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

Zakaria: Health insurance is for everyone

By Fareed Zakaria,

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, behind a paywall.

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Topics: Analysis • From Fareed • Health

soundoff (184 Responses)
  1. anesthtw

    I am an anesthesiologist in Taiwan. Taking care of 3-5 patients under anesthesia AT THE SAME TIME is my daily work. Sometimes that number climbs to 7-8, and my career record is 17! Seeking emergency medical care is so cheap in Taiwan that many people "abuse" it and every medical center here is as full as in peak-hour Costco. It is usual for a physician, no matter she/he works in a standalone clinic or a medical center, to see 30-50 patients in 3 hours.

    Now tell me you Americans envy the National Health Insurance system in Taiwan.

    March 19, 2012 at 9:18 am | Reply
  2. Dr. Chen in Taiwan

    I am a doctor in a medical center in Taiwan. Imaging that: 30-50 patients in a 3-hours clinic; a nurse care for 15-20 patients at night ! Do you still think the system provides a high quality health-care ?

    March 19, 2012 at 12:57 pm | Reply
  3. Roger

    "just 5% of the total, who account for 50% of American health care costs...."

    That seems to to sum it up. Do something about those 5% and costs will fall. The older you are the less you should get. A 90 year old should not get the same treatment as a 20 year old. Sounds cruel but true.

    March 19, 2012 at 3:05 pm | Reply
    • maggie

      Let's see how you feel about it when you're old. Surely you have/had grandparents once?

      March 19, 2012 at 3:12 pm | Reply
  4. Tom in San Diego

    This is pure propaganda...What can we point to, one thing, Obama has done well?

    March 19, 2012 at 3:12 pm | Reply
    • jason

      GM alive, Bin Laden dead. Google "Road we have travelled" and see the 16 min film.

      March 19, 2012 at 4:42 pm | Reply
  5. Paul Johnson

    It doesn't matter whether the bill is going to help or hurt, if it was done improperly or rqather it imposes actions against the constiution, then it needs to be voided and a new bill be passed in its place, hopefuly a bipartision bill this time.

    March 19, 2012 at 3:23 pm | Reply
  6. TRouble

    I think more than anything the writers opinion proves the point that our health care system along with virtually everything else should NOT be Federalized. If we would let the 50 state be there own little democracies (like Taiwan and Switzerland in this article) other states could follow the best examples, and we as people could vote by choosing where we want to live. But the Feds have WAY to much power and money and it needs to be repealed! Gov't should regulate – not own anything, with few exceptions. Live free or DIE!

    March 19, 2012 at 3:32 pm | Reply
    • Josh gonzalez

      Free to lose you home, life savings, and dignity and then die.

      March 19, 2012 at 3:42 pm | Reply
    • REG in AZ

      Having states creating their own solutions, with up to 50 different designs, is ridiculously just inviting chaos with unworkable, non-compatable programs. Instead of being manipulated by "the money" and their interests, the politicians need to honestly and responsibly cooperate to come up with an universal design that responsibly resolves the problems.

      March 19, 2012 at 3:45 pm | Reply
    • abcdxyz

      Or live free AND die!

      March 19, 2012 at 5:46 pm | Reply
  7. REG in AZ

    Reality Check: Critics of Obamacare offer no satisfactory solutions. Blocking Obamacare instead of having bipartisan cooperation to fine tune it is literally irresponsible and serves only the interests of "the few". Our current system ranks very low for quality and highest for costs among the wealthy and advanced countries. Something really needs to be done and providing coverage for everyone is one of the definite requirements necessary to ever make it work. To be conned and manipulated into ignoring these realities and to support blocking Obamacare is not only irresponsible but also just ignorant with the result being to continue with some system that has the highest costs and actually low overall quality, to just be serving the interests of "the few". Those are the realities.

