{"id":58370,"date":"2018-01-11T13:58:36","date_gmt":"2018-01-11T13:58:36","guid":{"rendered":"http:\/\/www.bnreport.com\/how-do-you-say-obamacare-in-german-2\/"},"modified":"2018-01-11T13:58:36","modified_gmt":"2018-01-11T13:58:36","slug":"how-do-you-say-obamacare-in-german-2","status":"publish","type":"post","link":"https:\/\/www.bnreport.com\/en\/how-do-you-say-obamacare-in-german-2\/","title":{"rendered":"How do you say Obamacare in German?"},"content":{"rendered":"

BERLIN \u2014 As Germany\u2019s Social Democrats (SPD) explore another coalition<\/a> with Angela Merkel\u2019s conservatives, party leaders are looking for a big policy victory to prove to their base that it\u2019s worth the trouble.<\/p>\n

That\u2019s why they\u2019re so insistent on reforming the German health insurance system \u2014 by creating a B\u00fcrgerversicherung<\/em>, or \u201ccitizens\u2019 insurance\u201d scheme, under which all Germans would be automatically insured.<\/p>\n

The SPD slumped to its worst ever result in last September\u2019s general election after four years as Merkel\u2019s junior partner, so party leaders and activists are wary of reprising that role. As they hold talks with the conservatives this week, an overhaul of Germany\u2019s health insurance system is sure to be one of the major sticking points.<\/p>\n

\u201cAs a Social Democrat, I work to ensure all people can share in medical advances,\u201d said B\u00e4rbel Bas, an SPD lawmaker in the party\u2019s health working group. \u201cCitizens\u2019 insurance would make the health system fairer, so no one in old age has to fear unaffordable premiums or poorer care.\u201d<\/p>\n

The SPD has advocated for some form of citizens\u2019 insurance for more than a decade, seeing it as key to social democratic core values; some in the party even suggested last month that citizens\u2019 insurance should be a precondition for talks with the CDU\/CSU bloc (though they\u2019ve since backed down from that idea).<\/p>\n

Germany\u2019s current health insurance system, which has structural roots as far back as the late 19th century, insures people in two distinct ways: through statutory public health insurance and private insurance. The SPD says this creates a two-tier setup, with wealthy people not contributing enough to the overall health system, to the detriment of the poor.<\/p>\n

<\/p>\n

Karl Lauterbach, member of the German Social Democrats (SPD) | Sean Gallup\/Getty Images<\/p>\n

\u201cWe want all people in Germany to be insured in the same way, and to introduce a citizens\u2019 insurance,\u201d the SPD\u2019s top leaders wrote in a four-page catalog of conditions last month. Long-time SPD health reform advocate Karl Lauterbach told the Bild am Sonntag newspaper it is the party\u2019s \u201cduty to our constituents to implement this.\u201d<\/p>\n

Merkel\u2019s conservatives, however, have consistently opposed the SPD proposal \u2014 and the idea has major opponents in the private insurance industry, which brought in \u20ac37 billion in premiums<\/a> in 2016 and could stand to lose much of its business if the SPD gets its way. And last week, representatives from some of the statutory insurance providers also came out against the plan<\/a>.<\/p>\n

\u201cFor many years in Germany public insurance and private insurance have coexisted,\u201d said Rudolf Henke, a CDU MP and long-time doctor who focuses on health issues in the Bundestag. \u201cAnd the public insurance companies have record surpluses, they\u2019re financially and qualitatively well-placed \u2026 we are pretty well taken care of in Germany.\u201d<\/p>\n

Two-track system <\/h3>\n

Right now, roughly nine in 10 Germans are insured under the statutory system, the default option, in which they and their employers split the cost of premiums equally. This insurance is managed by more than 100 Krankenkassen<\/em><\/a>, or health insurance funds, which together brought in more than \u20ac200 billion in premiums<\/a> in 2016.<\/p>\n

The remaining 8.8 million people, or just over 10 percent of the population, are insured by one of Germany\u2019s several dozen private insurance companies \u2014 either by choice or because of their professions. Civil servants and freelancers are covered through private insurance, and those earning over a certain amount (\u20ac57,600 per year in 2017) can choose between statutory insurance and private insurance.<\/p>\n

Though a relatively small proportion of the country\u2019s overall population holds private insurance, their typically higher premiums come with perks such as shorter waiting times and a wider range of choice in doctors. And since doctors get paid significantly more for treating private patients than statutory ones, many doctors prefer to take private patients.<\/p>\n

\u201cWhenever you say you are privately insured, the doors are open, you have immediate access and you get very thorough and very careful attention,\u201d said Klaus Hurrelmann, a professor at Berlin\u2019s Hertie School of Governance. \u201c[Doctors] get two to three times as much money for you, so it is really highly attractive to have people who are privately insured.\u201d<\/p>\n

