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Health reform Single health insurance given short shrift

Voters decided to maintain a system with more than 60 competing health insurance companies, but discussions on healthcare costs are likely to continue.

(Keystone)

Voters have clearly rejected the introduction of a single health insurance company. It was the third unsuccessful attempt by the political left in ten years to reform the Swiss healthcare insurance scheme.

Official results show 61.8% of voters throwing out the initiative by centre-left political parties, patients and consumer groups.

They wanted to replace the more than 60 private company insurers with a single payer system offering mandatory basic health insurance coverage.

Four of the country's 26 cantons - notably in western Switzerland - mustered a majority in favour of a single health insurer. 

Jacqueline Fehr, a leading promoter of the initiative, said the result was disappointing but did not spell the end for the idea of the single payer principle.

Fehr, a parliamentarian for the centre-left Social Democrats, said the number of citizens dissatisfied with the current health insurance system has increased since previous votes on a public single health insurance company in 2004 and 2007.

The Green Party for its part said the result is a victory for the powerful insurance industry. The group announced it would push ahead with plans to allow regional single health insurance companies.

Vote of confidence

Santésuisse, the Association of Health Insurance Companies, said the outcome at the ballot box was a vote of confidence for the insurance system. But it stressed the importance of finding ways to contain the steady increase in health costs.

“It is crucial to allow only therapies which are efficient and reasonable,” Santésuisse director Verena Nold told the Swiss News Agency. She also called for better controls of practising doctors. However, she dismissed any attempt to limit health services.

Interior Minister Alain Berset said voters expressed their support for the government’s health policy. “The vote helped clarify the situation and paves the way for further reform of the Swiss healthcare system,” he told journalists.

Berset said parliament made a major step last week to increase transparency among health insurers and tighten controls. He added additional measures were necessary to improve the quality of the health system by boosting coordination among and reducing medical errors.

“This is not the end of the reform efforts, but the vote helped clarify the situation,” he said.

Taxing eating out Restaurants lose bid for VAT parity with takeaways

PLACEHOLDER

A move to create a level playing field in value added tax for restaurants and takeaways has been rejected by a large majority of voters on Sunday. 

Faced with competition from takeaways, the restaurant and hotel association Gastrosuisse had mounted a political campaign to derail the success of their rivals, who benefit from a lower level of taxation.

The initiative was turned down by 71.5% of voters in the nationwide ballot. It failed to win the backing of any of Switzerland's 26 cantons. Turnout was average at 47%. 

The VAT rate for food and drink served in restaurants is fixed at 8%, while products sold over the counter in takeaways have a 2.5% rate. The discrepancy goes back to 1995, when VAT was introduced. It was decided to apply two different rates for food products sold over the counter and those served in restaurants.

PLACEHOLDER

On Sunday, Gastrosuisse expressed surprise at the outcome. "We'd had other feedback from the public," president Casimir Platzer said, adding the campaign showed that most of the general public  were unaware different rates existed and that the initiative had at least raised awareness of the importance of the restaurant sector.

“Gastrosuisse will now examine what other political steps can be taken to put an end to this VAT injustice,” said a statement.   

Today, the restaurant business is struggling. Restaurant revenues have dropped from CHF26 billion ($27 billion) to CHF23.1 billion since 2010. On one hand, restaurants are paying for a weak Swiss tourism sector: since 2008, hotel overnight stays have dropped more than 7%. It is also grappling with a boom in takeaway outlets and changes to public eating habits over the past two decades, whereby a growing number of people have opted for fast food at lunchtime instead of sit down meals. 

Gastrosuisse submitted the initiative to government in 2011, signed by over 118,000 citizens, in which it demanded a level playing field for restaurants and takeaways in tax. It argued that when VAT rates were set, the takeaway sector had hardly developed, but the number of outlets has since grown. It felt it unfair that a sandwich or a coffee served in a restaurant is more heavily taxed than the same product sold by a takeaway.

Little support

PLACEHOLDER

Finance Minister Eveline Widmer-Schlumpf welcomed Sunday's results, saying even tourism-orientated cantons had been opposed to the idea and were not convinced this was the best way to support the troubled restaurant industry. She had repeatedly called on voters to reject the initiative.

She did note however that this was not the end of the discussion on different VAT rates, and some simplification was needed. 

In the run up to the vote, the government had argued Gastrosuisse went too far with its demands. The only way to implement the initiative would have been for the VAT rate payable in restaurants to be lowered. That would mean a loss of CHF700-750 million annually to the federal coffers.

Any compensatory taxation measures would fall on other sectors, with social consequences too. An alternative solution would have been to raise the rate of tax due on other food products, including those sold by retailers. These products are currently taxed at a low rate because they are regarded as necessities. So an increase would have been hard to justify.

This position was shared by parliament, where the left and most of the centre had come out against the initiative.

