Will Swiss physicians opt for the health care kolkhoz?
The Neue Zürcher Zeitung NZZ reports today that the Swiss Medical Federation FMH has decided not to take sides in the vote on the socialist health insurance initiative due next spring.
By leaving the decision to the members, the FMH abandons definitely the defense of the liberal traditions of the medical profession. It is evident that one of the central motives for doctors to opt for a centralized federal health insurance scheme is their growing anger about the unreliable, inconstant and mostly aggressive politics of the various social insurance companies active in Switzerland under the umbrella of heavy federal and cantonal legislation.
Another probable motive is a change of paradigm in the autostereotype of the medical profession. Many young physicians no longer can imagine to engage in an independent and entrepreneurial professional activity.
Once they leave the hospital environment where they have become accustomed to be employees - mostly at an age where they are married with children and anxiously avoid professional reiks, they are often seduced by the possibility of entering into a so-called "tiers payant" relationship with the social insurance companies, under a contract where there is no need to ask payment from their patients, an where they can relay on payment by the insurance company. The tradition of the "tiers garant" system that had strengthened the relationship between primary care (and specialized) physicians and their patients by allowing direct comparison between price and performance, with payback by the insurance company to the patent has become shaky. It was the "tiers garant" method that allowed direct control of price and quality by the client, but since this system no longer exists in hospital treatment, young physicians are no longer prepared to enforce it.
As an economic editorial in the Neue Zürcher Zeitung a year ago said: "Before WTO, the Federal Constution had to guarantee the health of the farming profession, after WTO the Constitution might have to guarantee the health of the medical profession..."
Back in the Soviet Union, independent farmers, the so-called kulaks, were forced into the kolkhoz system of collective farming. It is one of the paradoxes of our era, that twenty years after the downfall of the Soviet system, Swiss farmers seriously prepare temselves to find their economic niche under the conditions of globalisation, and Swiss physicians increasingly lean toward collectivistic solutions of the healthcare system.
The crucial question is whether a majority of physicians will be tempted to seek shelter under an umbrella that would be a late imitation of the NHS in Britain, at a time when even in countries with a longstanding socialist tradition, there is a continuous shift away from state-controlled financing of the health care system.