    March 19, 2012 at 3:34 pm | Reply
  8. Art

    And just where are you going to get the doctors we need? We're at least 150,000 short now and can't process more to replace those "boomer docs" that are going to retire in the next 10 years. Or do you think they will work harder that the "new docs" who insist they will only work 40 hour weeks and not the 60 hours older docs do?

    March 19, 2012 at 3:35 pm | Reply
    • Cindy

      They need to do away with quotas for doctors and nurses. They keep quotas so they can keep doctors wages high and nurses wages low.

      March 19, 2012 at 4:37 pm | Reply
      • max

        what are you talking about? there are NO caps on how many patients a doctor can see, there ARE caps on how many patients a nurse can take care of. the show mentioned about taiwanese doctors having to see 200 patients/day. and if you read above posts written by taiwanese doctors themselves, you can see it's not easy. imagine yourself being a waiter, can you serve 200 customers/day and still survive? we need to stop making doctors as evil, hungry for money. just like any professions, there are always few rotten apples.

        March 21, 2012 at 4:42 pm |
  9. Josh gonzalez

    I support a public option.

    March 19, 2012 at 3:43 pm | Reply
  10. why

    Canada's Ontario Health Plan is not perfect but very close!

    March 19, 2012 at 3:43 pm | Reply
    • Ed

      That's why Canadians come to the US for treatment.

      March 19, 2012 at 3:58 pm | Reply
      • BFC

        Canadians come to the US for treatment because of the misguided perception of the uneducated that higher cost = higher quality.

        March 19, 2012 at 4:04 pm |
      • john

        Erm, isn't it the other way around...?

        March 19, 2012 at 4:24 pm |
  11. Travis

    Fareed is ObamaCare's shill!!!!

    If you saw the special he had yesterday it could not be more clear.

    It was totally irresponsible of Obama and others to pass such a law when the country was in such bad financial shape.

    If more attention had been given to the economy we would not still be in the mess we are in.

    It was all about Obama's ego. He was more interested in creating his legacy than in the financial future of the country.

    He has take us to thebankruptcybarkruptcy even without ObamaCare. I saidbeginninge begining that ObamaCare alone could bankrupt the country.

    My issues is not so much thahappenedCare happend – but that irresponsiblyesoponsibily. No one understood it when it was signed into law.

    Nancy Pelosi's not famous quote"you have to sign it to find out how it works" should go dowoutrageousmost outragous, partisan self-serving and arrogant quote in the history of this country.

    Rome was burning -– and Obama and his minions were focuseforeignwar in a foriegn land.

    Shame on Obama – Pelosi and particularly on CNN for provforum a political forsurrogate obvious serrogate thatshouldd to make it sould like he is an objective journalist!

    March 19, 2012 at 3:54 pm | Reply
    • Eric

      *sigh* I really don't know where to start. clearly, you listen WAY too much to Fox News Traitors, who are ripping this country apart with their lies and twists on the truth, all for the love of ratings/money. Same goes for Fat-head Rush and and Ann Coulter and other fear and hate mongers. As others here have said, tweaking the current healthcare plan is the only sensible thing to do. Obama has admitted its not perfect and wants to work on making it right. What the hell more do you want? An entire Congress of people voted for it in this DEMOCRACY. And Fareed a "shill" for Obama? Did you listen to this? He actually says he doesn't agree that Obamacare is the answer!! But he, like Obama, says its a start. I want to see how you feel when you, your friends, and your relatives feel when old age or trauma and injury and sickness comes to you and how you feel about getting healthcare that won't put you in the poor house. I'll be willing to bet you'll be first in line complaining about your "rights" and how the government isn't doing enough to help you...

      March 23, 2012 at 10:17 pm | Reply
  12. Ed

    Zakaria and the people who think the European system is so great should go live there for a few years and see the reality of that system. They are either unaware of the dark side of these GDP numbers or are deliberately ignoring them. I lived for 3 years with a German-American couple. They did't have closets because the government considers them rooms for tax purposes, they didn't have an outside TV antenna because there was a tax on one, they pay horrific gasoline taxes, they pay even worse driver and car licensing fees. They pay hidden Value Added Taxes on everything. These taxes affect everyone regardless of income. They are used to subsidize all their social programs. Many of these subsidies (such as health care) go to programs in the form of government payments so the costs are kept arbitrarily low for the users. Business don't want to expand. They don't want to hire new workers and pay the payroll taxes.

