The Socialist Party has today announced that they have collected 120'000 signatures in order to launch another referendum for what they rather cunningly call a "Public Health Insurance Scheme". What this actually means is a means related scheme (based solely on income) which would effectively just be a new method of taxation rather than allowing individual choice. It is not what many Brits would see as the introduction of a National Health Service (NHS) or Canada's Medicare policy within each Province.

I personally find the idea of a national mutual health scheme for the good of everyone to be a great principal and ideal but this isn't what the SP is talking about. Their referendum website is rather vague in specifics, but it speaks about the current health insurers in much the same tone as rip-off banks and finance houses. Although this populism is always a great vote winner for the left, read the information for yourself and see if there is any reason to bring this issue to the nation yet again in late 2013 or 2014 as the last time the socialists brought up the issue to vote in 2007, more than 70% of the voters turned down the intended reforms.

Although medical insurance is a costly part of life in Switzerland, the reason that the premiums are becoming higher is that more people are living longer, often undergoing complicated surgery late in life and essentially creating more costs than what they are paying for. No finger pointing, but 20 years ago people weren't having hip operations or other types of surgery that cost tens of thousand of Francs. It can't work both ways. If you want the treatment, you'll have to pay for it. The question is if we should continue to do that at our own discretion or have a big pool where not everyone pays in the same amount.

I believe there are three major factors affecting the price of our sickness insurance,

1. The level of subvention the hospitals receive from the cantons
2. The cost of administrating the many health insurance companies
3. The high level of pharmaceutical profits (SantéSuisse say CHF 300 million too much)

The last referendum was beaten down by scaremongering people into believing they would no longer be able to have fireside chats with their favourite doctor.

There are something like 85 different Swiss sickness insurance companies, ranging from 858,000 to 170 customers. So one could assume some forced merging would help the administrative overheads.

We are all getting older, and demanding better health care,and I think it is time to introduce some more efficiency. I would probably vote for the referendum.

I am insured with Visana on a managed care policy, the premiums are cheaper, and I can choose between 5 doctors in the same group practice. I believe this is the future style of health care.

Be happy ! at least you have a say in it ( Vote )

For me the worst thing about private health insurance isn't the cost. It's the stress that comes from having to constantly pay bills, then send bills to the health insurance company, and then argue with them over their responsibility to pay the bills.

This is by far my biggest complaint about Switzerland.

That's probably an issue related to your particular insurer rather than Switzerland in general. Have you looked into other insurers?

Considering the cost of insurance and level of coverage, even for an employee of covered in a large group in the US, we have a good deal. I am sensitive to the fact that I consume more resources than someone in her 30's and still pay the same premium. Perhaps some tightening of the risk pool would help - but large risk pools are so much better than assesing individual risk as some insurers do in the US.

The website is poorly documented in french. I don't get their arguments for a central insurance (something like the french "sécurité sociale") which ends up with billions of lost. For the moment and given the poor information I won't sign it.

I don't know about that. I mean, I am sure there are some insurers where this isn't a problem. But I don't think it's just a few who try to avoid paying up, as a search on this board alone will tell. Of the two insurers I've had, the accident one took 6 months to pay up (numerous apologies over "losing" stuff and "forgetting" about me) and my basic one tried to avoid pretty much all pregnancy related claims. Few things bring me to tears but dealing with an aggressive insurance company during a vulnerable time tops the list.

What irks me about this proposal (from what I read on the website) is the same thing that irks me about almost every referendum - lack of specifics. One is asked to vote for a concept but leave the details to be decided on later. And later, the law that is ultimately enacted can turn into something many would not have voted for.

If I could vote, I would vote no for this reason alone.

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Linking premiums to income would make the current system even more unfair, unless the restrictions to access to healthcare are also done away with.

As edot pointed out this could be an insurer thing. I remember when I was with Sympany or Avanex it was pretty easy: I would "charge" everything to the insurance card and they would process everything for me. I didn't have to pay neither in drugstores nor to the doctors, the insurer paid it directly and then sent me a bill for the part that I was still required to cover. The only drawback was then that the monthly fees were much higher compared to other companies.

I've got an open mind regarding this.

From what I've been briefly reading is that the left say they all have to offer the same thing so why have tons of different companies adding administrative costs and advertising costs and costs of changing to the already expensive health system and want a SUVA like health insurance.

The right are saying if there's a state monopoly there'll be no incentive to reduce costs so they wont go down.

I suppose both could be true. Looking at comparis though I pay 150 fr for the cheapest health insurance. The most expensive equivalent GP model costs just over 100 Fr or 66% more. I wonder how much percent the country on average could save switching to the cheapest insurer.

One way to reduce costs is surely for the consumers to take it into their own hands and put the insurers under pressure by consequently changing them

IMO, Switzerland is far too small to have so many different health-insurers.
If competition is so good - why aren't there different competing IVs, AHVs etc.?

