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Whole Foods’ John Mackey Gets ACA and Health $$ Wrong

Posted by John McDonough  January 22, 2013 12:41 PM

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I appreciate and patronize Whole Foods (and Stop & Shop) and had no knee-jerk reaction when I heard its CEO John Mackey refer to the Affordable Care Act (ACA/Obamacare) as "fascist." Eye-rolling, perhaps, at another example of over-the-top ACA hyperbole. Mackey quickly apologized for his "poor word choice" and added the below comment:

"I believe that, if the goal is universal health care, our country would be far better served by combining free enterprise capitalism with a strong governmental safety net for our poorest citizens and those with preexisting conditions, helping everyone to be able to buy insurance. This is what Switzerland does and I think we would be much better off copying that system than where we are currently headed in the United States."

So let's talk Switzerland. It is true -- the Swiss system is 100% private with no public health insurance like Medicare or Medicaid at all. But that's not all.  Swiss health insurers, by law, are 100% non-profit -- no profit-making plans at all. (Not quite "free market", huh?)  More than that, Swiss plans are even more tightly regulated than are health insurers in Massachusetts, one of the most heavily regulated health insurance markets in the nation. I used to joke, post MA-health reform and pre-ACA that Massachusetts has drifted out into the Atlantic and was heading toward ... Switzerland!

And how is the Swiss system doing? Here's a recent summary slide from the Commonwealth Fund:


On per capita health spending, the Swiss system is the third most expensive, and on health spending as percent of GDP, they are tied for 5th. And look at which nation is #2 on per capita health spending -- the Netherlands, the other leading nation that has pursued a totally private insurance and "managed competition" route. Some years the Swiss system has been #2. In other words, Swiss performance on spending only looks good in comparison with the U.S. , us. Now look at this Commonwealth Fund slide:


In 1980, the U.S. health care system already was the most expensive, though clearly bunched with the pack of most expensive nations. It was in the ensuing years that we broke loose, especially in the 1980s and the 2000s, the decades when deregulation and freeing health care "to act like a market" was near-religious doctrine. Mackey says:

"There is an alternative to mandated health care in free enterprise capitalism based on voluntary exchange for mutual gain."

He's right -- that is the alternative. We've tried it, and it has given us an explosively expensive system with deplorable quality and population health results.

I like your groceries, Mr. Mackey, much more than your ideas about health care.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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