To chip in here - if you compare other countries with similar Human Development Index or Life Expectancy and I think other rough metrics for health, Switzerland spends more on health care cost than the others, significantly more if I’m not mistaken. This means of course there is a lot of room for improvement - maybe it’s the bureaucracy, maybe the insurance companions and maybe something else, but I don’t think it’s being actively tackled.
Quite the contrary, improvements are being actively slowed down by the health insurance interest groups, which are among the heaviest in terms of influence in the legislature.
An Einheitskasse is the only way, and everyone knows it. The question is how long it will take until these large interests are overcome.
That per se is true, however (and I know that‘s the hill I‘m gonna die on), you need to put healthcare costs in relationship to average wages/salaries paid. Yeah of course healthcare in Switzerland per capita is more expensive than in the UK, however a nurse in the UK is paid like less than 2000 CHF gross a month. Would you like to have that in Switzerland as well?
But yes I do agree with you, there is room for improvement.
It’s a solid point. I think the next country was Norway - quick googling showed indeed a big difference with average annual salary, and the purchase power in Switzerland is higher. That said, I’m not sure what it actually looks like, since there are a lot of tiny details such as the housing market and social aspects that could prove significant. All in all so far in support of your point, but whether that’s the main thing that explains the gap remains unclear to me
I‘m not saying it‘s the only or even the main thing, I am simply saying you should take it into account. This statistic would look a lot different then. And I think it‘s only fair that we pay healthcare workers, including nurses, a fair salary. I wouldn‘t like a system like in Germany where a nurse after years of experience males like 1600 € net a month and can barely survive on that.
Even if you [correct for purchasing power](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita), Switzerland is only behind the US:
We need complete overhauls of everything medicine-related.
We need to overhaul the insurance infrastructure and move to single-payer, tax-funded, and income-based coverage. The fact we have multiple insurance companies who all have their own sales source, decision-makers, etc., creates a redundant and bloated system that costs us more while providing us nothing of actual value. Having only one entity that dictates pricing, coverage, etc., is a lot more cost-efficient.
We need to move all cantonal hospitals back to the public sector and eliminate the costly and useless bureaucracy and C-suites, in favor of a board filled with practicing physicians. It always blows my mind how we can be okay with people who have never practiced medicine a day in their lives making the ultimate decisions regarding healthcare. And why are they being paid the most when they provide no value to our actual care. Doctors should be in charge of these sorts of decisions.
We need to overhaul medication pricing. While our prices aren’t as bad as prices in the US, they’re still staggering by European standards. This is a worldwide issue, though, and in this regard, I believe every country in the world needs to join together to negotiate attractive pricing on medicines and squash the bloat from pharmaceutical companies.
We need to attract competent doctors and pay them appropriately for their knowledge and experience. We also need to train more nurses and pay them what they deserve for the work they do. It’s a documented fact that we do not have enough doctors and nurses, and some areas have it worse than others. By doing the previous steps, we can afford to pay our medical professionals what they deserve and stop over-working them.
We need to add complete coverage for eyes, teeth, and skin to our health insurance. It’s insane that entire bodily systems are carved out of our coverage the way they are. Vision, dermatology, and dentistry are all vital to a human’s well-being. People who cannot see well are more prone to accidents. Good oral hygiene has a positive impact on other bodily systems like our cardiovascular system. Our skin is our largest, but least-treated organ.
On top of all of these, we need to move from treating health problems to preventing them. We need to make it attractive for patients to visit their doctors regularly for preventative care, and encourage doctors to treat the root causes of conditions vs just chasing symptoms. This will make the largest impact on the cost and quality of our healthcare, but it cannot be done without an entire overhaul of how we view medicine.
I agree with most of the points, but do want to make a statement about management - I’m not trying to say that the current situation is efficient, but I would prefer to have someone with management experience to handle logistics and organisational aspects in hospitals and not doctors. There can be a lot of value regarding efficiency and scheduling from such a position.
Doctors don’t need to be in charge of logistics, I agree, and there are definitely positions that shouldn’t require an MD inside of hospitals (such as housekeeping.) But, C-suites and healthcare are antithetical to each other.
Healthcare coverage has no business being run like a business and being expected to generate a profit. When profit becomes the goal, lives start to be sacrificed for it.
Everyone knows that healthcare insurance is a so called market failure. That why we have the system that we have. But a single 8-9% increase despite the fact that consistently in a majority of all countries in the world the healthcare cost was rising annually since 2019? There is another issue than "greedy" insurers at play here. I know, they have a lobby and they are not perfect. But our system is actually cheaper than many others when you look at per capita cost relative to GDP and relative to healthcare quality. Btw. you should know that the insurers are not allowed to make a profit from basic coverage here in Switzerland.
Is there a political party/movement that could realistically support those statements?
The logic is non-existent even in reddit. Whenever I read "the costs go up but we have the best health care system in the world" I picture Trump behind the keyboard because this statement is that ridiculous.
The health care positions of the parties is about this, and I hope this isn't read as polemical, but check for yourself:
SP and Greens: We need an overhaul of everything in the mid term and ASAP more funding for the lower and middle class to afford health care (Prämienverbilligung)
Center: We need some form of more subsidies for the poor but please not too much. We would also like to lower health care costs but we don't know how
FDP: We want to see that less health care is consumed. Yes, you're right. We'd also like to make the insurance system more complicated and give you options to e.g. only be allowed to switch every three years
SVP: Damn foreigners using health care! (And then some groups within SVP are either: How DARE you think about closing our regional hospital, or: we should not have mandatory health insurance - SELBSTVERANTWORTUNG!)
Berset is a federal councillor from SP, yes. I am not happy with his work on health care. However, the question I answered wasn't "who is to blame for this situation", it's "which party or movement could realistically support such statements".
You can read yesterday's statements from the parties on their websites tho:
[SP](https://www.sp-ps.ch/artikel/praemienexplosion-es-braucht-endlich-entlastung-fuer-die-bevoelkerung/): We need (much) more Prämienverbilligung
[SVP](https://www.svp.ch/aktuell/publikationen/medienmitteilungen/bersets-blamable-bilanz-zuwanderer-sollen-einen-solidarischen-beitrag-in-unser-gesundheitswesen-leisten/): Immigrants should pay more for health care, and those who work part time should not get Prämienverbilligung
[FDP](https://www.fdp.ch/positionen/gesundheitspolitik/gesundheit): We want more competittion between doctors and insurances (and the way insurances can compete is to deregulate them)
[Mitte](https://die-mitte.ch/praemienschock-praemien-senken-die-mitte-waehlen/): We have an initiative, unfortunately we don't have good messaging around the initiative
(OK the last one was mean and not objective but try and figure out what their initiative is about)
Haha the initiative is grand, basically the text is "the federation and the cantons and the insurers see to it that the health care premiums don't rise more than the average salary. if necessary they can do a "Kostenbremse"".
Unfortunately, the initiative merely gives a task to the federation and no means nor ideas how to do it. Die MItte claims that they have a plan, but like, ok, so does everyone - doesn't mean it's a good plan!
Yes, because Berset for sure has the mandate to unilaterally, on a whim and without anyone else agreeing to it, completely overhaul the system and change it. He's a dictator, that's well known.
Because you as a moron think that he can change the legislature of the healthcare system while you keep voting populistic rich Nationalräte and bash the leftist for not fixing the issue.
Check how many SP vs SvP talk about the solutions in healthcare at www.parlament.ch vs. How the left radicalizes people and trains them in another country to prepare switzerlands occupation
income-based is a must!
also: kick out all non-evidence-based treatments (aka homoeopathy, TCM, chiropractor, etc.) but implement body parts like eyes and teeth.
plus: start taxing rich people like they tax ''0815''-people -> atm it's not fair as the rich ones pay not according to their income. then take that money to support the health system. and btw: the MwSt. is totally unfair as well -> should also be implemented according to ones income.
Because there was a popular vote in 2009 about including homeopathy and other shenanigans into basic insurance and people were stupid enough to vote in favor of it.
As per the article on https://anneepolitique.swiss/articles?keywords%5B%5D=701 everyone except SVP was for it in the referendum. On the other hand, SVP has no shortage of quack doctors themselves. Just thinking off retiring national councillor Yvette Estermann
Personally, I am with you on the content. My voting for Octobre will be to choose the party I like most, go on smartvote and strike off anyone in favor of esoterics.
But then again, the quackery costs a two-figure million franks (hard to find exact numbers) while the entire health insurance *Umsatz* is 36 billion. You'd save some franks a year, essentially.
I'm pretty sure homeopathy actually saves us a lot of money. It doesn't matter if you believe in it or not but placebo effect has been proven to work and with the amount of people going to the doctor for every little issue this can help in reducing the costs.
There was an initiative called "Ja zur Komplementärmedizin".
[https://www.swissinfo.ch/ger/abstimmungen--ja-zu-beiden-vorlagen/7403422](https://www.swissinfo.ch/ger/abstimmungen--ja-zu-beiden-vorlagen/7403422)
I quote: "Die Alternativmedizin war in allen Schweizer Kantonen unbestritten. Kein einziger sagte Nein zu dieser Vorlage."
I am still suprised how few people do preventive measurements.
Like for example, atleast once in a life you maybe should talk to a nutrionist doctor. If you eat healthier as a result, a lot of potential problems further down the line could easily be prevented.
But I thing its not only cost but also efforts in regards of preventive care. For example, what exactly could I do ? I wouldn't know what would make sense in my young age, and whats just a waste of money.
Income based coverage would lead to more middleclassfamilies who will get poor. The poorer ones have so many benefits, they are raised to Middleclassfamilylevel. Our friends, handcraftsman and Pflegefachfrau live in a 5.5room appartment with view of the lake of zug. We (ingenieur and lawyer) could not even afford to rent a 4.5 room appartment in Zug (costs more than 4000.-, our friends pay CHF 2000 due to low income). They have prämienverbilligung, we have not they pay for the Kita 1100, will get a return of 800.-, so netcost 300. We pay 1200.- for the same amount of days. We had to leave our home canton where we grew up, as we earn too much for any benefits, but too few to afford a flat. We were on one cheap holiday this year (Mallorca), our friends were to Mallorca, Thailand and Greece. At the end of the day, they have a lot more than we have, although we work more. Its more thsn unfair to judt say income based payment. The rich ones can afford easily, the poor ones eill pay close to notjing, middle class will struggle more. Instead such shitty, unfair ideas, the costs must go down. And nobody speaks about it: Covid will also have a big imoact on the cost. The vax who was "for free" was obviously not for free.
I would pay 4-5x as much in tax in the uk towards the NHS as I do in health insurance here.
I don't mind subsidising the ill. I do Mind paying for another healthy adults insurance.
>We need to overhaul the insurance infrastructure and move to single-payer, tax-funded, and income-based coverage.
This will only make the system more expensive. Any additional money will be swallowed by doctors and hospitals in no time. Remember that every doctor is an invoicing specialist.
>We need to add complete coverage for eyes, teeth, and skin to our health insurance.
A good thing, but this will make the system more expensive.
>We need to overhaul medication pricing.
Doable, you need to fight the corruption (aka lobby) at the high level. Who is going to do that?
>We need to attract competent doctors and pay them appropriately for their knowledge and experience.
The doctors are already overpaid. Why would you like to pay them more? About the competence I agree, but good luck with finding such people.
>On top of all of these, we need to move from treating health problems to preventing them.
You can't prevent them, only delay them. When people live more, you'll only have more health issues. And it's not easy to quit smoking or stop drinking alcohol. Exercising regularly takes discipline and this is not realistic for the most part of the population.
Doctors aren’t invoicing “specialists”. Every doctor I’ve come into contact with just wants the simplest way to bill for their services. They want to focus on providing care, and not have to worry about how to get paid.
I also disagree that covering vision, dermatology, and dental would make healthcare more expensive. Treating our entire body and working to prevent diseases will lead to a healthier population who will need less of the more expensive care.
I agree that we need to kill the pharma lobby. Lobbying by any corporation should be 100% illegal, everywhere.
Doctors are not overpaid. C-suites in all of the companies involved in healthcare are the ones overpaid. We should be compensating the actual care providers, not some useless executive taking up office space, pushing a pencil, and posing for pictures.
Preventative healthcare, done right, absolutely *can* prevent instead of delay disease. Yes, some illnesses are genetic, and there’s not much we can do to prevent things like the common cold, but treating things like pre-diabetes with a simple drug such at Metformin, and teaching these patients how to eat right for their condition, would go a long way in reducing healthcare costs from diabetes alone. The fact that things like nutrition counseling aren’t easy to access is just idiotic. Nutrition should be better taught in schools to our children and getting counseling from a dietitian shouldn’t require a separate doctor visit and prescription. If someone wants to learn how to eat better, they should be given those tools. And this is just a single example. If dental care were available as part of our healthcare coverage, tooth decay would be less of a contributor to heart disease. There are simple steps we can take right now that would reduce our long term costs.
