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Switzerland might be a good example (https://en.wikipedia.org/wiki/Healthcare_in_Switzerland):

Healthcare in Switzerland is universal and is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).



It's privatized, but not private like you would think of in the US. For example, insurers aren't allowed to profit off of the basic insurance everyone is required to get, they can only profit off of expanded coverage. They also have Medicare-style price controls which is obvious, but not private in the sense we use in the US.


So basically the big reason why it succeeds where ACA does not is because it regulates the prices?


That along with a real mandate and the fact that Switzerland is a tiny place (similar in population as Virginia, though 1/3 the physical size).


I've seen the geography argument brought up for a "Why no national insurance companies?" Apparently, network stuff is so localized that it's very hard to set up a national-level insurance company. Although I suspect state-by-state laws play into it as well.

At any rate, the sheer geographic size, plus the large population, plus the legalistic bizarreness of our federal/state divide, leads to a chaotic system, and we can't easily just legislate that away.


But why would a national insurance company be a prerequisite for quality healthcare in at least some states?


Interesting - the article doesn't seem to mention what happens if you're indigent. Also looks like it is highly regulated, between required coverage, not discriminating against existing conditions, and the "copay" (US term):

> and by a charge of 10% of the costs over and above the excess. This is known as the retention, and is up to a maximum of 700CHF (PPP-adjusted $429) per year.

That is absolute peanuts in terms of costs in the US.


How does this compare to the ACA, which also features a mandate?


It's complicated. But I think it's important to note here that, pre-ACA, the American system had two major flaws - high cost, and incomplete coverage. The ACA chose to address coverage first, rather than cost. The CDC reported the results here:

"More recently, the percentage of uninsured adults aged 18 to 64 decreased, from 22.3% in 2010 to 11.9% in the first 3 months of 2016. During this 6-year period, corresponding increases were seen in both public and private coverage among adults aged 18 to 64."




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