Zakaria: Health insurance is for everyone
March 16th, 2012
12:35 PM ET

Zakaria: Health insurance is for everyone

By Fareed Zakaria, TIME.com

Two years ago, Barack Obama signed into law the most comprehensive reform of American health care since Medicare. Most of its provisions haven’t been implemented yet. But the debate about it rages on at every level. Twenty-six states have filed legal challenges to it. And this month the Supreme Court will hear arguments about its constitutionality.

The centerpiece of the case against Obamacare is the requirement that everyone buy some kind of health insurance or face stiff penalties - the so-called individual mandate. It is a way of moving toward universal coverage without a government-run or single-payer system. It might surprise Americans to learn that another advanced industrial country, one with a totally private health care system, made precisely the same choice nearly 20 years ago: Switzerland. The lessons from Switzerland and other countries can’t resolve the constitutional issues, but they suggest the inevitability of some version of Obamacare.

Switzerland is not your typical European welfare-state society. It is extremely business-friendly and has always gone its own way, shunning the euro and charting its own course on health care. The country ranks higher than the U.S. on the Heritage Foundation’s Index of Economic Freedom.

Twenty years ago, Switzerland had a system very similar to America’s - private insurers, private providers - with very similar problems. People didn’t buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance. So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly.

The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high.

When Taiwan - another country with a strong free-market economy - decided to create a new health care system in the mid-1990s, it studied every existing model. It too chose a model of universal access and universal insurance but decided against having several private insurers, as Switzerland and the U.S. do. Instead it created a single insurer, basically a version of Medicare. The result: universal access and high-quality care at stunningly low costs. Taiwan spends only 7% of its GDP on health care.

The most striking aspect of America’s medical system remains how much of an outlier it is in the advanced industrial world. No other nation spends more than 12% of its total economy on health care. We do worse than most other countries on almost every measure of health outcomes: healthy-life expectancy, infant mortality and - crucially - patient satisfaction. Put simply, we have the most expensive, least efficient system of any rich country on the planet. Costs remain high on every level. Recently, the International Federation of Health Plans released a report comparing the prices in various countries of 23 medical services, from a routine checkup to an MRI to a dose of Lipitor. The U.S. had the highest costs in 22 of the 23 cases. An MRI costs $1,080 here; it costs $281 in France....

The Swiss and Taiwanese found that if you’re going to have an insurance model, you need a general one in which everyone is covered. Otherwise, healthy people don’t buy insurance and sick ones get gamed out of it. Catastrophic insurance - covering trauma and serious illnesses - isn’t a solution, because it’s chronically ill patients, just 5% of the total, who account for 50% of American health care costs....

The Obama bill expands access to 30 million Americans. That’s good economics and also the right thing to do. But it does little in the way of controlling costs. Medicare’s costs have stopped rising as fast as in the past. But for broader costs to decline, there is no alternative to having some kind of board that decides what is covered by insurance and what is not - as exists in every other advanced country. This has been demagogued as creating “death panels” when it is really the only sensible way to make the system work.

When listening to the debate about American health care, I find that many of the most fervent critics of government involvement argue almost entirely from abstract theoretical propositions about free markets. One can and should reason from principles. But one must also reason from reality, from facts on the ground. And the fact is that about 20 foreign countries provide health care for their citizens in some way or other. All of them - including free-market havens like Switzerland and Taiwan - have found that they need to use an insurance or government-sponsored model. All of them provide universal health care at much, much lower costs than we do and with better results....

Read my full article at TIME.com, behind a paywall.

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Topics: Analysis • From Fareed • Health

soundoff (184 Responses)
  1. Ramin Sabeti

    Hi
    I am an Iranian M.D.
    I want to share a project due to health care for all with you.
    is it possible?

    March 16, 2012 at 12:54 pm | Reply
    • M. Edward

      Why wouldn't it be possible? What is it you want to share?

      March 19, 2012 at 3:08 pm | Reply
      • Jacknyd

        Probably Herpies

        March 19, 2012 at 4:39 pm |
  2. Ken Kaniff

    Problem is my fellow Americans are so incredibly unhealthy. All we do is sit, stuff our faces with cheeseburgers and fried foods of every variety (deep fried butter, anyone?) and wash it all down with oceans of beer and soda.

