Voters are deciding on Sunday whether abortions should be covered by basic health insurance in Switzerland. The vote comes after conservatives launched an initiative to make the funding of abortion a “private matter”.
Backed by an inter-party committee made up essentially of conservative Christians, the people’s initiative was signed by about 110,000 voters – making it eligible for a popular vote.
It calls for the introduction of a new article in the federal constitution and states that abortion and foetal reduction (the elimination of one or more embryos in a pregnancy) should not be included in compulsory health insurance, apart from “rare exceptions concerning the mother”.
Opponents say the change would undermine the principle of solidarity enshrined in the mandatory health insurance system, whereby annual premiums are pooled to finance everybody’s needs. However, proponents of the initiative argue that it is unfair for people who object to abortions for moral reasons to have to help finance them.
“A private matter”
“To me, abortion is a private matter – just like contraceptives. That doesn’t bother anybody. But suddenly the health insurance is supposed to pay for abortions,” Peter Föhn, member of the initiative committee, told swissinfo.ch. Föhn is a senator and member of the Swiss People’s Party.
Yet the policy is not at all sudden. In 2002, the Swiss electorate approved the so-called first-trimester solution – which made abortion legal in the first 12 weeks of pregnancy. (Before 2002, women needed to have a professional verify that the procedure was necessary for mental health reasons.) That initiative, which passed with 72% of the votes, also established that private health insurance would cover the cost of voluntary terminations.
A consultant for the initiative’s “No” committee, Anne-Marie Rey says there is more at stake than the funding issue. The 71-year-old was the president of the committee that fought to decriminalise abortion in 2002.
“They don’t say what they really want. Their ultimate aim is to abolish abortion, and because they know they won’t succeed with that, they’re trying to gnaw away at it. It’s an attack on the vote we had in 2002,” Rey told swissinfo.ch.
Rey is the secretary of APAC, a federation of professionals specialised in handling unwanted pregnancies and contraception. Rey herself had an abortion some 50 years ago, when it was still illegal in Switzerland.
Like every constitutional change, the initiative would require a majority both of the nation’s people and of the cantons to pass.
Switzerland is fairly typical for Europe, but abortion policies around the world are quite varied.
Föhn says that in addition to the morality question, money is another reason why voters should support the initiative. He finds that health insurance is so “horrendously expensive” that many people can no longer afford it.
“In Switzerland today, a lot of services covered by health insurance really shouldn’t be,” Föhn said. His committee suggests that women take out extra health insurance if they think they might need an abortion at some point.
According to government figures, financing Switzerland’s abortions amounts to about CHF0.60 ($0.66) per insured person per year. (See infobox.)
“There’s no way that they’ll save some money with this. The financial argument is nuts,” countered Rey, pointing out that women with no financial resources would be the ones most affected if the initiative goes through.
“I fear very much that some of these women would return to do-it-yourself methods and have complications requiring medical care. Or they might have the baby, which would also be covered by health insurance,” she said.
Costs of abortion
According to government figures, the cost of a termination of pregnancy ranges from CHF600-3,000. ($670-3,350). The average cost of a pharmacological termination is CHF650 and a surgical termination comes to CHF1,000.
Overall, the costs are estimated at about CHF8 million a year. If treatment following an abortion is included, they are CHF10-12 million. This represents about 0.05% of all the costs that are covered by compulsory health insurance. However, a part of the cost is assumed directly by the pregnant women (deductible and percentage of costs to be paid) and is thus not incurred by the health insurance fund.
It is thought that these costs correspond to an average charge of CHF0.05-0.06 a month per insured person, as health minister Alain Berset told parliament.
The results of an opinion poll published by the Swiss Broadcasting Corporation on January 29 indicated that 58% of the electorate would reject the initiative. Of those polled, 36% said they would vote in favour of it, while the remaining 6% were unsure.
In parliament the initiative has the support of just a few Christian Democrats, a member of the Protestant Party and a bare majority of the Swiss People’s Party.
“It will probably be very tight. We don’t have a party behind us – we’re lone warriors. But I’m convinced that this will lead to a change in thinking and a focus on personal responsibility,” Föhn said.
“I think it will be a ‘No’, but the question is how strong. I do hope it will be more than 60%,” said Rey. She worries that a ‘Yes’ could chip away at the system’s principle of solidarity by launching new initiatives to cut services from the basic insurance menu.
Indeed, that’s what Föhn would like to see.
“If the people vote ‘Yes’, we can discuss a number of things. Then we could also remove other services from the mandatory health insurance,” Föhn said, citing examples such as heroin for addicts, unnecessary C-sections and perhaps emergency treatment for young people who binge drink at the weekend.
But asked about lung cancer treatment for smokers, Föhn said, “They’re already ill – that’s a bit different.”