The SPD argues that this discrepancy in privileges and available services is inherently unequal, giving unfair advantages to those who are able to pay more for them. What\u2019s more, it is very difficult for people to switch from private insurance to statutory insurance, meaning they have few alternatives if their premiums rise.<\/p>\n

The issue is an encapsulation of the party\u2019s core values of equality and social justice, which is part of why it\u2019s so high on party leaders\u2019 list of demands.<\/p>\n

B\u00fcrgerversicherung<\/em> \u201cis a very crucial and also an emotional thing for the social democratic family, not only for the party but for trade unions, and for all the left parties,\u201d said Severin Schmidt, a social policy expert at the Friedrich Ebert Stiftung, the affiliated political foundation for the SPD.<\/p>\n

Under the SPD\u2019s proposal, the country would eventually eliminate the use of private insurance as primary insurance, automatically placing all Germans into a single \u201ccitizens\u2019 insurance\u201d system, regardless of what kind of plan they\u2019d chosen before. Their premiums would be based on income, rather than on age or medical history.<\/p>\n

The \u201ccitizens\u2019 insurance\u201d would largely look like today\u2019s statutory insurance, but with some provisions to ensure more equal treatment: doctors would receive the same fees for all patients, for example, and employers would pay half an employee\u2019s premium regardless of the amount.<\/p>\n

They would start this process \u2014 which experts say is a decades-long endeavor \u2014 by moving civil servants and freelancers into the existing statutory system, then eventually bringing in other remaining private patients as well. People could still choose to purchase supplementary insurance on top of their primary plan, which would fund extras like private rooms during hospital stays or certain non-covered types of care.<\/p>\n

In a position paper on the issue<\/a>, the SPD\u2019s Lauterbach said \u201cthe restructuring of the system is a process\u201d and private insurance companies wouldn\u2019t be entirely eliminated. Instead, they could either opt to offer citizens insurance \u2014 in the way the Krankenkassen<\/em> now offer statutory insurance \u2014 or move toward offering supplemental insurance plans.<\/p>\n

The CDU, however, opposes the overall idea of citizens\u2019 insurance even if it is open to potential improvements to the existing health care system.<\/p>\n

\n

\u201cFor me, this concept of \u2018citizens\u2019 insurance\u2019 that the SPD presents doesn\u2019t bring any advantages over what we have now.\u201d \u2014 Katja Leikert, a CDU MP<\/em><\/p>\n<\/blockquote>\n

Members of the CDU say the current system actually works well for most Germans, and that such a huge overhaul would cause more problems than it would solve. And the plan\u2019s opponents also worry that decreased competition in German health insurance could drive up premiums and bring down the overall quality of care.<\/p>\n

There\u2019s also the question of how such a big shift would comply with German laws and the constitution, making future legal battles likely if the SPD\u2019s proposal were to be implemented. Another major issue is what would happen to the collective \u20ac233 billion in surplus funds<\/a> private insurance companies have built up to cover the care costs of Germany\u2019s aging population.<\/p>\n

\u201cFor me, this concept of \u2018citizens\u2019 insurance\u2019 that the SPD presents doesn\u2019t bring any advantages over what we have now,\u201d said Katja Leikert, a CDU MP who is a member of the party\u2019s health policy group. \u201cSo I\u2019m not convinced \u2026 I have taken a close look at this and truly can\u2019t understand [why it would be better].\u201d<\/p>\n

Possible compromise<\/h3>\n

Though it seems unlikely that the SPD will score an outright victory on the issue, there are signs a compromise might be possible: Merkel reiterated last month that the CDU is \u201cagainst\u201d such a system, for example, but suggested \u201ca variety of improvements\u201d could be on the table.<\/p>\n

One possibility is that the two parties agree to part of the SPD\u2019s proposal but stop short of actually doing away with private insurance. They could negotiate over equalizing doctors\u2019 fees for statutory and private patients, or could begin the process of bringing more people into statutory insurance by shifting over civil servants and freelancers from private insurance.<\/p>\n

Leikert, the CDU MP, named the latter as an example of a possible compromise in the coming negotiations.<\/p>\n

\u201cYou can say, for example, that all civil servants should come onto the statutory health insurance,\u201d she said. \u201cYou can do it, sure \u2014 I find that as a politician, you always need to be ready to compromise. And if that\u2019s the price of having a stable government, you can also share the price.\u201d<\/p>\n

Original Article<\/a><\/p>\n

[contf]
\n[contfnew]
\n <\/p>\n

Politico<\/h5>\n

[contfnewc]
\n[contfnewc]<\/p>\n","protected":false},"excerpt":{"rendered":"

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