What aspect of America's immigration model do you think intersects with this?

> You said private healthcare/insurance were to blame. Switzerland has private health insurance.

Private business in all western countries operates within the regulations and laws that cover them. The health insurance industry in Switzerland operates under a very different set of regulations and laws than the same industry in the USA. If you want to blame the OP for not being more explicit - "private healthcare/insurance and the regulatory framework are to blame" - then fine, but ... this is actually the crux of the issue.

> but ... this is actually the crux of the issue

I'm not sure it is. Universal healthcare is orthogonal to private health insurance. That's the lesson of Switzerland's example. I don't believe this is commonly known or accepted in American politics. Instead, any attempt at reform is pitched and vilified as an attempt to end private health insurance and healthcare.

It may not be commonly known in the USA. However, I'm a european immigrant of 33 years, and it's well known to me.

However, "private health insurance" is not, in and of itself, really "a thing". Only "private health insurance plus a regulatory structure for it". It is in this department that the US falls over so badly, while, for example, Switzerland gets it (mostly) right.

Not sure why you're getting downvoted, but this is exactly correct. Universal healthcare != public healthcare.

Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk.

Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere.

> Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance

So does the US: https://www.healthcare.gov/glossary/minimum-essential-covera...

> there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk.

> Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere.

You're mistaken, Switzerland has no centralized social insurance — it is fully privatized (for real medicine as well as alternative medicine), and is decentralized among its Cantons. It's just that the private Swiss insurers tend to be non-profits (same holds true for the US, e.g. Blue Cross, Kaiser, etc) and the for-profit insurers' profits are heavily capped/regulated (same holds true for the US).

Social insurance is covered by AHV/SVA/IV (funded by salary deductions and cover congenital defects, invalidity, some rehabilitation therapies and other non profitable coverage) and of course healthcare is not fully privatized as you say: private insurances are private, offering highly regulated compulsory insurance and can offer less regulated additional insurance. Some hospitals/clinics/health and elderly centers (cantonal) are kept with public debt & public donations even if deficitary because private clinics would be unprofitable otherwise.

I don't know if you legitimately do not know that.

I did not talk about federal/cantonal to avoid writing a thesis in a comment. I never said it was centralized.

You're conflating Switzerland's social pension with the Swiss health insurance system. Swiss pensions do not subsidize the cost of healthcare delivery, and are not used to cover health costs at the point of service (for real or alternative medicine). The payment of healthcare at the point of service is facilitated by a fully privatized industry of insurers.

Salary deductions pay for subsidies to lower income beneficiaries to purchase the same private health insurance (KV) as everyone else. This is more or less identical to the US's ACA, and in fact the ACA was modeled after the Swiss healthcare system.

The one big difference between the US's ACA and the Swiss healthcare system is that the ACA also included an employer mandate and stimulated a regime in which the majority of working-age adults receive their private health insurance from their employers as opposed to the individual market, which is not how the Swiss KV works.

I guess that you don't know that, for example, if you get operated of a congenital defect in Switzerland, the bill goes to the SVA instead of to your private insurance (and so on for specific cases)

I am not conflating anything, you have a superficial understanding that makes you think it is privatized. If you dig into the spending public & private and the actual details you would see that Switzerland is not privatized as people generally think.

I'm referring to the majority of working age adults.

Even the US uses Medicare for certain congenital diseases as well (as well as end-stage renal disease).

The Swiss private KV system accounts for the vast majority of health expenditure, even more so than the US where half of health expenditure is nationalized in Medicare and Medicaid.

But another way in which Switzerland maintains its healthcare system with public money is through the -often deficitary- cantonal hospitals/clinics/health care centers (also helped at the municipal level)

As a heads up, ‘deficitary’ doesn’t mean ‘deficit running’ in English. It is closer to the word ‘deficient’ which I don’t think is your intended meaning. Thanks for the insightful comments.

Thanks for the comment! I was meaning the former (under debt).

The intention of my comments was to make clear that in that regard, Switzerland is not an efficient free market private insurance paradise. There are lots of nuances to it, and the private insurance system in fact brings in inefficiencies, namely, a very complex and costly cost itemization and enormous amounts of paperwork and stress for doctors, customers, employers, and the insurances (for example, if there is an accident in a public place involving a car, there are at least one or two days worth of people's times just filling in forms)

I'm not sure that your argument makes the case you think it does. The majority of Swiss health expenditure is in the private sector (which differentiates it from many other healthcare systems). Subsidies and municipal market participants do not change that fact. In every industry in the world, the government may play a participatory role within a greater market. We see this in the US in the food industry as well (food stamps, food banks, etc) — but that still doesn't change that it is essentially privatized. If the US adopted, like-for-like, Switzerland's healthcare system, the US's public spending towards healthcare would decrease, not increase.

Fortunately, life-threatening, chronic, bankruptcy-inducing, rare-and-disabling conditions represent a relatively small portion of the total healthcare spending (removing the most widespread chronic conditions). Those are also the least profitable things to insure (require a constant and sustained spending to maintain the knowledge/capability and fund research even if underutilized) if we want to ensure that any human can get reasonable access to those treatments regardless of their wealth. For this reason, countries like Switzerland or Germany maintain a "healthy" public (with lots of adjectives) healthcare system alongside.

This is where you might be out of your element, it seems. Life-threatening / chronic / bankruptcy-inducing conditions do not represent a "relatively small" — at least in the US, 90% of health expenditure is on chronic health conditions (https://www.cdc.gov/chronicdisease/about/costs/index.htm) — this includes heart disease, stroke, cancer, and diabetes. I work in the industry and this comports with what I see on the ground as well.

In Switzerland (and also the Netherlands), the vast majority of this is covered by private health insurance, not via any sort of public health insurance. That's what sets Switzerland and the Netherlands apart from other peer developed countries, and they have results to show for it.

Regarding rare conditions, we agree — even the US has a public healthcare system alongside which covers rare conditions (e.g. end stage renal disease). US's Medicare Advantage system of private individual health insurance for senior citizens (with Original Medicare as a public option) is also a proven model with results to show for it. The CBO expects that by 2032, 61% of health insurance expenditure for senior citizens will be by the private sector (https://www.kff.org/medicare/issue-brief/medicare-advantage-...).

OK - sorry then! That makes total sense too; I was simply reading too much into the payments discussion happening. Thanks for being polite and for your contributions.

But that’s the same as the US. If you are born with a disability you can get social security insurance (SSI) payments that can also qualify for public (Medicaid) insurance.

https://www.cbpp.org/research/social-security/ssi-a-lifeline...

TIL Blue Cross is a "non-profit"

Blue Cross is sort of a franchise system with different regional/state franchises. All of them were originally nonprofit but many have changed over the years to be for-profit (notably BCBS of California, for example). My local franchise, BCBS of North Carolina is still not for profit: Blue Cross NC is a fully taxed, not-for-profit North Carolina company with major operations centers in Durham, Fayetteville and Winston-Salem. https://www.bluecrossnc.com/about-us

Ah good catch I was moving the goalposts there - I think in my head public and universal and basically interchangeable - if everyone has it is it a public good regardless of if it's provided by a collection of "private" companies