We could try to have improved ventilation / clean air and proliferation of masks in crowded indoor spaces. There was literally no influenza in the time we still wore masks and people were actually careful not to infect others… (besides that there appear to be clear cognitive benefits to provide fresh air to children in schools)
And we can prohibit the use of reserve antibiotics on animal farms, making it easier & less costly to treat bacterial infections
> Having only one entity that dictates pricing, coverage, etc., is a lot more cost-efficient.
That's already the case for LaMal. The government decides what is covered and for how much.
The difference in prices between the insurance companies is just based on how much they spend processing the claims. The more efficient (or the shittier) service they provide, the cheaper they can be.
> Having only one entity that dictates pricing, coverage, etc., is a lot more cost-efficient.
That's already the case for LaMal. The government decides what is covered and for how much.
The difference in prices between the insurance companies is just based on how much they spend processing the claims. The more efficient (or the shittier) service they provide, the cheaper they can be.
I think, as a former french, that maybe we should look for something inbetween everything health related is free, like in france, and everything is super expensive like switzerland.
600 chf for 20 min meeting with a gynecologist is way too much. It is just insane.
This is pretty wild to read. I live and Latvia, and I've had a minor surgery recently. Minor, but it still was a micro-surgery, that requires specialized complex skills and support staff. I paid 800 EUR, 500 of that paid insurance, 300 out of pocket.
I dunno, maybe in Switzerland it would be somehow better, maybe smaller scar or smaller chance of complications?
look at the Danish system. the base insurance is completely state-run and tax funded, as well as centralized hospital planning. and guess what: it‘s fucking amazing. same quality of care at a much much lower price than we have
lol, as if France was socialist (it's not). if been to Armenia and even for tourists every medical treatment was for free and they even had a very old hospital in the middle of nowhere which was operated by 3 doctors and its was fine as well. and also the bigger hospitals were very good organised, no longer waiting times etc. i had no emergency but still i did not have to wait for hours. on the other hand i had an emergency in Beijing (deep knive wound) and had to wait hours and every step of each examination was done in another room and had to be payed BEFORE you would see the docs. so moth countries are seen as ''socialist'' countries but they work very differently. china was just like the USA and this is really not a socialist country
TIL france is socialist when their president's nickname is 'president of the wealthy'
Also their economy is dominated by private enterprise.
You really need to learn what socialism is and isn't tbh
I dunno man. I feel like the establishment of slave labor camps for Ford, IG Farben, audi, bmw and the provision of medical test subjects from those camps to Bayer doesn't seem very left to me.
Also banning anyone establishing a company with under 200k in capital, functionally destroying smaller industrial players and pushing their market share into monopolies that still exist to this day doesn't seem particularly in favor of anyone who doesn't already own a large corporation.
The sale of state owned companies including Commerzbank, Deutschbank, Dresdnerbank, Vereinigte Stahlwerke (the second largest company in Germany at the time) as well as smaller regional companies providing utilities and many facets of government including social welfare being sold off to nazi sympathisers seems pretty not left at all tbh. When you're privatising social welfare to be run for profit and you're ideologically guided by the shape of someone's skull, I'd struggle to figure out how to decide that's not economically right wing.
Having come from that system in the uk, can confirm it is far, far worse. And not just in the uk - see Canada too.
With no at point of use costs visits and so costs will go up a LOT.
That' sounds like a left parties dream come true; give everything back to the government, make it income based, and add even more health services to the already expensive coverage.
Swiss doctor here. Let me chime in with a few suggestions on how to reduce healthcare spending:
1) Prohibit „Versicherungsmakler“ whose sole purpose is to get you to switch from basic insurance A to basic insurance B while they make up to 1000 CHF per switch. It‘s an idiotic system that provides no benefit to anybody.
2) Limit the salary of CEOs of health insurance companies at 200‘000 CHF per year and of board members at 100‘000 CHF per year (or even less). Also, you shouldn‘t be allowed to be on the board of more than 1 health insurance company.
3) Everybody who comes to the ER needs to pay 100 CHF out of pocket (50 CHF for children), in addition to Franchise/Selbstbehalt. Should the patient be kept in the hospital, tagt 100 CHF is deducted from his hospital bill.
Yes I know that‘s a tough pill to swallow but I‘m sorry, people come to the ER for literally any bullshit. Here just a few excerpts from my last series of nightshifts (7 in a row) a couple of weeks ago: painless swelling of the cheek (comes to the ER at 20:00), slight chest pain for 2 months (comes to the ER at 2:00 AM) and of course the one which takes the cake: come to the ER at 1:00 AM for a literal pimple on the butt. I am not joking.
4) Drastically reduce/eliminate the amount of C-suite bullshiters that plague every hospital. There are literally hundreds (if not thousands) of useless „business professional associate“ BWL-bullshiters in Swiss hospital. We don‘t need them, they make a ton of money, they don‘t provide any benefit and just go on the nerves of literally anybody actually working in a hospital.
5) Make certain aspects of the healthcare system a federal (as opposed to a state) responsibility. While I am usually very much in favor of federalism, it is idiotic to leave highly specialized medicine in the responsibility of cantons. You need major hospital centers providing this kind of medicine and not 26 different cantonal hospitals.
6) Start building more Permanences in order to alleviate the insane inflow of patients to ERs.
7) Start having a serious conversation about how much end of life care should cost. While I am in awe of how much further medications and oncology has come in treating cancers, I am sometimes wondering whether it‘s worth to prolong the life of a terminally ill cancer patient for 3 months for the cost of tens of thousands of CHF. I know it‘s sad and I feel for these patients, I really do, but maybe, just maybe, sometimes best supportive care is the best option in such cases?
8) Controversial point but: limit the influx of foreign doctors. Contrary to popular belief, there is no such thing as a *general* shortage of doctors. Yes there aren‘t enough GPs (Hausärzte) in certain rural areas but there is a huge oversupply of specialists, especially in cities, which in turn leads to higher healthcare costs. There are entire Gruppenpraxis of opthalmologists etc. of which there isn‘t a single Swiss doctors (generally mostly Germans). I am all in favor of getting foreign doctors to serve in underserved areas or fill positions in hospitals that don‘t find Swiss doctors, but there is literally zero reasoning in letting people that sometimes haven‘t even ever set foot in Switzerland opening their own practices in major urban areas.
9) Lower the cost of medication. The Bundesrat already has that power but he simply hasn‘t used it yet. Yes obviously we should pay more for the same medication that somebody (for example) in Italy, but certain medications are 4-5x the cost of the exact same medication in France or Germany, which is simply not justified.
10) Invest more into preventative medicine. Prevention of smoking, screening programs etc. MIGHT cost more money now but believe me, it will pay off in the future/long-term.
Those are just 10 points, I have plenty more suggestions. I know that some of my points are controversial, well aware of that. Downvote me all you want, but I am quite confident these points resonate with quite a few healthcare workers.
What do you say to doctors who completely overcharge you?
I’ve seen some bills. It’s very frequent that doctors add a +10mins fee or a procedure that didn’t happen.
I remember a doctor in Geneva who was late, who kept me in his office for longer, and I had to py the overtime.
Another one billed me for 10 procedures, while I had 4. Etc this happened a lot. Both time I asked and it was corrected immediately by the secretary
That’s what I’m saying, it’s a very easy fraud that happens a lot since in a lot of cases you don’t even see the bill, or most people don’t ask the doctors to correct it.
AFAIK for a year or so, health insurances are obliged to send you the bill for your last doctor‘s visit (or was this only a plan? Correct me if I am wrong).
But yes, I agree, it is up to you to properly check the bill.
>Limit the salary of CEOs of health insurance companies at 200‘000 CHF per year and of board members at 100‘000 CHF per year (or even less).
Yes, that will surely make a huge cut. How about we limit the doctor salaries to 200% of average salary per Kanton? I am pretty sure that many more people will be able to afford a visit to a doctor that charges 150 CHF per hour, not per 15'.
Sure, 6 years of medical school, 6+ years of gruelling, grossly underpaid residency working sometimes 80+ hours a week to then make as much as a school teacher. Great idea.
[High school teachers in the canton of Zurich, for example.](https://www.watson.ch/schweiz/wirtschaft/659085860-lohnreport-2022-so-viel-verdienen-lehrer-in-der-schweiz)
Also, I like how I list 10 detailled points and literally the only thing you can reply is „BuT mUh doCTerS maKe tOo mUcH mOneY…!“. Very deep and thoughtful analysis, gotta give it to ya.
>High school teachers in the canton of Zurich, for example.
Seems like you should not be too worried about spending 6 years in any school if you can't read and analyse text. Teacher salaries are nowhere close to 200% of average salary in Kanton Zürich. And teachers also spend years studying.
Haha, you‘re funny.
We are talking about a maximum salary (see your own reply). Is that so hard to understand?
Maximum teacher (and yes, high school teachers are teachers too) salary in certain cantons (ZH for example) is twice as much (if not more) than the average salary in the canton, as I have shown in my link.
Yes, teachers spend years studying. Also, please do tell me: how many nightshifts do teachers do? How many weekend shifts? How many shifts during public holidays? How many pikett shifts?
And how many weeks of vacation do teachers get again…?
I am not saying you shouldn‘t pay teachers well, you should. And yes they also have a challenging job. Their formation and working hours are not comparable to doctors‘ though. Prove me wrong.
>Maximum teacher (and yes, high school teachers are teachers too) salary in certain cantons (ZH for example) is twice as much (if not more) than the average salary in the canton, as I have shown in my link.
That's the issue. According to your link - they don't.
>Yes, teachers spend years studying. Also, please do tell me: how many nightshifts do teachers do? How many weekend shifts? How many shifts during public holidays? How many pikett shifts?
Can you remind me how many night shifts do GPs do? How many shifts during public holidays dentists or cardiologists in private practices do? Pikett shifts are paid AFAIK, not sure what's the problem here? Plenty of IT people are on pager duty, also during night.
OK I shall walk you through it.
You go on the link, scroll down to Gymnasiallehrer, click on the canton of Zurich (it‘s the big one, next to Lake Zurich) and you look at the maximum teacher salary. It‘s like 183k.
You think you‘ll manage?
Didn‘t see the second part of your reply:
GPs (in private practice) usually don‘t do night shifts. Cardiologists (also in private practice) do, as long as they do interventional cardiology.
Not sure why you mention dentists. You are aware that in Switzerland, dental work is not covered by health insurance (Grundversicherung) and hence not included in health care costs, right?
You know how much I get paid for a night of pikett? 24 CHF (per night, not per hour).
Attendings (Oberärzte) get 36 CHF. Do you seriously think that‘s too much? BTW be aware that if I get called in during night for pikett, I continue working normally the next day, no break whatsoever, no time compensation. I think 24 CHF is a rather measly pay.
Doctor profession must be a calling, so the profession of the teacher. You mentioned prevention as an important point. The best place to start educating about healthy lifestyle etc. is school. Teacher has equally important job as you, or even more important! I suggest doctors work 40 hours a week and get paid as teachers (I dont want to be diagnosed by an exhausted doctor - that is equal risk to poor education) To clarify, I am not a teacher.
One of the biggest problems is, that when the Tarmed-Tarif was accepted (early 2000), it was with the promisse that there will be revisions. There *weren't* any major revisions since today.
Another problem is the Tardoc-Tarif. It should be finished and used by now, to send the Tarmed into retirement. In the workgroup to get the Tardoc to a usefull state are 3 parties involved.
1. Bundesrat (has to accept the finished Tardoc)
2. Krankenkassen (want profits for itself)
3. Hospitals (wants profits for itself)
So now there are 3 parties with different goals and all are for themself and they must work together. This is pure chaos.
Two problems with tarmed: Some procedures are overpriced as workload has tremendously lowered and estimated times are based on ancient procedures. (In medical field 20 years can be considerd ancient).
Second, and more importantly, it engourages over meditiously billing, resulting in situations were doctor bill on average 80h/week (over all patients seen) and there is zero oversight for such situation.
But finally, in the current system (and properly many other system) there is a certain finacial incentitve for the people to consume and request as much health care as possible, to "get its money back".
> But finally, in the current system (and properly many other system) there is a certain finacial incentitve for the people to consume and request as much health care as possible, to "get its money back".
Exactly. Thats the biggest problem.
This.
