The German coalition government—and in particular the chancellor, Angela Merkel—has been heavily criticised for plans to reform the country’s underfunded health system by raising the fees paid by members of state health insurance schemes.
Under the proposal healthcare insurance fees paid by employees and their employers will rise by around 0.5% by 2007. In addition, for the first time in the national health system’s 150 year history, tax revenues will be used to help finance it. The government will spend €1.5bn (£1bn; $1.9bn) in 2007 and €3bn a year from 2008 onwards, mainly to help fund children’s health insurance.
The deal was presented by Ms Merkel’s coalition of Christian Democrats, Christian Socialists, and Social Democrats on 3 July, after months of hard discussions.
The aim is to reform a system that costs around €145bn a year. The German health system is financed equally by insured people and their employers. The deficit in the health budget has been blamed on higher spending on drugs and hospital treatments, as well as a drop in the number of people paying insurance, because of a rise in unemployment (BMJ 2006;333:14, 1 Jul).
Ms Merkel said the reform was “an important breakthrough” and that this reform was not the “answer to the future but is dealing with the mistakes of past years.” Edmund Stoiber, the leader of the Christian Socialist party, which works alongside the Christian Democrats and has its political base in Bavaria, said he was glad further tax rises were averted.
However, the reform plans drew fire from the more left wing Social Democrats, from the opposition, including the Free Democrat party, and from business leaders.
The critics said the reform was not far reaching enough and was even counterproductive. Dieter Hundt, president of the German employers’ association, said that the reform was diametrically opposed to the government’s declared objective of cutting non-wage labour costs and creating new jobs. Guido Westerwelle, the leader of the Free Democrats, the biggest opposition party, said the reform reminded him of a “planned economy: it has nothing to do with free competition.”
The Social Democrats were frustrated because their plan for a tax based health fund had failed, as had its proposals for larger contributions from the 8.4 million privately insured people in Germany. Despite the compromise the Social Democrat finance minister, Peer Steinbrück, is convinced that taxes have to be raised to finance the health system in the future.
Criticism also came from Ms Merkel’s own party members. Peter Müller, a Christian Democrat and first minister of the state of Saarland, said that the rise in health insurance fees should have been avoided, for instance by cutting down on payments for sports injuries.
Politicians will have to act swiftly, because the state health insurance companies fear that the rise of 0.5% will not be enough to cover costs.
“Most insurance companies are expecting a deficit of 0.6% to 0.8% for 2007,” said Hans Jürgen Ahrens, the head of Germany’s largest health insurance company, AOK.
