In Germany there is a kind of crisis competition, competition for attention and quick political action. The war in Ukraine, the upheavals on the energy markets and inflation are at the forefront. Even previous major issues such as the corona pandemic or global warming take a back seat.
Bulky challenges such as those in healthcare and nursing have an even harder time. And that, although they affect every citizen and form one of the largest branches of the economy.
Every eighth employee works in the healthcare sector, and the gross value added accounts for more than 12 percent of the economy as a whole. Almost two thirds of health expenditure is made by statutory health insurance, which represents 90 percent of the population.
A pitiful makeshift
But unless a devilish wave of contagion is sweeping the country, few are interested in the situation in the healthcare industry.
This is regrettable, because the lack of attention has led to Health Minister Karl Lauterbach (SPD) being able to submit an amendment to the Bundestag this Friday, which is nothing more than a pathetic makeshift.
The Statutory Health Insurance Funds Financial Stabilization Act manages to get the funds through the new year with a bang, but is far from bringing revenue and expenditure into line in the long term.
The proposal postpones this problem until spring, when Lauterbach’s house wants to present “recommendations for stable, reliable and solidarity-based financing of the statutory health insurance system”. So the law already contains an expiry date, thereby acknowledging its inadequacy.
So far too little has happened
One would expect that the traffic light would have long thought about “stable, reliable and solidary financing”. In fact, there are approaches to this in the coalition agreement. The intention was to strengthen the income side by “regularly increasing the dynamics” of the federal subsidy and by using tax money to pay higher contributions for recipients of unemployment benefit II.
On the expenditure side, a “federal-state pact” was planned in order to streamline the hospital system and achieve better care at lower costs. Little has happened. The “short-term” planned commission of clinic experts was a long time coming, drew criticism and has not yet achieved anything. The increase in the federal subsidy was less than expected, and there is nothing at all about Hartz IV recipients.
The financing of statutory health insurance is another policy area in which the left and the liberal government partners do not find each other. Finance Minister Christian Lindner (FDP) is quite rightly reluctant to provide fresh tax funds, the federal subsidy already amounts to 14.5 billion euros a year. Lindner insists that the health insurers tap into their reserves first, that savings are made in the system and that it pays more for itself through higher additional contributions.
There is a risk of worse care
It was a mistake to promise an ALG II solution and now back down. Because in political horse-trading, that leads to the SPD and the Greens smelling the dawn with their demand to introduce citizen insurance.
Voices are getting louder and louder to raise the contribution assessment and compulsory insurance limits so that more money flows into the system and it is more difficult to switch to private insurance.
Citizen insurance through the back door is the wrong approach. The thinning out of private health insurance leads to poorer care and fewer medical innovations, as the standard health insurers show elsewhere. Higher assessment limits drive up the additional wage costs, they not only burden the battered middle class, but also their employers.
In addition, the pay-as-you-go system would become less and less future-proof and more and more expensive because, unlike private health insurance, it does not have old-age provisions in an aging society.
You have to talk about combined private and legal procedures. For example, the benefits covered by statutory health insurance could decrease the higher the income; the rest could be provided for on the market. But just tinkering with the earnings is misleading. 280 billion euros a year must suffice, despite the demographics and the expensive but beneficial medical advances. The main task is to push the expenses.
It is fatal that Lauterbach rules out cuts in benefits while at the same time being able to live well with higher burdens on taxpayers and contributors. His new law is not an expression of social foresight, but of a lack of ideas and helplessness.