    The Swiss and Taiwanese aren't slothful gluttons like we are.

    March 16, 2012 at 1:03 pm | Reply
    • grenadaboy

      very true, and then they don't sue you for the consequence of their idiocy.

      March 16, 2012 at 2:22 pm | Reply
      • MiketheElectrician

        Actaully, there are numerous remedies to people who sue for no-cause.

        March 19, 2012 at 3:36 pm |
    • Sboo

      but canadians and other Europeans have diabetes and obesity problems, too. even bigger aging population.
      and their universal health care costs are also smaller.

      March 16, 2012 at 2:25 pm | Reply
      • Pragmatist

        These countries also RATION care (I said it!) to control costs. If you are above a certain age, you don't get dialysis and no organ transplants etc. Once you make something free, it loses all value and if you want to make it free , you have to establish limits. I just don't think the American people will except this, they want everything done.

        March 19, 2012 at 3:09 pm |
      • miamigrrrl

        Guess what Pragmatist-health care is RATIONED in the US as well, and far more stringently.

        March 19, 2012 at 3:36 pm |
      • I don't think so

        @ Pragmatist: sorry, but you don't have your facts straight. There is NOT rationing of health care services in Canada. When my father had lung cancer in his 70s, they never said, "Hey, you're too old! We're going to save our money rather than try to help you out!" Instead, when they saw he was fit for treatment, they got him started on 8-weeks of radiotherapy. The focus is on the patient's health; not on the cost. Canadian doctors I worked with said they never would want to work in the US because they believed they would lose the ability to practice medicine as they felt they needed to practice it to help their patients. They had free reign to make decisions with their patients without insurance companies interfering. That, my friend, is freedom!

        March 19, 2012 at 4:07 pm |
    • j. von hettlingen

      In Swiitzerland there are many private health insurance companies offering different models, from the basic, which is compulsory for everyone to more sophisticated options, that guarantee the insurers a single room in hospitals, transport and different kinds of therapies etc.etc. It takes an expert to do the cherry-picking in a jungle and get the value for money. An insurer has to be mindful of not being ripped of. There are healthy people who have been paying premiums the whole life without claiming their benefits. The insurance is for emergencies and other unexpected events in life. Moreover also as a gesture of solidarity.

      March 17, 2012 at 6:27 am | Reply
      • Kevin

        Sounds like car insurance to me. Safe drivers who have never gotten in an accident, but still have to pay premiums without reaping any benefits.

        March 19, 2012 at 4:02 pm |
      • I don't think so

        Kevin, having a healthy society where people aren't losing their homes and leading to your house values dropping . . . those are tangible benefits. Americans are too selfish to understand that by helping their neighbours, they create a safety net for themselves. As a Canadian-European living in the US and having lived in numerous countries, I've never seen anything more inefficient and poor at the US health system. And I've had very good insurance, supposedly, in the US.

        March 19, 2012 at 4:09 pm |
      • talshar

        Americans are too selfish to understand that by helping their neighbours, they create a safety net for themselves.
        __________________________________________________________________________________________

        The dominant ideology of Republican-ism discourages any concept of shared or civic responsibility.

        Sometimes I think it would be good to give the right wing of this country everything it wants, just long enough for them to witness the hellish consequences.

        These are people who say – gov-ment hands off my medicare – with no sense of irony!

        March 19, 2012 at 4:30 pm |
      • American in Switzerland

        agreed

        March 26, 2012 at 10:32 pm |
    • fofotavour

      I agree with you that we have many more unhealthy people in America due to bad eating habit. And when the First Lady tried to point to it, she was bombarded with awful remarks. I guess some people prefer to be wrong than to be educated.

      March 19, 2012 at 3:02 pm | Reply
      • SJSC

        Not just bad eating habits but worse, drug use, alcohol abuse and smoking. I don't really feel the righteous need to send my tax dollars to care for people who live such lifestyles.

