Stalled Development for Health Insurance

While the AHV symbolized for progress after the Second World War, other social insurance bills failed. A proposal for modest tuberculosis insurance was rejected at the ballot. Issues such as a national obligation for health insurance thus remained off the agenda for the foreseeable future.

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On 22nd May 1949, a majority of voters rejected an amendment to the Tuberculosis Act of 1928. The proposal by the Federal Council and Parliament primarily proposed periodic check-ups for the population on the basis of newly developed screening technology. It enabled the quick and reliable identification of the infected, but not yet ill people – often referred to as carriers or spreaders at the time. Political opposition that led to a referendum and derailed the proposal was not only directed against the forced medical exams and the costs involved, but also against the fact that the proposal would have introduced mandatory health insurance for low-income social groups. 

Health insurers had previously offered voluntary tuberculosis insurance in addition to general health insurance. This practice was supported by contributions from the Confederation. In 1946, three quarters of health insurance policyholders benefited from this form of supplementary insurance. This amounted to less than half of the overall population. The rejected proposal was based on the premise that infected people unable to afford treatment could pose a threat to the health of others. The proposed compulsory insurance would have therefore served first and foremost as prophylaxis.

During the referendum campaign, the controversial question remained as to whether the Confederation sought to introduce compulsory health insurance through the back door in tandem with the amended Tuberculosis Act. The proposal suffered a resounding defeat at the ballot with 75 percent of the electorate saying no. The Confederation and administration interpreted the result as a rejection of compulsory health insurance in general.

Literatur / Bibliographie / Bibliografia / References: Lengwiler Martin (2009), Das verpasste Jahrzehnt. Krankenversicherung und Gesundheitspolitik (1938–1949), in M. Leimgruber, M. Lengwiler (ed.), Umbruch an der ‹inneren Front›. Krieg und Sozialpolitik in der Schweiz 1938–1948, 165–184, Zürich; Gredig Daniel (2002), Von der „Gehilfin“ des Arztes zur professionellen Sozialarbeiterin. Professionalisierung in der sozialen Arbeit und die Bedeutung der Sozialversicherungen am Beispiel der Tuberkulosenfürsorge Basel (1911–1961), in: H.-J. Gilomen, S. Guex, B. Studer (ed.), Von der Barmherzigkeit zur Sozialversicherung. Umbrüche und Kontinuitäten vom Spätmittelalter bis zum 20. Jahrhundert, 221–241, Zürich; Immergut Ellen M. (1992), Health Politics. Interests and Institutions in Western Europe, Cambridge.