Health: how Parliament wants to control spending



The costs exceed 83 billion: why does nobody really want to curb them?

The National Council advises the center’s cost brake initiative. In future, the party wants to prevent bonuses from increasing faster than wages. But she is alone with the problem.

Federal Councilor Alain Berset is trying to convince Parliament of the objectives. He follows him with an extremely small majority.

Alessandro Della Valle / KEYSTONE

Thomas de Courten called the cost control initiative “dangerous”. The SVP of health therefore demanded Tuesday at the National Council on behalf of the health commission that the initiative of the center party be rejected. The cost brake does not take into account medical progress or the aging of the population. If bonuses are rising much faster than salaries, action should automatically be taken – and reduce expenses. The Federal Council also warns against “rationing” and “two-class medicine”.

Apart from the center party, no one wants the initiative.

And yet, the Health Commission has been working on a counter-proposal since January. Because nervousness is rising regarding September, when the next round of bonuses is due. FDP National Councilor Philippe Nantermod has warned that costs will increase dramatically in 2022, so premiums could also increase by up to 9%. The industry expects a similar scenario in 2023. The Health Commission didn’t want to sit idly by and watch costs grow, Nantermod said.

Surprising turnaround: the targets aren’t dead after all

And yet, the counter-proposal that the Federal Council had drawn up and which pursues similar objectives to the initiative failed with health policies. But on Tuesday, the idea celebrated an unexpected revival in the National Council: with 94 votes to 91, the plenum voted on cost targets which should trigger corrections if they are exceeded. At the very least, the physicians, cantons and insurers involved should jointly examine whether cost-cutting measures are necessary.

The majority of the council won against the SVP, FDP and GLP – also because four SVP members and three Green Liberals missed the vote. However, it’s still unclear whether the counter-proposal will survive in this release. The project has not yet been discussed, the National Council must still decide on Wednesday on the individual measures and the overall package. GLP and Greens will decide: do they offer a helping hand for a compromise?

Although costs were widely seen as an issue, the UDC rejected the counter-proposal from the outset. The FDP was also always skeptical, but then used the vehicle to introduce its own measures. But because the targets are back in the law, the FDP also rejects the counter-proposal. There is no reason to bail out the center in this case, explained Aargau National Councilor Maja Riniker.

Paradise for gourmets: The reproach to the opponents

Gerhard Pfister, chairman of the center, is committed to his party's cost control initiative.

Gerhard Pfister, chairman of the center, is committed to his party’s cost control initiative.

Alessandro Della Valle / KEYSTONE

In fact, Gerhard Pfister’s party is seeking a compromise to withdraw the face-saving initiative. But it must meet certain conditions – such as goals. The fact that other parties are struggling with this is due to the “healthcare cartel”, Pfister said. It lives so well today on bad incentives that these are no longer bad, but profitable. “The health system in Switzerland is a unique perpetual mobile self-service, a paradise for gourmands”, declared the president of the center. The billion-dollar market is full of experts, consultants, committees and interest groups who don’t want to change their lucrative business model. Pfister concludes his sweeping statement with the following recommendation: the only way to break the cartel is to pressure the targets. The fact that a majority in Parliament does not want this is demonstrated by the close association with the lobbies.

Difficult search for allies

After all: the SP helps with the counter-proposal, even if not with full conviction. The party must arm itself with arguments if it wants to defend its own initiative to reduce dues. Calling for government support without trying to get to the root of the problem would be too easy. In addition, she receives active support from the center for a generous counter-proposal design to the bonus initiative.

The Greens, on the other hand, do not attach much importance to cost targets: services must be available, affordable and accessible to all. In general, the problem is not the costs, but the financing.

And finally, the GLP is also in a dilemma. The party rejects the cost targets, but considers that a counter-proposal is useful for initiating reforms.

Are goals really the last word in cutting costs? The Council of States will also have to take up this question.

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