        March 19, 2012 at 4:58 pm |
    • Ren car

      Ken Kaniff said:

      "Problem is my fellow Americans are so incredibly unhealthy. All we do is sit, stuff our faces with cheeseburgers and fried foods of every variety (deep fried butter, anyone?) and wash it all down with oceans of beer and soda. The Swiss and Taiwanese aren't slothful gluttons like we are."

      I agree. Most people who opposes Obamacare are from the Red States.. also known as the Fat States.. also known as the republican states.

      March 19, 2012 at 3:11 pm | Reply
    • crazyvermont

      This article is comparing apples to oranges

      March 19, 2012 at 3:28 pm | Reply
      • Just Moi

        They may not have the same system, but it is showing you that all major nations in the world have such systems and they work. Plain and simple. Don't believe it will work in America? Look to Mass... seems to be doing great there: people are happy, costs are down.

        March 19, 2012 at 4:42 pm |
    • Stephen

      And they also do not give away citizenship just because of where someone happens to drop a baby.

      March 19, 2012 at 3:38 pm | Reply
      • SJSC

        Excellent point.

        March 19, 2012 at 4:59 pm |
  3. BShortridge

    Thank you for your research and analysis on this issue. Over the decades, I have not come across a successful health care program that cares for such a geographically disperse and culturally diverse population as the USA. Scandanavia, Switzerland, Minnesota, Massachussetts, for a while the Indian Health Services, and even a program I was involved with in Appalachia are excellent models to emulate. But how do we modify ones such as these or the ones you researched one that will work in the USA?

    March 16, 2012 at 1:57 pm | Reply
    • grenadaboy

      the first thing is to stop suing providers to put an end to defensive medical practices. we could legislate limited indemnities through mediation. when mal practice insurers can't quantify their exposer, premiums sky rocket, and providers are forced to generate cash flow by any means possible.

      March 16, 2012 at 2:27 pm | Reply
      • Robin Crites

        That's no excuse, medical malpractice is less than one percent of the cost of medical care.

        March 16, 2012 at 6:49 pm |
      • Matunos

        Sounds great, until you are a victim of actual medical malpractice.

        March 16, 2012 at 8:42 pm |
      • Jeffrey M. Lobosky MD

        Makes perfect sense...however in the last Presidential/Congressional election cycle the trial lawyers donated almost $300M in campaign contributions to politicians (>80% to democrats). Should be no surprise that the ACA has nothing in it but lip service to tort reform.

        March 18, 2012 at 2:09 pm |
      • Jeffrey M. Lobosky MD

        But tort reform must be more than capping limits on pain and suffering. It should be designed to protect patients from negligent care and doctors from frivolous suits. Current "lottery" mentality does neither. Vast majority of injured patients never file a grievance and in majority of cases brought against doctors the physicians have no culpability.

        March 18, 2012 at 2:14 pm |
      • maggie

        Jeffrey M. Lobosky MD said:

        Makes perfect sense...however in the last Presidential/Congressional election cycle the trial lawyers donated almost $300M in campaign contributions to politicians (>80% to democrats). Should be no surprise that the ACA has nothing in it but lip service to tort reform.

        ***********
        Jeffrey, you're smarter than to place blame on who trial lawyers contribute to. The fact of the matter is that accidents happen; mistakes happen. Trouble is, when you mess up, it affects a body part I may no longer have and I deserve to be compensated for it somehow. What the right number is, who knows? But why should society place a dollar value on my lost limb or deceased child? That what juries are for. Ultimately, that's who decides what a case is worth, not the lawyers. You know better but alas, ideology has gotten the best of you.

        March 19, 2012 at 3:07 pm |
    • George Fulmore

      The more that meaningful people review the benefits of health care reform, the more they will be in favor of it. We are the only country in the world, for example, where the inability to pay hospital bills is the leading cause of bankruptcy. The Affordable Care Act will end that. And then there are the areas of affordability and access. The Act will end denials of applications for folks with "pre-conditions." And it will stop insurance companies from dropping enrollees when they get sick. As for affordability, the Act will use the money that now goes to pay for fees and services of people without medical insurance - who now get services at county hospitals, for example – and use that money to subsidize the insurance premiums of those who cannot afford to pay for the full premiums. The Act will also cut down on the costs of medical care in the U.S. over time, by encouraging and forcing hospitals and doctors to work colaboratively and more efficiently. The Affordable Care Act is movement in the right direction for a country that now has 17% of its citizens without health care insurance. We can afford it, as country. And it is the right thing to do.

