Universal coverage and individual mandate in Switzerland: lessons for Massachusetts.

Executive Summary Massachusetts is not the first to mandate that everyone buy insurance as a way to achieve universal health coverage, and is not the first to get queasy about seeing that solution through. Like Americans, the Swiss were not eager to accept the double principles of universal coverage and a mandate on individuals: it took almost a century before these two elements were added to the Swiss system in 1996. Eleven years after, this issue brief presents the challenges Switzerland is facing and the lessons Massachusetts may learn from its experience. 1. Have a system that relies on competition among private insurers within a regulated system. 2. Have a system which is built on a mixture of private and public delivery. 3. Consider individual mandate as an effective way to achieve universal coverage. Lessons: What have we learned in Switzerland from our decade long experience with an individual mandate that is instructive for Massachusetts may be summarized in four main points: First, the queasiness felt in Massachusetts is natural, but not a reason to waver. Despite the fact 97 percent of the population already had insurance in Switzerland, the introduction of the individual mandate induced deep modifications in the Swiss culture. Eleven years after the implementation of the individual mandate nobody seeks to be relieved of this obligation. Second, there is growing scrutiny of insurance companies and heightened demands for accountability in a system in which everyone must purchase coverage. Specific concerns about insurers have focused on the opacity of their business practices and finances, the lack of competition among insurers, and their illegal attempts to identify and enroll healthy people and avoid people in poorer health. Third, affordability of health insurance has become a huge public issue. With rising health care costs, more than one-third of Swiss families now qualify for public subsidies. Even though federal spending for subsidies for health insurance has more than doubled since 1996, an increasing number of middle-class families cannot afford their premiums. Finally, the mandate and the reform helped focus attention on the problem of health care costs and sharpened attention to the relative responsibility of major players. Perhaps the diverse, broad-based coalition of stakeholders that supported health reform in Massachusetts can develop some lessons to share with the Swiss in the areas of affordability and 2 health care cost control. The Swiss experience suggests that these issues will certainly be your …