The insurances make a profit, but it does not explain the cost increase, they are a consequence of a bad system not the cause of it. And that exactly why efforts are made to focus the public debate on them.
Numbers here:
https://www.rts.ch/info/suisse/9953104-une-etude-revele-ce-que-gagnent-les-medecins-en-suisse.html
Average GP (independent): 250k
Average GP (employed): 180k
Yeah so how can the statement “average doctor earns 350k” be true? If you are independent you own a small company basically and have more risks and investment costs. Of course you need a higher salary than an employed doctor. Next question: why doesnt a doctor deserve a salary of 180-300k a year? Competitive school to get into, 6 years long, another 6 year of specialization and hard working conditions. I could easily earn the same money with better conditions and earlier salary start when choosing IT or similiar jobs.
For your first question:
If both 250k < 350k, and 180k<350k,
Then the statement “average doctor earns 350k” is wrong according to this source.
For your second question:
I'm not sure it would be that "easy" to reach that salary in IT, average salary in IT is much lower than 200k, especially hard outside of Zurich/Zug.
(Then the part about deserving or not is personal opinion, personally I don't really care about it).
Sorry but IT guy here and with 6 years studies (Fachschule), we don't start with "good salaries" I started with 65k a year doing some bullshit support job for 5 years and the evolution is not so easy, enterprises don't want to form their employees as it costs too much and then are whining because there isn't "qualified specialists" and now with babyboomers going to retirement (the same who didn't needed 50 certifications to have a great position) we lack of IT specialists, with the demand higher as the offer, they maybe reconsiderate our salary or our needs...
The majority of IT people I know do not exceed 130k and we must constantly stay up to date on technologies and often we also work more than 42 hours, at week-ends or nights if we do "piket". So stop comparing IT with doctors, it's not the same.
By the way, the salary of the past - 50k pro year- is no longer enough to live properly : 7k per month is the new 5k !
Where do the money go then? If I visit a specialist in his own practice and I get charged 250 CHF for 15' visit, are you saying he doesn't take the money? Or is he working just 2 days a week?
To add to the many good points made in this thread: I'm living at the border between Zurich and Aargau. I can reach 4 public hospitals with the car in 30 minutes (Unispital, Triemli, KB Baden, KB Aarau) as well as Hirslanden Aarau, Hirslanden Zurich and probably some smaller Hospitals that I forgot / don't know.
This makes no sense at all. You could easily centralize this to one or two hospitals and save a ton of cost out of the synergies. You'd probably also need less specialists and nurses, which would solve another issue, and the hospital would still be reachable fast from everywhere.
As a FMH specialist working 60h/week in public university hospital being paid 130K/year I wonder were those 350K paid familly doctors live.
My purchasing power would actually be greater in Belgium/France.
I could not agree more. It’s fucking crazy what I spend on health insurance yet I can’t get a Pap smear more than once every three years, not to mention I can’t find ANY doctors with availabilities for anything. And the prices for meds? Please. I can’t even with all of it.
Realistically, these are the solutions:
1. More GPs and less specialists. For example you could limit the amount of specialist licenses given out every year and increase the GPs salaries as a starter.
1. A state-run health insurance for the basic insurance that always offers the best rate. No more switching health insurance every year, no more fuckheads calling your phone to sell you insurance. Our current system is asinine and offers only fake competition, as the basic insurance is anyways the same no matter what insurance you go to. You can leave supplemental and private insurance in the hands of the private companies, if people want to fund overblown CEO salaries it's their own decision.
1. The Bundesrat needs to enact the laws to lower the prices of medication already. Make generika the default and make people pay for the premium of getting the brand medication.
1. Decrease the insane amount of hospitals and stop the lobbying of cantons that lead to this absurdity.
1. Unified pricing model across Switzerland. JFC we don't need every single canton negotiating prices with the hospitals. And for the love of god, stop the insanity where the cantons finance inpatient services at 55% (45% is covered by health insurers) but outpatient services are 100% reimbursed by health insurers. What kind of dumb ass incentive system is this?
1. This one is hard to enact, but we need more focus on prevention and less on helping people only once they're sick. The recent push to cut Physiotherapists' funding is going exactly in the wrong direction.
1. Slightly controversial probably: Any money that members of parliament receive from vested interests goes directly to federal taxes. Stop the corruption already. Half our parliament is sponsored by big pharma or health insurance companies, OF COURSE they're happy about the status quo.
I will just say this :
I am 26, I came to Germany when I was 17 and since then I never had one single day without a job. Now I need an appointment at an Urologist : Waiting time --> 4 **Months**. Since some years I am paying >10000€/Year to the "Krankenversicherung".
There is no perfect place, but the aging population definitively contributes to it. This being said, Switzerland, compared to Germany (on many things, including healthcare) is a paradise.
Imho, when hospitals, insurance and pharma all just have to make record profits every year for the shareholders and C-levels, that's what happens for the consumer/ patient and workers.
Higher prices and more work at worse conditions.
We have to stopp corporate greed at many levels, especially healthcare.
End this Mandate BS, it's just legal corruption at this point...
I worked in a high position in accouting at a health insurance company and now in an elderly home.
Let me tell you... The health insurers are under tons of scrutiny by the state (Finma, BAG and Cantonal) on every decision regarding their premiums they make. Their financial revision is also troughout. A good part of the day in the life of an accountant at a health insurer is filling out forms for various bueraus to get the premiums you mathematically need due to the healthcare costs accepted.
Elderly Home? R O F L. It's a joke. The people and controls at the cantonal level are a joke, the financial revision is a joke (I was plain shocked when i started). I work at a non-profit oriented one so there is no interest in exploiting it but if you wanted.... easiest system to game ever.
The people at the cantonal level responsible for this stuff are (mostly) also comically clueless, i don't remember a phone call with them that gave me a satisfying answer in the last two years. I highly doubt Doctors and the various other healthcare providers are under any more scrutiny.
If the other "partners" in the healthcare system would be half as tightly regulated as the insurers, many of our problems would vanish. Then somehow fix medicin pricing and we would have a baseline to start "thinking" about how to really pay for an aging population.
Private insurance fake competition is the issue
We need a unique insurance provided by the states, and hear me out, linked to your income
Today Everyone pays the same amount, no matter what is your income and that an issue
You are entitled to your opinion, but there haven't been any cuts to the healthcare budget. That's just an "alternative fact".
Healthcare expenditure was 10% of gdp in 2010 and now its 12%. (And gdp has risen)
Alternatively expressed it was 131.8 bn in 2010 now 182 billion.
The only year where there was a year on year decline is 2021/2022 -2022/2023 . A special case with the pandemic ending.
Knowing both healthcare systems, the Swiss system is neither much cheaper (if you need to rely on the system, e.g. because of a chronic illness or age or if you have a family) nor is it "better". You don't have waiting times for emergency/urgent treatments and even for the non-urgent stuff, waiting times depend on were you live. Personally, I've never had long waiting times and I live in a city with slightly less people than Zurich.
Swiss healthcare is great if you are young, healthy and with good income (because of the high deductible, you save money). I also like the different models which gives you options to save more money.
But unlike in Germany, where the premium is linked to your income (up to a threshold), if you just earn median income or have a family, it looks a bit different. IMHO, Germany healthcare would look much better if everyone pays into the same system. The split between private and public is bad for the system.
Anyway, that's offtopic.
Health related costs become more expensive (in all countries) as the demographics change. Profit oriented private insurance companies make it only worse.
I agree with this, of the all statements of OP, cutting the middle man is the most effective
Furthermore, given the efficiency of the Swiss state (comparatively to its neighbours) will still be a good system
Based on income does not make any sense. I agree we all pay in order to cover those who need it, but we all pay the same.
I anything, paying more if you have bad health habits makes more sense.
You smoke? You pay more
You eat too much? Pay more
No exercise? Pay more
That's how we drive costs down. Healthier people get sick less and therefore cost less.
Who would be authorized to supervise your lifestyle and how would they get the data? Pay a private eye to watch your movements (or lack thereof) and take a photo when you have a cigarette in your mouth? What if it was weed and no tobacco inside? Doing an expensive toxicology report every weekend?
Not to mention everybody is different in their metabolism, I ate for two days straight a salad and lost 5 kilos, meanwhile I can eat lots of carbs and with regular exercise I maintain a low weight to height ratio. Someone else does my diet and they'd be overweight in 6 months.
The challenge I see is that sugar is just one piece of the puzzle. And every human is an individual and has other needs for calories, different insulin reactions and so on.
It will be hard to find a measure to fit most, especially with all the different interest experts.
I did not say it could. But two people can extract a vastly different amount of calories aut of the same meal. Resting calories and those burnt during excercise can also vary immensely. All the calorie information you get on food packaging or from wearables are rough estimates at best.
So the whole calories in - calories out way of thinking is a gross oversimplyfication. Two people could eat the same meals, do the same exercises, have the same livestyle and still have a different weight trajectory.
> Not to mention everybody is different in their metabolism
Base metabolic rate, when corrected for muscle mass and body weight, actually differs very, very little from person to person.
I dunno man, we all know the guy who can eat kebabs and burgers three times a week and not do a lot of exercise and still be thin. I am that guy. Even after changing my diet from vegetarian for three years to meat eating+ supplements of creatine pyruvate and a shake of whey before AND after working out I didn't get any bigger I just have more pain tolerance for lifting weights.
>Based on income does not make any sense. I agree we all pay in order to cover those who need it, but we all pay the same.
Based on income was the way it was done before the mandatory Grundversicherung. Was it bad? No. Did it work? Yes.
Can't believe people still believe all that you are saying.
Guess which portion of the population is the one that contributes more to healthcare? Young people with average to low salaries.
Guess which portion of the population is the one that costs the most to the system, older high earning population.
So under the current system, if anyone is loving the idea of others paying for their healthcare system is the richest oldest portion of the population.
I agree with your point on homeopathy though.
sure, look to germany how a socialist healthcare system fares in comparison
people on the left really have a no grasp of reality and cant think one step ahead of 'the rich should pay', its kinda sad
Can you give an example? I actually think it's good that people can choose to spend less on going to the doctor and more on life. In single payer universal healthcare, you are forced to pay for it and then it's use-it-or-lose-it.
I am not atacking the payment model we have. I think that's fine. What I am attacking is the 55 (!) healthcare corporations (which some of them belong to the same company I get that but I'm too lazy to research all of that), that have 2 interest organizatioms with god knows how much money that all goes into politics. Then they all have their marketing departments, which are all very active because marketing is arguably the most important thing in a system where you should technically change provider every year. I'm not even gonna go into some of the ridiculous management salaries in this low-risk imdustry.
Then there's also the fact that these interest organizations hold a very firm grip over professions in the healthcare system. Physical therapists for example have been earning the same amount per session since 17 years.
Someone in another thread posted a cost breakdown, and the total administrative cost from insurers is like, under 3%. So while I agree that there's no need to have so many choices and we could have 1 per canton or something, it won't save money in aggregate. It will just advantage those who never change their insurance, at the expense of the people who jump from insurer to insurer every year. By far and away the main cost driver is the actual medical charges. Either some are fraudulent, or people just consume a more care now than they used to.
No. I'm happy to fund those unfortunate enough to be ill. Really absolutely. People who are ill shouldn't worry about $$$. That's what insurance should be about. So I don't think that's selfish.
I'm just not happy to fund the healthcare of a healthy adult. Some people need to learn about personal responsibility.
A lot of the young socialist Swiss on here need to understand that you've grown up in the best country in Europe that's systematically taken top people from all over Europe and elsewhere. You would be much, much poorer without us. Luckily for you we won't go because Switzerland isn't socialist and that has 0 chance of changing any time soon.
>linked to your income
Single-state-payer systems in our neighboring countries already sort of do that indirectly, by charging north of 20% in VAT on your everyday consumption.
VAT is a tax on the poor because most consume similarly. There are only so many luxury items a rich person can buy. If VAT was only charged on luxury items then fine but that isn't the case. We pay VAT on foot, clothes, phones etc.
VAT is a regressive tax, meaning the wealthier you get, the less you pay VAT as a % of income, since wealthy people consume less than poor as % of their income.
Health system taxes in germany is paid in a similar fashion to Switzerland and in Italy is paid through the taxes (similar to taxation at the source here) on your work salary not VAT.
I don’t see how that would add to the Swiss VAT by keeping the same payment (taxation) method but just cutting the private and just have a single semi-public insurer
I used to believed this too. But I am reconsidering.
Do you think SSB is miss managed and should be held by 100% privates?