    March 19, 2012 at 3:57 pm | Reply
    • BFC

      We pay the same taxes. We're just not receiving any of the benefit. In this country, our tax dollars go to oil subsidies, bloated military industrial contracts, and unlimited perks for wealthy members of congress.

      March 19, 2012 at 4:02 pm | Reply
    • Eric

      ... and that's why Germany is the strongest economy in the world right now....

      March 23, 2012 at 10:19 pm | Reply
  13. BFC

    I can't fathom how anyone can say our health care system is fine the way it is. The fact of the matter is the current system is indefensible. We pay far more than any developed nation and receive a far inferior service. Evey single person in the country, even those fighting vehemently against health care reform, is getting screwed over by the current system.

    March 19, 2012 at 3:59 pm | Reply
  14. PK

    Taiwan has 1.5% the population of the US. Switzerland has 2.5% the population of the US. To suggest that what works in those countries would work here is idiotic.

    March 19, 2012 at 4:04 pm | Reply
  15. Sheryl Mexic

    Go Obamacare. I have personally benefitted from it.

    March 19, 2012 at 4:08 pm | Reply
  16. James

    I am amazed by the food protions when I travel to the U.S. I look around restaurents and I see a large number of obese people usually with food that are inappropriate for their size and their health. I believe a lot more resources should go into preventive health care starting at the community and school levels. People must be educated on healthy lifestyles and eating habits. Just like a bar can be held responsible for serving execessive amounts of alcohol to patrons, restaurents should also be watching what they serve.

    March 19, 2012 at 4:12 pm | Reply
  17. John

    Amen to PK...the reason you don't compare the systems in Europe, are because their populations are larger and their systems don't work. You do what every liberal does, you hand pick the one or two instances where it "works," ignore the fact that there are almost no similarities between our countries, and trot it out as the perfect example of why we can make it work here!

    The problem of people not buying health care is that the government steps in a pays for treatment, or requires emergency rooms to do so, even when people who can afford health care but choose not to buy it come in for treatment. It's like handing out free chocolate bars while at the same time complaining that there is too much obesity. Stop feeding the moochers, and then they will buy health care.

    March 19, 2012 at 4:16 pm | Reply
  18. tbone

    Nothing EVER comes from the government free.
    and if government sponsored heathcare is so good, why are the Canadians looking to disband it for a free market system like ours? Because they cant afford it!
    And to the people who say Canadians dont ration health care; want to explain why the canadian hc system was under fire here a while back for denying care to the dying child that ended up coming to the USA for care?

    March 19, 2012 at 4:20 pm | Reply
    • Eric

      I've worked in Canada and talked extensively to the average Joe there and they LOVE their healthcare system. That's just the truth, like it or not.

      March 23, 2012 at 10:22 pm | Reply
  19. John

    And I notice that Zakaria doesn't argue the term "death panels," he dismisses it by calling it demagogue-ing, again a typical liberal tactic. How about engage on the issue instead of dismissing it. You are like people who dismiss criticism of Obama as racist, and never actually discuss the question at hand. The reason people call them "Death Panels," is because what will end up happening is that the decision made by a board will end up determining whether or not someone lives or dies based on some sort of actuarial table. If it doesn't make sense from a cost standpoint, the government won't cover it and basically condemn a person to die. Seems like the term is appropriate...

    March 19, 2012 at 4:21 pm | Reply
    • Cindy

      Where have you been living? We already have death panels based on your wealth. Do you think the poor guy could get the same treatment for pancreatic cancer as Steve Jobs?

      March 19, 2012 at 4:31 pm | Reply
    • abcdxyz

      Now we just let those who don't have insurance die. People, we ALREADY have health care rationing in the US, what don't you get?

