{"id":526153,"date":"2024-12-23T11:53:24","date_gmt":"2024-12-23T10:53:24","guid":{"rendered":"https:\/\/leregardlibre.com\/?p=526153"},"modified":"2025-12-13T22:42:50","modified_gmt":"2025-12-13T21:42:50","slug":"2024-health-pensions","status":"publish","type":"post","link":"https:\/\/leregardlibre.com\/en\/politique\/suisse\/2024-sante-retraites\/","title":{"rendered":"2024, a mess for Swiss health and pension policy"},"content":{"rendered":"

Demographic realities have been largely absent from political debates over the past year.<\/strong> in terms of pensions and healthcare costs. It's time to renew our welfare state on the basis of a coherent, long-term vision.<\/strong><\/p>\n\n\n\n\n\n\n\n

Old-age and survivors' insurance (AVS), 2th<\/sup> pilier, co\u00fbts de la sant\u00e9… quel bilan tirer de la super-s\u00e9quence politique qu’a connue la Suisse en mati\u00e8re de pr\u00e9voyance et de sant\u00e9 cette ann\u00e9e?<\/p>\n\n\n\n

Malheureusement, pas grand-chose. Les d\u00e9bats qui ont eu lieu en 2024 rappellent l’histoire des trois petits cochons: par facilit\u00e9, parce que \u00abnous avons toujours fait comme \u00e7a\u00bb, nous avons b\u00e2ti des projets politiques de paille sans anticiper le loup qui allait les balayer. Ce loup, inexorable, imp\u00e9rissable (contrairement \u00e0 ceux sur lesquels Albert R\u00f6sti a autoris\u00e9 le tir, mais c\u2019est un autre sujet), cette menace qui p\u00e8se sur notre Etat social, c’est \u00e9videmment la d\u00e9mographie.<\/p>\n\n\n\n

Righting the ship before it sinks<\/h3>\n\n\n\n

Let's set the scene: we know that the aging of the population is putting a strain on the two main expenses of the social state: pensions and healthcare. In 1924, 6% of the population was aged 65 and over. One hundred years later, this figure had risen to 20%. Unsurprisingly, it's in this phase of life that healthcare costs soar. This fifth of the population aged 65 and over contributes 45% to healthcare costs.<\/p>\n\n\n\n

Le nombre de personnes actives par personne retrait\u00e9e, appel\u00e9 le ratio de d\u00e9pendance, raconte une histoire similaire; il passe de 6,3 \u00e0 l’introduction de l\u2019AVS en 1948 \u00e0 3,2 en 2019. Et la tendance continue de plus belle. Certes, les femmes ne cotisaient pas au moment de l\u2019introduction de cette assurance sociale. Toutefois, le nombre de cotisants par rente \u00e0 verser est pass\u00e9 de 3,5 en 1975 \u00e0 2,4 \u00e0 2021, as already documented by Le Regard Libre<\/em><\/a>.<\/p>\n\n\n\n

In short, our social liner is slowly but surely taking a nosedive.<\/p>\n\n\n\n

Pay more or receive less<\/h3>\n\n\n\n

There are two possible ways to get our welfare state back on its feet: reduce costs and\/or increase revenues. This observation may seem simplistic, but it highlights a fact that is too often overlooked in the debate: the fountain of youth capable of halting the ageing process does not exist. Whether we like it or not, the tsunami of baby boomers <\/em>retirement is coming. Any measure, however creative, must act on one of these two levers.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

Le sch\u00e9ma ci-dessus illustre les principales options \u00e0 notre disposition. Baisser les co\u00fbts est possible en diminuant les prestations ou en diminuant l’\u00e9ligibilit\u00e9. Pour les retraites, cela passe par exemple par une baisse des rentes ou une augmentation de l\u2019\u00e2ge de r\u00e9f\u00e9rence pour le d\u00e9part \u00e0 la retraite.<\/p>\n\n\n\n

Increasing revenues follows the same logic. There are three possible levers. None is obvious. The first lever is to increase contributions - health insurance premiums, employee contributions or taxes. The second is to increase the number of contributors by stimulating demographic growth. This can be achieved through immigration or birth policies. More indirectly, the third lever is a policy favoring economic growth. Mechanically, higher wage levels also increase contributions to the welfare state. However, the chain of causality is longer and more uncertain.                    <\/p>\n\n\n\n

