Is it any surprise that Switzerland has, arguably, the world's finest health care system?  Would you expect any less from a nation where the air is crisp, the streets are clean, and the trains run on time?

• Everyone is covered
• Health outcomes are excellent
• Health costs are reasonable
• Patient satisfaction is high           

What’s especially remarkable about the Swiss system is that it is admired by both liberals and conservatives. Liberals like it because it guarantees universal coverage and conservatives like it because there's no burden on business. 

Although more expensive than the British and French systems, the Swiss system is much less expensive than the American system. Mortality rates are lower, waiting times are shorter, and technology is advanced. Not surpris-ingly, patient satisfaction is among the highest in Europe.

There are four major health care systems: the British system, in which the government employs doctors and runs hospitals; the French system, which is largely financed, but not run, by government; the Swiss system, which is financed through a tightly regulated insurance industry; and the American system.

As Paul Krugman points out in his outstanding New York Times piece, the American system has British, French, and Swiss elements. The Veterans Administration system follows the British model, Medicare follows the French model, and the Massachusetts Health Plan follows the Swiss model. 

Most Americans rely on an unregulated insurance industry, which fails on most counts: costs are exorbitant, outcomes are poor, coverage is restricted, and patient satisfaction is low. The major European systems – British, French, and Swiss – produce better results. The British system is the least expensive, but access to care, patient satisfaction, and technological innovation lag behind the Swiss.

The Swiss system works by regulating commercial insurance. People buy insurance directly from insurance companies, so businesses are out of the loop. Everyone must carry insurance, and those who don’t pay a penalty.

The government subsidizes the cost of insurance for low-income individuals (about one-third of the population). The affluent are not subsidized. (Contrast that with Medicare, which covers everyone over the age of 65, including wealthy people who don't need government assistance.)

In Switzerland, insurance companies must provide basic insurance to all recipients and cannot deny coverage on the basis of poor health. Premiums are not affected by health status. "Basic insurance" is defined by government, which decides which drugs, lab tests, and devices will be covered. Deductibles and premiums are tightly regulated and cannot exceed certain limits. Insur-ance companies cannot profit from the basic plan, though they may profit from supplemental insurance.

The Swiss health care system costs 40% less than the American system (on a per capita basis). Health care costs rise at a slower rate than in America. Healthy lifestyles (e.g. not smoking) translate into lower premiums, and people keep their coverage when they change or lose jobs.

The Swiss system has been criticized by right-wingers, who hate government, and by left-wingers, who hate insurance companies. But facts are facts, and results are results. By any standard, the system delivers. And the result is a nation of healthy, satisfied people.

So why aren’t Americans talking about the Swiss system?

Well, actually we are. The Swiss system is the crux of the Obama plan. Specifically, it meets Obama's goals:   

• Reduce growth of health care costs for businesses and government
• Protect families from bankruptcy or debt from health care costs
• Guarantee choice of doctors and health plans 
• Invest in prevention and wellness 
• Improve patient safety and quality of care 
• Assure affordable, quality health coverage for all Americans
• Maintain coverage when changing or losing a job
• End barriers to coverage for people with pre-existing medical conditions  

So before we get too upset about single-payer and other details in the emerging health plan, let’s remember that the Swiss are masters of efficiency and proficiency. They are long-lived, cost-conscious, and technologically advanced.

If Obama takes us as far as Switzerland, he will have done us all an incalculable service.

*I am indebted to Paul Krugman for his indispensable analysis of the American and European health care systems.