G Health Minister Nina Warken is once again under fire — this time for her actions rather than for inaction. That is at least encouraging and came so suddenly that some media outlets felt compelled to praise. The CDU minister, who is currently presenting her austerity proposals for the German health system, faces discontent from all sides: from health insurers, pharmacists, doctors, the hospital lobby, and patient representatives. That, too, is not a bad sign: Warken is indeed taking on (almost) all of the numerous stakeholder groups. And yet with her reforms she tinkers only with the symptoms, not with the root causes of the problems.
The German health system costs more than 350 billion euros; health insurers spent more than €350 billion last year. In the EU comparison, Germany tops the charts for health expenditures, but not for health outcomes. Our life expectancy, for instance, is slightly below average; in Italy or Sweden people live almost three years longer on average. The German health system is particularly expensive, but not particularly good.
That Warken wants to link rising expenditures to revenues so that contributions do not rise further is correct. Logically, she also aims at all sectors. But in the end it is again the insured who should pay disproportionately. With higher co-payments for medications and some also soon with higher contributions, because the free supplementary insurance for spouses would disappear. Those who think that’s acceptable overlook that the supplementary contributions have also risen in recent months; people are already paying more, and in the future they will get less as a result. This creates a social tilt to the detriment of those who already have to watch every euro, a tilt that the planned increase of the contribution assessment ceiling by 300 euros cannot offset.
Notably, who is holding back in the chorus of critics: the pharmaceutical industry, indeed. Medicines in Germany are disproportionately expensive, and drug spending is the second-largest cost block. It would have been fairer and cheaper for the insured if Warken had slowed the stock prices and profit margins that have been rising, too.
The coalition does not have the courage to tackle the underlying problems
But Warken is not that combative after all. And neither she nor the black-red coalition have the courage and the will to address the underlying systemic problems in the health care system: the expensive dual structure of outpatient and inpatient specialist care, the unsolidary coexistence of private and statutory health insurance, and the general possibility of deriving private profits from the public-financed structures. Those would be real reforms for the majority of people.
