Caring for those who cannot afford health coverage

“Caring for those who cannot afford health coverage”
Published 30 Nov 2017 | swissinfo.ch
by Tony Ganzer and Geraldine Wong Sak Hoi

“…Health care in the United States has prompted aggressively partisan debates about the role of government in social services, about costs, and even about taxes. Most skirmishes don’t include extended bipartisan recognition of the people who fall through the cracks of the American patchwork system, and the threads by which some of them are barely hanging on.

Even with implementation of the Affordable Care Act, or Obamacare, there are still 28 million non-elderly uninsured people in the country. Although Obamacare expanded health coverage and assistance for millions of people, it doesn’t equate to universal coverage. Cost is a big reason why people remain uninsured, and for some, a lack of legal immigration status prevents getting insurance. Others without insurance faced a problem of making too much money to qualify for subsidies on the insurance exchanges, so they opt to roll the dice without insurance rather than pay full price.

A major group helped by the ACA are those too poor to have insurance through an employer plan or through the open market. Medicaid is the main public program available to help low-income or some disabled individuals (it covers 62 million people). A similar program called the Children’s Health Insurance Program, or CHIP, helps cover children. Part of the ACA allowed for states to expand Medicaid coverage, opening up Medicaid to people who weren’t initially eligible. But states weren’t forced to expand the program and could structure it to their preferences, which has led to a disparate system…”

Read the full article at swissinfo.ch 

Do American and Swiss patients get what they pay for?

“Do American and Swiss patients get what they pay for?”
Published 16 Nov 2017 | swissinfo.ch
by Tony Ganzer and Geraldine Wong Sak Hoi

“Health care doesn’t come cheap in the United States or Switzerland, and depending on your situation, the bill can vary widely. Are Americans and the Swiss getting top-quality care for their money?

Several readers wanted to know how much residents in the two countries pay for health care, in terms of public and private contributions, and whether the quality of care justifies the costs.

We’ve already given a primer on the health care systems in each country, and how many different insurance options US residents have depending on how much they make, what they do, and how old they are.

What does it cost, and why?

US healthcare spending is a whopping 17% of GDP, or more than $9,000 per capita. (Some estimates put the cost per person over $10,000).  By comparison, Switzerland spends about 12% of GDP, at more than $6,300 per capita.

One reason for the higher cost in the US is that variety in coverage we mentioned before.  With so many different insurance options and programs, there are lots of opportunities for increased administrative costs, and variety in how people might interact with health care services. It’s more expensive for someone to just go to an emergency room than deal with a doctor visit, for example.  The EMTALA Act requires that the public have access to emergency care regardless of ability to pay. But that was meant to enable a patient to be stabilized and not as a general health care solution.

In some ways the Swiss health care system before reform looked a lot like the core of the US system. What changes did Switzerland make?

The biggest reasons for higher health care costs in the US might be linked to two things: prices and patients.”

Read the full article at swissinfo.ch

Two patchwork healthcare systems, and two stories of reform

“Two patchwork healthcare systems, and two stories of reform”
Published 2 Nov 2017 | swissinfo.ch
by Tony Ganzer and Geraldine Wong Sak Hoi, with input from Veronica DeVore

“In some ways the Swiss health care system before reform looked a lot like the core of the United States’ system, which might be why many eyed Switzerland during the wrangling over the Affordable Care Act. What changes did the Swiss make and what’s been the result?

In this first article in our series looking at health care on both sides of the Atlantic, we answer that question, sent in by one of our readers. He wondered what the Swiss system was like before reform and how it came about.

​​​​​​​Why was there a desire for reform?

Before reform, insurance in Switzerland was not compulsory, rather voluntary, paid for in large part by premiums and co-pays. There was federal and cantonal support to help people who needed it, but that made up only 15 percent of financing. Some have argued that one “American” characteristic of this pre-reform system may have been the trend of private insurers snapping up non-profit “mutual” health plans, and refocusing on profits. This led private insurers to compete for “wealthy and healthy clients” because it’s cheaper and more profitable to insure people who are, well, healthier.  Regulation existed in this pre-reform Helvetia, but wasn’t too heavy-handed.

It’s important to say that, even with more of an “American-style” system, Switzerland was still covering more than 90% of the population. (Some estimates put it at 96%). Why? Maybe one reason is because the Swiss are more risk averse, and have a strong sense of personal responsibility when it comes to health care.”

Read the full article at swissinfo

Trekking East: Holiday Edition

Moon rising

I have fancied myself a fairly prolific traveler in the last years, stretching the bounds of my passport and camera across mostly European locales.  I was lucky enough to see sights in Norway, Germany, France, the UK, Belgium, the Netherlands, Luxembourg, Switzerland, Italy, the Czech Republic, Poland, Greece, Egypt, Ireland, and Canada, since 2008.  Each journey has its own set of challenges; in Greece, I wasn’t sure if the protestors from television would overrun my family as we climbed the Acropolis (they didn’t); or in the Czech Republic, I had to try to work as a reporter and snag interviews while not knowing any Slavic languages and having no experience there.  The challenges are what make trips exciting and worthwhile, though…at least in theory.

My troupe’s latest journey set us onto America’s roadways, moving all of our things, by car, from Washington State to Ohio.  Cleveland will be our new home, one that we are eager to embrace and settle into after months of transition from Switzerland to the United States.  But this car journey is an epic feat for even regular drivers, and I hadn’t driven more than a few hours in the four years I lived abroad.  To move us to Ohio would take more than 30 hours of driving time, spread through five long days.

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Rediscovering the “homeland”

Welcome back

It wasn’t a surprise, but it also wasn’t necessarily the easiest solution:  my former employer World Radio Switzerland was sold by the public service, destined to become a local commercial station in Geneva.  That change has happened, and the vast majority of regular news staff from the public service were let go.

Our station had a tough history–one better explained in person and over a beverage–but it had accomplished an impressive task of producing award-winning coverage about Switzerland, and educating Swiss and ex-pats alike as to how that idiosyncratic country works (or doesn’t.)

The staff of WRS was given about a year to prepare itself for the eventual sale.  Some claimed our jobs would be secure until 2014, others, myself included, expected less.  We lost our political reporter and news director right away, and others were looking at the door.

As my family had to begin to think about schooling for my child, and I had to focus on my dissertation for my MA, we made one of the hardest decisions we have ever made: quit, leave Switzerland, and leave Europe, after four years abroad.  Shortly after we made this decision, and I gave my notice, the station’s sale was finalized and a timeline was in motion.

Staff had about three months before they would be laid-off, and the station and all content would disappear to be reborn as another kind of radio.  It is not my kind of radio, but it didn’t really affect me; my plans were already in motion.

Readjusting to the USA, which I hadn’t visited in two years, has been difficult.  It is even more difficult than when I returned from two months in Germany back in 2008.  At that time I wrote this: “People ask if it’s hard to readjust after two months abroad.  In some ways it is: the little German I know is now less useful, and I have to be careful not to use it without context.  It’s weird not using trains and public transport, even walking everywhere.  And it’s weird answering the question “is it hard to readjust after two months abroad.”

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Dealing with Terrorism (Deutsch)

Police

Some months ago a journalist told me the Germans were quite naive about terrorism, and they don’t speak about it as often or at as great lengths as Americans do.  I was curious to find out if that was true, and whether a comparison could be made.  I wrote this piece for Radiowelt on Bayern2, but am not sure they ran it.  Here it is in any case.

English translation below.

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