      March 19, 2012 at 2:23 am | Reply
      • crazyvermont

        My daughter lives in Europe and travels frequently to USA for even the most basic of medical treatments due to waiting time and lack of access. Just wonder how this "jives" with his study?

        March 19, 2012 at 3:31 pm |
      • Jess C

        And my friends who live in the UK think our system is horrible, so go figure. They seem perfectly happy with theirs.

        March 19, 2012 at 5:06 pm |
      • R. V. Kirk

        Excellent special report! The bottom line is with the demographics of Baby Boomers aging and the huge costs incurred during the last year of life for the elderly, there will be a tipping point where Medicare just cannot pay for the bill for millions and millions of retirees.

        THINKING OUTSIDE THE BOX and looking at the total picture, here's an idea to throw around:
        Instead of providing only catastrophic health insurance, what if we only provided basic (and preventative care). Those worried about a terrible illness could plan and save for it themselves (rather than slough it off as "insurance will pay," ) AND there would be less serious illnesses if we did good preventative and primary care! People could choose between their electronic toys, new cars, etc., or funding their own possible future medical expenses (HSA probably work well). A Baby Boomer myself, I'm not anticipating getting every last expensive procedure, replacement and operation as I continue to age and approach death. I can cope with it very nicely the good old fashioned way–with family support and individual responsibility. (I've seen hundreds in that last year or two of life and it ain't pretty! The greatest beneficiaries of these hopeless attempted heroics is the health care "industry".)

        March 22, 2012 at 6:10 pm |
      • David Wong, MD - SnapHealth.com founder

        Unfortunately, the Affordable Care Act will not end that - it will likely make the cost of care go up. Already hospital systems are buying up doctors practices creating monopolies. There was a Wall Street Journal article where the writer went to the exact same cardiologist from a year ago now owned by a hospital and the fees had tripled! The CEO of Aetna has already predicted that health insurance premiums will DOUBLE in 2014. And the IRS says that the lowest cost premium for a family of 4 on the health insurance exchanges will be $20,000 a year. Who is this affordable for??

        Yes, I can sit and complain and poke holes in other people's arguments or I can spend my "freetime" creating a solution.

        Well here it is: snaphealth.com

        [youtube=http://www.youtube.com/watch?v=bdprGRJpJow&w=640&h=390]

        March 31, 2013 at 12:08 am |
  4. Linda Swisher

    Decisions based on data. How refreshing!! We can and must learn more about health care delivery. Evaluating outcomes is one of the best ways. Data not Demagogy. .

    March 16, 2012 at 2:24 pm | Reply
  5. bl4ck0utsUn

    Medicare has very stringent guidelines for healthcare providers, and the 5% in general are on Medicare. Medicare pays for your care as they deem fair, they set the limits to what they will and will not pay for, say you come to the hospital septic, (bacterial infection in the blood) during your work up in the ER, while doctors and nurses are working dilligently to save your life, someone forgets to get a urine sample. Sepsis is often caused by a urinary infection gone wild, said patient is now stable and transfered to the acute floor. Your nurse notices your urine looks like puss. Because checking your urine in the ER was overlooked, Medicare will not cover the cost to treat your urine infection, costing the hospital $1400-$3000 sometimes more, thus the guy with private insurence gets charged $8 for a single Tylenol tablet.
    Further more, if said infection is ID'd on arrival Medicare, dictates it will pay a maximum of $1400 to treat said infection in one state but in another it will pay $3000. So Medicare is not an answer! This is only one example. Standards of care, have improved the system some. Private insurense is following suit. Eventual this will lead to fewer health care facilities, as rural and hometown hospitals go under, and cooperations come in to pick the bones! The existing system is broken!

    March 16, 2012 at 4:27 pm | Reply
  6. rollo

    I lived in France where their universal health care is point of national pride. between 7 and 8% of gdp goes to paying for it, and everyone is covered; while in this country, 17% goes to health care, in addition, you must buy insurance from corporations, whose onterest is to make money for share holders?! I lived in France for years, and I was asked, why does America do this to it's own people?... I could never answer.

