The Swiss electorate clearly rejected the initiative to introduce a single health insurance scheme nationwide in the referendum of 28 September 2014. The 61.8% 'No' votes are a clear endorsement of the competition-based healthcare system. A popular initiative was launched in western Switzerland in autumn 2017 to create a single health insurance scheme for each canton. These institutions would set a standard premium for all insured persons in the canton in question. Existing health insurers would be consigned to the role of checking and paying bills. CSS rejects the idea of a single health insurance scheme for all Switzerland – as well as at the national and regional level. Under a system monopolised by a single general health insurer, insured persons would lose the possibility afforded them by law of changing health insurance in the event of mismanagement or poor service quality. With a cantonal health insurance scheme, they would only be able to change between what would effectively be insurance clearing houses, but would have no option other than to stick with the cantonal health insurer even if it was badly managed and premiums increased drastically. Yet it is precisely the threat of accelerated cost growth that looms large in this scenario, as a single cantonal health insurance scheme would have no incentive to offer attractive premiums and the service providers that profit from high medical tariffs would be represented in the organisation’s managing body and thus have a say in setting premiums. Major conflicts of interest are pre-programmed. What is more, a single health insurance scheme would come under political pressure to massively reduce its reserves, which would in turn jeopardize the institution’s financial stability given even the slightest misjudgement of how costs were likely to develop. The resulting financial imbalance could then only be corrected through a substantial increase in premiums or using taxpayers’ money.