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The Swiss and Dutch health care systems are suddenly all the rage in the United States. They have features similar to proposals by at least two presidential hopefuls, and next month the top U.S. health official will visit Switzerland and the Netherlands to take a look.
Health and Human Services Secretary Michael Leavitt will visit Switzerland on Nov. 7 and then fly to The Hague for two days. His schedule is filled with meetings with ministers and technocrats, hospital officials and insurance executives and patients and their advocates. His visit was scheduled, department officials said, because policy experts in Washington have promoted Swiss and Dutch provisions as models.
In Switzerland and the Netherlands, everyone has to obtain health insurance or pay a penalty. Employers are exempt from the mandates, and private insurers and hospitals provide care.
"We have been hearing a lot of people in the health policy community talk about how those two countries had been doing new things in health access, and the secretary wanted to get a closer look at what they're doing," a department official said.
The trip is not a sign, however, that the Bush administration is considering major health initiatives, officials said.
"We don't have anything cooking that we haven't announced," the department official said. "We would not endorse a system like the Netherlands or Switzerland's. But if there's something we could learn about their system, we should learn about it."
Other people, however, are endorsing the two countries' health systems.
The proposals of Senator Hillary Rodham Clinton and John Edwards, both of whom are seeking the Democratic nomination for the presidency, borrow heavily from the two countries. Mitt Romney's health care revisions when he was governor of Massachusetts were in part modeled on provisions in Switzerland, although Romney has not endorsed this approach as a candidate seeking the Republican presidential nomination.
The Healthy Americans Act, introduced by Senators Ron Wyden, an Oregon Democrat, and Robert Bennett, a Utah Republican, would largely adopt the Dutch model.
Wyden said the plan for Leavitt's trip was part of growing Republican support for proposals for universal health care through individual mandates and private providers.
"I think Mr. Leavitt's trip is a really positive development," Wyden said.
A spokeswoman for America's Health Insurance Plans, Susan Pisano, said she had been struck by Leavitt's timing. On Wednesday, Pisano's trade group will be the host of a luncheon at which Dutch and Swiss insurance executives will discuss the plans in Europe.
The event is meant to dispel the idea that every nation that provides universal health care does so through a government-run system.
"The only models we seem to focus on here are those in Canada and Great Britain, which both have government-run systems," Pisano said.
"We thought it made sense to look at two countries that have universal coverage but rely on the private sector to get there."
W. David Helms, president of AcademyHealth, a health policy research organization in Washington, said he met top Dutch health officials for several days this month in the Netherlands.
The Netherlands is a particularly good model for the United States, Helms said, because it has solved two basic problems: moving from an employer-based system to one in which individuals buy their own insurance and subsidizing care for the poor.
"I think the Netherlands is hot right now because a number of people are realizing that we need to go to an individual-based system instead of an employer-based one," he said.
President George W. Bush recently proposed eliminating the different tax treatment for employer-purchased and individually purchased health insurance by letting individuals buy insurance with pre-tax dollars.
Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said interest in the Swiss and Dutch models had soared among policy experts because of a growing consensus that the United States would never adopt a single-payer system.
Blendon said that the Massachusetts plan and Governor Arnold Schwarzenegger's proposal for California demonstrated that such programs were politically feasible and that the Netherlands and Switzerland showed they could work.
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