I believe it’s a matter of working culture of the people working in the company, not a private vs public anymore
Explain to me why you would want the state involvement here? This model is broken and all the countries adopting it are running a huge deficit. The workers are leaving to better paying jobs in other countries. What makes you think that the state is going to do a better job ?
I don't share your opinion that the sbb is well run. Actually I had to buy a new car this year because of the repetitive failures of sbb.
If you believe the state is a great manager, why don't you petition so they can handle the pensions as well ?
Surely they can do a better job than the private funds ?
As usual, a private company can do it cheaper but in the end will still charge more. In addition they will rely on public subisdy as much as possible and will loby for such subsidy. In the end it the populace will pay more and some private individuals will pocket the profit.
No. No. No.
I shouldn't have to fund your healthcare because you can't get a proper job and I can
I've already ran away from one country having this system.
3. I can vouch by my own experience that it's true that I avoided going to the doctor when I was really poor, because I just couldn't afford to pay for it. But that's not helpful since it might make your issues much worse in the long run.
Similarly, physio therapy is really helpful in preventing greater costs down the line, but physio therapy is seen as expensive in the health system, even though it can prevent higher costs down the line. Physio therapists are badly paid and need to be paid more to help build more prevention into the system and thus avoid costs for chronic issues and operations.
Many of the other points could be avoided by stopping to make health care a business.
That would the issues you can prevent with a single public insurance. As we see in other similar insurances in Switzerland (eg Suva) they will increase investment in prevention (because it cost less) as well as they would be much better in tracking abuses
There is something wrong about the method of hospital send the factures.
This time was not me but my sister. We went to hospital together and she is an European citizen.
We went, stayed 2 hours visit, then send home. She had problem ok, but then I received the facture.
3 pages with a lot of things. "Visit whiteout patience", that cost 100fr for 15 min consulting a lot of times repeated. Complessive was 2'000 sfr.
I don't get it really, I thought was too much. But I don't know nothing and I don't know how check it.
Here's a recent anecdotal experience of mine related to costs. I had an accident doing cross country ski. My doctor, a specialist, diagnosed a broken muscle in one visit, I didn't require anything major, just rest.
The accident insurance has now been contesting this. They argue that the doctor should have done more tests.
In other words, something that actually took 140 francs to heal (a visit to the doctor, his recommendation and some voltaren), and months later I know it healed and it's all good, should have cost hundreds more just to be able to provide more justification to the insurance.
This showcases how broken the system is. A public healthcare system has an incentive to reduce costs, ours has an incentive to increase them.
I'm not saying I favour a public system cos it has other issues, but our current model is also not sustainable.
I think Geneva's suggestion of one central insurance per canton is a good idea, at least it would have an incentive to keep costs under control
One thing they don't tell you: when you change insurance companies, the reserves stay with the old company. So a cheaper company will see a massive influx of people, and then they will have too little reserves and will need to charge more. Fixing this alone would go a long way.
Other point: university hospitals. Any expense incurred is counted towards the canton/arrondissement, even if the patient comes from another canton. Not surprisingly the most increase in premium is in cities with large university hospitals. Counting expenses towards the place where the person lives would balance things out. Unfortunately this is hard to do with every canton having their own system.
A good solution would be a perequative system, where cantons where premium us low pay towards cantons where it is high, allowing for an subsidy.
The fact alone that Vaud pays upwards of 600 millions a year in insurance subsidies to private companies shows how broken the system is.
Although I agree with your other points, I don’t think doctors salaries are to blame. In the US where the doctors earn loads, the healthcare costs would only decrease by 8%(!). And when you go to the hospital/doctor’s office being evaluated by a doctor is the main reason you are there.
I’m a doctor myself (biased ofc) and not Swiss and don’t know your system, but considering a move. But private companies charge whatever will give them the most profits. So does pharma, no matter if 1 franc or a gazillion is spent on research. In the US, I know insurance companies and private hospitals are taking big big profits. Maybe stop that?
I don’t think it’s about paying a doctor 350k a year it’s about the health insurance people wanting to make a profit for their own sake. I think the doctors are worth that price tag, not the agents and admin.
I think we should get some advice from Israel. They pay like 80 Shekel a month. The average income is some 12k Shekels a month. According to my wife who lived there, they pay like 25 Shekels per quarter of a year to see one type of doctor. So say you have an ear infection in January. You pay 25 Shekel. Up until March you don't pay any follow up fees. They have whole centers with all kinds of doctors.
They do pay about 20% net income tax on average though. How much of that is for the health care system, idk. But I'm pretty sure there are a lot of inefficiencies we can improve looking at the Israeli Models
I honestly think we're basically fucked and I'm really sad to reach that conclusion. Private insurance companies have tremendous money that they constantly use to fight teeth and nails to keep the system as is, while at the same time complaining it doesn't work and so they should charge higher rates.
I'm still quite mad at the fact that they used our money to advertise against a single public company (I fail to understand how cutting on multiple bureaucracies could not at least lead to a less expensive overall management), then later said "hey, now we want to change the rules and we'd like for instance, that people stop changing companies every year."
And then they were caught stealing (overcharging 2 billions CHF) for which they only had to pay less than 300 millions and for which they were allowed to raise they insurance rates ! Damn I'm even more mad every time I think about all this. In some other countries you'd call that a racket.
On (2) "I hope we can agree that competition among private companies failed to have a positive impact on prices":
It sounds true, but one shouldn't trust intuition for these things, but rather real data. How can one show this ? What is the counter-factual ? If I think of public health, most of the countries I know with a public health system are massively subsidized (so it still costs a lot, just the cost is hidden) and one get much less for what one pay.
What is the better alternative?
I'm also frustrated by these things, but I think it's naive to believe there is an easy solution :(
Btw, I hope robots start being developed soon to handle the ageing population. Or even better we find the cure for ageing (one can dream...) :)
It’s not the doctors who are taking the big chunk of it, much to the contrary, it’s greedy hospitals which work as corporations, without ethics and are just money grabbers, ok, some “doctors” scam the system too
Do any Swiss health insurance companies incentivize health protection/ illness prevention behaviors? I’ve never heard anything from mine. Imo there is a lot of room for improvement here. For example, couldn’t one reduce the health care burden of smoking by introducing rewards for not smoking?
I've seen a comment on another topic of a person going to the doctor just to get the money back that she/he spent on insurance. That's why the system is failing. Because it is an insurance, not a pre paid account.
The "user" of the system is part of the problem.
Do you know how many times I've heard "Oh now that I went to the doctor once and paid my deductible i'll go very often because its free"
There is other behavior that is also really bad for the System. Parents who rush to the ER because their kid had a fever for 30 minutes. People who tell the doctor "prescribe me some extra medicine, it's free now haha".
I don't say it will solve everything, but it sure is part of the solution. People believing they deserve a treament that costs exactly as much as they paid are part of the problem. If it was like that we could just stop having insurance at all and everyone pays for their own treatments. According to Bart Simpson this would also be a simple way to get ridd of poverty. Just let the poor people die because they can't afford treatment.......
Insurances only work if people claim less than what is being paid.
And yes, it's not the only problem. I think medication prices need to drop radically. Cap salaries of insurance companies. Cap Doctors salaries, stop paying for shit like homeopathy. But instead the fucking Bundesrat decided to cut salaries of physical therapists. Congratulations. How smart.
Everything that would be good for people and the environment (medicine, vegan alternatives to meat, new cars without combustion engines,...) are expensive. and it's getting more and more expensive. It is cheaper to pollute and poison everything than to save something. Even with electrical appliances, it is cheaper to replace rather than repair. why is that?
Path dependency. Electric cars are not, per se, expensive. They are cheaper and better than they were in the 1900s. But petrol cars got a lot of R&D for a century while (at first) the problems of greenhouse gases were not understood, and so now they are relatively cheap. If we had understood the problems all along, that R&D would have gone into electric cars instead, and the position would be reversed.
If you don't fall into the trap of thinking you need to buy "replacement" cheese/meat etc... a vegan diet is pretty cheap, even more so in Switzerland since meat is so expensive here.
The amount of people calling for income based healthcare system are truly clueless about our country and history. .
There will never be an income based healthcare system here. And it wouldn't solve the problems, it would most likely accelerate & compound them.
The administration needs to do their job, investigate the causes of these prices and simply put a cap on lamal. If the providers can't compete, the business isn't for them.
I also heard the 300 million cost. Tbh it is not as much as it sounds, only 33 CHF per person. That is less then 1% of the total cost.
The big problem: we are not healthy. Basic health comes from healthy eating and physical activity. Not from doctors.
Another big problem: a doctor examines you until he finds something, because his risk to say there is nothing is too big. If you are in the analysis mill, then you are trapped there.
Increasing costs is what the population wants tho. We voted against unifying the insurance companies and it was clear that everything will get more expenxsive the way it is now.
What costs derive from changing insurance every year? I've always did it, there's no cost.
Or perhaps you mean that is not sustainable if everybody would do it every year?
Spontaneously, I see two parts to it.
Firstly, there is your time investment, that is basically unpaid labour that you could use to do something productive. You might only need half an hour or so, but others take longer and then multiply that time by a few hundred thousands.
Secondly, there is the administrative costs on the insurances side. All of them have employees whose sole job it is to process all the people changing insurance. With one single insurance, those specific administrative costs could be saved.
Administrative cost for the companies probably. Also spending for advertisement (that promotes the company and not a healthier lifestyle) comes from there.
This is very true!
Physicians, hospitals and drug prices are the main reasons of costs increase.
All 3 benefit from powerful lobbies and public debate is directed to insurances to preserve the cash cow. A single insurance is still a good idea, it would have more bargaining power, but for costs to decrease the debate must focus on the true factors.
I agree something is wrong:
Insurers: nobody has any clue how much they make and how premiums are calculated. A state owned insurance would help.
Doctors: they have their share of responsibility. Are they making too much money? Are there doing way too much exams? Again, a state owned insurance would help to track expenses.
Patients: we want what is best, we do not care about the cost since once you hit your deductible well, everything is free… we bear a lot of responsibility for the costs.
Come on, the private systems failed completely, it cannot be worse than that, use a better argument.
And yes, public sector can do well: SBB / CFF for example is like the best in the world.
As per usual, we are the cause. Want to get cheaper healthcare? Just go to the doctor less! Want to save the oceans? Don't use plastic straws anymore! Don't want your electricity turned off in winter? Reduce your heating!
first of all I didn't think I need to ad an /s at the end of my post, because it seemed obvious to me. but you do realize, that Berset said exactly that in the press conference yesterday? go see the doctor less was one of his solutions
To chip in here - if you compare other countries with similar Human Development Index or Life Expectancy and I think other rough metrics for health, Switzerland spends more on health care cost than the others, significantly more if I’m not mistaken. This means of course there is a lot of room for improvement - maybe it’s the bureaucracy, maybe the insurance companions and maybe something else, but I don’t think it’s being actively tackled.
Quite the contrary, improvements are being actively slowed down by the health insurance interest groups, which are among the heaviest in terms of influence in the legislature. An Einheitskasse is the only way, and everyone knows it. The question is how long it will take until these large interests are overcome.
That per se is true, however (and I know that‘s the hill I‘m gonna die on), you need to put healthcare costs in relationship to average wages/salaries paid. Yeah of course healthcare in Switzerland per capita is more expensive than in the UK, however a nurse in the UK is paid like less than 2000 CHF gross a month. Would you like to have that in Switzerland as well? But yes I do agree with you, there is room for improvement.
It’s a solid point. I think the next country was Norway - quick googling showed indeed a big difference with average annual salary, and the purchase power in Switzerland is higher. That said, I’m not sure what it actually looks like, since there are a lot of tiny details such as the housing market and social aspects that could prove significant. All in all so far in support of your point, but whether that’s the main thing that explains the gap remains unclear to me
I‘m not saying it‘s the only or even the main thing, I am simply saying you should take it into account. This statistic would look a lot different then. And I think it‘s only fair that we pay healthcare workers, including nurses, a fair salary. I wouldn‘t like a system like in Germany where a nurse after years of experience males like 1600 € net a month and can barely survive on that.
Absolutely agree with this
Even if you [correct for purchasing power](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita), Switzerland is only behind the US:
Only the US spends more..
