Ali- With the health care ….eeerrrrr…midnight benefits roulette game… roaring in the US, I thought I would take a couple minutes to share how the Swiss do health care. Some may be surprised to hear that Switzerland doesn’t have a single payer system like most of Europe. Instead they opted for what is essentially Obamacare (but they did it first – Swiss health care law passed in 1996). In fact, this New York Times article pointed to Switzerland during the 2009 health care debate as a potential model for the US.
First, there is a big fat individual mandate. Now Americans can’t stand the idea of someone telling them what to buy but the Swiss seem to be well onboard with the fact that the only way to have a stable health care care system with controlled rates is to have healthy low risk people paying in to support sicker high risk people. Proof is in the pudding here: according to Wikipedia, in 2010 the Swiss spent 11.4% of GDP on healthcare while the Americans trying to tame their Wild West insurance market spent 17.6%.
And they are REALLY serious about the individual mandate. 
When we got here, I brought with me all sorts of letters from Johns Hopkins Employees Health Care saying that the Abrahams were covered for overseas care. I was determined to get out of this extra burden on our budget, particularly since we were 1) already covered and 2) anticipated not using any health care while here because frankly I figured gynecological exams or teeth cleanings were not going to be more enjoyable in Swiss German.
So note that when you arrive in Switzerland they give you 90 days to get your health care butt in gear. We spent a good portion of that submitting paperwork under the assumption that, once the Swiss knew we were already insured in the US, they would let us out of obligatorische krankenversicherung, i.e. obligatory health insurance. 
Well we fought the law….and the law won. As of 2014 they shut down almost all loopholes; basically only poor visiting students are exempt. Switzerland 1, Abrahams 0. So Joe dutifully went to the insurance marketplace called Comparis and shopped for a bare bones policy.
Ok a little more about how Swisscare works. First, rates for policies can’t be based on any personal characteristics like age or health status. They are just a function of the benefits, health care model you choose, and the deductible you pick. Second there is a fixed maximum out of pocket amount that an insurance can make you pay, which is the deductible + 700 CHF. Third, there is a set list of stuff that has to be covered including a whole rainbow of basic services. You can find this information all in English or 3 other languages on the Comparis site.
For plans, you can choose one of four different health care models: standard free choice plan where you can see any doctor you want, a family doctor plan where you have one primary doctor who triages you, an HMO which locks you into a network and a telemedicine model where you start all care with a phone call. The later three options will lower your monthly premiums.
So for our purposes, Joe got us a 2500 CHF deductible telemedicine plan
, for a total cost for all Abrahams of 578 CHF per month. Now by arguing the point we had managed to secure a stay of execution for another 2 months, so we had to sign up by the end of December 2016.
Now what happens if you don’t sign up you ask???
Weeeellllll purely to satisfy your curiosity, we neglected to sign up until February, at which point we received a very polite letter in English telling us that we owed a fat penalty of around 600 CHF in total, but we managed to talk them down to about half that after mailing in our extensive collection of letters to and from the Zurich Gesundheitsdirektion.
So we have paid into the Swisscare system now about a total of 3000 CHF, and used Swiss health care 0 times. You’d think I’d be bitter about it but I’m really not. In the end we could afford to subsidize some poor sick Swiss person or imigrant. And while we didn’t use health care here, we certainly used a fantastic public school system and beautiful clean rivers to swim in and well managed transit, etc etc, all of which someone else subsidized for us because we paid very little by way of Swiss taxes.
And that’s how public services have to work. Everyone pays in and some use more and some use less but it all eventually goes around because eventually the subsidizers get sick and become the subsidized.
Last note about Swisscare. You also get a pretty awesome health card with a chip that can hold, if you want, all you health care info, which sure beats carrying around a fat folder full of medical records. 