JUDY WOODRUFF: We return now to our special
series on universal health care.
Since the pandemic began, a growing number
of Americans think the U.S. health care system
is below average compared to other nations.
That is according to our latest "PBS NewsHour"/Marist
poll.
As the U.S. considers changes, William Brangham
and producer Jason Kane travel to Switzerland,
which has preserved the private insurance
market, while still achieving universal coverage.
Like this whole series, this story was filmed
before the pandemic erupted.
WILLIAM BRANGHAM: The Swiss shop for health
insurance a lot like they do their groceries.
There's a wide array of choices. This cheese
or that one? One with the high deductible
or one with the high premium?
For all Swiss families, like the Prestons,
it's a system that, in some ways, is even
more market-driven than our own. But the big
difference? Everyone here is covered.
The idea behind it is what's known as social
solidarity, and it's what impressed American-born
Jason, who's a teacher, when he moved here
and married Sabine (ph), who is Swiss.
JASON PRESTON, Switzerland: For me, it's just
sort of a basic right, and they seem to appreciate
that.
WILLIAM BRANGHAM: Do you see it that way,
too? I know that the Swiss talk about it that
way. Do you buy that idea that health care
is a right?
JASON PRESTON: Yes, because, I mean -- yes,
I mean, coming from where I come from, there's
this sort of negativity in the States that,
well, if you're poor, then it's almost like
you deserve to die, right, for being poor.
It's like you're being punished for circumstances
that are outside of your control. It may not
be said like that explicitly, but that's kind
of the feeling, the vibe that's given off,
that, well, if you can't afford it, well,
you don't deserve to be well.
WILLIAM BRANGHAM: Health insurance in Switzerland
is costly. Jason and Sabine pay about 16 percent
of their income on premiums.
On top of that, the average Swiss pays more
out of pocket for things like co-pays than
the average American. But the Prestons like
the care they get, and they like buying into
a system that protects everyone.
JASON PRESTON: Here, it's a bit more humane.
It's like, look, there's a basic level of
care that people deserve. It costs, but you
still deserve it. And I think that the Swiss
government's commitment to that is spot on.
WILLIAM BRANGHAM: This is one of the men who
helped design that system.
Thomas Zeltner was Switzerland's state secretary
of health for many years, and is now a consultant
to the government, and, until recently, chaired
one of the country's private insurance companies.
THOMAS ZELTNER, Former Swiss Secretary of
Health: In the '90s, there was a debate on,
is health care such an essential part of well-being,
and feeling safe in your country and in your
neighborhood, that you want that everyone
has access to it?
And, actually, it was something like 70 percent
of the population who said, we want that.
WILLIAM BRANGHAM: Wow. That is a resounding
yes.
THOMAS ZELTNER: Yes.
WILLIAM BRANGHAM: Zeltner says one of the
crucial innovations was separating health
insurance from employment, which has allowed
the Swiss to keep their health insurance during
the pandemic, while millions of Americans
are losing theirs when they lose their jobs.
They have been able to separate the two, but
instead of making the government the single
payer, like in the U.K., they have made it
so that a wide array of insurance companies
can flourish.
THOMAS ZELTNER: And the fun thing is, you
can choose. And I just told a friend, I can
choose to go to the barber here or there.
Since 30 years, I go to the same barber.
(LAUGHTER)
WILLIAM BRANGHAM: And he does a nice job.
THOMAS ZELTNER: But the option -- but the
option to be able to choose is kind of a freedom.
WILLIAM BRANGHAM: This is all now baked into
society, as Swiss as this country's famously
punctual rail system.
There are roughly 60 private companies selling
plans, but the Swiss government does take
a firm hand in regulation. It mandates basic
coverage that all plans must include, and
the government sets the prices that can be
charged for medications and procedures.
Depending on the plan they choose, the Swiss
can pick their own doctors and avoid needing
referrals for specialists. Wait times for
procedures are low, in part because doctors
get paid well, there's a lot of them, and
the system is competitive.
I met up with New York University's Victor
Rodwin. He's a health policy expert who's
traveling across the country studying its
health care system.
VICTOR RODWIN, New York University: The Swiss
have the lowest avoidable mortality rate.
WILLIAM BRANGHAM: Avoidable mortality.
VICTOR RODWIN: Which means -- which means
mortality amenable to health care intervention.
It means the lowest rate of people who die
who shouldn't die. The U.S. has the highest.