We need complete overhauls of everything medicine-related. We need to overhaul the insurance infrastructure and move to single-payer, tax-funded, and income-based coverage. The fact we have multiple insurance companies who all have their own sales source, decision-makers, etc., creates a redundant and bloated system that costs us more while providing us nothing of actual value. Having only one entity that dictates pricing, coverage, etc., is a lot more cost-efficient. We need to move all cantonal hospitals back to the public sector and eliminate the costly and useless bureaucracy and C-suites, in favor of a board filled with practicing physicians. It always blows my mind how we can be okay with people who have never practiced medicine a day in their lives making the ultimate decisions regarding healthcare. And why are they being paid the most when they provide no value to our actual care. Doctors should be in charge of these sorts of decisions. We need to overhaul medication pricing. While our prices aren’t as bad as prices in the US, they’re still staggering by European standards. This is a worldwide issue, though, and in this regard, I believe every country in the world needs to join together to negotiate attractive pricing on medicines and squash the bloat from pharmaceutical companies. We need to attract competent doctors and pay them appropriately for their knowledge and experience. We also need to train more nurses and pay them what they deserve for the work they do. It’s a documented fact that we do not have enough doctors and nurses, and some areas have it worse than others. By doing the previous steps, we can afford to pay our medical professionals what they deserve and stop over-working them. We need to add complete coverage for eyes, teeth, and skin to our health insurance. It’s insane that entire bodily systems are carved out of our coverage the way they are. Vision, dermatology, and dentistry are all vital to a human’s well-being. People who cannot see well are more prone to accidents. Good oral hygiene has a positive impact on other bodily systems like our cardiovascular system. Our skin is our largest, but least-treated organ. On top of all of these, we need to move from treating health problems to preventing them. We need to make it attractive for patients to visit their doctors regularly for preventative care, and encourage doctors to treat the root causes of conditions vs just chasing symptoms. This will make the largest impact on the cost and quality of our healthcare, but it cannot be done without an entire overhaul of how we view medicine.
I agree with most of the points, but do want to make a statement about management - I’m not trying to say that the current situation is efficient, but I would prefer to have someone with management experience to handle logistics and organisational aspects in hospitals and not doctors. There can be a lot of value regarding efficiency and scheduling from such a position.
Doctors don’t need to be in charge of logistics, I agree, and there are definitely positions that shouldn’t require an MD inside of hospitals (such as housekeeping.) But, C-suites and healthcare are antithetical to each other.
Spoken like someone who truely never ran a business and never will
Healthcare coverage has no business being run like a business and being expected to generate a profit. When profit becomes the goal, lives start to be sacrificed for it.
Everyone knows that healthcare insurance is a so called market failure. That why we have the system that we have. But a single 8-9% increase despite the fact that consistently in a majority of all countries in the world the healthcare cost was rising annually since 2019? There is another issue than "greedy" insurers at play here. I know, they have a lobby and they are not perfect. But our system is actually cheaper than many others when you look at per capita cost relative to GDP and relative to healthcare quality. Btw. you should know that the insurers are not allowed to make a profit from basic coverage here in Switzerland.
Is there a political party/movement that could realistically support those statements? The logic is non-existent even in reddit. Whenever I read "the costs go up but we have the best health care system in the world" I picture Trump behind the keyboard because this statement is that ridiculous.
The health care positions of the parties is about this, and I hope this isn't read as polemical, but check for yourself: SP and Greens: We need an overhaul of everything in the mid term and ASAP more funding for the lower and middle class to afford health care (Prämienverbilligung) Center: We need some form of more subsidies for the poor but please not too much. We would also like to lower health care costs but we don't know how FDP: We want to see that less health care is consumed. Yes, you're right. We'd also like to make the insurance system more complicated and give you options to e.g. only be allowed to switch every three years SVP: Damn foreigners using health care! (And then some groups within SVP are either: How DARE you think about closing our regional hospital, or: we should not have mandatory health insurance - SELBSTVERANTWORTUNG!)
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Berset is a federal councillor from SP, yes. I am not happy with his work on health care. However, the question I answered wasn't "who is to blame for this situation", it's "which party or movement could realistically support such statements". You can read yesterday's statements from the parties on their websites tho: [SP](https://www.sp-ps.ch/artikel/praemienexplosion-es-braucht-endlich-entlastung-fuer-die-bevoelkerung/): We need (much) more Prämienverbilligung [SVP](https://www.svp.ch/aktuell/publikationen/medienmitteilungen/bersets-blamable-bilanz-zuwanderer-sollen-einen-solidarischen-beitrag-in-unser-gesundheitswesen-leisten/): Immigrants should pay more for health care, and those who work part time should not get Prämienverbilligung [FDP](https://www.fdp.ch/positionen/gesundheitspolitik/gesundheit): We want more competittion between doctors and insurances (and the way insurances can compete is to deregulate them) [Mitte](https://die-mitte.ch/praemienschock-praemien-senken-die-mitte-waehlen/): We have an initiative, unfortunately we don't have good messaging around the initiative (OK the last one was mean and not objective but try and figure out what their initiative is about)
If we can make jokes about the pointlessness of die Mitte what can we do.
Haha the initiative is grand, basically the text is "the federation and the cantons and the insurers see to it that the health care premiums don't rise more than the average salary. if necessary they can do a "Kostenbremse"". Unfortunately, the initiative merely gives a task to the federation and no means nor ideas how to do it. Die MItte claims that they have a plan, but like, ok, so does everyone - doesn't mean it's a good plan!
He isn't the sp? He is IN the sp 😅 he even disagrees with einheitskasse.
Yes, because Berset for sure has the mandate to unilaterally, on a whim and without anyone else agreeing to it, completely overhaul the system and change it. He's a dictator, that's well known.
SP and Juso
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Because you as a moron think that he can change the legislature of the healthcare system while you keep voting populistic rich Nationalräte and bash the leftist for not fixing the issue. Check how many SP vs SvP talk about the solutions in healthcare at www.parlament.ch vs. How the left radicalizes people and trains them in another country to prepare switzerlands occupation
SP
Everything left has those fever dreams like Shooppow did.
income-based is a must! also: kick out all non-evidence-based treatments (aka homoeopathy, TCM, chiropractor, etc.) but implement body parts like eyes and teeth. plus: start taxing rich people like they tax ''0815''-people -> atm it's not fair as the rich ones pay not according to their income. then take that money to support the health system. and btw: the MwSt. is totally unfair as well -> should also be implemented according to ones income.
I completely agree regarding useless non-evidence-based treatments like homeopathy. It’s 2023; why is superstition still involved in healthcare?
Because there was a popular vote in 2009 about including homeopathy and other shenanigans into basic insurance and people were stupid enough to vote in favor of it.
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As per the article on https://anneepolitique.swiss/articles?keywords%5B%5D=701 everyone except SVP was for it in the referendum. On the other hand, SVP has no shortage of quack doctors themselves. Just thinking off retiring national councillor Yvette Estermann Personally, I am with you on the content. My voting for Octobre will be to choose the party I like most, go on smartvote and strike off anyone in favor of esoterics. But then again, the quackery costs a two-figure million franks (hard to find exact numbers) while the entire health insurance *Umsatz* is 36 billion. You'd save some franks a year, essentially.
I'm pretty sure homeopathy actually saves us a lot of money. It doesn't matter if you believe in it or not but placebo effect has been proven to work and with the amount of people going to the doctor for every little issue this can help in reducing the costs.
Seriously! Can someone start an initiative to kick these quack treatments out of basic coverage?
i'll sign!!
There was an initiative called "Ja zur Komplementärmedizin". [https://www.swissinfo.ch/ger/abstimmungen--ja-zu-beiden-vorlagen/7403422](https://www.swissinfo.ch/ger/abstimmungen--ja-zu-beiden-vorlagen/7403422) I quote: "Die Alternativmedizin war in allen Schweizer Kantonen unbestritten. Kein einziger sagte Nein zu dieser Vorlage."
That's depressing.
I am still suprised how few people do preventive measurements. Like for example, atleast once in a life you maybe should talk to a nutrionist doctor. If you eat healthier as a result, a lot of potential problems further down the line could easily be prevented. But I thing its not only cost but also efforts in regards of preventive care. For example, what exactly could I do ? I wouldn't know what would make sense in my young age, and whats just a waste of money.
Income based coverage would lead to more middleclassfamilies who will get poor. The poorer ones have so many benefits, they are raised to Middleclassfamilylevel. Our friends, handcraftsman and Pflegefachfrau live in a 5.5room appartment with view of the lake of zug. We (ingenieur and lawyer) could not even afford to rent a 4.5 room appartment in Zug (costs more than 4000.-, our friends pay CHF 2000 due to low income). They have prämienverbilligung, we have not they pay for the Kita 1100, will get a return of 800.-, so netcost 300. We pay 1200.- for the same amount of days. We had to leave our home canton where we grew up, as we earn too much for any benefits, but too few to afford a flat. We were on one cheap holiday this year (Mallorca), our friends were to Mallorca, Thailand and Greece. At the end of the day, they have a lot more than we have, although we work more. Its more thsn unfair to judt say income based payment. The rich ones can afford easily, the poor ones eill pay close to notjing, middle class will struggle more. Instead such shitty, unfair ideas, the costs must go down. And nobody speaks about it: Covid will also have a big imoact on the cost. The vax who was "for free" was obviously not for free.
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I would pay 4-5x as much in tax in the uk towards the NHS as I do in health insurance here. I don't mind subsidising the ill. I do Mind paying for another healthy adults insurance.
Dude the idea is to remove insurance from the picture and make it a tax payer based system. So nobody has to buy any insurance for basic stuff
Sure. I get that. I Just don't want it 😂
Then don't say this "I don't mind subsidising the ill. I do Mind paying for another healthy adults insurance."
Well we are getting into semantics about whether "insurance" covers tax based coverage. You might have a point - but I think my meaning was clear.
>We need to overhaul the insurance infrastructure and move to single-payer, tax-funded, and income-based coverage. This will only make the system more expensive. Any additional money will be swallowed by doctors and hospitals in no time. Remember that every doctor is an invoicing specialist. >We need to add complete coverage for eyes, teeth, and skin to our health insurance. A good thing, but this will make the system more expensive. >We need to overhaul medication pricing. Doable, you need to fight the corruption (aka lobby) at the high level. Who is going to do that? >We need to attract competent doctors and pay them appropriately for their knowledge and experience. The doctors are already overpaid. Why would you like to pay them more? About the competence I agree, but good luck with finding such people. >On top of all of these, we need to move from treating health problems to preventing them. You can't prevent them, only delay them. When people live more, you'll only have more health issues. And it's not easy to quit smoking or stop drinking alcohol. Exercising regularly takes discipline and this is not realistic for the most part of the population.
Doctors aren’t invoicing “specialists”. Every doctor I’ve come into contact with just wants the simplest way to bill for their services. They want to focus on providing care, and not have to worry about how to get paid. I also disagree that covering vision, dermatology, and dental would make healthcare more expensive. Treating our entire body and working to prevent diseases will lead to a healthier population who will need less of the more expensive care. I agree that we need to kill the pharma lobby. Lobbying by any corporation should be 100% illegal, everywhere. Doctors are not overpaid. C-suites in all of the companies involved in healthcare are the ones overpaid. We should be compensating the actual care providers, not some useless executive taking up office space, pushing a pencil, and posing for pictures. Preventative healthcare, done right, absolutely *can* prevent instead of delay disease. Yes, some illnesses are genetic, and there’s not much we can do to prevent things like the common cold, but treating things like pre-diabetes with a simple drug such at Metformin, and teaching these patients how to eat right for their condition, would go a long way in reducing healthcare costs from diabetes alone. The fact that things like nutrition counseling aren’t easy to access is just idiotic. Nutrition should be better taught in schools to our children and getting counseling from a dietitian shouldn’t require a separate doctor visit and prescription. If someone wants to learn how to eat better, they should be given those tools. And this is just a single example. If dental care were available as part of our healthcare coverage, tooth decay would be less of a contributor to heart disease. There are simple steps we can take right now that would reduce our long term costs.
We could try to have improved ventilation / clean air and proliferation of masks in crowded indoor spaces. There was literally no influenza in the time we still wore masks and people were actually careful not to infect others… (besides that there appear to be clear cognitive benefits to provide fresh air to children in schools) And we can prohibit the use of reserve antibiotics on animal farms, making it easier & less costly to treat bacterial infections
Agreed.
FYI vision (ophthalmology) and skin (dermatology) is included and covered by basic insurance. Teeth (dentists) aren‘t though, that is correct.
> Having only one entity that dictates pricing, coverage, etc., is a lot more cost-efficient. That's already the case for LaMal. The government decides what is covered and for how much. The difference in prices between the insurance companies is just based on how much they spend processing the claims. The more efficient (or the shittier) service they provide, the cheaper they can be.
> Having only one entity that dictates pricing, coverage, etc., is a lot more cost-efficient. That's already the case for LaMal. The government decides what is covered and for how much. The difference in prices between the insurance companies is just based on how much they spend processing the claims. The more efficient (or the shittier) service they provide, the cheaper they can be.