    March 16, 2012 at 4:35 pm | Reply
    • Joey Tranchina

      "I lived in France for years, and I was asked, why does America do this to it's own people?... I could never answer."

      Why? Why does a shepherd take sheep to be sheared?
      Because in a democracy, everyone gets the government they deserve.
      Americans want their government to run on autopilot... it does.. this is how it runs...

      PS. I too live in France.

      March 16, 2012 at 11:45 pm | Reply
      • maggie

        No, unfortunately, Americans want the benefits of life in America to accrue only to those who can be part of the market. Woe is everyone else. BTW, I am also moving to France. I spend a great deal of time there and it won't surprise you to learn that I receive excellent healthcare while I'm there, albeit in cash, but for far less than I would ever have to pay in the U.S.

        March 19, 2012 at 3:09 pm |
  7. Timmy Suckle

    I kissed my way up to VP at a health insurance company. Now I take over $500,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
    But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
    Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $106,800 level. Now I only pay 1.3% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.

    March 16, 2012 at 5:04 pm | Reply
    • Rosie

      I might not like the register of your post, but you seem to be the one that has got it right. The only reason why an MRI is $280 in France and over $1,000 in the US are insurance companies and Medical Cartels, as you so adequately call them.

      I have been part of medical insurance systems (as a patient) in Canada, the US, Mexico, Colombia and Brazil, and the US system seems to be the only one that is completely out of whack. It is a paradox that having what is probably the most advanced science, the US has a terrible medical care. It used to be that patients from Latin America with resources choose to treat themselves in the US, but that is not the case anymore. Mexican, Colombian and Brazilian doctors are as good, or even better, as US ones, and many of them have often been trained in the US, but have left the twisted health insurance practices behind.

      In my view, the problem is that everybody, politicians, doctors and, of course, medical cartels just go around beating the bush and not addressing the real problem, which is inflated prices by health insurance companies. Politicians get elected with money from the Medical cartels and Medical cartels are protected by the politicians. A vicious circle in which ONLY the patients loose. Patients have their part of the blame too. They have become careless about their health and its cost. As long as the insurance pays, they do not care how much the bill is. I once asked for my lab records (because I travel often and want to carry them with me) and had to fight with the lab personnel who said the records were between them and my doctor!!! Similarly, a lab company was billing my and my insurance company several times for the same procedure. When I called the insurance company to alert them, I was literally told this was NONE of my business. My health and how much I pay for health care will always be my business, and I do not want to get ripped of neither my Medical cartels nor by politicians.

      March 16, 2012 at 7:13 pm | Reply
    • dave

      Michelle, is that you? Your nose is growing.....

      March 19, 2012 at 3:34 pm | Reply
    • jason

      Excellent post. The funny thing is, Republicans hate the plan even though it is *a Republican Plan*. They came up with it (Heritage Foundation) and was Bob Dol's platform. Now they hate it simply because Obama is advocating it.

      March 19, 2012 at 4:07 pm | Reply
    • What

      Did the democratic chair write this post? You are crazy to think that people would believe that all of the political garbage coming out of the left would just happen to be listed in your post. Look even if you are for real and the political rethoric was all a coincidence. wink wink.... I still could not believe that someone who was so inept and was lucky enogh to get this cushy job would put it at risk just to get a reaction and would want to create resentment...

      Anyway don't waste my time.

      BTY – forgot to cover the women vote... just add women hater and you should be golden.

      March 26, 2012 at 9:54 pm | Reply
  8. matt

    If such a plan were fully implemented in America, how do we deal with Medicare, Medicaid,and indigent patients?
    How do we pay for the health care of illegal aliens? Do we deport them to obviate that need? Why grant exemptions to 1,400 plus groups or employers as has occured over the last 3 years?

    Everyone will increasingly become the exception to the rule.

    Tell me again about health insurance for everyone.

    March 16, 2012 at 8:30 pm | Reply
    • Matunos

      Yeah we're probably the only advanced county that has poor people and illegal immigrants. Nobody else has figured this out, ever.

