Passing Healthcare Reform- Key Politicians’ impacts with Regards to Switzerland and the U.S.

1
Sarah DeCloux
Comparative Politics
ProfessorTomVillis
February25, 2013
Passing Healthcare Reform: Key Politicians’ impacts with Regards to Comparison between
Switzerland and the U.S.
Healthcare reform has a historical background for being highly controversial in
politics. For starters, healthcare impacts entire populations directly. Everyone has to
live with the outcome, therefore, politicians need to be successful the first time
around; there are no second chances. In addition, healthcare must be affordable for a
diverse economic population. As the cost of treatment goes up, so the importance of
maintaining sustainable prices becomes crucial. Healthcare is a complex creature and
needs to be handled with delicate consideration. Funding, systematic distribution of
services and quality are all important elements that must have priority in the minds of
policy makers when creating a healthcare system that contributes instead of detracts
from the national wellbeing.
So how do politicians pass healthcare reform while keeping the multitude of
factors in mind? The purpose of the paper is to explain the politics involved in
reforming two similar, yet very different, healthcare systems in two dissimilar
countries: the United States of America and Switzerland. We will look at the political
journey of reform in each state while paying specific attention to the key politicians
who were instrumental in positive and negative aspects of these transformations. As

2
healthcare is a politically charged issue, this comparison will show that the
disagreement between politicians and parties is the same for both nations, however;
it will also show that there is more than one way to pass healthcare reform.
On February 24, 2009, President Obama proposed health care reform for the
United States. Knowing there would be many obstacles to reform he stated, “So let
there be no doubt: Health care reform cannot wait, it must not wait, and it will not
wait another year.”1 President Obama was adamant about passing healthcare reform
and didn’t give much time to accomplish such a difficult task. From the start when
the Senate Finance Committee began discussions regarding the budget deficit and
how to reform healthcare efficiently, there was enormous controversy surrounding it.
Senator Max Baucus (a Democrat from Montana) and Senator Chuck Grassley (a
Republican from Iowa) led the Senate Finance Committee in hearing ideas for reform.
While the Republicans listened to experts critically, the Democrats had already come
up with a plan. This was the beginning of the battle between President Obama and his
Democrat allies, and the GOP resistance.
Republican Senator Charles Grassley, of the Senate Finance Committee, was
not swayed by the president, as he had consistently claimed that he would not
support any bill if there were not enough Republicans to mandate a 70-80 vote.2
1
Emily Smith, "Timeline of the Health Care Law," CNN, June 28, 2012, accessed February 24,
2013, http://www.cnn.com/2012/06/17/politics/health-care-timeline/.
2
John K. Iglehart, "Obama's Vision and the Prospects for Health Care Reform," The New
England Journal of Medicine, October 1, 2009,
http://www.nejm.org/doi/full/10.1056/NEJMp0908476?view.

3
Meaning, he would vote on the Republican side unless there was a seventy to eighty
percent majority in agreement. Still, the first reform draft was passed in the senate
after a month-long markup, during which 788 proposed amendments had to be
considered. Fifteen days later, the house also passed the bill by an extremely small
margin.
The second draft brought on a new, more intense, struggle between the two
parties. Bill Nelson (a Democrat from Nebraska) was one of three Senate members
who had not been persuaded into voting either way. He was pressured fiercely by the
Democratic Party and President Obama to vote in favor of healthcare reform. Hence,
he became the 60th and final vote needed to pass the second draft of reform entitled
‘America’s Affordable Health Choices Act.’3
The second draft was in the works, when Senator Ted Kennedy died after his
battle with cancer. Senator Kennedy had been extremely influential in supporting the
President’s plan, as healthcare reform in America was his lifelong dream. The death
of Senator Ted Kennedy, in August 2009, left democrats fearful at the prospect that
the former majority they had previously enjoyed was at risk. President Obama quickly
stepped up to back democrat Martha Coakley speaking on her behalf during the
Massachusetts elections to fill Senator Kennedy’s seat. In a close race, Republican
Scott Brown won the election and replaced Massachusetts’ seat in the senate. Scott
Brown’s vow to vote against any health reform bill compelled the Democrats to take
3

