Luddites of the world, unite!

Every year about this time the Swiss Government publishes a list of the prices of the various health care plans offered by all the health insurers in Switzerland. Swiss citizens have a couple of months to decide whether they want to change their insurer. The free market (sort of) at work, bliss when compared with Obamacare-Hell in the USA and Leninist-NHS-Hell in the UK.

We learn from Edgar Schuler in the Zurich Tages-Anzeiger this morning that one health insurer is always the cheapest on that list – and by a large margin: the Krankenkasse Turbenthal, 'Turbenthal Health Insurance'.

Turbenthal is a small town just to the east of Zurich. The company's office is a small bookcase of ringfiles and a Hermes Ambassador typewriter; its Chairman, Managing Director and only employee is a man called Daniel Rüegg. Neither email, PC or mobile phone disturb this administrative idyll, just the clatter of the Hermes, the messenger of the gods.

The company currently has around 400 customers, all of whom Daniel Rüegg knows personally. 'Only 400?', you ask. Yes, because its customers must live in Turbenthal or its environs. It offers a single plan and relies on the sense of personal responsibility of its customers.

'The computer makes you ill' [Rüegg] says, he sees that all around. The 63 year-old has never used one in his life. But he is not interested in converting other people: 'I accept that. Whoever wants to work with a computer should do so – no problem'. But then the man with the optimistic moustache becomes quite emphatic: 'In our country we have always tried to give everyone the freedom to live their lives in the way they want'.

We laissez-faire, free-market thugs think: 'Wonderful!'

However, the state has other ideas about Rüegg's low-tech, economical approach and his paper interface to its own megadata-crunching model. True, the government says that a health insurer can use whatever technology it wants, but ultimately its customers by law have to have a chip-card to get them through all the corners of the health service labyrinth. Rüegg clearly cannot produce this on his Hermes Ambassador. So off everyone goes to the Federal Court of Administration, the salomonic judgement of which is still outstanding on this case: freedom and frugality or Big-Admin conformity and standardisation?

It has to be said that as far as the second option is concerned, many healthcare providers still don't really understand or take seriously the healthcare chip-card. It is an expression of administrative piety. It is still quite common to be asked to fill in a form on registration and the card is ignored. If the card is even requested it is only so that the receptionist can type the principal data elements by hand into the provider's own computer system. The government can force every citizen to carry one of these things, but they can't force the service providers to use them.

Update 06.11.2017

After 27 pages of legal pondering – 4,000 CHF, a bargain! – the Swiss Federal Administrative Court decided on 24 October 2017 that Daniel Rüegg's typewriter and filing system cannot be considered to be a health insurance system. Decision PDF [DE], Press Release PDF [DE].

Mr Rüegg has 30 days to decide whether to take the issue one last step to the Federal Court, but the outlook for him seems bleak.

Many commentators on the subject feel that the costs of the more expensive insurers are not inflated by the computer systems or the rabbits who operate them, but rather by the many upper layers of foxes who operate the lower layers of rabbits.