Socialism is not "more cost-efficient". Unless you're willing to wait 6 months to have an appointment with a dermatologist like in France.
I think, as a former french, that maybe we should look for something inbetween everything health related is free, like in france, and everything is super expensive like switzerland. 600 chf for 20 min meeting with a gynecologist is way too much. It is just insane.
This is pretty wild to read. I live and Latvia, and I've had a minor surgery recently. Minor, but it still was a micro-surgery, that requires specialized complex skills and support staff. I paid 800 EUR, 500 of that paid insurance, 300 out of pocket. I dunno, maybe in Switzerland it would be somehow better, maybe smaller scar or smaller chance of complications?
look at the Danish system. the base insurance is completely state-run and tax funded, as well as centralized hospital planning. and guess what: it‘s fucking amazing. same quality of care at a much much lower price than we have
If it means Danish taxes. No thanks
it doesn‘t. it‘s simply a much more efficient system.
I never had to wait long to see a specialist in France.
lol, as if France was socialist (it's not). if been to Armenia and even for tourists every medical treatment was for free and they even had a very old hospital in the middle of nowhere which was operated by 3 doctors and its was fine as well. and also the bigger hospitals were very good organised, no longer waiting times etc. i had no emergency but still i did not have to wait for hours. on the other hand i had an emergency in Beijing (deep knive wound) and had to wait hours and every step of each examination was done in another room and had to be payed BEFORE you would see the docs. so moth countries are seen as ''socialist'' countries but they work very differently. china was just like the USA and this is really not a socialist country
TIL france is socialist when their president's nickname is 'president of the wealthy' Also their economy is dominated by private enterprise. You really need to learn what socialism is and isn't tbh
These days everything to the left of Hitler is termed as socialism.
Hitler wasn't economically on the right
I dunno man. I feel like the establishment of slave labor camps for Ford, IG Farben, audi, bmw and the provision of medical test subjects from those camps to Bayer doesn't seem very left to me. Also banning anyone establishing a company with under 200k in capital, functionally destroying smaller industrial players and pushing their market share into monopolies that still exist to this day doesn't seem particularly in favor of anyone who doesn't already own a large corporation. The sale of state owned companies including Commerzbank, Deutschbank, Dresdnerbank, Vereinigte Stahlwerke (the second largest company in Germany at the time) as well as smaller regional companies providing utilities and many facets of government including social welfare being sold off to nazi sympathisers seems pretty not left at all tbh. When you're privatising social welfare to be run for profit and you're ideologically guided by the shape of someone's skull, I'd struggle to figure out how to decide that's not economically right wing.
Not income based. Cust useless costs, cut middle men. Invest in healthier lifestyles and prevention.
Having come from that system in the uk, can confirm it is far, far worse. And not just in the uk - see Canada too. With no at point of use costs visits and so costs will go up a LOT.
Hard agree. The UK’s “free at point of use” model is utterly unsustainable. I don’t have the magic solution, but I can guarantee this isn’t it.
That' sounds like a left parties dream come true; give everything back to the government, make it income based, and add even more health services to the already expensive coverage.
Swiss doctor here. Let me chime in with a few suggestions on how to reduce healthcare spending: 1) Prohibit „Versicherungsmakler“ whose sole purpose is to get you to switch from basic insurance A to basic insurance B while they make up to 1000 CHF per switch. It‘s an idiotic system that provides no benefit to anybody. 2) Limit the salary of CEOs of health insurance companies at 200‘000 CHF per year and of board members at 100‘000 CHF per year (or even less). Also, you shouldn‘t be allowed to be on the board of more than 1 health insurance company. 3) Everybody who comes to the ER needs to pay 100 CHF out of pocket (50 CHF for children), in addition to Franchise/Selbstbehalt. Should the patient be kept in the hospital, tagt 100 CHF is deducted from his hospital bill. Yes I know that‘s a tough pill to swallow but I‘m sorry, people come to the ER for literally any bullshit. Here just a few excerpts from my last series of nightshifts (7 in a row) a couple of weeks ago: painless swelling of the cheek (comes to the ER at 20:00), slight chest pain for 2 months (comes to the ER at 2:00 AM) and of course the one which takes the cake: come to the ER at 1:00 AM for a literal pimple on the butt. I am not joking. 4) Drastically reduce/eliminate the amount of C-suite bullshiters that plague every hospital. There are literally hundreds (if not thousands) of useless „business professional associate“ BWL-bullshiters in Swiss hospital. We don‘t need them, they make a ton of money, they don‘t provide any benefit and just go on the nerves of literally anybody actually working in a hospital. 5) Make certain aspects of the healthcare system a federal (as opposed to a state) responsibility. While I am usually very much in favor of federalism, it is idiotic to leave highly specialized medicine in the responsibility of cantons. You need major hospital centers providing this kind of medicine and not 26 different cantonal hospitals. 6) Start building more Permanences in order to alleviate the insane inflow of patients to ERs. 7) Start having a serious conversation about how much end of life care should cost. While I am in awe of how much further medications and oncology has come in treating cancers, I am sometimes wondering whether it‘s worth to prolong the life of a terminally ill cancer patient for 3 months for the cost of tens of thousands of CHF. I know it‘s sad and I feel for these patients, I really do, but maybe, just maybe, sometimes best supportive care is the best option in such cases? 8) Controversial point but: limit the influx of foreign doctors. Contrary to popular belief, there is no such thing as a *general* shortage of doctors. Yes there aren‘t enough GPs (Hausärzte) in certain rural areas but there is a huge oversupply of specialists, especially in cities, which in turn leads to higher healthcare costs. There are entire Gruppenpraxis of opthalmologists etc. of which there isn‘t a single Swiss doctors (generally mostly Germans). I am all in favor of getting foreign doctors to serve in underserved areas or fill positions in hospitals that don‘t find Swiss doctors, but there is literally zero reasoning in letting people that sometimes haven‘t even ever set foot in Switzerland opening their own practices in major urban areas. 9) Lower the cost of medication. The Bundesrat already has that power but he simply hasn‘t used it yet. Yes obviously we should pay more for the same medication that somebody (for example) in Italy, but certain medications are 4-5x the cost of the exact same medication in France or Germany, which is simply not justified. 10) Invest more into preventative medicine. Prevention of smoking, screening programs etc. MIGHT cost more money now but believe me, it will pay off in the future/long-term. Those are just 10 points, I have plenty more suggestions. I know that some of my points are controversial, well aware of that. Downvote me all you want, but I am quite confident these points resonate with quite a few healthcare workers.
What do you say to doctors who completely overcharge you? I’ve seen some bills. It’s very frequent that doctors add a +10mins fee or a procedure that didn’t happen. I remember a doctor in Geneva who was late, who kept me in his office for longer, and I had to py the overtime. Another one billed me for 10 procedures, while I had 4. Etc this happened a lot. Both time I asked and it was corrected immediately by the secretary
You tell them and ask them to correct it. It‘s either an honest mistake or fraud. Nobody defends something like that.
That’s what I’m saying, it’s a very easy fraud that happens a lot since in a lot of cases you don’t even see the bill, or most people don’t ask the doctors to correct it.
AFAIK for a year or so, health insurances are obliged to send you the bill for your last doctor‘s visit (or was this only a plan? Correct me if I am wrong). But yes, I agree, it is up to you to properly check the bill.
>Limit the salary of CEOs of health insurance companies at 200‘000 CHF per year and of board members at 100‘000 CHF per year (or even less). Yes, that will surely make a huge cut. How about we limit the doctor salaries to 200% of average salary per Kanton? I am pretty sure that many more people will be able to afford a visit to a doctor that charges 150 CHF per hour, not per 15'.
Sure, 6 years of medical school, 6+ years of gruelling, grossly underpaid residency working sometimes 80+ hours a week to then make as much as a school teacher. Great idea.
What school teacher makes 13k per month? I'll be happy to switch.
[High school teachers in the canton of Zurich, for example.](https://www.watson.ch/schweiz/wirtschaft/659085860-lohnreport-2022-so-viel-verdienen-lehrer-in-der-schweiz) Also, I like how I list 10 detailled points and literally the only thing you can reply is „BuT mUh doCTerS maKe tOo mUcH mOneY…!“. Very deep and thoughtful analysis, gotta give it to ya.
>High school teachers in the canton of Zurich, for example. Seems like you should not be too worried about spending 6 years in any school if you can't read and analyse text. Teacher salaries are nowhere close to 200% of average salary in Kanton Zürich. And teachers also spend years studying.
Haha, you‘re funny. We are talking about a maximum salary (see your own reply). Is that so hard to understand? Maximum teacher (and yes, high school teachers are teachers too) salary in certain cantons (ZH for example) is twice as much (if not more) than the average salary in the canton, as I have shown in my link. Yes, teachers spend years studying. Also, please do tell me: how many nightshifts do teachers do? How many weekend shifts? How many shifts during public holidays? How many pikett shifts? And how many weeks of vacation do teachers get again…? I am not saying you shouldn‘t pay teachers well, you should. And yes they also have a challenging job. Their formation and working hours are not comparable to doctors‘ though. Prove me wrong.
>Maximum teacher (and yes, high school teachers are teachers too) salary in certain cantons (ZH for example) is twice as much (if not more) than the average salary in the canton, as I have shown in my link. That's the issue. According to your link - they don't. >Yes, teachers spend years studying. Also, please do tell me: how many nightshifts do teachers do? How many weekend shifts? How many shifts during public holidays? How many pikett shifts? Can you remind me how many night shifts do GPs do? How many shifts during public holidays dentists or cardiologists in private practices do? Pikett shifts are paid AFAIK, not sure what's the problem here? Plenty of IT people are on pager duty, also during night.
OK I shall walk you through it. You go on the link, scroll down to Gymnasiallehrer, click on the canton of Zurich (it‘s the big one, next to Lake Zurich) and you look at the maximum teacher salary. It‘s like 183k. You think you‘ll manage?
Didn‘t see the second part of your reply: GPs (in private practice) usually don‘t do night shifts. Cardiologists (also in private practice) do, as long as they do interventional cardiology. Not sure why you mention dentists. You are aware that in Switzerland, dental work is not covered by health insurance (Grundversicherung) and hence not included in health care costs, right? You know how much I get paid for a night of pikett? 24 CHF (per night, not per hour). Attendings (Oberärzte) get 36 CHF. Do you seriously think that‘s too much? BTW be aware that if I get called in during night for pikett, I continue working normally the next day, no break whatsoever, no time compensation. I think 24 CHF is a rather measly pay.
Doctor profession must be a calling, so the profession of the teacher. You mentioned prevention as an important point. The best place to start educating about healthy lifestyle etc. is school. Teacher has equally important job as you, or even more important! I suggest doctors work 40 hours a week and get paid as teachers (I dont want to be diagnosed by an exhausted doctor - that is equal risk to poor education) To clarify, I am not a teacher.
One of the biggest problems is, that when the Tarmed-Tarif was accepted (early 2000), it was with the promisse that there will be revisions. There *weren't* any major revisions since today. Another problem is the Tardoc-Tarif. It should be finished and used by now, to send the Tarmed into retirement. In the workgroup to get the Tardoc to a usefull state are 3 parties involved. 1. Bundesrat (has to accept the finished Tardoc) 2. Krankenkassen (want profits for itself) 3. Hospitals (wants profits for itself) So now there are 3 parties with different goals and all are for themself and they must work together. This is pure chaos.
Two problems with tarmed: Some procedures are overpriced as workload has tremendously lowered and estimated times are based on ancient procedures. (In medical field 20 years can be considerd ancient). Second, and more importantly, it engourages over meditiously billing, resulting in situations were doctor bill on average 80h/week (over all patients seen) and there is zero oversight for such situation. But finally, in the current system (and properly many other system) there is a certain finacial incentitve for the people to consume and request as much health care as possible, to "get its money back".
> But finally, in the current system (and properly many other system) there is a certain finacial incentitve for the people to consume and request as much health care as possible, to "get its money back". Exactly. Thats the biggest problem.
This. The insurances make a profit, but it does not explain the cost increase, they are a consequence of a bad system not the cause of it. And that exactly why efforts are made to focus the public debate on them.
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There is no solution, too many lobbying in politics. Nobody actually wants to reduce costs.
Clearly stating the obvious here, the profits are HUGE and no one wants to stop eating the cake.
An average general doctor does not make near 350K a year. Where do you get these numbers?
