Doctors reject citizens’ insurance: lobbyists in white

By rejecting the citizens’ insurance, the German Physicians’ Congress has safeguarded its political interests. A change in the system would cost physicians dearly.

The German medical profession is stubborn when it comes to citizens’ insurance. Photo: dpa

Dressed in black suits, they sit in long rows of chairs in the Hannover Congress Centrum and applaud. They are doctors, but you can see it in their faces: They are also officials. They have traveled to the German Medical Congress as elected representatives, 250 representatives of the state medical associations. One should not be surprised if politics is fiercely played in front of this audience – especially in an election year.

"Here and now, no one can say how the electorate will decide," emphasizes the President of the German Medical Association, Frank Ulrich Montgomery. "We are committed to the cause alone anyway, our ideology is patient care and quality, not redistribution and not world improvement either." So no politics after all?

"What would it actually be like if we had one health insurance fund for everyone, but you were dissatisfied as a patient?" later asks German Health Minister Daniel Bahr (FDP). "Where would you want to switch to then?" His criticism is of the idea of merging statutory and private health insurance, which is favored by the SPD, the Greens and the Left Party.

Montgomery also said at the physicians’ conference that the motto of physicians is responsibility and freedom, "not state medicine and uniform insurance." So the doctors’ functionaries are shooting against supposed restructuring plans after all. This no longer sounds as neutral and politically distant as Montgomery had presented himself shortly before.

Clearly voted against

The physicians’ conference then also voted clearly against the new system. The fierce rejection of a citizens’ insurance plan is not surprising, because redistribution plans would reshuffle the cards: Private health insurance companies currently thrive on a system that accepts healthier and wealthier individuals and offers relatively favorable rates to insureds with high incomes. Citizen insurance would eliminate such privileges. And who likes to let that happen to them?

But who gets specific? And talks about privately insured people in Germany being treated like little kings at the doctor’s office? That practices in regions with a high proportion of private patients would have to accept massive losses in the event of a system change? Because the system for privately insured patients includes more leeway to charge higher fees or to perform additional treatments, the benefits of which for the patient are not always perfectly proven.

The German healthcare system is not only characterized by high treatment quality, as Montgomery and Bahr emphasize, but also by blatant lobbying. If you start digging up established structures, you make enemies. But the legislator must consider an approach that entails job losses and revenue losses for practices under market efficiency criteria and at least calculate its introduction. With the noble goal of making the system cheaper and even fairer in the long run.

"We can’t solve the problem on our own".

It is unclear whether existing inequalities are a consequence of the insurance system at all. For example, men who belong to a higher income bracket live on average 10.8 years older than those who live in relative poverty. For women, the difference is still 8.4 years. All these people are insured, so the cause is to be found in their different living conditions, not primarily in the insurance policy.

To that, Montgomery says, "We can’t solve the problem alone. We need early help from social workers, children’s educators and teachers." So it won’t work without help from politicians after all. Because a pure debate about the insurance system misses the point. Once again, it’s about overall social structures, about the question of "How do I live healthily?" The social factor remains the biggest cost-setting screw in the healthcare system.

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