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Comment by mseebach | Hacker News Reader

He said reintroduce market forces, not remove all regulations.

I'm a pretty big fan of the swiss model, I think it contains the best of both worlds:

You're forced to buy a certified policy with a certain (broad) coverage. If the cost of such a policy exceeds 8% of your annual income, government makes up the rest.

Both insurers and providers are regulated heavily for quality control, but compete freely for their business.

The result is a generally consumer driver system, as opposed to an insurer driven (US) or state-bureaucracy driven (most of Europe) model.

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Didn't the US basically go with the Swiss model with the ACA?

We've still got all of our previous healthcare systems (Medicare, Medicaid), but the ACA added mandatory insurance with specified minimum coverage, and helps pay for the insurance of the poorest people.

There seems to be elements, but hardly the important ones (making insurance and provisioning consumer facing).

What's your definition of "best"?

There are only two measures of effectiveness.

Per capita costs and life expectancy.

How does Switzerland rate?

There are only two measures of effectiveness

In the free market you could argue that 'customer satisfaction' is the only measure of effectiveness you need to consider. Equating customer satisfaction with best solution fails in everything from automobile ratings to elections.

> There are only two measures of effectiveness. Per capita costs and life expectancy.

Uh, no. Health care is a lot more than keeping people alive.

Cost: More expensive than the European average, quite a bit cheaper than the US.

Life expectancy: second in the world, at 81.81.

https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

EDIT: And, since it apparently wasn't clear from context, by "best of both worlds", I mean that it manages to get a competitive, consumer oriented system without sacrificing universal coverage and regulation of quality.

Life expectancy correlates nicely with wellness.

Adopt the phrase "patient oriented system" and I'm totally on board.

> Life expectancy correlates nicely with wellness.

It may correlate reasonably well, but there are plenty of ways life expectancy can be the same for systems with very different level of "wellness". For a long time, Sweden had special wards for people in persistent vegetative states because there was no provision for ending care, for example, resulting in people being kept alive for years long than they otherwise would. I believe they loosened the requirements for ending care quite a while ago. But there are plenty of other ways that life expectancy can correlate badly with "wellness", e.g. poor treatment of patents with long term conditions such as dementia where patients can often easily survive for a decade or more but where quality of life can be massively different depending on treatment.

Defining "wellness", I can do no better than rely on societal norms.

I've spent much time in critical care, as both a patient and an advocate.

Quality of life is of utmost importance. I support DNRs, euthanasia, and so forth.

But I would not presume to impose my values on anyone else.

Switzerland is likely first in the world. Japan's number is bogus, it's artificially inflated by rampant benefits fraud.

>There are only two measures of effectiveness.

>Per capita costs and life expectancy.

This is laughably wrong. The biggest influence on life expectancy isn't the medical system at all - it's the lifestyle habits of the populace. Genetics play a big role as well.

The most important contributors to those two things are likely to be something other than the health care system.

For example if you increase the tax on cigarettes you increase life expectancy.

And if you increase immigration, and therefore decrease the average age of your population, you will decrease per capita costs.

Sounds quite a bit like PP/ACA.

If everyone has insurance, what makes providers compete on price?

I don't understand, they compete like any other business? The same for less money or a better product for the same (or more) money (a poor product for even less money, of course, is not an option).

The people choosing who to patronize aren't the people paying, so where's the incentive to compete on price?

Providers, dammit, not insurers. Makes sense now. Sorry.

Good question, I don't actually know. Surely the insurers will make them compete, but that should also happen in the US, and obviously not fixing the problem.

To get more customers from 'the other guy?' If they all cost the same, then no one will switch, but if Insurance Company A is cheaper, then maybe someone will switch from Insurance Company B.

[ I'm assuming that you mean 'insurance providers' and not 'medical care providers.' ]

Odd how three people all responded to me with the interpretation that I was being a moron rather than the interpretation that I was asking a tough question.

Think of car insurance, which is mandatory (agree some people still ignore it) yet is super competitive. And they don't compete on price. They just differentiate in the market around price and services.

The UK healthcare system is 96% or so publicly funded. Yet I choose my private GP. If they don't treat me well, I go somewhere else. So while they can't compete for me by price, they need to be efficient enough to be able to afford to provide care their patients are happy with, or they loose their patients, and with it their funding.

They also need to keep their cost under control, as their cost determines their profitability: The rate they get paid to take NHS patients is set across the board.

And if/when the NHS sees the cost of providing certain care drops across the board, they can and do push the price they are willing to pay for it down.

The UK incidentally has a healthcare system that is substantially cheaper than the US, yet ranked substantially higher by the WHO.

I spent 5 weeks in hospital last year for Pulmonary Edema (fluid on the lungs) related to diabetic-induced heart problems. Two ops and 5 stents later I can't fault the UK NHS model. It's not perfect, but it does a great job without bankrupting the patient.

> If everyone has insurance, what makes providers compete on price?

Strictly speaking, they don't.

But they have a strong incentive to limit costs because of insurance company reimbursement policies and the conditions for getting "in network" for HMO-style plans.

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