      March 19, 2012 at 5:48 pm | Reply
  20. tbone

    ENJOY! Heres your future under Obamacare

    March 19, 2012 at 4:24 pm | Reply
    • Eric

      ...written by fear mongering facist Republicans... lies, twisted truths and spin. As usual, coming from the moronic right-wing.

      March 23, 2012 at 10:24 pm | Reply
      • Michelle

        Everyone republican and independent who loves America is not a moron. Please stop the left demeaning comments. I am educated and middle class as you would like to call it. I am a woman and a mother. We just don't want the dems who were against civil rights to begin with to try to take down this country again. and now claim you are for blacks and women what a joke... What are you for anyway... resentment, name calling, hate, civil anger? I just can never figure it out what are you so mad at? Why can't a republican or independant just say what they think without resorting to calling all of us stupid? How about just making your point and move on?

        Do dems take bully classes or were just raised this way?

        March 26, 2012 at 10:13 pm |
  21. Robyn

    So Republicans have set themselves up as the party that is against schools, colleges, children, old people, poor people, the middle class, science, history, art, music, medical care, liberals, moderates, normal conservatives, every religion except extremist Christianity, Every race except whites, Every ethnic background except England, and all women.

    Exactly who is left?

    March 19, 2012 at 4:26 pm | Reply
    • tbone

      racists like you that like to label everyone as if you have a clue how others really think.

      March 19, 2012 at 4:29 pm | Reply
    • jason

      Rich, white, extremely conservative Christian country club male is who is left.

      March 19, 2012 at 4:52 pm | Reply
    • JC in Western U.S.

      unborn children and men employed full time at jobs that offer health insurance

      March 19, 2012 at 4:59 pm | Reply
    • Eric

      Well put, Robyn. All that's left is Congress. It's become a career choice for most of them, because they know they will get rich-er in the job, either by legal insider trading or nice fees on corporate boards or other consulting positions selling influence.

      March 25, 2012 at 7:08 pm | Reply
  22. Cindy

    I have learned that the people holding the "Vote No" signs are the deadbeats. They do not want to pay for insurance, but they want to go to the hospital and want the rest of us to pickup their healthcare tab. The same group of people that never want to pay their bills.

    March 19, 2012 at 4:28 pm | Reply
    • tbone

      Close the ER to them.
      If they want to use it they can get job.
      Its called survival of the fittest and at last glance our world was overpopulated due to coddling these losers anyway.
      If they need help let them go ask the same religious venues that they like to treat as filth.

      March 19, 2012 at 4:32 pm | Reply
      • JC in Western U.S.

        And what do you say to people born with disabilities that prevent them from working and to the elderly who worked to make sure you had a roof over your head and food on the table. Are they expendable to you?

        March 19, 2012 at 4:58 pm |
  23. tbone

    Obamacare does nothing to fix the problem with todays health care system. It just takes control of it.

    If a MRI is 250 bucks in France and 1500 bucks here...... figure out why.
    Could it be the cost of malpractice insurance? Lawyers? Insurance Fraud?
    If US doctors have to pay $10,000 a year for insurance and in France its $500 does it take a rocket scientist to see where the cost is being recouped?
    Better not address the problem though when we can just takeover the whole system.

    March 19, 2012 at 4:28 pm | Reply
    • jason

      I work in MRI and I can tell you that it is not because of fraud or lawyers. It is because healthcare is a for profit game here, and with profit, more is always better. The medical device makers, hospitals and their administrators, doctors, insurers, all of them are on a gravy train. They don't want to get off. All of them have figured out that in the US, you can always ask for more for healthcare and they will receive more. So they keep asking for more. More profit, more bonus, more gravy.

      As long as the central purpose of a basic life necessity like health care is profit, it will never be cost effective.