      March 16, 2012 at 8:46 pm | Reply
  9. Joey Tranchina

    Fix the political system and a medical system would be doable.
    As long a politicians are for sale nothing functional is possible.

    The other problem is that Americans live isolated in their own "Leather Stocking Tales."
    In Europe we see ourselves as part of society where all the parts need medical service.

    March 16, 2012 at 11:39 pm | Reply
  10. bl4ck0utsUn

    @ Timmy (blood sucker), don't worry death comes for everyone and he doesn't take insurance!

    March 17, 2012 at 5:14 am | Reply
  11. RickyLFerrari

    Let me tell you one thing that the best health insurance plans has completely different set of meaning for different type of people. For those who are rich, the plan which can earn them more is best. However, those who are in the middle class have different ideas. They think that insurance plan is the best for which they will have to pay minimum premium. However, the poor person does not even know that what is health insurance? If you are one of them search online for "Penny Health" and get smart about insurance.

    March 17, 2012 at 9:36 am | Reply
  12. Stefan Metzeler

    Incidentally, the way the author presents the Swiss system before the mandatory health insurance, less than 20 years ago, is completely absurd.

    The cost of insurance was so cheap that EVERYONE could afford it. Full coverage went for $60 per month. Over 95% of the people were fully insured and most of those who were not were rich and didn't think they needed it. No one was so poor that they could not afford $60. Social security coverage is excellent. If someone could really not have paid the $60, it would have been much easier for government to just pay that amount instead of tinkering with the system!

    More than 50% of the total cost was born by wealthy people who bought extra insurance, granting them individual hospital rooms and access to the head doctor, but which they practically never used, as they tended to be very healthy individuals. When insurance became mandatory, costs skyrocketed and even the upper middle class stopped buying such extra insurance, hence the cost was redistributed much more over the middle and lower class, especially as about 30% of the people are now completely exempt from payment, as their insurance is covered with tax money.

    Today, those who pay nothing are the biggest consumers of health care. Not out of necessity, but simply because they don't bother to think about it. They clog up the emergency services with simple cases of 'flu, thus costing their insurance (which they don't pay for) $700 per incident, instead of $60 for a normal day-time doctor visit.

    The average person living entirely on social security costs $4'000 in health care per year, while the average Swiss person who pays for his insurance generates costs of well under $2'000. There is no relationship between being on social security and being sick. People who are disabled, chronically ill etc. are supported by a special insurance, they are not included in this statistic.

    I'm outraged at the complete misrepresentation of the disastrous Swiss expansion of government control over the health care sector. It is an utter, complete, unmitigated disaster. To quote it as an "example" is simply a scandal and a lie. It was one of the worst plagues inflicted on my country over the last 20 years, along with the VAT tax, which seriously damaged our economy, and the reduction of our gun rights, which have led to an explosion of violent crime.

    Do NOT fall for the lies!!!

    March 17, 2012 at 10:06 am | Reply
    • Nick

      Paid for, much?

      March 17, 2012 at 4:23 pm | Reply
      • Stefan Metzeler

        Back before government mandated health insurance, $60 per month, now $280, with $2'000 deductible and much worse coverage.

        I don't see my first post. That would have clarified a lot.

        I challenge Mr.Zakaria to a public debate. He obviously doesn't know anything about the Swiss system and the abysmal failure it is.

        I'll come to the US to debate him on CNN or any other channel he chooses. I can also bring along several doctors and other experts on the issue.

        March 17, 2012 at 6:38 pm |
    • maggie

      You should be outraged about the cost of health insurance in this country and what little you get in return comparatively.

      March 19, 2012 at 3:10 pm | Reply
    • dave

      CNN please use someone more creditable than Zakariya to feed the kool-aid drinkers. Maybe then the rest of us would take you more seriously.

      March 19, 2012 at 3:38 pm | Reply
    • dave

      CNN please use someone more CREDIBLE than Zakariya to feed the kool-aid drinkers. Maybe then the rest of us would take you more seriously.

      Sorry for the typo.

      March 19, 2012 at 3:39 pm | Reply
  13. Jay

    Call me a cynic but aren't all the tallest buildings in each state owned by insurance companies ??........ Just saying!