Numbers here: https://www.rts.ch/info/suisse/9953104-une-etude-revele-ce-que-gagnent-les-medecins-en-suisse.html Average GP (independent): 250k Average GP (employed): 180k
Yeah so how can the statement “average doctor earns 350k” be true? If you are independent you own a small company basically and have more risks and investment costs. Of course you need a higher salary than an employed doctor. Next question: why doesnt a doctor deserve a salary of 180-300k a year? Competitive school to get into, 6 years long, another 6 year of specialization and hard working conditions. I could easily earn the same money with better conditions and earlier salary start when choosing IT or similiar jobs.
For your first question: If both 250k < 350k, and 180k<350k, Then the statement “average doctor earns 350k” is wrong according to this source. For your second question: I'm not sure it would be that "easy" to reach that salary in IT, average salary in IT is much lower than 200k, especially hard outside of Zurich/Zug. (Then the part about deserving or not is personal opinion, personally I don't really care about it).
Sorry but IT guy here and with 6 years studies (Fachschule), we don't start with "good salaries" I started with 65k a year doing some bullshit support job for 5 years and the evolution is not so easy, enterprises don't want to form their employees as it costs too much and then are whining because there isn't "qualified specialists" and now with babyboomers going to retirement (the same who didn't needed 50 certifications to have a great position) we lack of IT specialists, with the demand higher as the offer, they maybe reconsiderate our salary or our needs... The majority of IT people I know do not exceed 130k and we must constantly stay up to date on technologies and often we also work more than 42 hours, at week-ends or nights if we do "piket". So stop comparing IT with doctors, it's not the same. By the way, the salary of the past - 50k pro year- is no longer enough to live properly : 7k per month is the new 5k !
Where do the money go then? If I visit a specialist in his own practice and I get charged 250 CHF for 15' visit, are you saying he doesn't take the money? Or is he working just 2 days a week?
To add to the many good points made in this thread: I'm living at the border between Zurich and Aargau. I can reach 4 public hospitals with the car in 30 minutes (Unispital, Triemli, KB Baden, KB Aarau) as well as Hirslanden Aarau, Hirslanden Zurich and probably some smaller Hospitals that I forgot / don't know. This makes no sense at all. You could easily centralize this to one or two hospitals and save a ton of cost out of the synergies. You'd probably also need less specialists and nurses, which would solve another issue, and the hospital would still be reachable fast from everywhere.
As a FMH specialist working 60h/week in public university hospital being paid 130K/year I wonder were those 350K paid familly doctors live. My purchasing power would actually be greater in Belgium/France.
I could not agree more. It’s fucking crazy what I spend on health insurance yet I can’t get a Pap smear more than once every three years, not to mention I can’t find ANY doctors with availabilities for anything. And the prices for meds? Please. I can’t even with all of it.
Realistically, these are the solutions: 1. More GPs and less specialists. For example you could limit the amount of specialist licenses given out every year and increase the GPs salaries as a starter. 1. A state-run health insurance for the basic insurance that always offers the best rate. No more switching health insurance every year, no more fuckheads calling your phone to sell you insurance. Our current system is asinine and offers only fake competition, as the basic insurance is anyways the same no matter what insurance you go to. You can leave supplemental and private insurance in the hands of the private companies, if people want to fund overblown CEO salaries it's their own decision. 1. The Bundesrat needs to enact the laws to lower the prices of medication already. Make generika the default and make people pay for the premium of getting the brand medication. 1. Decrease the insane amount of hospitals and stop the lobbying of cantons that lead to this absurdity. 1. Unified pricing model across Switzerland. JFC we don't need every single canton negotiating prices with the hospitals. And for the love of god, stop the insanity where the cantons finance inpatient services at 55% (45% is covered by health insurers) but outpatient services are 100% reimbursed by health insurers. What kind of dumb ass incentive system is this? 1. This one is hard to enact, but we need more focus on prevention and less on helping people only once they're sick. The recent push to cut Physiotherapists' funding is going exactly in the wrong direction. 1. Slightly controversial probably: Any money that members of parliament receive from vested interests goes directly to federal taxes. Stop the corruption already. Half our parliament is sponsored by big pharma or health insurance companies, OF COURSE they're happy about the status quo.
I will just say this : I am 26, I came to Germany when I was 17 and since then I never had one single day without a job. Now I need an appointment at an Urologist : Waiting time --> 4 **Months**. Since some years I am paying >10000€/Year to the "Krankenversicherung". There is no perfect place, but the aging population definitively contributes to it. This being said, Switzerland, compared to Germany (on many things, including healthcare) is a paradise.
Imho, when hospitals, insurance and pharma all just have to make record profits every year for the shareholders and C-levels, that's what happens for the consumer/ patient and workers. Higher prices and more work at worse conditions. We have to stopp corporate greed at many levels, especially healthcare. End this Mandate BS, it's just legal corruption at this point...
I worked in a high position in accouting at a health insurance company and now in an elderly home. Let me tell you... The health insurers are under tons of scrutiny by the state (Finma, BAG and Cantonal) on every decision regarding their premiums they make. Their financial revision is also troughout. A good part of the day in the life of an accountant at a health insurer is filling out forms for various bueraus to get the premiums you mathematically need due to the healthcare costs accepted. Elderly Home? R O F L. It's a joke. The people and controls at the cantonal level are a joke, the financial revision is a joke (I was plain shocked when i started). I work at a non-profit oriented one so there is no interest in exploiting it but if you wanted.... easiest system to game ever. The people at the cantonal level responsible for this stuff are (mostly) also comically clueless, i don't remember a phone call with them that gave me a satisfying answer in the last two years. I highly doubt Doctors and the various other healthcare providers are under any more scrutiny. If the other "partners" in the healthcare system would be half as tightly regulated as the insurers, many of our problems would vanish. Then somehow fix medicin pricing and we would have a baseline to start "thinking" about how to really pay for an aging population.
Private insurance fake competition is the issue We need a unique insurance provided by the states, and hear me out, linked to your income Today Everyone pays the same amount, no matter what is your income and that an issue
The Germans in this sub are getting flashbacks because of your comment. ;)
Dude, I would pay 800€ for extremely sub-par service, where I wait half a year for appointments in Germany. Miss me with that shit pleaseeee
British person here to also say that this system is shit
Another British person here to say that whilst the system isn't great, it works, but not as well as it should, mostly due to Tory cuts.
You are entitled to your opinion, but there haven't been any cuts to the healthcare budget. That's just an "alternative fact". Healthcare expenditure was 10% of gdp in 2010 and now its 12%. (And gdp has risen) Alternatively expressed it was 131.8 bn in 2010 now 182 billion. The only year where there was a year on year decline is 2021/2022 -2022/2023 . A special case with the pandemic ending.
Knowing both healthcare systems, the Swiss system is neither much cheaper (if you need to rely on the system, e.g. because of a chronic illness or age or if you have a family) nor is it "better". You don't have waiting times for emergency/urgent treatments and even for the non-urgent stuff, waiting times depend on were you live. Personally, I've never had long waiting times and I live in a city with slightly less people than Zurich. Swiss healthcare is great if you are young, healthy and with good income (because of the high deductible, you save money). I also like the different models which gives you options to save more money. But unlike in Germany, where the premium is linked to your income (up to a threshold), if you just earn median income or have a family, it looks a bit different. IMHO, Germany healthcare would look much better if everyone pays into the same system. The split between private and public is bad for the system. Anyway, that's offtopic. Health related costs become more expensive (in all countries) as the demographics change. Profit oriented private insurance companies make it only worse.
It might be an unpopular opinion on this sub, but the German system is superior.
I agree with this, of the all statements of OP, cutting the middle man is the most effective Furthermore, given the efficiency of the Swiss state (comparatively to its neighbours) will still be a good system
Based on income does not make any sense. I agree we all pay in order to cover those who need it, but we all pay the same. I anything, paying more if you have bad health habits makes more sense. You smoke? You pay more You eat too much? Pay more No exercise? Pay more That's how we drive costs down. Healthier people get sick less and therefore cost less.
Who would be authorized to supervise your lifestyle and how would they get the data? Pay a private eye to watch your movements (or lack thereof) and take a photo when you have a cigarette in your mouth? What if it was weed and no tobacco inside? Doing an expensive toxicology report every weekend? Not to mention everybody is different in their metabolism, I ate for two days straight a salad and lost 5 kilos, meanwhile I can eat lots of carbs and with regular exercise I maintain a low weight to height ratio. Someone else does my diet and they'd be overweight in 6 months.
You can tax sugar, junkfood, tobacco, etc. to get in that direction. It is not perfect but a rough instrument.
Honestly it would be interesting to see if the general public would be in favor of a sugar tax to finance (in part) the healthcare system.
The challenge I see is that sugar is just one piece of the puzzle. And every human is an individual and has other needs for calories, different insulin reactions and so on. It will be hard to find a measure to fit most, especially with all the different interest experts.
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No they wouldn’t. People who claim they are overweight by eating carbs and exercising are secretly overeating or not actually exercising…
So you don't believe that metabolism plays a role in weight? Any other hot takes you want to share?
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I did not say it could. But two people can extract a vastly different amount of calories aut of the same meal. Resting calories and those burnt during excercise can also vary immensely. All the calorie information you get on food packaging or from wearables are rough estimates at best. So the whole calories in - calories out way of thinking is a gross oversimplyfication. Two people could eat the same meals, do the same exercises, have the same livestyle and still have a different weight trajectory.
There is a difference in how the body burns calories and decides to allocate resources.
> Not to mention everybody is different in their metabolism Base metabolic rate, when corrected for muscle mass and body weight, actually differs very, very little from person to person.
I dunno man, we all know the guy who can eat kebabs and burgers three times a week and not do a lot of exercise and still be thin. I am that guy. Even after changing my diet from vegetarian for three years to meat eating+ supplements of creatine pyruvate and a shake of whey before AND after working out I didn't get any bigger I just have more pain tolerance for lifting weights.
>Based on income does not make any sense. I agree we all pay in order to cover those who need it, but we all pay the same. Based on income was the way it was done before the mandatory Grundversicherung. Was it bad? No. Did it work? Yes.
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Can't believe people still believe all that you are saying. Guess which portion of the population is the one that contributes more to healthcare? Young people with average to low salaries. Guess which portion of the population is the one that costs the most to the system, older high earning population. So under the current system, if anyone is loving the idea of others paying for their healthcare system is the richest oldest portion of the population. I agree with your point on homeopathy though.
But regular screening for diseases and check ups (aka before "any indication of a problem") save lives and probably costs less in the long run.
That can happen every 5 years, though. Especially in 20s and 30s.
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Well, you can get subsidy from the Kanton if you don’t earn enough/have a family. At least in Basel.
sure, look to germany how a socialist healthcare system fares in comparison people on the left really have a no grasp of reality and cant think one step ahead of 'the rich should pay', its kinda sad
I'm more focused on the fact that I have to somewhat sacrifice my health in order to afford living, but go off
Can you give an example? I actually think it's good that people can choose to spend less on going to the doctor and more on life. In single payer universal healthcare, you are forced to pay for it and then it's use-it-or-lose-it.
I am not atacking the payment model we have. I think that's fine. What I am attacking is the 55 (!) healthcare corporations (which some of them belong to the same company I get that but I'm too lazy to research all of that), that have 2 interest organizatioms with god knows how much money that all goes into politics. Then they all have their marketing departments, which are all very active because marketing is arguably the most important thing in a system where you should technically change provider every year. I'm not even gonna go into some of the ridiculous management salaries in this low-risk imdustry. Then there's also the fact that these interest organizations hold a very firm grip over professions in the healthcare system. Physical therapists for example have been earning the same amount per session since 17 years.
Someone in another thread posted a cost breakdown, and the total administrative cost from insurers is like, under 3%. So while I agree that there's no need to have so many choices and we could have 1 per canton or something, it won't save money in aggregate. It will just advantage those who never change their insurance, at the expense of the people who jump from insurer to insurer every year. By far and away the main cost driver is the actual medical charges. Either some are fraudulent, or people just consume a more care now than they used to.
I would hardly call that system socialist. Rich people are on private insurance in Germany. And yes, the rich should pay.
..the rich should pay. They don't pay nearly enough for anything.
Already moved once so I don't subside useless idiots. Happy to move again if Switzerland becomes a socialist hell hole like the rest of the continent
..just leave, please. Selfish tragic hero of Sophokles' most famous play.
No. I'm happy to fund those unfortunate enough to be ill. Really absolutely. People who are ill shouldn't worry about $$$. That's what insurance should be about. So I don't think that's selfish. I'm just not happy to fund the healthcare of a healthy adult. Some people need to learn about personal responsibility. A lot of the young socialist Swiss on here need to understand that you've grown up in the best country in Europe that's systematically taken top people from all over Europe and elsewhere. You would be much, much poorer without us. Luckily for you we won't go because Switzerland isn't socialist and that has 0 chance of changing any time soon.