Hello Assassin,

You would need to read the text carefully. What the SP/PS is proposing is not means-tested and not centralised, but organised in each canton.

Please do not misinform people.

The argument is simple: currently the private insurers are wasting OUR money in advertising and administration costs are very high.

This money would be better used in prevention for example, where very little is done in Switzerland.

The new scheme would be very much similar to SUVA (accident insurance), which works well.

I do not think anyone in Switzerland would like a centralised French-type scheme and the left knows this.

Personally I am a liberal and strongly believe in competition, but in domains where it doesn't benefit the bulk of the population it should be replaced but a public scheme. Like schools, the police forces, etc.

Usually, the "cheapest" insurers just compete for the young and healthy.
They are also usually the ones where you have to haggle over what they pay in the end...

We have that in Germany as well: all the old and sick people end-up at AOK, which is usually racking up losses left and right.
To combat the losses, a fund has been set up where the insurers with don't produced losses have to pay into - rendering the whole system ad absurdum.
IIRC, a similar system has been setup in Switzerland...

I've never had to use my health insurance so I wouldn't know but with the obligatory health insurance there should be no haggling cause it is clearly defined what they have to cover and what not. As I've said though I've no experience how it is in the real world.....

1) True enough, I suppose. However, if the cantons start paying into the hospitals, all that does is move the burden around a bit - but in the end, we as taxpayers still pay it. So there's no real benefit to increasing cantonal contributions to the hospitals.

2) I'm really hard pressed to see the logic in your second point. When does making something either a) government-managed or b) into a monopoly actually increase efficiency? Surely there is overhead associated with multiple insurance companies, but each company has strong motivation to keep costs as low as possible in order to maximize profits. Government-run or monopolistic firms have less motivation to do so.

Additionally, I'm a big fan of consumer choice. I've selected my health insurance company (SWICA) for two reasons - they offer me 500 bucks a year towards my fitness membership (which I would have anyway, so in essence I get 2.7 months of insurance free each year), and because they will for the rest of my life calculate my premiums as if I was 27 years old (based on my age when I joined up). Other people may choose other companies because different plans help them more (i.e. little_isabella might want a company that pays in advance). These benefits need to be offset by increases elsewhere (i.e. cost of premiums, etc) so they cannot all be effectively offered by a single company.

3) People everywhere say the pharma companies earn too much, but it's the same pharma companies supplying drugs all over the world, so it's not a uniquely Swiss "problem". What people often fail to account for is the risk taken by these companies in developing drugs. Research costs are high, and most new drugs never make it to market because they don't pan out. Yes, they make a tidy profit when the drugs do work, but you couldn't motivate me to invest billions at high risk for an expected return of a hundred million. Many startup companies in the life sciences arena fold long before reaching profitability.

That last point pretty much comes down to "how much profit should we allow people to make" and assumptions that we can better judge the risks involved than the markets.

I'm not so keen on this rather vague referendum. The Swiss healthcare system is the best one I've seen to date. Sure, it costs, but quality always does.

I, unfortunately, have had many occasions to use my insurer, and have never had any trouble whatsoever. Some bills get sent to me, but if I send the bill to the insurer on receipt, I get reimbursed before the payment leaves my account.

As a percentage of salary, I pay less here (+AHV deductions etc.) than I did for eeNIC in the UK*. That, coupled with almost instant access to specialists, MRIs, choice of hospitals, doctors etc., indicates to me that the Swiss health care system is still excellent value for money.

Enforcing a merger may well result in lower premiums, but will, I think, inevitably lead to a decline in service. The more the government becomes involved, the more inevitable the decline. I'd vote against, admittedly on the basis that such a change would work against me. If I could be convinced it would benefit the majority, then I would vote for it.

*Of course, that might mean I just have far to high a salary...

Firstly thanks for the heads up about SWICA regarding them keeping the premiums stable. I'll have a look into this. But are these not benefits of your supplimentary insurance? The obligatory insurance should offer the exact benefits. Maybe there's a difference in payment methods but that really should be the only difference

There does not need to be a government central fund, but having 85 companies managing 8 million customers is clearly an enormous waste.

A Cantonal insurance scheme would work very well, with subsidies to hospitals being reflected in the premiums and tax levels.

There are huge profits made by the middle men here. When you go abroad check the prices. I can buy a large tube of Voltaren in a French ski resort pharmacy at half the price to where it is made, and sold, in Basel. And why are cheap medicines like Aspirin so expensive? Aspirin lost it's trademark in 1919!

When you claim its a waste (based on facts or just what you think?), do you also take all the jobs these 85 are creating and thus the taxes that are reclaimed?

Switzerland has the highest standard of living for a reason. Why should they experiment and introduce systematic changes which evidently have failed in all other countries?