pean Union: Implications of Single Market
230. Ibid.
Legislation and Competition Policy," European
231. Gautam Naik, "Dutch Treatment: In Holland,
Health Policy Group, September 2004.
Some See Model for U.S. Health-Care System,"
249. Disney et al., Impatient for Change, pp. 2938.
Wall Street Journal, September 6, 2007.
250. Civitas, "The Swiss Healthcare System," (Lon-
232. OECD, "OECD Health Data 2007: Statistics
don: The Institute for the Study of Civil Society,
and Indicators for 30 Countries."
2002), http://www.civitas.org.uk/pdf/Switzerland.
233. Rudolf Klein, "The Troubled Transformation
pdf. This number differs from the official OECD
of Britain's National Health Service," New England
percentage because the OECD defines government
Journal of Medicine 355 (2006): 40915.
expenditure on health to include government-man-
dated insurance premiums, even if they are spent on
234. Daniel Martin, "Billions Squandered as NHS
private insurance. Under this definition, all private
Fails to Deliver," Daily Mail, September 12, 2007.
insurance purchased in Massachusetts under its
new compulsory health care plan would be catego-
235. Ibid.
rized as a public expenditure on health, for example.
The cited number excludes mandatory insurance
236. Anthony Browne, "Deadly Rise in Wait for
premiums because, though Swiss citizens are
Cancer Care," London Observer, March 3, 2002.
required to purchase a basic insurance plan, that
plan comes from privately owned and even "for-
237. Anthony Browne, "Cash-Strapped NHS
profit" insurance companies. Individuals have con-
Hospitals Chase Private Patient "Bonanza," London
siderable freedom of choice among insurers.
Observer, December 16, 2001.
Furthermore, premiums are paid directly to the
insurers rather than collected directly by the gov-
238. "Too Successful: The Hospitals Forced to Intro-
ernment. For all those reasons the Swiss system dif-
duce Minimum Waiting Times," Daily Telegraph,
fers significantly from, say, Germany, where I believe
August 7, 2006.
it is proper to include payments to sickness funds as
a governmental rather than a private expenditure.
239. Ibid.
251. Michael Tanner, "No Miracle in Massa-
240. Martin, "Billions Squandered as NHS Fails
chusetts: Why Governor Romney's Health Care
to Deliver."
Reform Won't Work." However, Regina Herzlinger
of Harvard University notes the important distinc-
241. John C. Goodman, "Health Care in a Free Society:
tion that, unlike most systems of managed compe-
Rebutting the Myths of National Health Insurance,"
tition, including both the Clinton and Romney
Cato Policy Analysis no. 532, January 27, 2005.
versions, the Swiss system is not employer based (e-
mail to author, October 3, 2007).
242. Richard Lewis and John Appleby, "Can the
English NHS Meet the 18-Week Waiting List Target?"
252. For more on the concept of managed com-
Journal of the Royal Society of Medicine 99 (206): 1013.
petition, see Enthoven, "The History and Princi-
ples of Managed Competition."
243. David Rose, "Waiting List Crisis as NHS
Cuts Costs," London Times, June 56, 2007.
253. Association of Swiss Health Insurance Com-
panies and CIA World Factbook (Washington: Central
244. Callahan and Wasunna, Medicine and the
Intelligence Agency).
Market: Equity v. Choice, p. 93.
254. Michael Tanner, "Individual Mandates for
245. Lewis and Appleby, "Can the English NHS
Health Insurance: Slippery Slope to National
Meet the 18-Week Waiting List Target?"
Health Care," Cato Institute Policy Analysis no.
565, April 5, 2006.
246. "NHS Should Not Treat Those with Un-
healthy Lifestyles, Say Tories," Evening Standard,
255. E-mail from Sabine Alder, Communications
September 4, 2007.
Manager, Association Suisse d'Assurances, to author,
October 4, 2007; Greg Kelly, "Can Government Force
247. Elizabeth Docteur and Howard Oxley, "Health-
People to Buy Insurance?" Issues and Answers no. 123,
Care Systems: Lessons from the Reform Experience,"
Council for Affordable Health Insurance, March
OECD Working Paper no. 9, December 5, 2003.
2004, citing data from the Insurance Research Coun-
cil, http://www.cahi.org/cahi_contents/resources/
248. Sarah Thomson and Elias Mossialos, "Reg-
pdf/n123GovernmentMan date.pdf.
ulating Private Health Insurance in the Euro-
45