    March 17, 2012 at 10:13 pm | Reply
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    March 18, 2012 at 7:58 am | Reply
  15. Eric Click

    Mr. Zakaria, I saw you just now on Ali Veshi's program, plugging your special tonight. I commend you on your approach to the problem, but I became concerned when you started talking about the critics and objections to Obamacare. You're an intelligent man, and its great that you approach things from a practical standpoint of facts and reality. That said, and I'm sure you've probably accounted for this, but a significant proportion of the critics you speak of do not operate on a rational plane. Its not that they can't approach the problem from a practical standpoint, but that they refuse to engage it, and I say this not as some tethered observer from afar, but as someone who frequently engages people who act and believe this way. I hope your special addresses how to overcome this in the course of future debates and movements on healthcare reform: That there are some people who will never accept anything other than what they believe is right, even if that "right" is based on a farsical absurdity. The knowledge of what solution works best for a problem is of little utility if the resources and mechanics of implementing it and overcoming obstacles to it are not there.

    March 18, 2012 at 3:57 pm | Reply
    • dave

      Do you REALLY think Mr. Zakaria reads all of these......... Sorry Eric, it's not Clickin'

      March 19, 2012 at 3:41 pm | Reply
  16. susan sherwood

    when can we see this program about health care in usa. Road map for Health care. We live in Italy thanks

    March 18, 2012 at 4:01 pm | Reply
  17. Darrell

    Anecdotal evidence for why the mandate is bad-
    I'm self-employed with no health insurance. This is because of having dealt with insurers' policies in the past and my own extensive shopping for insurance has left me with the indelible observation that health insurance is an incredibly bad deal here in the U.S.. One is actually being more financially responsible for not purchasing a policy that is too expensive and yet fails to provide adequate coverage. You're better off having a savings account. Until there's a mandate to solve this problem (this has been the problem all along, btw), Obama'a mandate just sounds like catering to the health insurance co.'s bottom line.

    March 18, 2012 at 4:15 pm | Reply
    • Sara

      What do you do when you get sick and need major surgery? Are you just going to go bankrupt and let the rest of us pay for you when the hospital has to write it off? Do you really have hundreds of thousands of dollars in your savings account for that?

      March 19, 2012 at 3:12 am | Reply
    • Ron R

      If you develop a serious medical condition that requires expensive care that drives you into bankruptcy you will still be treated, but at taxpayers' expense not yours. Is it fair for you to lay your health care expenses on me when you could have paid ahead of time by buying insurance. Your savings in premiums is my cost! I object!

      March 25, 2012 at 10:52 am | Reply
  18. Joyce Geis

    Obama is in bed with the insurance companies! When will the public & media ever ask the question..... Why did Obama require Americans to buy HEALTH INSURANCE but gave the HEALTH INSURANCE COMPANIES A FOUR YEAR PASS covering people with pre-existing conditions? I have applied for the government program and they denied me. They said I was denied because when I applied for Blue Cross Blue Shield I did not ask for insurance policy that would allow BCBS NOT cover my PRE-EXISTING conditioning. Now... WHY do I need to PAY for a policy? By the way...I was born with my condition. We are the AMERICAN PEOPLE that OBAMA HEALTH CARE DENIED yet WE NEED IT THE MOST!!!

    March 18, 2012 at 4:16 pm | Reply
    • youloze

      You must have spoken to the wrong people...Trying calling again

      March 19, 2012 at 3:33 pm | Reply
  19. david

    Obama Care :
    You can not make mandatory for every body,to purchase Heath Insurance .
    If people are not employed and have no money ,where will they get the money to buy Heath Insurace ?
    The answer is very simple and logic:
    Every body gets basic health insurance,regardless if you have or you don't have an income
    Every body who has an income and files a tax return ,a mandatory flat procentaj of your income (to be determned) is taken and is alocated to pay for the basic heath insurance for every body .I say flat rate because ,if you make more money you will pay more and vice-versa .
    If you are not happy with what the basic health insurance is offering ,if you have the money ( that is the reason we all work so hard ) you are free to buy additional health insurance .

