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Comment by mft_ | Hacker News Reader

So one would think.

And yet, living in Switzerland after the UK involved one after another discovery of how well-ordered and -run a country could be. And then moving to Germany was like stepping back even further behind my memories of the UK.

I'm sure you could find examples of countries that do specific things as well as Switzerland; but I'm not aware of many places that do almost everything so excellently. (Maybe Japan, in many respects, but I lack sufficient direct experience to adequately judge.)

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I don't doubt there are differences.

I doubt they're insurmountable. Again, because the Swiss aren't some genetically superior subspecies. Culture can be changed.

I see Americans talk about how impossible universal healthcare is as if the rest of the developed world hasn't largely figured it out.

Nothing is insurmountable; however each one of us must play within the practical constraints of our local geographies (political, social, financial and physical). The parent comment probably means that Switzerland is in a positive on all axes unlike the rest of the world.

It’s politics. Boil most things down and the technical is inconsequential when compared to the politics.

Look at the political system of Switzerland and you will see a radically different setup.

And I think that’s the horse. The rest is cart. Yes they are rich but why? Yes they are relatively stable socially but why? Decentralised Canton government structure + direct democracy (referendums all the time for things that matter). That, I think, is why all the rest.

Heh, you were walking right up to my viewpoint and then turned away. A parliamentary democracy with proportional representation has way more influence IMO, and you'll find another couple of relatively well-run countries that work like that.

I think there's more to it than that.

From a philosophical perspective, I love the cantonal/direct democracy model. But it's supported by a strong culture of awareness of current affairs, and involvement in the political process. (Of course, these two aspects are likely strongly synergistic.)

However, I'm not sure this unique political structure explains the trains running on time, the sensible choices made about the internet structure (per the article), the top-of-the-world healthcare system, the Swiss cheese science institute, or many other aspects of the broader country. It may partly explain the routinely excellent government bureaucracy (say that with a straight face anywhere else!), the convenient and reliable local public transport options, and the local police being well-resourced to the point of apparent boredom.

Awareness doesn't happen automatically either. During referendums ppl also get flyers explaining the subject, positive and negative things about it

Ppl also recently voted for eid which should reduce bureaucratic hurdles

Imo in many cases public transport problems in other areas are heavily related to corruption

For me, this is the point of the article. People fought and the best decision was the result. And I suspect there's a fundamental cultural difference that makes the fight much less fair in America.

Been an American my entire life. 45+ years. I've never heard a single person say that universal healthcare is "impossible".

https://www.nbcnews.com/politics/donald-trump/trump-says-not...

> President Donald Trump on Wednesday said it’s “not possible” for the federal government to fund Medicare, Medicaid and child care costs, arguing that it should be up to the states to “take care” of those programs while the federal government focuses on military spending.

I guess I'm pretty confused on what your point is here?

Universal Healthcare would be a new program in the US that would see a drastic tax increase, in that our healthcare spending currently going to insurance companies would instead go to a new federal agency. The amount of money companies and citizens spend on it may or may not also increase, but your quote has basically nothing to do with that.

That’s sleight of hand. “Ooooh! A tax increase! Scary!”

If I can pay $100 in tax to save $200 in premiums and copays, that’s a win. The US is an extreme outlier in healthcare spend.

It's like you're purposefully misreading what I'm saying. I wasn't saying it was scary. I was saying that Trump saying we can't afford current programs has nothing to do with universal healthcare. Universal healthcare would be funded through a large tax increase, the majority (or entirety) of which would be redirecting the money going to health insurance companies.

Again, no one has said this is impossible, which is my original point. Even Trump's idiotic rambling, which was mainly about child care costs, said nothing about the impossibility of universal healthcare.

I'm an American and I've heard it often, usually with a bunch of strange excuses. We're too big, we're too diverse, there's too many states, and on. None of those actually make very much sense, but I've heard it all for why universal healthcare could never work in the US.

We must live on opposite sides of US cause I’ve never heard anyone say that it is possible (except few politicans who thought it may be a good way to win an election but also knew that it was not possible and gave up once they got elected)

> Culture can be changed.

Over the course of a hundred or so years maybe. Culture is hard work.

Switzerland uses a system similar to the original plan for Obamacare, where individuals are mandated to buy insurance, so if Switzerland is what you mean by "universal healthcare" then it's not only not impossible, but the USA already has a more voluntary take on the exact same concept.

The ACA has been steadily kneecapped since its inception.

And the “more voluntary” bit is pretty important. As is it costing about double.

The US system is more expensive partly because Americans throw a fit any time insurers try to constrain costs. The blowup over anesthetists is one example. Swiss insurers seem more able to tell doctors they're spending too much and to cut it out, without patients engaging in lobbying efforts to stop it. It's a cultural difference rather than an important difference in system design.

The healthcare system is actually one of the few things Switzerland isn't doing that well. It's somewhat "americanized", lots of "extra" insurances for random areas that will only accept you if you're healthy. Base insurance is regulated, has to accept all customers, and you're required to (pay for and) have it.

The FR and UK systems are better IMHO.

Just to be clear, the Swiss healthcare system is still very good. Just not perfect.

It might be (like many things in Switzerland) reassuringly expensive, but my original point was that on many objective metrics (e.g. longevity, avoidable mortality, cancer diagnosis and survival, waiting times, etc.) the Swiss healthcare system consistently achieves some of the best outcomes in the world.

The NHS (for example) costs less, and (depending on how you measure the value of health outcomes) might be more cost effective, but the outcomes aren't as good.

> I'm not aware of many places that do almost everything so excellently

Probably Singapore, which is sometimes described as the Switzerland of Asia anyway. 10 Gb symmetric fibre is broadly available at around SGD $50/month (about 35 EUR).

This is not to say that it isn't well run, but I think it would be fair to mention that Singapore is one of the most densely populated countries on Earth (#3 overall; #1 among countries with population >1 million.)

Separately, I am not totally sure just how widely deployed FTTH is in Switzerland. Here in Zürich it's everywhere, but zooming in on some rural place on init7's map tells quite a different story (perhaps not surprisingly).

https://ftth.init7.net

Singapore seems very oppressive and medieval when it comes to punishment of crimes. I wouldn't want to live there.

You wouldn't want to live there because it's too safe?

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