Realistic Healthcare Reform for America

my experience with three healthcare systems and why the swiss model may be the next frontier

My intention was to get this article up when the topic was unavoidably relevant 👀, but life and my own procrastination had other plans. Regardless, it’s STILL relevant, despite it not being in the news, that America’s complete joke of a healthcare system is broken and Americans live every day with that low-buzzing, subconscious stress that they are one medical bill away from bankruptcy. (Unless they’re a billionaire… but friendly reminder, most of us are closer to living in poverty than being a billionaire… even if you’re a millionaire).

Anyway, health insurance and the U.S. healthcare system has been a hyper-fixation of mine since 2017 when I, a financial coach, had a medical bill go to collections.

Backstory

First of all, I didn’t even know about the bill–I was living that digital nomad life at the time and my providers were still sending paper bills in the mail… who does that anymore?!? I only found out about the collections when I touched down on U.S. soil and inserted my Verizon sim card to be welcomed by a voicemail from the collections agency. I called them back, explained my situation, and they basically took it out of collections and wiped it from my record (I’m still shocked) and THAT, my friends, is why you pick up the phone and just ask because you literally have nothing to lose.

My radicalizing moment came when I then proceeded to spend hours on the most infuriating three-way-call of my life, with my insurance company and the billing department of my health clinic, listening to both of them talk about how there was “nothing they could do” to change the coding on either end so I was just stuck with the $3k bill for blood work… BLOOD WORK!!! (A $200 out-of-pocket charge if I would have just made the hour-long drive to a goddamn Quest Diagnostics instead of my local hospital’s health clinic, which I pre-confirmed was covered under my insurance.)

I think 9 out of every 10 Americans has a version of this story. Many stories being way more sad, frustrating, and bankrupting than mine Any way you slice it, the most uniting issue in this very divided country has to be that our healthcare system is broken and health insurance feels like a giant scam. And as we just entered 2025, most of my clients saw a premium increase without any real value of benefits being added (probably some got taken away).

Now that I’ve lived in two other countries outside of the U.S., each with very different healthcare systems, I feel like I have some experience to share. Does that make me an expert? Absolutely not. I have no idea what would or wouldn’t work in America, or why we have failed to do anything about the decades long issue (besides the half-assed attempt with the ACA… which is still something, better than nothing) but maybe just sharing how health insurance and healthcare accessibility works (and actually functions) in other countries with my fellow commoners can somehow trickle its way up to the decision makers and get some functionality into the system… somehow.

In any case, you’re about to learn how the Swiss healthcare and health insurance system works. Are there flaws? Absolutely. But as far as America is concerned, literally anything is better than the dumpster fire we have now. And I find the Swiss model to be the most realistic “disruption” for the American ways.

The Ideal World vs. Reality

Before digging into the Swiss system, I should mention that I did live in Italy for two years… a place with a national healthcare system, where you pay next to nothing to see the doctor and get your prescriptions. My inhaler medication (Ventolin) without a prescription or national health insurance card was 3 Euro…. if I would have had a health insurance card, the medicine would have been 1 Euro. A joke when comparing it to my $52 per inhaler I paid back in the States. For even greater contrast, an EpiPen would run you 15 Euro* with a prescription. (*prices could be different as it’s been years since I checked)

In a perfect world, we'd ditch health insurance altogether. It's basically a middleman that makes everything slower and more complicated. A single-payer system, where the government covers everyone, would be the ultimate goal. Healthcare is a human right, after all, not a luxury.

But let's be honest, America has trust issues when it comes to the government. We've been conditioned to believe that anything public is automatically inferior. This exists because our politicians choose to “starve the beast” by underfunding public services, making them inefficient and ineffective, leading them to be politically unpopular, thus serving the politicians’ goals to cut spending to said services in the first place. If you’ve ever wondered, “the U.S. is one of the richest nations with the most brilliant minds and most cutting-edge technology, why is it so archaic to get my passport or file my taxes?” that’s exactly why.

The truth is, this "public services are bad" narrative is often manufactured, and lobbied heavily by for-profit, private institutions. Powerful corporations and politicians benefit from keeping us convinced that the government can't do anything right and public services would be a poor use of our taxpayer dollars.

So, while a single-payer system might be a long shot right now, we can still take inspiration from the Swiss model. It proves that Americans can actually keep their private insurance and have affordable and accessible healthcare.

The Swiss Model

Here's how the Swiss keep their healthcare system in check:

Mandatory Coverage:

Everyone in Switzerland is required to have health insurance. We had three months to secure ours upon becoming residents, and it was retroactively applied to the day we moved to Switzerland. This creates a larger risk pool, which helps keep costs down. All adults and children are required to have their own individual policies.

