The councils of states are stepping on the brakes on the expansion of premium reductions. Rightly so. If you want to curb healthcare costs, you should start with the cantons.
A large proportion of healthcare costs are financed through per capita premiums, which places a greater burden on financially weak households.
As if the money was lying on the street in Bern. One can only marvel at the nonchalance with which the centre-left decided on a multi-billion dollar social expansion in the summer. Even a third of the FDP, which is supposedly responsible in terms of financial policy, took part when the National Council launched one of the most expensive ideas in recent history.
It’s a two-billion-dollar project: the federal government and the cantons are to increase their spending on reducing health insurance premiums for low-income households from 5.5 to 7.7 billion francs a year. The federal government should pay most of it. Shortly before, the same parliament had decided to massively increase spending on the army. They also want to spend more on climate protection. Everyone who wanted to see it could see that everything is not possible together. The majority didn’t want it.
The biggest chunk is the expansion of premium reductions. Here the Council of States now has the thankless task of trimming the high-flying plans. The first step back to reason has been taken: the Social Commission announced on Friday that it also wants an expansion, but a much smaller one. It should amount to CHF 0.5 instead of CHF 2.2 billion, and the cantons alone should pay. That may sound like a maneuver to keep the federal coffers harmless.
The underestimated power of the cantons
But the proposal is well thought out. Not all cantons would be equally affected. Above all, those in which the premiums are high but the cantonal reductions are low would have to pay more. There would now be minimum requirements by the federal government. This is undoubtedly an unsightly encroachment on the autonomy of the cantons. But at least he’s in moderation. And he’s going in the right direction because he’s holding the cantons accountable.
To put it undiplomatically: If you are looking for the main causes of rising healthcare costs, you should start with the cantonal governments. They are spoken of far too seldom. In terms of health policy, they play a multiple role that is as important as it is difficult. They own hospitals, they distribute questionable subsidies to hospitals, they decide on tariffs and more. Whether health care costs and premiums are high in a canton depends to a large extent on cantonal decisions.
Uniform funding would help
The high density of hospitals speaks volumes. Switzerland would hardly have so many hospitals with such a wide range if some cantons didn’t keep their protective hand over them. When canton politicians think of hospitals, they primarily think of the many jobs that depend on them, as well as the population and the economy, who want a hospital nearby. Health care costs come later. This is momentous.
Those who want to curb cost growth should ensure that the cantons have to shoulder a larger part of it themselves. You can do this with a premium reduction. More important, however, would be uniform funding, which politicians have been struggling with for years. It could mean that the cantons pay more and the premiums rise less. Parliament should finally decide on this bill. For once, all players in the healthcare system agree on this – only the cantons are slowing down. That speaks for the reform.