Germany is a country full of contradictions. There is the highest level of engineering and a horrible cell phone network, a self-image as a land of poets and thinkers and schools in which the plaster comes from the ceiling. And there is: the German health system. Perhaps it is the greatest contradiction of all. Because the status of one of the richest countries in the world does not fit the reality of the majority of patients at all.
The German health system divides them into two classes, those with private and statutory insurance. This separation has grown historically, it began in the 19th century. Proponents justify the fact that they still exist, for example, with “freedom of choice” about their own insurance. But in truth it has turned out to be nothing more than a selection between rich and poor, between important and unimportant, between “Please come over this afternoon” and “Unfortunately we won’t have any free dates again until March 2023”. This is unworthy and ridiculous – and it has to come to an end.
Life paths run differently, some are accompanied by robust health, others characterized by illness. Some lead to financial prosperity, others do not. Neither of these provide any information about the lifetime achievement behind them – and for this reason alone the differences in the quality of care of patients cannot be justified. But anyone who calls a specialist practice today or wants to book an appointment online must realize that the question “How are you insured?” is far more important than “Where does it hurt?”. The practices can often charge three times as much for private patients as for those with statutory health insurance, which has consequences for the allocation of appointments – and it is nothing more than a massive error in the system.
Millions of people are disadvantaged, that has to change
But even for those who have reached a higher income level and have opted for private insurance, bitter surprises await from time to time. Because while they benefit from quick appointments and better performance in good times, it can become uncomfortable when life circumstances change. Phases with lower income are simply not possible – and a switch back to the statutory health insurance fund is not completely impossible, but the system is actually not intended.
If one looks at the positions of the political parties on this question, one could believe that the attitude to the dual system is an ideological question – as rigorous as some demand “citizens’ insurance” for all and others rail against it. The logic is actually simple: The German health system disadvantages millions of people, it promotes injustice. So it has to be changed.
Opponents of a uniform system for everyone often argue with financial aspects. The private insurances fed a lot of money into the system, they say, that would be missing if the separation into two insurance classes no longer existed. A study by the employer-related Institute of German Business recently came to the conclusion that citizens’ insurance would initially lower the contributions for everyone, but would return to the contribution level of today after six years. It is actually interesting, but before the financing questions must come the quality and access to medical care.
Of course, a single insurance system will not end all inequalities. There will be special services and offers of additional insurance. Nobody has to worry that the German health system no longer earns enough. But the preselection already when making appointments to prevent this massive difference in access to medical care – that alone would be worth the effort of a system change.
Nobody should think that the end of the dual insurance system will make everyone happy. But if everyone in a country like Germany were annoyed in the same way, that would be a relevant contribution to social cohesion. And if those who are already having a hard time because money is scarce or their health is impaired were not also disadvantaged in the doctor’s office, that would be simple: right.