No Employer Sponsored Plans: Since coverage is mandatory, health insurance is not tied to a Swiss resident’s employer. This makes insurance equally accessible to all residents and simpler for all employers in Switzerland to manage benefits. Some employers opt to provide a “health insurance benefit” in the form of pay each month to cover the costs of an average policy, but if you lose your job, your insurance, coverage and premiums all stays the same.

Subsidies: Since basic insurance is mandated, the government does provide subsidies to help lower income individuals afford their premiums, similar to the ACA in the United States. Switzerland is still a very high-cost country, with health insurance being a decent expense (but generally much lower than comparable policies in the U.S.) and although minimum wage is something like $3k per month, families earning under $120k per year can often qualify for government assistance. (That’s because our cost of living is bonkers, not because the government is overly generous.)

Basic Compulsory Coverage:

Since everyone is required to have insurance, every insurance company is required to provide a basic level of compulsory insurance coverage at nationally standardized deductible amounts. (They use the term “excess” instead of deductible.) The lowest deductible being (CHF) 300 Swiss Francs per year for adults, CHF 0 for children up to the age of 18, and the highest deductible being CHF 2,500 per year for adults and CHF 600 for children which many with low medical needs opt for in order to get a lower premium.

This basic compulsory coverage covers a lot of things (as it should) from full coverage of pre-natal and post-natal care for birthing mothers (you don’t even have to hit your deductible to get full coverage when pregnant), to doctors visits, prescriptions, hospital visits, psychology, and seeing many types of specialists as long as you’re referred to by your physician (or you pay for a different, more expensive level of insurance).

Supplementary Insurance: Although the compulsory insurance covers the basics of what you would need in terms of healthcare, some opt to add additional supplementary insurance options onto their basic package. My husband and I both have a preventative supplemental policy costing us each about CHF 15 per month and it provides us each with a gym membership reimbursement of up to CHF 500 per year, coverage for travel vaccinations, and lots of extra maternity benefits like reimbursements for pre- and post-natal courses.

We also have another supplemental policy costing us each about CHF 30 per month (with an additional deductible of CHF 600 for these specific treatments) that provides coverage for treatment abroad (since we’re both expats and do a lot of travel) plus reimbursements for alternative treatments like acupuncture, massage therapy, osteopathy, and a wide variety of other offerings.

Finally, most insurers will offer a supplementary add-on for hospital coverage. Although the compulsory plan covers you for a hospital stay, your recovery is often in a “general ward” which could mean you’re sharing a room with up to five other people. Honestly, if you’re in the hospital recovering from emergency surgery, I’d imagine you’d take what you get if that’s what you can afford. But again, many people opt to pay for semi-private or private hospital coverage so they can have more choice of the hospital, the doctors who see them, and the privacy of the recovery rooms.

Alternative Models: In addition to the standard coverage model (basic coverage with free choice of doctor) there are alternative models that many insurers provide that can make your premium more or less expensive by restricting provider choice. The health maintenance organization model (aka HMOs - which my husband and I have), family doctor model (those first two being that you need to see a physician before getting a prescription or seeing a specialist) and telmed model where you need to call a hotline prior to seeing a doctor. All of these more “restrictive” models would reduce the premium of the standard coverage model which likely prevents abusive practices people may engage in by freely seeing specialists and requiring insurance to cover it.

I bring up these supplemental policies and alternative models because I think most Americans believe that a public health system (or a system that’s not for profit and more fair, like in Switzerland) would mean you don’t get any choice and are left with archaic, non-functioning solutions. But the reality is, these systems provide basic services to everyone (which is honestly good enough for all of us), and they also oftentimes provide those who have the funds and want to be particular with their treatment the options to have what they want and need. Yes, you have to pay more, but look at what we get in the U.S. for paying our sky-high private health insurance premiums!?! Usually fancy looking hospitals and private recovery rooms, but actually, a nightmare of bills to pay because your insurance doesn’t end up covering it OR hours of headaches and paperwork and so much waiting on hold, assuming you have the time, to get them to pay up.

Non-Profit Insurers:

Insurance companies in Switzerland are non-profit, but they haven’t always been. In 1994, they adopted a system of universal coverage based on a private insurance model, requiring all insurers to provide basic coverage without making a profit. This means they're focused on providing affordable coverage, not maximizing profits. (Shocking, I know.) I did learn recently that the supplemental coverage that anyone can add to their basic plan can have a profit incentive, and honestly… fair.

While the companies don’t focus on profit, they still have to compete with each other, which keeps the costs of coverage within a comparable range, at least within the canton they are operating in.

There are 56 nonprofit insurers that compete on cantonal exchanges. A Swiss canton is like a state in the U.S., and health insurance premiums in Switzerland are priced based on age, the canton where you live, which model you choose and your deductible (plus any supplementary additions).