WILLIAM BRANGHAM: The Swiss live about five
years longer, on average, than we do, and
they're a lot healthier than we are, suffering
far lower rates of asthma, diabetes, heart
disease and hypertension.
Rodwin credits part of that to Swiss health
care, a system which polls incredibly well
here.
VICTOR RODWIN: They express high confidence
in the medical profession and high confidence
that, if a problem occurs, they know they're
covered.
There's a sense of quality in this country
which goes from chocolate to cheese to watches.
And in health care, it's the same. They do
things carefully and at generally high quality.
WILLIAM BRANGHAM: Swiss officials say there's
another main reason they achieve these results.
It requires everyone, like Mel Hirsig, to
have insurance, no excuses.
It's similar to the individual mandate with
the Affordable Care Act but, unlike the ACA,
this mandate has sharp teeth. The government
will garnish your wages if you don't comply.
That's partly how they get universal coverage,
but, for young people like Hirsig, who don't
need a lot of medical care, it can seem like
a big imposition.
So, what happens? If you don't buy the insurance,
what happens to you?
MELANIE HIRSIG, Switzerland: Well, it's also
like you have to be registered to get a job,
you have to have an address, you have to then
show the local council office your proof of
health insurance and blah, blah, blah.
WILLIAM BRANGHAM: Oh, really?
MELANIE HIRSIG: So, they can chase you down
quite easily.
WILLIAM BRANGHAM: Oh, really?
MELANIE HIRSIG: Mm-hmm.
WILLIAM BRANGHAM: And if the government wasn't
forcing you to buy health insurance, do you
think you would buy it anyway?
MELANIE HIRSIG: No. I wouldn't have it for...
WILLIAM BRANGHAM: Just because that monthly
cost is too much?
MELANIE HIRSIG: And because I don't use it.
I don't get my money's worth out of it.
WILLIAM BRANGHAM: The government offers premium
subsidies for lower-income workers, and it
caps yearly out-of-pocket expenses. So, unlike
the U.S., people rarely go bankrupt from medical
bills.
WOMAN: That's the list of all your debt.
WILLIAM BRANGHAM: But those premiums can sometimes
lead to serious debt for middle-income families.
This woman didn't want her name revealed because
of the stigma around debt. Her husband had
multiple surgeries, lost his job, and their
income dried up.
WOMAN: We were getting subsidies to help pay
for the health insurance, but we still had
to pay a large portion ourselves.
WILLIAM BRANGHAM: And even with the subsidy,
it still was unaffordable?
WOMAN: At the time, it was unaffordable for
us, yes. I think it is expensive, but I think
the health care is also very good.
WILLIAM BRANGHAM: So, even though the costs
put you at real financial peril, you still
see some benefit to the system?
WOMAN: Because I see that, if everybody pays
into health insurance, it makes the quality
of health insurance better for the population.
DR. ASHISH JHA, Director, Harvard Global Health
Institute: Intensive care is very expensive.
WILLIAM BRANGHAM: Brown University's Dr. Ashish
Jha studies health care systems around the
world, and he traveled with us for this series
as a collaborator.
DR. ASHISH JHA: I think what's really remarkable
about what we have seen here in Switzerland
is, it's a totally different model for achieving
universal health coverage, getting -- making
sure everybody has access to health care,
providing high-quality care, in a way that's
so different from what the U.K. does, through
the National Health Service, and actually,
in many ways, pretty different from the U.S.
approach.
WILLIAM BRANGHAM: Jha notes the U.S., of course,
is a much bigger nation than Switzerland,
has a higher poverty rate, and the Swiss have
a more robust safety net. But there's more.
DR. ASHISH JHA: And that is kind of the rule-following
mentality of the Swiss, that the government
says, you must buy health insurance, and everybody
says yes, OK, we will buy health insurance,
as opposed to in America, where we bristle
when the government tells us we have to do
anything.
And we bring up the broccoli argument: What
if the government made you eat broccoli? The
Swiss don't worry about eating broccoli. They
think, if the government thinks that's something
we ought to do, we will do it.
And in that way, it is very different, and
it allows the Swiss health system to function
differently than what we have been able to
do in the U.S.
WILLIAM BRANGHAM: For the record, the Preston
girls not big fans of broccoli, but Sabine
and Jason are fine with it.
They also know the insurance mandate costs
them a lot, but they see it as part of the
greater good, part of being Swiss.
For the "PBS NewsHour," I'm William Brangham
in Oberhofen am Thunersee, Switzerland.