      March 19, 2012 at 4:50 pm | Reply
      • max

        jason, you make it as though it is very easy to get an MRI authorized by an insurance company. i spent 3 hours on the phone to get them authorize it and even then, it may deny outright after the procedure done. medicare will deny paying for an MRI if it finds later that the film was normal and "unnecessary". maybe from your point of view, working in an MRI place where so many MRIs are ordered, you find that excessive. but for those that needs MRIs, not enough is done. so, which is it?
        people complain about insurance companies trying to make money by denying care. people also complain about doctors and hospitals trying to make money by providing too much unnecessary care. and then people lump these two groups together against patients.

        March 21, 2012 at 5:25 pm |
      • Eric

        Max, Jason is dead on right. The insurance company is the one trying to maximize profits by denying you. The pharma companies are trying to max profits by telling you to tell your doctor you need some pill they saw advertised on TV, and by bribing the doctors to prescribe their pills, with free vacations and other loot and kickbacks. Hospitals are advertising!! That alone is kinda creepy, when you think about it. This is America. It's ALL about money money money, and people and corporations will do ANYTHING to get more more more. It's human nature, but when combined with capitalism, you get runaway, sickening, greed.

        March 25, 2012 at 7:17 pm |
  24. Katy Brown

    The problem with any of this is the cost and affodability for the entire nation. There is little question that most people would like to provided everyone health care. But not at the cost of bankrupting our country.

    How much in taxes are we going to have to pay for this system to pay for itself? Why are 10 years of premiums being collected to pay for 6 years of benefits? That is not paying for itself!!

    What are the individual tax rates in these countries compared to the US? Do you know that a "Scandanavian" country like Sweeden has an income tax rate ranging from 54% to 61%. Are you willing to give up over 50% of your income in income tax so everyone can have health care? Then, you still have your local taxes, property taxes, state taxes on top of that?

    March 19, 2012 at 4:31 pm | Reply
  25. Rudolph

    Such fools here falling prey to the utopian scams being force fed.
    For any of the evolved folks out there, know that your children will grow up in a country where EVERYTHING is a right and EVERYTHING is FREE.... except the people

    March 19, 2012 at 4:33 pm | Reply
  26. Ken Margo

    The real problem is republicans brain washing/misinforming people. If republicans were honest, admit it is THEIR idea and explain to the tea party and other republicans it is the best for them. We can save money on lawsuits and figure out a way to makes things better to save costs and cover more people.

    March 19, 2012 at 4:49 pm | Reply
  27. SJSC

    Two problems with U.S. univeral care that will differ from Swiss:
    1) nothing the US government touches gets cheaper
    2) US govenment is becoming increasingly business-unfriendly – which is one of the positives noted of the Swiss plan.

    March 19, 2012 at 4:51 pm | Reply
  28. JC in Western U.S.

    We need to allow younger people the CHOICE (or not) to buy into Medicare for coverage, and make Medicare and private insurance co-providers on a percentage basis such as (just as an example) 80-20, with 80% of the premium going into Medicare and 20% to private insurance. Medicare would become the primary insurance and the private company would become the secondary insurance. The advantage to the employee is that Medicare travels with them, and they don't become indentured servants to their employer just for health insurance. The advantage to Medicare is that they would get additional premiums and younger (presumably healthier) participants. The advantage to private insurers is that they would only have to cover what Medicare didn't, and wouldn't be saddled with having to provide mandatory coverage of aging people in failing health.

    March 19, 2012 at 4:54 pm | Reply
  29. Steve

    Obamacare is not about health care being "free" – it's about managing it more effectively so we are paying less for the SAME health care, via insurance companies, per person. Simple. But so many of you have bought into so much spin and lies, you bite the hand that feeds you. So sad, and so ignorant.

    March 19, 2012 at 5:00 pm | Reply
  30. abcdxyz

    We're already spending 17% of GDP on health care–wouldn't it be better if we could at least make that 17% of GDP cover everybody? It's not that we're now not spending money on health care–we are!

    March 19, 2012 at 5:52 pm | Reply
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