The 26 cantons in Switzerland are still ripe with options. (Remember, Switzerland is a very small country, the population of the U.S. is nearly 38 times larger, so when contrasting the 56 insurers here to the almost 1000 insurers in the U.S., Switzerland actually provides MORE choice per capita.)

Probably the most attractive and, one would think, intuitive solution to America’s broken health insurance system is to make the insurance companies not-for-profit. Therefore, they can focus on providing the best service and care (the real purpose of a health insurance company) rather than figuring out how to further fuck over its customers in order to be more profitable.

Government Regulations in Healthcare:

It also helps that the Swiss government, during the 1994 reform of a system that previously looked much like our current U.S. system, began regulating costs on both sides of the spectrum. Requiring the same basic coverage provided equally to everyone from the insurers, at standardized deductibles, but also negotiating prices with hospitals, doctors, and pharmaceutical companies to provide cost controls and keep prices from spiraling out of control.

The goal of regulating these costs, covered through the basic insurance coverage, is for providers to charge a rate structure that provides high-quality and useful healthcare at the best possible price that is cost-effective and equitable. Naturally, this keeps things fair for the private, not-for-profit insurers, as it helps them keep their business model functional and premiums competitive, but it’s also keeps cost down for the individual who may have to elect for a non-covered treatment. Recently, my husband elected to get an MRI even though it wouldn’t be covered by insurance. The service cost approximately $500 in Switzerland, an offering that averages closer to $1200 in the U.S. (but varies widely just depending on where you get it).

The Challenges

I’m not naive to the fact that the American way has become increasingly individualized and isolationist. I wish every American could spend sometime in a country where they don’t have to live with that low-buzzing, always-there, unconscious stress of the lack of the existence of any type of safety net.

We’ve politicized government regulation so much that it’s viewed as anti-business, anti-winning, and anti-American, so much so that we’ll vote against our own best interest to disrupt and reform the system. We tried once with the ACA (but it got stripped of its parts so much that it became only a little impactful) and I fear we’ll never get there again. Here are the challenges I foresee with trying to implement a more equitable, but still “privatized” (because, America) Swiss system:

Challenges with Mandatory Coverage:

Obama tried to include a national mandate on health insurance when he first introduced the ACA, but it was struck down as unconstitutional, so this could be a big challenge to implement in the U.S..

However, if you consider the fact that 49 out of 50 states in America legally require all drivers to carry a car insurance policy, it’s not a huge leap to get health coverage on that same mandatory level. The argument may be that car insurance is about liability (the harm and costs you could pose to others by driving a car) but if you consider that uninsured persons accessing medical care tend not to pay their medical bills, a similar liability of high costs gets rolled over onto other insurance-carrying citizens. There’s an argument there worth making, and certainly some research to back it up.

Challenges with Making Insurance Companies into Non-Profits:

I’m sure there’s a constitutional limitation there, and shareholders would be up in arms. It would certainly be unsettling in the financial markets, as a whole. But sometimes big disruptions need to be made for the basic human decency and equity to a civilization. Americans are suffering under this inept industry, and taking the profit-motive out of it could be the real solution we’re looking for.

Challenges with Cost Control Regulations:

Americans are always chirping about government overreach in the private sector, and under our newly sworn in administration, I have no hope for any further regulation taking place… well, in any industry. Cost controls, however, end up benefiting everyone when we’re all on the same page and same team. Once we remove for-profit initiatives from health insurance, they’ll be begging for cost controls implemented by federal or state governments. Individuals benefit no matter what. And the government, which ends up bearing a huge brunt of the inflated costs of our current healthcare system, would prosper.

Probably a pipe dream:

This is already a terribly long article so I won’t harp on any longer. Just to say, I recognize that this is probably a pipe dream, but as I mentioned at the top: knowing what’s possible and how other countries operate (even if you can’t move there and experience it for a year yourself) is what can make real change possible. Keep learning, keep talking, and let’s all hope that one day healthcare in America isn’t seen as a “privilege” but a “basic human right” even if we’re mandated to pay for it… at least we’re all guaranteed that basic level of care.

Work With Me

Hey! Just because the system we have to operate in isn’t ideal, doesn’t mean you’re doomed to struggle within it. If you’re finally making some good money and feel like you should or could be doing better, but somehow are still struggling to get by… OR if you’re absolutely crushing it but you know you could put your money to better use and optimize things a little more (let’s take advantage of those tax breaks while we have ‘em!) then I’m the person you want on speed dial.

I work one-on-one with individuals and households bringing in over $100k a year and looking to optimize their cash flow so they can win the money game in this somewhat treacherous system. Click here to learn more about my CFO Method or jump straight to my client intake questionnaire so we can start working together. Chat soon!

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