment.

The insurance is private, the healthcare providers are private. Health insurance is mandatory. That pretty much describes Obamacare, except the Swiss will sue you for not having the mandatory health insurance.

I mean, there's still a difference. The profit motive is now fully normalized in US healthcare. At this moment, just about every single hospital in the US is understaffed to the point of patient endangerment / harm. And nobody can do anything about it, because it is the entire industry, and our society has accepted that maximized profits come before patient care.

“Patient care” is not the ultimate good. It must trade off against other priorities in the society. We cannot dedicate 100% of our resources to patient care.

This means that even public healthcare systems must operate on a budget, the resources are still limited, and in actual practice this means that the public systems are also understaffed, often (if not, in fact, typically) more so than in US.

In my personal experience, wait times and availability of healthcare in public system in Poland are pretty dismal compared to US. I also heard similar opinions from most of my friends and colleagues who immigrated to US from Canada and UK; they universally say that they are actually able to get higher quality service in US with shorter wait times.

You cannot just throw catchphrases about “maximizing profits” and proceed as if it settles the issue, you have to actually argue that some other approach will bring better outcomes, and you need to argue why similar approaches to what you propose applied elsewhere have empirically not brought the outcomes you expect to see in US.

In CH I can go to a different doctor if I don’t like one. They run their own businesses. It’s their incentive to take me. It’s amazing!!! Totally normal to everyone from here.

I just go on OneDoc and select one according to my preferences. Unbelievable!! I use CSS in Wallis and I can email and call them and get a reply very fast. I have the direct phone number of my guy at the insurance office. Maybe a perk of village living. To them I’m a client rather than an annoyance, unlike with Försäkringskassan in SE. If I wasn’t satisfied, I could select another one. Not quite possible in a socialist health care system.

Health care in CH is still public, even if most actors are private companies. The baseline cost are shared socially. That's why the premiums increase every year.

It’s not any more public than in America. Individuals pay their own health insurance premiums. Individuals who don’t have enough money can receive a subsidy from the canton: https://www.ch.ch/en/health/health-insurance/health-insuranc.... That’s exactly how Obamacare works. The cap at which the subsidy kicks in is almost the same, too: 8% of income in CH, 8.5% under Obamacare.

And on top of that the US has a fully publicly funded system, Medicaid.

Thank you for beating me to the punch regarding the Swiss system vis-a-vis the US post-Obamacare. The mental gymnastics that people (not just here, but on Reddit and online in general) resort to to maintain their presupposition that the US system is completely unique (and thus "capitalist"/"not socialist") compared to the rest of the world get very tiresome.

A huge contributor to the confusion in US discussion of the issue comes from the fact that the two countries we are closest to, Canada and UK, both have free-at-use systems. Too many Americans think that all other developed countries' systems are "100% free" and "just like the NHS", when they are arguably more the aberration when compared to DACH's sickness funds, France's 30% copays, and the Australian system that really, really, really encourages going private. This creates a weird feedback loop in which residents of other countries, in turn, get confused about their own systems when compared to the US's.

It turns out that without competition there is zero incentive whatsoever to be efficient with resources. Who cares, it’s not your money!

It’s simple game theory. When you’re the only game in town, you can charge as much as you want, and provide as little service as you wish.

Come to the US and you will not be treated as customer but as a sucker.

Most of the payment for healthcare (in the US) comes from insurance companies and government health coverage. It's no surprise that the providers pay more attention to those agencies than the patients.

If you want to be treated as a customer, you can use one of the concierge services, although paying for that in addition to insurance would make me feel like a sucker, too.

Isn’t this whole thing about Americans health insurance being tied to their jobs a side effect of some crazy WW2 regulation? Not sure how it works over there

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