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Swiss politicians agree that healthcare system has to change – but how?

Swiss parliamentarians on all sides are convinced that the healthcare system needs reforming. Yet the people’s initiatives on health costs and health insurance premiums are far from enjoying unanimous support. We discuss the issue in our Let’s Talk programme.  

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Faced with constantly increasing healthcare costs, more and more people in Switzerland are having to tighten their belts just to be able to pay their health insurance premiums. In the federal parliament in Bern, the main political parties agree on the need to act, but not on solutions.

On June 9 the Swiss people will vote on two proposals: the first, from the Centre Party, proposes capping healthcare costs; the second, from the Social Democratic Party, wants to cap health insurance premiums.

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The proposal from the Social Democrats says health insurance premiums should not exceed 10% of household income. This measure would cost the federal government and the cantons CHF3.5 billion ($3.8 billion) to CHF5 billion a year, according to estimates from the Federal Office of Public Health.

“The federal government is being called upon to devote 10% of its budget to funding subsidies. So it will be necessary to increase all taxes by 10%, as well as the sales tax,” warns Cyril Aellen from the Radical-Liberal Party in our Let’s Talk video debate.

“You are just raising the usual spectre of tax increases to scare the citizens,” responds Social Democrat parliamentarian Baptiste Hurni. He points out that just this kind of ceiling for premiums has been put in place in canton Vaud and the government there hasn’t needed to raise taxes to pay for it. “The bill for healthcare costs just needs to be spread around differently, because households can no longer bear the burden,” he says.  

For Benjamin Roduit from the Centre Party, the proposal from the Social Democrats does not focus on helping the people who struggle to pay their premiums: “80% of people have the means to pay for their healthcare costs,” he insists.

‘Empty shell’

The Centre Party has its own proposal for reining in healthcare costs. Its initiative proposes to force the federal government to act when healthcare costs increase by 20% more than income in a given year.

>> Costs of health insurance are increasing faster than wages, as this chart shows:

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Hurni believes that the Centre Party’s proposal isn’t clear enough, because it doesn’t specify concrete actions that will bring down costs. “This is just an empty shell of a proposal, the worst we’ve seen in politics these past 20 years,” he claims. Hurni admits he is not totally opposed to the initiative, but he intends to leave his voting paper blank.

Aellen is also critical of the Centre Party’s proposal. “It’s really a guillotine clause: do nothing, but when costs start rising too much, bring down the axe,” is how he describes it.

Aellen is supporting the government’s indirect counterproposal to the initiative of the Centre Party, which would become law if the initiative is turned down by voters. This counterproposal stipulates that the government and the cantons specify goals for controlling the costs of health insurance.  

Roduit rejects the criticisms of the other parties. “The concrete actions to be taken are not laid out in the wording of the initiative, for they are well known, but it will be up to the healthcare providers to implement them,” he says. He quotes as examples greater use of generic drugs or having an electronic file for each patient.

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Households bear a heavy burden

One feature of the Swiss healthcare system is that a quarter of the costs have to be picked up by households themselves. This proportion is higher than the average for the OECD countries.

The costs Swiss consumers have to pay are just too high, Hurni insists. “These insurance premiums are unjust, for they are not matched to the incomes of the people insured. What’s more, people have to pay a deductible out of their own pocket, and they also have to fork out for dental care or an ambulance,” he says.

Aellen opposes any matching of payments to income. “A large chunk of the costs is already paid from taxes, which is fair. We just need to help those who are unable to pay their own way,” he believes.

Keeping up quality of care

In Britain, it’s the opposite: people don’t pay premiums or medical expenses, because the system is financed entirely by taxes. Jérémy Ramsden, a Swiss living near London, sees the flaws in this model: “The English system leads to problems of over-consumption of medical services.”

Baptiste Hurni admits that “by trying too hard to develop a system for everyone – with no deductibles or co-payments – a multi-speed, overcrowded system has been created in England”. For the time being, he believes that Switzerland has managed to maintain a satisfactory quality of care. “The problem is that people can no longer afford to pay for the system,” he says.

“There is an element of personal responsibility in the healthcare system,” says Roduit. In Switzerland as elsewhere, he maintains, it’s crucial to discourage unnecessary medical care. This would reduce costs by 20%. “One thing is clear,” he warns. “If we don’t do something now, we are headed for a two-tier healthcare system.”

Aellen also appreciates the quality of care available to every consumer. “But it shouldn’t be a sort of ‘open bar’. Today, insured people can go to the doctor as often as they like, and get the same test two or three times. We’ve got to put a stop to that,” he says.

Adapted from French by Terence MacNamee/ts

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