4
serious action. Knowing that they would no longer have the higher edge to push the
bill passed the senate, they went to desperate lengths to keep the ball rolling.4
Although President Obama claimed to adhere to a bipartisan policy, his address
to Congress, during the Bipartisan Health Care – Summit 5, threatened to use
“reconciliation” in order to overthrow them entirely if they did not adhere to the
desires of the Democratic. Reconciliation, a process only historically used when
dealing with issues regarding deficit and budget, was indeed used to defeat the
Republican Party and pass the healthcare reform bill. On March 21, 2010, the Senate
used the reconciliation clause to pass the Patient Protection and Affordable Care Act
despite 100% opposition from Republicans. It was signed into law by President Obama
on March 23, 2010.5
President Obama used several tactics to threaten, demean, and pressure any
opposition to his bill. In addition, his demand to pass healthcare reform by the end of
the year heightened the controversy of the situation and truly forced a stalemate
between the Republicans and Democrats. Obama refused to fail at his objective and
constantly reminded Congress, “I am not the first president to take up this cause, but
I am determined to be the last.”6 The phrase, “My way or the highway,” comes to
4
5
Ibid
6
"Remarks by the President to a Joint Session of Congress on Health Care | The White House,"
Remarks by the President to a Joint Session of Congress on Health Care | The White House,
accessed February 24, 2013, http://www.whitehouse.gov/the_press_office/Remarks-by-the-
President-to-a-Joint-Session-of-Congress-on-Health-Care.

5
mind when describing the President’s leadership style and influence regarding
healthcare reform in America.
*Health Insurance Reform in Switzerland was also extremely controversial and
tricky. The decentralized Swiss government was forced to reform healthcare due to
rapidly rising costs. In an attempt to understand how large the issue was, “The
Government appointed a commission of experts, representatives from labor and
capital and civilservants to develop an encompassing overview of the financial
problems and possibilities of social insurance in Switzerland.”7 The government felt
that regulating insurance would be the best way to cut costs. Their main goals were
to contain costs, provide efficiency, control the market competition thereby
increasing solidarity, and promote individual responsibility.
The proposal was presented to Parliament in 1991. However, in a state with
direct democracy the government needed to take the national referendum into
account. In order to define direct democracy and national referendums we must
realize that, “In the Swiss political system, legislative reforms (and other political
decisions) must pass a popular referendum. The referendum system is the primary
cause of a built-in conservative bias in policy making because radical changes mostly
7
Silja Häusermann, "Reform Opportunities in a Bismarckian Latecomer: Restructuring the Swiss
Welfare State," Government Department, Harvard University and IPZ, University of Zurich,
June 2006,
http://www.people.fas.harvard.edu/~ces/conferences/bismarck/docs/pdf/haeusermann.pdf.
*Findinginformation regardingkey politiciansin Swiss healthcarereformwas extremely difficult,therefore this
section was organized differently than the previous section on the United States.

6
do not find a majority.”8 Depending on how you look at it, direct-democracy can be a
blessing or a curse. In the positive, it gives the common everyday person a voice and
reinforces a sense of beliefs and belonging. Yet on the other hand, direct-democracy
maintains a much slower pace for passing legislation. “Two of the three reforms
(healthcare and pension) have been subjected to a referendum, which shows a
weakness of well-established consensus building mechanisms within government and
parliament.”9 From this perspective it almost makes the federal government
redundant, but someone has to draft legislation.
Since most health related responsibilities do not fall to the federal government
they also depended on cantonal and municipal entities to provide them with the task
of reform. The cantons in Switzerland are broken up into 26 separate entities.10 As
their governmental system requires, “The federal government can only legislate on a
social policy once the authority to do so is transferred from the sub-national.”11 Once
the federal government was laden with the responsibility of reform, they also
8
European Observatory on Health Care Systems, "Health Care Systems in Transition:
Switzerland," Who.int, 2000,
http://www.euro.who.int/__data/assets/pdf_file/0003/96411/E68670.pdf.
9
Jochen Clasen, "Social Insurance in Europe," Google Books, 1997, accessed February 24, 2013,
http://books.google.com/books/about/Social_Insurance_in_Europe.html?id=dogOb37lX5EC.
10
11
Silja Häusermann, "Reform Opportunities in a Bismarckian Latecomer: Restructuring the
Swiss Welfare State," Government Department, Harvard University and IPZ, University of
Zurich, June 2006,