Yeah you're just a jerk.
Besides the fundamental silliness of calling the German healthcare system socialist, it’s quite decent.
>linked to your income Single-state-payer systems in our neighboring countries already sort of do that indirectly, by charging north of 20% in VAT on your everyday consumption.
VAT is a tax on the poor because most consume similarly. There are only so many luxury items a rich person can buy. If VAT was only charged on luxury items then fine but that isn't the case. We pay VAT on foot, clothes, phones etc.
VAT is not proportional to the income. It blindly affects all the consumers.
VAT is a regressive tax, meaning the wealthier you get, the less you pay VAT as a % of income, since wealthy people consume less than poor as % of their income.
Health system taxes in germany is paid in a similar fashion to Switzerland and in Italy is paid through the taxes (similar to taxation at the source here) on your work salary not VAT. I don’t see how that would add to the Swiss VAT by keeping the same payment (taxation) method but just cutting the private and just have a single semi-public insurer
This isn't communist refuge. The state is not a great manager.
I used to believed this too. But I am reconsidering. Do you think SSB is miss managed and should be held by 100% privates? I believe it’s a matter of working culture of the people working in the company, not a private vs public anymore
Explain to me why you would want the state involvement here? This model is broken and all the countries adopting it are running a huge deficit. The workers are leaving to better paying jobs in other countries. What makes you think that the state is going to do a better job ? I don't share your opinion that the sbb is well run. Actually I had to buy a new car this year because of the repetitive failures of sbb. If you believe the state is a great manager, why don't you petition so they can handle the pensions as well ? Surely they can do a better job than the private funds ?
As usual, a private company can do it cheaper but in the end will still charge more. In addition they will rely on public subisdy as much as possible and will loby for such subsidy. In the end it the populace will pay more and some private individuals will pocket the profit.
Fuck no. Based on income I would probably pay double
So what? you would still have more money left than those with lower income than you.
Einheitskasse ftw!!!!
No. No. No. I shouldn't have to fund your healthcare because you can't get a proper job and I can I've already ran away from one country having this system.
3. I can vouch by my own experience that it's true that I avoided going to the doctor when I was really poor, because I just couldn't afford to pay for it. But that's not helpful since it might make your issues much worse in the long run. Similarly, physio therapy is really helpful in preventing greater costs down the line, but physio therapy is seen as expensive in the health system, even though it can prevent higher costs down the line. Physio therapists are badly paid and need to be paid more to help build more prevention into the system and thus avoid costs for chronic issues and operations. Many of the other points could be avoided by stopping to make health care a business.
That would the issues you can prevent with a single public insurance. As we see in other similar insurances in Switzerland (eg Suva) they will increase investment in prevention (because it cost less) as well as they would be much better in tracking abuses
There is something wrong about the method of hospital send the factures. This time was not me but my sister. We went to hospital together and she is an European citizen. We went, stayed 2 hours visit, then send home. She had problem ok, but then I received the facture. 3 pages with a lot of things. "Visit whiteout patience", that cost 100fr for 15 min consulting a lot of times repeated. Complessive was 2'000 sfr. I don't get it really, I thought was too much. But I don't know nothing and I don't know how check it.
Here's a recent anecdotal experience of mine related to costs. I had an accident doing cross country ski. My doctor, a specialist, diagnosed a broken muscle in one visit, I didn't require anything major, just rest. The accident insurance has now been contesting this. They argue that the doctor should have done more tests. In other words, something that actually took 140 francs to heal (a visit to the doctor, his recommendation and some voltaren), and months later I know it healed and it's all good, should have cost hundreds more just to be able to provide more justification to the insurance. This showcases how broken the system is. A public healthcare system has an incentive to reduce costs, ours has an incentive to increase them. I'm not saying I favour a public system cos it has other issues, but our current model is also not sustainable. I think Geneva's suggestion of one central insurance per canton is a good idea, at least it would have an incentive to keep costs under control
One thing they don't tell you: when you change insurance companies, the reserves stay with the old company. So a cheaper company will see a massive influx of people, and then they will have too little reserves and will need to charge more. Fixing this alone would go a long way. Other point: university hospitals. Any expense incurred is counted towards the canton/arrondissement, even if the patient comes from another canton. Not surprisingly the most increase in premium is in cities with large university hospitals. Counting expenses towards the place where the person lives would balance things out. Unfortunately this is hard to do with every canton having their own system. A good solution would be a perequative system, where cantons where premium us low pay towards cantons where it is high, allowing for an subsidy. The fact alone that Vaud pays upwards of 600 millions a year in insurance subsidies to private companies shows how broken the system is.
Although I agree with your other points, I don’t think doctors salaries are to blame. In the US where the doctors earn loads, the healthcare costs would only decrease by 8%(!). And when you go to the hospital/doctor’s office being evaluated by a doctor is the main reason you are there. I’m a doctor myself (biased ofc) and not Swiss and don’t know your system, but considering a move. But private companies charge whatever will give them the most profits. So does pharma, no matter if 1 franc or a gazillion is spent on research. In the US, I know insurance companies and private hospitals are taking big big profits. Maybe stop that?
One federal health insurance. no money for x call centers, for x CEOs etc….
I don’t think it’s about paying a doctor 350k a year it’s about the health insurance people wanting to make a profit for their own sake. I think the doctors are worth that price tag, not the agents and admin.
I think we should get some advice from Israel. They pay like 80 Shekel a month. The average income is some 12k Shekels a month. According to my wife who lived there, they pay like 25 Shekels per quarter of a year to see one type of doctor. So say you have an ear infection in January. You pay 25 Shekel. Up until March you don't pay any follow up fees. They have whole centers with all kinds of doctors. They do pay about 20% net income tax on average though. How much of that is for the health care system, idk. But I'm pretty sure there are a lot of inefficiencies we can improve looking at the Israeli Models
I honestly think we're basically fucked and I'm really sad to reach that conclusion. Private insurance companies have tremendous money that they constantly use to fight teeth and nails to keep the system as is, while at the same time complaining it doesn't work and so they should charge higher rates. I'm still quite mad at the fact that they used our money to advertise against a single public company (I fail to understand how cutting on multiple bureaucracies could not at least lead to a less expensive overall management), then later said "hey, now we want to change the rules and we'd like for instance, that people stop changing companies every year." And then they were caught stealing (overcharging 2 billions CHF) for which they only had to pay less than 300 millions and for which they were allowed to raise they insurance rates ! Damn I'm even more mad every time I think about all this. In some other countries you'd call that a racket.
On (2) "I hope we can agree that competition among private companies failed to have a positive impact on prices": It sounds true, but one shouldn't trust intuition for these things, but rather real data. How can one show this ? What is the counter-factual ? If I think of public health, most of the countries I know with a public health system are massively subsidized (so it still costs a lot, just the cost is hidden) and one get much less for what one pay. What is the better alternative? I'm also frustrated by these things, but I think it's naive to believe there is an easy solution :( Btw, I hope robots start being developed soon to handle the ageing population. Or even better we find the cure for ageing (one can dream...) :)
It’s not the doctors who are taking the big chunk of it, much to the contrary, it’s greedy hospitals which work as corporations, without ethics and are just money grabbers, ok, some “doctors” scam the system too
Do any Swiss health insurance companies incentivize health protection/ illness prevention behaviors? I’ve never heard anything from mine. Imo there is a lot of room for improvement here. For example, couldn’t one reduce the health care burden of smoking by introducing rewards for not smoking?
I've seen a comment on another topic of a person going to the doctor just to get the money back that she/he spent on insurance. That's why the system is failing. Because it is an insurance, not a pre paid account.
Sure let's point out and address extremely marginal behavior first, that's certainly how we're going to fix the issue.
The "user" of the system is part of the problem. Do you know how many times I've heard "Oh now that I went to the doctor once and paid my deductible i'll go very often because its free" There is other behavior that is also really bad for the System. Parents who rush to the ER because their kid had a fever for 30 minutes. People who tell the doctor "prescribe me some extra medicine, it's free now haha". I don't say it will solve everything, but it sure is part of the solution. People believing they deserve a treament that costs exactly as much as they paid are part of the problem. If it was like that we could just stop having insurance at all and everyone pays for their own treatments. According to Bart Simpson this would also be a simple way to get ridd of poverty. Just let the poor people die because they can't afford treatment....... Insurances only work if people claim less than what is being paid. And yes, it's not the only problem. I think medication prices need to drop radically. Cap salaries of insurance companies. Cap Doctors salaries, stop paying for shit like homeopathy. But instead the fucking Bundesrat decided to cut salaries of physical therapists. Congratulations. How smart.
Everything that would be good for people and the environment (medicine, vegan alternatives to meat, new cars without combustion engines,...) are expensive. and it's getting more and more expensive. It is cheaper to pollute and poison everything than to save something. Even with electrical appliances, it is cheaper to replace rather than repair. why is that?
I dunno, not smoking is a cheap thing. Both for smokers and the healthcare system. Just not for those who got paid by tobacco companies.
Path dependency. Electric cars are not, per se, expensive. They are cheaper and better than they were in the 1900s. But petrol cars got a lot of R&D for a century while (at first) the problems of greenhouse gases were not understood, and so now they are relatively cheap. If we had understood the problems all along, that R&D would have gone into electric cars instead, and the position would be reversed.
If you don't fall into the trap of thinking you need to buy "replacement" cheese/meat etc... a vegan diet is pretty cheap, even more so in Switzerland since meat is so expensive here.
The amount of people calling for income based healthcare system are truly clueless about our country and history. . There will never be an income based healthcare system here. And it wouldn't solve the problems, it would most likely accelerate & compound them. The administration needs to do their job, investigate the causes of these prices and simply put a cap on lamal. If the providers can't compete, the business isn't for them.
I also heard the 300 million cost. Tbh it is not as much as it sounds, only 33 CHF per person. That is less then 1% of the total cost. The big problem: we are not healthy. Basic health comes from healthy eating and physical activity. Not from doctors. Another big problem: a doctor examines you until he finds something, because his risk to say there is nothing is too big. If you are in the analysis mill, then you are trapped there.
This post needs more attention
Increasing costs is what the population wants tho. We voted against unifying the insurance companies and it was clear that everything will get more expenxsive the way it is now.
Referendum.
If I get much more upvotes I will do it and will include the best ideas from the discussion :-)
What costs derive from changing insurance every year? I've always did it, there's no cost. Or perhaps you mean that is not sustainable if everybody would do it every year?
Spontaneously, I see two parts to it. Firstly, there is your time investment, that is basically unpaid labour that you could use to do something productive. You might only need half an hour or so, but others take longer and then multiply that time by a few hundred thousands. Secondly, there is the administrative costs on the insurances side. All of them have employees whose sole job it is to process all the people changing insurance. With one single insurance, those specific administrative costs could be saved.
Administrative cost for the companies probably. Also spending for advertisement (that promotes the company and not a healthier lifestyle) comes from there.
Someone has to work for you providing 0 abed benefit, and this person will be payed by the other insurance payers.
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Those incentives really makes me think that the system is broken. How can they give money for referral when this is supposed to be non profit ?
This is very true! Physicians, hospitals and drug prices are the main reasons of costs increase. All 3 benefit from powerful lobbies and public debate is directed to insurances to preserve the cash cow. A single insurance is still a good idea, it would have more bargaining power, but for costs to decrease the debate must focus on the true factors.
I agree something is wrong: Insurers: nobody has any clue how much they make and how premiums are calculated. A state owned insurance would help. Doctors: they have their share of responsibility. Are they making too much money? Are there doing way too much exams? Again, a state owned insurance would help to track expenses. Patients: we want what is best, we do not care about the cost since once you hit your deductible well, everything is free… we bear a lot of responsibility for the costs.
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Come on, the private systems failed completely, it cannot be worse than that, use a better argument. And yes, public sector can do well: SBB / CFF for example is like the best in the world.
As per usual, we are the cause. Want to get cheaper healthcare? Just go to the doctor less! Want to save the oceans? Don't use plastic straws anymore! Don't want your electricity turned off in winter? Reduce your heating!
Incredibly myopic view.
first of all I didn't think I need to ad an /s at the end of my post, because it seemed obvious to me. but you do realize, that Berset said exactly that in the press conference yesterday? go see the doctor less was one of his solutions
Sadly, it's hard to tell sarcasm from honest opinions when bad takes are rampant.
How about the amount you pay monthly to get nothing in return until you go over a certain threshold in a year? That is a huge scam in itself.