Monday, August 17, 2009

Need Health Care Reform? Raise a Glass to the Swiss.



Given all the hot-under-the-collar hullabaloo over health care reform in America, I feel compelled to offer my fellow Yankees a drink. Let’s all peruse a wine list and chill out for a moment, shall we? How about a premier cru Chablis? Or a wonderful 15-year-old Bordeaux? Or, if you’re a Bubblehead like me, champagne? Veuve Cliquot is available in splits and full bottles.

This wine list I’m using, by the way, comes from a “semi-private” hospital here in Geneva, Switzerland – a “clinique” as they’re called. I am not kidding. In Switzerland, among other things, you can eat and drink damn well in its health care facilities.

When it comes to health care reform, everyone’s talking about our neighbors to the north these days. But I say: Yoo-hoo. Over here. I know it’s easy to confuse Switzerland with Sweden (or, in the case of our credit card companies, Swaziland), but you gotta check it out. Because right now, Switzerland probably has the system that’s closest to what Obama is ideally proposing for America. And lemme tell you, it doesn’t suck.

In Switzerland, everyone is required to have health insurance. This can be provided by employers (the cost deducted from your pay) or purchased privately. It’s not cheap. But for those who can’t afford anything else, a basic “public” health insurance is offered by the Swiss government at reduced rates. Everyone is covered, and there are no exclusions for pre-existing conditions. Admittedly, I don’t fully understand the nuts-and-bolts of the system – I think malpractice liability is also extremely limited here – and there are undoubtedly drawbacks, shortcomings, and abuses like anywhere else.

But overall, health care in Switzerland seems to be a hybrid between the socialized medicine of Canada and the current for-profit dysfunction of our own.

And the quality ranges from decent to ridiculously, obscenely good.

Case in point: that wine list.

At a clinique, you can come out of an anesthetized fog and order a bottle of Rasteau’s Domaine La Soumade’s Cuvee Prestige for only 34 francs. Or plunk down 120 bones for a 1994 Haute Medoc.

I know this because recently, I had a small, routine “procedure” done here in Geneva. In the US, it would’ve been performed as outpatient surgery, but in Switzerland, they keep you overnight because it involves general anesthesia, and they want to make sure you’re okay afterwards and infections don’t set in. Care and caution – not expediency – are the priorities.

Lucky, lucky me, I’d never had to stay overnight in a hospital until this point. Now I was going into a clinique where they spoke only French. To say that I was an anxious wreck is an understatement.

I should mention that I went to this particular hospital simply because it’s the one my doctor is affiliated with. Also, it required a guarantee from our insurer beforehand stating that we were, in fact, covered. My husband is what might be termed "an international civil servant," and I’m a writer. We’re comfortable, but in Switzerland, with its bankers and Saudi princes and gazillionaires, we’re probably barely middle-class. The health insurance we have is very good, though not gold-plated top-of-the-line. It covers us for roughly 80%. And the cost of doctors and such, as I’ve said, is high – at least as much as it is in the US.

Nonetheless, I was required to fill out only one short form before my admission to the clinique, and they dealt directly with our insurer for the guarantee.

Then, I was led to a gorgeous, phenomenally light and clean room that almost looked like a Philip Starck hotel. I was given a flimsy robe – but one that thoughtfully closed on the side – and also a pair of slippers! And a toothbrush with a tiny tube of toothpaste! And a comb! And a Caran D’Ache pen! (So sue me: I’m easily impressed. I still go bazookies over the little shampoos at the Marriott).

Then, I got a visit from “la dieticienne.” I thought she was just coming to tell me what I shouldn’t ingest after the anesthesia. But no. She wanted to know what I wanted for dinner after the surgery. Did I have any allergies?

“Well, goat cheese,” I laughed. “But I guess that shouldn’t be a problem here.”

“Actually, it is,” she said, straight-faced. “Tonight, we’re offering a warm goat cheese salad with fresh rosemary. I’ll make sure you just get the salad.”

Then, she held up a menu.

I had a choice, she informed me, between seafood lasagna and beouf bourgignon. Tarte tatin or a berry cobbler.

“You’re fucking kidding me, right?” I said. “Ha. Ha ha. I suppose you’ve got a wine list, too?”

With a shrug, she pointed to the drawer in my nightstand. There, right between the tv remote and the bed pan, was the wine list.

