Swiss voters reject single payer
Health reform flops at the ballot box
NZZ Online
March 11, 2007
An overwhelming majority of voters have thrown out a proposal for a single health insurance company in Switzerland, with premiums based on income and wealth.
Final results showed 71 per cent of voters rejected the reform. Turnout was close to 46 per cent, slightly above average.
There are currently 87 private insurers providing mandatory basic health care coverage for Swiss residents under a 1996 law. But health premiums have soared over the past decade.
More than 100,000 people are no longer covered because they haven’t paid their premiums.
Switzerland has the most expensive health system in Europe, according to an international comparison. It spent 11.6 per cent on health in 2005, ahead of Germany and France but behind the United States.
http://www.nzz.ch/2007/03/11/eng/article7609812.html
And…
Costs dominate health insurance debate
swissinfo
March 6, 2007
Supporters and opponents of a single health insurance company - to come to a nationwide vote next Sunday - are at odds over the financial impact of the proposal.
The initiative, backed by the political centre-left but opposed by the government and business world, wants parliament to determine the funding model. But costs have become a sore point.
In 2003 voters rejected a plan for health insurance to be funded by a rise in VAT with premiums set according to income and wealth. This would have replaced the current system of obligatory private health insurance as offered by 87 firms.
Mindful of this, the authors of this latest initiative were careful to leave the financing issue to parliament. The only requirement is that premiums are set according to a person’s “economic capacity”.
“The vote is about deciding on a radical change to the basic insurance, not about voting for a precise financial model,” Hans-Jürg Fehr, president of the centre-left Social Democratic Party, has said.
But this has led to some uncertainty about the sums involved — a situation that santésuisse, the umbrella organisation of Swiss health insurers, has been quick to exploit.
It has drawn up its own financing model, which shows that the middle class is most likely to lose out under the single insurance plan.
Earlier this year, santésuisse put its model online on the Comparis website, a comparison service which, among other things, allows the public to compare health insurance prices.
Santésuisse based its model on several hypotheses. The first was that there would be no premium rise for those on an income of more than SFr120,000 ($96,000) — to avoid health insurance acting as a form of tax on the rich. The lower limit for paying premiums was set at SFr20,000.
According to santésuisse, the new system would be mostly funded by people with incomes in between these two sums — basically the middle classes.
Secondly, it projected that costs assumed by basic health insurance would rise by ten per cent because savings options, such as excesses (i.e., deductibles), would no longer be available under a single insurance.
An excess is what an insured person decides to pay for health services before the insurance reimburses. The higher the excess, the lower the monthly premium — and the less paid out by insurers.
Santésuisse’s move caused temperatures to run high among the initiative’s supporters on the left. Whereas the Green Party wanted to keep income-based premiums, the Social Democrats drew up a model that increased the number of people eligible for premium reductions (60 per cent compared with the current 30 per cent).
Financing would come from a three per cent rise on premiums for those with incomes above SFr100,000, with no top limit. This would bring in an estimated SFr1.2 billion a year, said the party. Excesses would still be valid.
An additional SFr500 million would come from the lower administration costs arising from a single health insurance, it added.
After some resistance, the supporters of the initiative finally put their figures on Comparis as well. The public can now consult both models, but with rather different results.
According to santésuisse, a family of four from Lausanne with a taxable income of SFr90,000 would pay SFr100-SFr200 more per month. But the initiative’s model claims the same family would save around SFr300.
The differences become even larger for incomes of SFr100,000-SFr120,000.
And…
Swiss spurn health insurance plan
BBC News
March 12, 2007
A row over costs in the last few days before the vote caused confusion. Supporters of the plan claimed an average family of four would save about 300 Swiss francs ($250) a month under the new scheme.
Using the same figures, Switzerland’s health insurers said the family would actually pay up to 200 francs ($150) more.
One reason (explaining the election results) may be the power of the insurance sector, and of the big pharmaceutical companies in Switzerland - both are important to the Swiss economy and both have strong lobby groups, our correspondent reports.
http://news.bbc.co.uk/2/hi/europe/6436995.stm
Comment:
By Don McCanne, MD
In evaluating health care reform proposals, one of the first questions individuals ask is, “What is it going to cost me?”
The Swiss organization representing Switzerland’s private health insurers, santésuisse, was ready with an answer. Although the measure would require that premiums would be set according to a person’s economic capacity (means tested premiums), santésuisse made the assumption that lower-income individuals would have smaller premiums or no premiums, whereas the wealthy would not have an increase in premiums. The impact of that would be to shift most of the cost of reduced premiums to the middle-income citizens.
Some would contend that this analysis was dishonest since the intent of the measure was to have means testing apply throughout the income scale. Others would contend that this analysis was appropriate because it would be unfair to require the wealthy to pay more than the full premium. Although it was a measure calling for progressive funding of health care, santésuisse found that modeling it as a welfare program provided results that supported their political agenda.
After considerable delay, the proponents of the initiative finally provided an analysis compliant with the intent of this measure, but it was too little, too late. The polls demonstrated increasing opposition, and by the time of the election, most of those who had been undecided voted against it.
As in the United States, the insurance and pharmaceutical lobbies played a major role in fending off this reform effort. But it would be a mistake to accept the results as simply a buy off of an election by vested interests with too much money and too much power.
The voters did hear the message of the proponents. The voters did understand that everyone would be covered. Middle-income individuals did hear that they would pay less if they were willing to increase taxes on the rich.
But the clearest message of all was that a government-run program would replace their private insurance plan. 71 percent of the voters didn’t like that message.
Many reading this will dispute that conclusion and contend that the polls in the United States prove that we do want to replace private plans with a single payer program of national health insurance. If that is true, then why haven’t we already enacted Medicare for All? Have the insurers and pharmaceutical firms really bought us off?
If you want to change the dynamics in the United States, then you are going to have to show the healthy workforce that their employer-sponsored coverage is bad for their finances and bad for their health. It’s true, but that’s going to be a hard sell. But that’s what you have to do.