7
received pressure from the many interest groups which insisted they had a say as
well. In order for reform to be successful, it was crucial that the federal council took
all of the reactions of the many actors into consideration and formulated a plan based
on compromise.
The complexities faced by the government in mandating national insurance
coverage were, and still are, the reason social reform in Switzerland takes so long.
Readmitting a constitutional amendment for mandatory health insurance took 106
years, from 1890 till 1996.12 This delay in time shows how slow social reform can be in
a direct-democracy. The debate regarding retrenchment was nothing new for
Switzerland. Over the fifteen years prior to the legislation actually getting passed,
cost containment had been a major priority for the Swiss government and people.
This was one aspect of reform that everyone agreed on. However, proceeding with
reform in light of ever growing concerns for economic and demographic development
provided a large divide amongst several actors. One major issue dealt with the extent
to which reform would reach, “There is far more controversy about the measures that
need to be enacted to achieve the aims of the reform. The federal government feels
that the fundamental mechanisms of the law must be retained and refined, whereas
other actors are demanding more far-reaching reforms.”13
12 Silja Häusermann, "Reform Opportunities in a Bismarckian Latecomer: Restructuring the
Zurich, June 2006,
13 European Observatory on Health Care Systems, "Health Care Systems in Transition:

8
Although the government had to keep in mind all of the groups and entities
that could have opposed the reform, one area that remained stable was the
cooperation of the political parties. There are four parties which have remained
consistent for over 45 years, the Social Democrats, Liberal Democrats, Swiss People’s
Party, and the Christian Democrats. Three out of four parties claim similar stances
when it comes to social reform and thus contributed greatly to the success of pursuing
healthcare reform. These three parties together had the power to push through even
controversial measures, but the knowledge of the impending public referendum kept
them in check.14 Still, political parties becoming more influential in Swiss politics has
become a trend since 1980, “Political parties have become more relevant in policy
formulation, compared to the past. Many recent modernizing reforms were designed
by the parties in parliament, rather than by labor and capital in the pre-parliamentary
negotiations. This may be explained by the inability of the social partners to foster
compromises over retrenchment, by the higher proportion of women in parliament or
by the stronger sensibility of parties to libertarian values and gender equality, as
compared to trade unions and business organizations.”15 Regardless, it was not party
agendas that complicated healthcare reform. In fact, since 1990 the political parties
have been very successful in negotiating compromise between them. And since the
14 Jochen Clasen, "Social Insurance in Europe," Google Books, 1997, accessed February 24,
2013,
Zurich, June 2006,

9
majority had a common goal of reducing cost expenditures in healthcare, they easily
agreed on how to define reform, "Social policy in Switzerland does not mean
redistribution, but status protection.”16 Their aim was not to redistribute wealth, but
to encourage active participation and individual responsibility to finance the
mandatory health insurance.
Ruth Dreifuss, the first female president of Switzerland, made it her mission to
push healthcare reform through this process. Before her presidency, in the position of
the interior minister, she began by dividing and conquering. Health reform was set in
two stages. First, she concentrated on a global budget and increasing federal
subsidies. Then she attempted to move some of the weight for hospital funding to the
cantons. However, the cantons felt that the added financial burden was too much to
bear, thus they would not approve the motion.17 These types of obstacles did not
bother Dreifuss, despite the recurring opposition from many sides she continued to
negotiate the details of reform. This persistent attitude made her seem like the
Margaret Thatcher of Switzerland. Whenever someone is determined to accomplish a
goal there are always those who will reject the idea. The right-winged, Swiss People’s
Party was that conflicting entity. On the occasion of Dreifuss’ retirement, the party
president Ueli Maurer stated, “I appreciated Ms. Dreifuss as a very obstinate and
Zurich, June 2006,
17