Of course, creativity is allowed; other measures can be imagined, such as the proposal by the Latin Conference of Health and Social Affairs to organize separate financing of the costs of health care for the elderly. But in the end, the costs will have to be covered.<\/p>\n\n\n\n

Soon to go broke<\/h3>\n\n\n\n

Small problem: no political majority is emerging in favor of a combination of measures to turn the Swiss social system around. Some measures seem unimaginable in liberal Switzerland - think, for example, of natalist policies. Others, such as the continuous adjustment of health insurance premiums, are the target of a growing backlash.<\/p>\n\n\n\n

Far from solving the problem, the people have overloaded the boat by adopting a 13th<\/sup> pension without agreeing on corresponding funding. In fact, the soap opera surrounding this additional pension speaks volumes about the deep-rooted evil that plagues us all: our collective inability to grasp an issue in its entirety and build coherent political alternatives. An inability that sometimes borders on denial.<\/p>\n\n\n\n

Increase pensions without affecting the retirement age, employee contributions or the number of active contributors, it's not consistent<\/strong>.<\/p>\n\n\n\n

Reducing immigration to Switzerland while maintaining the social state as it is, it's not consistent<\/strong>.<\/p>\n\n\n\n

Reduce the proportion of taxes supporting this social state, without substituting it with other sources of funding, or assuming net cuts, it's not consistent<\/strong>.<\/p>\n\n\n\n

That's why 2024 has been such a disappointment: most of the projects put to the vote are insulated straw houses, designed for the short term without taking into account either external constraints or the needs of the future.<\/p>\n\n\n\n

Redistribution does not solve the underlying problem<\/h3>\n\n\n\n

At this point in the discussion, it's common to hear people exclaim: \u00abIt's simple, just tax the rich!\u00bb<\/p>\n\n\n\n

While it's a source of concern (and I'm one of them) that contributions to healthcare costs are not no more<\/a> income-dependent, the profound and lasting mutation of our age pyramid cannot be compensated for by increasing the contributions of the wealthy alone\u00bb (whatever that means).<\/p>\n\n\n\n

Who pays?\u00ab will certainly be an important political debate in Switzerland, as the country looks to rebuild its welfare state. VAT or employee contributions: the controversy over the financing of the 13th<\/sup> pension is a case in point. Even so, this is a subsidiary debate to the main question, which remains: what kind of welfare state do we want, and are we prepared to finance it, in the context of an ageing society?<\/p>\n\n\n\n

Back to a tried and tested method<\/h3>\n\n\n\n

When it comes to coherence, the party apparatuses may retort: \u00abBut we're proposing a coherent political alternative!\u00bb, and they'd be right. But since the Grand Soir of an absolute majority is not about to happen, we need to return to a tried-and-tested method of Swiss politics: compromise. And we haven't seen much of that lately when it comes to health and social policy.<\/p>\n\n\n\n

Was it necessary to push through the increase in women's retirement age without attaching some of the numerous measures on the table<\/a> to advance de facto equality, in order to rally the other side?<\/p>\n\n\n\n

Was it necessary to propose a much-needed reform of the 2th<\/sup> pillar (BVG), without combining it with more measures to address women's under-activity in the labor market<\/a>? The reform of the coordination deduction was certainly a step in the right direction, but barely scratched the surface of the problem. Our ability to build concrete projects for our social state will depend to a large extent on our capacity to put together acceptable reform packages, transcending partisan trench warfare of which a growing proportion of the population is growing weary. It is probably on this condition that the story of the three little pigs will have a happy ending.<\/p>\n\n\n\n

Darius Farman<\/strong> is a researcher in political and economic sciences. He contributes to the work of various research institutes in Switzerland.<\/em><\/p>\n\n\n\n

You've just read an open-access forum. Debates, analyses, cultural news: subscribe<\/a> to support us and get access to all our content!<\/h6>","protected":false},"excerpt":{"rendered":"

Demographic realities have been largely absent from the political debates on pensions and healthcare costs over the past year. 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