ZURICH. Parliament opens its autumn session this week with a cost containment package that, if it survives the National Council, the Council of States and a probable referendum, might shave a little off premium growth by 2028. The letters announcing next year's premiums arrive in October. That is the gap in which Swiss health politics now lives, and it is wide enough to fall into.
I do not underestimate the work. Binding growth targets, reference pricing for generics, a shift of hospital funding: these are serious instruments, negotiated over months, and they are better than the alternative, which is another year of the same trajectory dressed up as reform. What they are not is an answer to the envelope that will land on kitchen tables in seven weeks.
Consider the record. Premiums have risen faster than wages for a decade. Each autumn the same choreography repeats: a number, a press conference, a promise that the next reform will be the one that works. Households have learned to treat the promise as a weather forecast, interesting, possibly accurate, and of no use today.
The objection is always the same: that you cannot unwind a CHF 100 billion system between August and October. Of course you cannot. The question is why a country that votes four times a year, and that can write a neutrality clause into its constitution in a single September, cannot move a subsidy or a deductible on a timetable that matches the bill.
What the debate lacks is not information but honesty about trade-offs. Every franc of relief for one group is a franc of cost for another, and every group is organised. Insurers, doctors, cantons, the pharmaceutical industry: each has a position, a press officer and a reason why the cut should fall elsewhere. Patients have a letter.
I do not argue for a magic freeze. I argue for a temporary one. A single year in which the Confederation and the cantons absorb the increase, financed by a surcharge on the highest incomes and by a raid on the reserves that some insurers still sit on, would be a crude instrument. It would also be a signal that the people who vote are the people the system is for.
The counterargument deserves a fair hearing. Absorbing the increase once creates a precedent, and precedents in Swiss social insurance have a way of becoming entitlements. Health economists will say that a freeze does nothing to the underlying cost curve, and they will be right. They will be right in 2028. They will not be the ones opening the envelope in October.
Abroad, Switzerland is admired for outcomes it achieved by being unromantic about itself. We could use more of that unromantic clarity at home. The system works. The bill for the system works even better, for everyone except the household that pays it.
The choice, then, is not between principle and pragmatism. It is between a principle that serves the country and one that merely decorates the session. Relief that lands in 2028 is a plan. Relief that lands before the letter is a decision. Parliament, this autumn, might consider making one.