THE BOSTON GLOBE: MASSACHUSETTS isn't the first place to mandate that everyone buy insurance as a way to achieve universal health coverage, and it isn't the first to get queasy about seeing through that solution.
Like Americans, the Swiss were not eager to accept the double principles of universal coverage and a mandate on individuals to purchase health insurance. It took almost a century and political debates as contentious as those in the Massachusetts Legislature before these two elements were added to the Swiss system in 1996.
What made a very reluctant Swiss population finally accept (by a small majority of 52 percent) such a fundamental change? Prior to the individual mandate, insurers were largely unregulated and could reject older people or those in poor health or charge them very high premiums. As a result, lifetime coverage was uncertain and health insurance was increasingly unaffordable for people with low incomes.
The goals of the Swiss reforms sound familiar to Massachusetts: Cover everyone, make insurance more affordable for low and moderate income people, and control health care costs. The individual mandate was combined with insurance market reforms that require Swiss insurers to offer a standardized, comprehensive benefit package defined by the federal government. Individuals can choose from products that have different deductibles (ranging from $240 to $2,050), and they have the right to change health insurers every year. Federal subsidies are available to low and moderate income people to make coverage more affordable.
Eleven years later, Switzerland has achieved its goal of universal coverage: Everyone has access to the same comprehensive health insurance coverage, at the same premiums, and to the same quality of medical care. The Swiss example on health insurance reform (more) By Béatrice Schaad Noble
Mark Alexander