10
without frills politician. But he added: Her policies were wrong. She leaves us a great
deal of unsolved problems in social security. From this perspective, we welcome her
retirement.”18Despite all controversy, parliamentary debates on healthcare reform
continued until March of 1994 when the National Referendum took place, finally
passing the reform legislation into law.19
Now that we have looked at both the U.S. and Swiss reforms, we will compare
some of the similarities and difference between the two states, such as direct
democracy versus representative democracy, party cooperation, the power of
persuasion and leadership by Obama and Dreifuss, and the outcome of healthcare
reform in Switzerland, especially as it pertains to the future outcome of reform in the
United States.
As previously mentioned, direct democracy has both positive and negative
aspects. From a liberal perspective the positive impacts seem to outweigh the
negative effects. Representative democracy puts more emphasis on government
member’s personal opinions when it comes to the United States and truly defies
liberal theory as the U.S. government has thrown out their responsibility to represent
the entirety of the American population. Instead of the government working for the
people, the United States government has continually caused a clash with the
18
"Dreifuss Leaves behind a Controversial Political Legacy," Swissinfo.ch, November 25, 2002,
accessed February 24, 2013,
http://www.swissinfo.ch/eng/Specials/Votes_for_women!/Women_in_politics/Dreifuss_leaves_b
ehind_a_controversial_political_legacy.html?cid=3031464.
19
Jochen Clasen, "Social Insurance in Europe," Google Books, 1997, accessed February 24,
2013,

11
American people without regard to their thoughts or opinions. It would be interesting
to see what the U.S. would be like if a direct democracy replaced the current
representative democracy. Using Switzerland as an example, we might see that the
U.S. government would actually be held accountable; however, we may also see that
in a country as large as the United States, the negative impact of extended time to
pass legislation would overthrow the positive view of giving the American people a
voice. This new autonomous government has taken liberties far beyond what the
American founders intended. This idea can be clearly seen in the ruckus caused by
healthcare reform in the U.S. After President Obama succeeded with his reform,
several states revolted, petitioning the Supreme Court to rule the imposed insurance
reform unconstitutional. Even then, the checks and balances system proved
ineffective to keep the government accountable to the people. This has
deconstructed American solidarity causing vast distrust of the government and
widespread apathy.
Secondly, political parties in Switzerland and the United States have both
maintained consistent legitimacy in their respective countries. The difference
between these two states is the level to which they have been able to negotiate and
compromise. While Switzerland does not have a balance between parties, this fact is
inconsequential when considering the effect of reason and caution which remains in
the minds of those in government due to acknowledgement of national referendum.
Yet in the United States, the collaboration between Republicans and Democrats is
nonexistent. New trends of stalemate and the death of bipartisan cooperation have
taken over the majority of decision-making in Washington.

12
Third, leadership from Barack Obama and Ruth Dreifuss have both been
characterized by strong, defiant agendas and unwavering commitment to passing
healthcare reform. They have both received criticism for their stubborn platforms
when working with their respective governments. However, whencomparing their
style and tactics which they used to ensure their aims were met, it is evident that
Dreifuss has accomplished more by considering all the alternatives which were being
presented. Although her views were not appreciated by a large number, she insisted
that the importance of containing healthcare costs was more important than personal
opinion. She did not waiver on her mission, but looked at alternative solutions to
make reform happen instead of polarizing her government, as is the case with Obama.
Obama showed a lack of tact at times when trying to coerce the Republican Party to
agree with his plan. On more than one occasion he took the liberty to threaten the
Republican Party, essentially saying they could either get on board or do things the
hard way. His condescending message to Republicans exacerbated the already
controversial issue of reforming healthcare. As a result, the struggle of expanding
health insurance in the United States became yet another reason for Americans to
disapprove of the lack of cooperation within their government.
Finally, looking at the outcome of Swiss healthcare reform, we can see that
healthcare cost have continued to rise in Switzerland despite attempts to curtail the
issue, albeit they are rising at a slower rate. Switzerland has indeed incorporated
universal health coverage for their citizens and readjusted the financial burden so
that everyone is able to receive medical attention regardless their income. This
reform would have been impossible to implement if not for the federal government.

