To add to that:
We have a militia system, which on first glance is a good thing. But then you realize that a plurality of parliamentarians are lawyers, business-people, advisors and other higher economic class individuals. Too many of them are on boards of directors or other high management positions in corporations. Compared to other western countries, it is more mixed, but clear conflicts of interests are present and it is still skewed towards the economic elite. The reasons for this are many, but among others voters getting such individuals in high positions can be paired with people in lower economic classes having less opportunities or motivation to run for office. Which is why local organizing is of utmost importance. You can see the effect in parliaments on a local level: They far more closely represent the population than on a state or federal level. Then there’s party politics, but that’ll get too long, soooo: Next point:
The media landscape: Your point about a billionaire having great impact on the electoral landscape extends to the media. You can count the owners of the local papers on one hand. Said billionaire owns some of them as well as an own TV channel if you can call it that. And there’s a general animosity towards the SRG SSR with political and legislative attacks to weaken it.
I’m not surprised the EFAS got approved. It is a complex topic where you would need to read almost the whole KVG to truly understand what’s going on and the messaging of the opponents was sub-optimal to put it mildly.
The opposing opinion in the official booklet, at least for the German version, was incomprehensible and without concrete links to the substance of the issue or their claims. E.g. HOW are the insurers getting more power? What will they be able to do, that they can’t already? What are the absolute numbers, that show that premiums will rise, when the official report mentions sinking costs? Why will the quality of care deteriorate? They mention privatization, but don’t tell you what would facilitate that…
The Pro side mainly stressed the positive of correcting the disincentives towards cheaper ambulatory treatments through changing to the uniform financing formula, which in and of itself and without further context is a valid and good point. Both substantively and politically.
And my biggest problem lies with the official ‘examining review’ from the Federal Chancellery. I know it is normal to try and project what the changes in law could affect in reality. Imho they did it in a biased way. Why am I saying that? Because every argument and scenario they brought up was positive and basically the pro-opinion reads like a summary of the official review. Also: When making simplifications from the actual legal text, they used a more positive description (E.g. “coordination” vs. “restriction” talking about the states limiting offered services). There aren’t many absolute numbers to understand just how much money will shift between insurers, states and patients and what that would mean. In such a situation it is even more incumbent on the opponents to make the downsides clear and fill those gaps.