[Democracy and health insurance reform in Switzerland]

This article examines the challenges of health insurance reform in Switzerland from a political science perspective. Despite increasing pressure due to rising insurance premiums, major reforms of the system remain difficult to implement. The analysis highlights three mechanisms that hinder these reforms: the institutionalization of the system, which stabilizes existing policies; the role of voters, whose choices are influenced by social and identity factors rather than objective analysis; and the conservative bias of politicians, who often underestimate public support for structural changes. This article thus underscores the inherent constraints of democracy in the field of health policy and the importance of institutional and behavioral dynamics in shaping reforms.