Endlessly increasing subsidies is not tenable: health insurance benefits must be reduced to slow down the rise in premiums, part of the right is calling for. And yet: when the LAMal was launched in 1996, it was planned to subsidize up to a third of the Swiss population, with premiums capped at 8% of income, recalled the former President of the Confederation Ruth Dreifuss on the Infrarouge set.
Introduce a tax of 50 francs for an emergency consultation, raise the minimum deductible for basic insurance from 300 to 400 francs or even remove homeopathy or psychotherapies from the catalog of reimbursed treatments: it is now on the services front that proposals are being made to reduce health costs.
>> Read in particular: 400 francs instead of 300, the Federal Council wants to increase the minimum health insurance deductible
Should we “declutter” the catalog? Has basic insurance become luxury insurance? More broadly, should we rethink the LAMal to deal with the explosion in costs?
The link between bonus and income dismissed at the last moment
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Invited on the Infrarouge set to debate it, the former head of the Department of the Interior from 1993 to 2002 Ruth Dreifuss was in charge of Health during the adoption of Federal Health Insurance Act in 1996, to the point that she is often called the “mother” of LAMal. “A baby that I adopted,” explains the woman who was also the first female president of the Confederation, in 1999.
“It was carried out on the basis of the work of a commission which brought together all kinds of partners in the health system, representatives of all parties and members of the Swiss Trade Union Union. They are the ones who developed this compromise [la LAMal]”, explique Ruth Dreifuss.
However, she points out, “this project was taken up by the Federal Council, with one exception: the commission proposed that we put in the law a limit on the amount of premiums at 8% [du revenu] for households. The Federal Council put this vague intention in the message [à l’intention du Parlement]saying he ‘would like’ it to be like that, but he refused to put it into law.”
>> Read also: The PS launches an initiative to link the amount of health insurance premiums to income
A solidarity that is lacking
In its message at the time, the Federal Council went even further. Limiting the amount of premiums to 8% of income would require that a third of the Swiss population be subsidized. Today, only a quarter of the population is.
Is LAMal therefore a deficit system in its very conception, a system designed to be supported by subsidies, one not going without the other, from the beginning? For Ruth Dreifuss, the question does not arise in these terms: the system was designed to be accompanied by solidarity which did not materialize.
It is clear that with rising healthcare costs, premiums have become unbearable. And the subsidy system did not follow
“The solidarity that is missing in the system is real solidarity based on the financial capacity of households. We have a system, today, where the poorest are largely supported by subsidies or social assistance, and a category of people who could pay much higher premiums, which they would do in other countries,” analyzes the former socialist federal councilor.
“Those who suffer are the middle class. They earn too much to have subsidies, and not enough for their bonuses to be bearable […] It is clear that with the increase in health costs, they have become almost unbearable, and the subsidy system has not kept up,” laments Ruth Dreifuss.
>> Read also: Mother of the LAMal, Ruth Dreifuss is saddened by her evolution
No reduction in benefits
In his eyes, the solution does not involve a reduction in the catalog of services. “The idea of reducing access to care is absolutely contrary to what the idea of the LAMal was, and still is,” she defends. And to recall that one of its goals was to create access to care for all, to establish solidarity between sick and healthy people, young and old, men and women, at a time when the health system was in crisis and was pushing insurance funds towards bankruptcy.
The idea of reducing access to care is absolutely contrary to the idea of the LAMal
“Reducing health costs was not one of the stated goals” of the LAMal, also underlines Ruth Dreifuss. “Because health insurance is simply the payment system of a healthcare system. The question we should ask ourselves is ‘what is not working on the healthcare system side’, and not just on the LAMal side.”
There is therefore no question of reducing benefits. “Which does not mean that we should not study whether they are useful, economical, whether they could not be done in a less costly way,” notes the former federal councilor.
>> On this subject: Four billion francs in medical costs overbilled per year
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