13
However, the cantons have also played a large part in emphasizing their role to shape
reform as well. It is far too early to know precisely the impact that healthcare reform
in the U.S. will have; but if we apply Switzerland’s example to the United States, the
outcome for the U.S. will not be as desired. A reworking of health insurance and
financial burden is not enough to cut the necessary costs in healthcare. Healthcare
expenses will continue to rise, just as they have in Switzerland. What both
governments failed to do was to enlist those at the bottom of reform; the doctors,
nurses and healthcare administrators. They failed to rework the way medicine is
provided in hospitals and doctors’ offices. Without reforming healthcare management
and distribution they stand little chance to restrict the excessive flow of cash into
healthcare.
In conclusion, we can see that multiple factors play into healthcare reform,
both causing and being affected by the controversy of the topic. Both states had the
ultimate goal of keeping healthcare costs to a minimum. Dreifuss was not well
received by the Swiss People’s Party. She faced adversity when navigating through the
many levels of government and public support she needed to pass healthcare reform,
but she did not let opposition keep her from her task. Obama did the same in a much
different way. He took on the challenge of reforming healthcare, but became so
caught up in the political games that he quit listening to the common people that had
inspired him to pursue healthcare reform in the first place. The specific leadership
styles of each president are typical of politics in their respective countries. U.S.
politics are quite dramatic while those of Switzerland maintain composure under
pressure. And while healthcare reform would be controversial in any country, the

14
comparison betweenSwitzerland and the United States shows that controversy can be
handled in many different ways.

15
Bibliography
Clasen, Jochen. "Social Insurance in Europe." Google Books. 1997. Accessed February 24,
2013.
"Dreifuss Leaves behind a Controversial Political Legacy." Swissinfo.ch. November 25, 2002.
Accessed February 24, 2013.
http://www.swissinfo.ch/eng/Specials/Votes_for_women!/Women_in_politics/Dreifuss_leaves_b
ehind_a_controversial_political_legacy.html?cid=3031464.
European Observatory on Health Care Systems. "Health Care Systems in Transition:
Switzerland." Who.int. 2000.
Häusermann, Silja. "Reform Opportunities in a Bismarckian Latecomer: Restructuring the Swiss
Welfare State." Government Department, Harvard University and IPZ, University of Zurich.
June 2006.
Iglehart, John K. "Obama's Vision and the Prospects for Health Care Reform." The New England
Journal of Medicine. October 1, 2009.
http://www.nejm.org/doi/full/10.1056/NEJMp0908476?view.
"Remarks by the President to a Joint Session of Congress on Health Care | The White House."
Remarks by the President to a Joint Session of Congress on Health Care | The White House.
Accessed February 24, 2013. http://www.whitehouse.gov/the_press_office/Remarks-by-the-
President-to-a-Joint-Session-of-Congress-on-Health-Care.
Smith, Emily. "Timeline of the Health Care Law." CNN. June 28, 2012. Accessed February 24,
2013. http://www.cnn.com/2012/06/17/politics/health-care-timeline/.

Passing Healthcare Reform- Key Politicians’ impacts with Regards to Switzerland and the U.S.

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Passing Healthcare Reform- Key Politicians’ impacts with Regards to Switzerland and the U.S.

Ähnlich wie Passing Healthcare Reform- Key Politicians’ impacts with Regards to Switzerland and the U.S. (20)

Passing Healthcare Reform- Key Politicians’ impacts with Regards to Switzerland and the U.S.