MICHELE NORRIS, host:
Over the past several weeks, we've been reporting on health care in European countries. In the U.S., health care is one of the top issues for voters this year. As lawmakers prepare for another round of health reform, the system in Switzerland has drawn a lot of attention in health policy circles. Like in the U.S., Swiss people spend a lot on health care, but there are some fundamental differences.
Everyone in Switzerland is required to buy insurance, and the minimum package is more comprehensive than many U.S. insurance policies. NPR's Julie Rovner met a Swiss family that's experienced the health care systems on both sides of the Atlantic.
JULIE ROVNER: Cecile Crettol-Rappaz is Swiss, but she was actually living in the U.S. when her daughter Anais began having emotional problems. Anais was seven at the time.
Ms. CECILE CRETTOL-RAPPAZ: In Washington, D.C., we find extremely well-trained people who worked with Anais, but everything costs a lot.
ROVNER: There was a lot of testing, some psychotherapy and medication. Crettol-Rappaz was luckier than many Americans. Her Swiss insurance covered at least some of her daughter's psychiatric bills, even while her family was here in the States. Many Americans have far less coverage for mental health than for other types of conditions. After four years in Washington, the Rappaz family returned home to Geneva.
Ms. CRETTOL-RAPPAZ: And then she had this huge breakdown because she changed into middle school. And then she was hospitalized.
ROVNER: Anais was ultimately diagnosed with a rare form of childhood-onset schizophrenia. That's when Cecile says she was most thankful for her Swiss health and disability coverage.
Ms. CRETTOL-RAPPAZ: For example, her hospitalization, she was five months hospitalized in the special care for young psychotic children. And that was paid by insurance. Our daughter got three-times-a-week psychotherapy. She has therapy with horses two times a week.
ROVNER: That horse therapy is popular in Europe. It's to help children with emotional problems learn to use their bodies. Today, Anais is 17. She goes to a special school. Soon, she'll start another program offered by the hospital in Geneva that will provide a wide array of services, including art therapy. She's quiet but otherwise friendly, as she shyly poses for a photo with her mother in their comfortable Geneva apartment.
Later, sitting on the terrace that overlooks a lush courtyard, Cecile explains that their generous health care coverage doesn't come cheap.
Ms. CRETTOL-RAPPAZ: We have, like, a luxury system of health, but it costs a lot.
ROVNER: Almost $1,000 a month just in mandatory premiums in the case of the Crettol-Rappaz family. That's pretty typical for this part of Switzerland. Cecile brings out the family's health insurance bills. She keeps them in a three-ring binder. Here's how it breaks down.
Ms. CRETTOL-RAPPAZ: For me, it's 400.
ROVNER: That's 400 Swiss francs per month, about $390. Her employer, the Swiss grocery chain Migros, pays 60 francs towards that, although in Switzerland companies don't have to contribute to their workers' insurance.
Cecil turns to her husband Bernard's bill. He pays less because he chose a plan that limits his choice of doctors. Next page. Now she's on to the extras. In order to get some of the few things that aren't included in the basic Swiss package, the family also buys supplemental insurance.
Ms. CRETTOL-RAPPAZ: Okay. For me, 30 francs. That means that I get, for example, all kind of prevention, help at home, glasses, alternative medicine, all these things.
ROVNER: Cecile and her husband also have added policies to provide them with semi-private rooms if they need hospital care. Those are another 105 francs a month each.
Ms. CRETTOL-RAPPAZ: That's amazing how expensive it is.
(Soundbite of laughter)
Ms. CRETTOL-RAPPAZ: I just realized that.
ROVNER: Well, not that amazing. Selling supplemental insurance is the only way Swiss health insurers are allowed to make a profit. By law, they can't profit on the basic insurance package - that's the part everyone is required to buy. Insurers can't discriminate against sick people in the sale of the basic plan either. But they can refuse to sell supplemental coverage to people who are already sick, people like Anais.
Still, Cecile says about the only thing that really bothers her about the Swiss health system is not how much she pays, but the fact that health insurance premiums don't vary according to people's incomes.
Ms. CRETTOL-RAPPAZ: I pay what I pay, but my neighbor, you know, she pays also 400 francs, even though she has a salary which is half mine, for example. And that's unfair.
ROVNER: There are efforts underway to change that, but what about the insurance mandate? Does she object to the fact that she's required by law to buy insurance? Cecile laughs.
Ms. CRETTOL-RAPPAZ: Oh, that's really American, your question. No, because you are so used to have this individualistic way of thinking, this pioneer mentality, where everybody has to taking care of themselves. It's good for people who have no problems, but there is a bunch of people who have fragilities, who have problems. And these people need a social net.
ROVNER: In the end, says Peter Zweifel, a Swiss health economist, that may be the biggest difference between the Swiss and American health care systems - that Swiss willingness, even eagerness, to provide for one another and why passing a law to cover everyone, as the Swiss did in 1994, remains such an uphill battle in the U.S.
Professor PETER ZWEIFEL (University of Zurich): If you'll permit my remark, I don't see American voters forcing their politicians to write anything like this into law. It's in your genes. Your ancestors emigrated from European countries because they did not believe in redistribution, but they heavily believe in everyone is responsible for his own luck, or unluck - whatever. That's not a criticism. It's just a fact that the mindset of the U.S. population is a slightly different one from the Swiss.
ROVNER: Which may help explain why a universal coverage system - even one based on private insurance like Switzerland's - still seems a long, long ways off. Congress just may, however, pass a law in the coming weeks to require health insurers to cover mental illness to the same extent they cover physical ailments. It's been 12 years in the making. Julie Rovner, NPR News.
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