As soon as she left, I told my husband that – if I did indeed survive the 20-minute procedure – he had to go get our digital camera and photograph all this shit. Otherwise, folks back home would never believe it. God knows I didn’t – and I was sitting there.

After I’d placed my dinner order, the anesthesiologist stopped by to confirm what we’d discussed during our uninterrupted, 45-minute meeting the day before. I got several lovely visits from nurses as well. And then, after the 20-minute procedure – which went without a hitch -- my doctor came by to see me. Twice.

And I got not only a three-course dinner, but a three-course lunch before check-out the next day. Salad Caprese. Fish in a beurre-blanc sauce with potatoes “nature” and homemade wild mushroom ravioli. I shit thee not: it was one of the best meals I’ve ever eaten. I almost forgot dessert – blackberries in a red wine sauce. They served it to me when I was already changed out of my robe. “Madame, n’obliez pas votre dessert!” the nurse cried.

M’am, don’t forget to eat your dessert.

That was the only thing they handed me before I left – no further forms to complete, no bills to pay. Just a spoon and a cup full of berries.

God, I loved that clinique.

This is semi-private Swiss health care.

Now, I’m aware that comparing Switzerland’s system with America’s is in some ways specious, misleading, and unfair. Apples and oranges, to a degree. The entire population of Switzerland (7 million), after all, isn’t even equal to my hometown of Noo Yawk alone. It’s easier to provide excellent health care to a limited number of people with a huge amount of resources – especially when these people are generally in fine shape to begin with -- given their mountain air, and their perverse addiction to things like hiking, biking, and skiing, and their high standard of living and excellent fresh food an’ all.

What’s more, unlike us Americans, the Swiss are, well, how to I put this? Anal. They’re not only highly organized, but reserved – there’s none of the rhetorical or emotional extremism that we have in America. Temperamentally and culturally, they’re a lot more community-minded and a lot less freewheeling than we are.

While this can make for some truly terrible rock’n’roll, it can also result in remarkably shrewd, balanced, and humane policy-making. They’ve managed to strike a balance between single-payer, universal, “socialist” health care and a system where 15 percent of the population goes uninsured, a pre-existing condition can screw you for life, and even those with coverage can go bankrupt after a single nasty twist of fate. It's also a system that incorporates holistic and preventive medicine: massages and herbs, anyone?

Sure, I’ve had a bad experience or two with Swiss doctors – one ob-gyn kept fondling my breasts long after the exam was over – and my little stay at the clinique cost my husband and I a hefty amount out-of-pocket when all was said and done, too. Like I said: it ain’t perfect.

But in certain ways, it’s better. So while many Swiss doctors do some of their training in the US, some of our policy makers might want to do a little more investigating over here in return. The Swiss system has its costs and inequities, but nobody’s uninsured, or denied coverage because they once had a polyp, or living in fear of losing their job because it means their asthmatic child will go without medicine, or having to take out a second mortgage because their spouse had a stroke and they’ve maxed out their lifetime deductible.

The Swiss system strikes a balance between the private sector and public health. It’s pricey, but humane and inspiring. It suggests what can be delivered when the focus of medicine is on healing and prevention.

I, for one, will drink to that.

4 comments:

fivecats said...

careful or the Righteous Right are going to start saying Obama's plan comes with a Wine List, too.

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Chantal said...

Enjoy your blog. I've heard great things from women who had babies in Switzerland too. Sounds like one big fancy hotel experience, with a little blood on the side. Great article in the New York times comparing the Swiss healthcare system to Obama's plan: http://www.nytimes.com/2009/08/17/opinion/17krugman.html?_r=3

Richard said...

I absolutely love that country, we come and visit as frequently as $$$ allow. Also, they nurse anesthetists there, just like in the US...Ausgezeichnet (whoops, wrong part of the country)

DavidShag said...

I have yet to hear of an industrialized country (including Canada) where the majority - (usually overwhelming majority) don't LOVE their health care system. Americans, despite lip service - believe in equality less than any other nation in the world. They LOVE the idea that the lottery of luck might wind them up on top, and just in case it does, they want nothing to interfere with their ability to lord it over the less lucky, who will then be derided as sinful, shiftless, lazy and whiny. If feudalism were ever put to a vote, and neither party spoke out on it, folks would vote it in by a landslide. Here, where one daily hears that we have the "best health care in the world", 100,000 people a year die from things they CATCH in the hospital. You are speaking to the irrational. Congratulations on discovering the awful truth!