In parliament, only the Swiss People’s Party backed the Gastrosuisse initiative. It said the restaurant business represented an important sector of the economy and was worthy of support. It also argued the current VAT system favoured the fast food trend, which contradicted public awareness campaigns for people to eat more healthily.

Final results:

Single health insurance company: 38.2% yes, 61.8% no. Unified VAT rate in catering industry: 28.5% yes, 71.5% no. 

Turnout: 46.7%

About 170,000 citizens, notably Swiss expats, were eligible to vote online. Nearly 26,000 of them – 15.2% - used the opportunity to take part in ongoing trials with e-voting, according to the Federal Chancellery.

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VAT in Switzerland

Switzerland has one of the lowest VAT regimes in Europe. Most products are currently taxed at 8%. A special rate of 3.8% is being applied to the hotel sector, which has been going through a difficult patch. Numerous products considered as necessities or of social and cultural importance – retail foods, medicines, seeds, books, newspapers – are taxed at 2.5%. No tax is levied on a number of social, health, cultural, sporting and educational services. VAT is the government’s biggest single moneymaker. In 2012 it yielded CHF22.3 billion, over a third of all tax revenues.

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Vote results in the cantons

Basel City and Basel Country won’t merge: The two Basel cantons won’t become one after a vote on September 28 where 68.3% of voters in Basel Country said no to the beginning of merger negotiations. Supporters of the merger had argued it would save both cantons money, politicians against the measure argued citizens of Basel Country should preserve their rural identity and not fuse themselves to a city. 

Transparency in politics: The latest Swiss call for full transparency in politics was nipped in the bud as voters in canton Aargau rejected an initiative seeking to shed light on campaign financing and politicians’ financial entanglements. Voters rejected the proposal with 55.7% no votes. 

Lake Geneva tunnel blocked: Voters in canton Geneva rejected plans to build a new 1.5-kilometre-long road tunnel under the lake. A total of 63% of voters turned down the initiative.

Electing foreigners: Canton Jura has voted 54% in favour of allowing foreigners to hold seats in government, while canton Schaffhausen 85% of voters said no to a proposal that would have allowed some non-Swiss to vote.

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Political scientist Claude Longchamp of the leading GfS Bern research and polling institute said Sunday’s result shows voters preference for the status quo. “The promoters of the single health insurance company failed to show the individual benefits of the proposed reform,” he told public radio.

Turnout was average, at 46.7%. Longchamp also noted a certain voter fatigue on Sunday, compared with previous ballots earlier this year.

Costs

The proponents of a single payer principle argued the current system is too costly and fails to provide for competition among insurers at the expense of consumers.

Critics also accused insurance companies of trying to attract young and healthy customers, undermining the principle of solidarity with the old and infirm.

Initiative promoters said up to CHF350 million ($372 million) could have been saved on administration, and total health expenditure could have been reduced by about 10% over the next few years.

However, most political parties, the government and the business community recommended rejection of the initiative. They say Switzerland has one of the most successful healthcare systems in the world.

Opponents warned of an inefficient bureaucratic organisation if citizens are no longer free to decide on the health insurer of their choice.

Mandatory 

Basic health insurance coverage was made mandatory for Swiss residents in 1994.

Costs for individual health insurance premiums have been increasing steadily over the past decades. Total expenditure for healthcare reached a total of CHF68 billion, with just over a third going towards the basic insurance coverage.

The interior ministry last week announced an average increase of 4% for the insurance premiums next year.

So far Swiss voters have had the final say on 191 initiatives in total. But only 20 of them have won a majority at the ballot box since 1891.

Final results:

Single health insurance company: 38.2.% yes, 61.8% no

Unified VAT rate in catering industry: 28.5% yes, 71.5% no

Turnout: 46.7%

About 170,000 citizens, notably Swiss expats, were eligible to vote online. Nearly 26,000 of them – 15.2% - used the opportunity to take part in ongoing trials with e-voting, according to the Federal Chancellery.

end of infobox

Vote results in the cantons

Basel City and Basel Country won’t merge: The two Basel cantons won’t become one after a vote on September 28 where 68.3% of voters in Basel Country said no to the beginning of merger negotiations. Supporters of the merger had argued it would save both cantons money, politicians against the measure argued citizens of Basel Country should preserve their rural identity and not fuse themselves to a city. 

Transparency in politics: The latest Swiss call for full transparency in politics was nipped in the bud as voters in canton Aargau rejected an initiative seeking to shed light on campaign financing and politicians’ financial entanglements. Voters rejected the proposal with 55.7% no votes. 

Lake Geneva tunnel blocked: Voters in canton Geneva rejected plans to build a new 1.5-kilometre-long road tunnel under the lake. A total of 63% of voters turned down the initiative.

Electing foreigners: Canton Jura has voted 54% in favour of allowing foreigners to hold seats in government, while canton Schaffhausen 85% of voters said no to a proposal that would have allowed some non-Swiss to vote.

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swissinfo.ch


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