    March 18, 2012 at 10:13 pm | Reply
  20. Joseph R. Walsh

    Thank You Fareed Zakaria, Health Care is a necessity we all need and Obama's Affordable Care Act is the beginning of the answer. Anyone wanting to know more about the Affordable Care Act should read "Health Care Reform" by Jonathan Gruber. It's in comic book form and easy to read. I highly recommend it.

    March 18, 2012 at 10:38 pm | Reply
  21. Cindy

    An enlightening and informative commentary however, I am rather surprised Canada’s Health Care model was not discussed in the comparison evaluations.

    March 19, 2012 at 1:59 am | Reply
  22. Dr. Kuo in Taiwan

    Dear Fareed Zakaria:
    I am a physician in Taiwan. Thanks for your praise and I know you use Taiwan as an example to emphasize the high cost of US health care. However, the "universal access and high-quality care at stunningly low costs" in Taiwan is based on long working-time and large working load of health care personnel with diminishing incentive. The consequence is that today, most doctors want to do beauty therapy or other jobs and there are no enough nurses in most hospitals. The healthcare system is in danger because of universal access and high-quality care at "stunningly" low costs, which only occurs in sweatshop factory. Maybe, you should consider not only the low cost but what the unreasonable low price of health care will do to the country.

    March 19, 2012 at 2:13 am | Reply
    • abcdxyz

      Dr. Kuo, thank you for your observations–they are very worthwhile. I'm not sure about working conditions for doctors in the US, but I can tell you anecdotally that many people have told me that their relatives have received poor nursing care in major hospitals in the US because the hospitals won't pay to have enough nurses on the floor at any given time to care for the patient load.

      March 19, 2012 at 5:44 pm | Reply
  23. J Leung

    I am a Taiwanese doctor too. I absolutely agree with the opinion of Dr. Kuo. Actually now the people in Taiwan is trying to burn out all the potential medical resources in order to achieve a so called "universal access and high-quality care at stunningly low costs" goal. It is not a stable system, although it seems to be working quite well at the moment. A Chinese proverb says that no high quality goods is cheap. And cheap goods can look as if it is good in appearance but not the overall quality. My point is that a good system should be run with a reasonable cost, not just pursing low cost, which is what the Taiwanese people is doing!

    March 19, 2012 at 4:55 am | Reply
  24. J Leung

    I strongly recommend the Americans to check the system in Canada, UK, Australia and New Zealand. Their health care systems are sure not really perfect but at least these systems have already run for much longer than that of Taiwan, they are quite stable and people in these countries have largely accepted and showed more than average satisfaction of these systems. It is sure that poor people in these countries should never worry about not able to seek medical help as a result of their health insurance cards being locked up, because they cannot afford the health insurance fee.

    March 19, 2012 at 5:45 am | Reply
    • max

      Dr. Leung, thanks for sharing your points of view from a taiwanese doctor's perspective. americans will never go for british or european systems because there is no way we will be willing to pay that much in taxes. as far as evaluation of satisfaction is concerned, it is very difficult to do an accurate measurement of satisfaction because "people know what they know." just like most people never know if their parents are "the best" or "the worst" simply they don't have any other choice or chance to experience anything different than what they already have. healthcare is one of those experiences that you either like it or you don't.

      March 20, 2012 at 2:27 pm | Reply
  25. bluedog03

    1 of the great things about the US is that if we want to see how things will work on a national scale, we don't look to other, smaller, less powerful countries. We can look @ our own country & states. Before Obama forced his healthcare plan on the US, we should have given the states' plans a chance. So far, the plan in Mass. is performing acceptably, but @ a high cost. The micro-national healthcare program called Tri-Care (a control group if there ever was 1) sees very high service delays & misdiagnoses, while the natl Medicare system is bankrupt. My wife had a MRI the other day & her wait was 5 days, b/c it was not an emergency, while in France, it would have been @ LEAST 5 days, ONLY if it WAS an emergency. Just b/c a program works in Taiwan doesn't mean it will succeed in the US. When a state govt or the feds can come up with a plan that really works, THEN let's talk about usurping our natl freedoms 4 sum utopian ideal like "universal access." Most Americans are unwilling 2 trade off their freedoms 4 a promise from the same ppl who brought us the US Post Ofc.

    March 19, 2012 at 6:18 am | Reply
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