The supplementary premium charged by health insurance plans rose by an average of 0.3 percent at the start of 2023. It is set to rise again in 2024. Why are health insurance plans constantly short on funds?
Hans-Jürgen Urban: Expenditures are rising. This is due, particularly in recent years, to costly laws that provide more money to doctors and developers of health apps, for example, without improving the quality of care. But part of the increase in spending is also attributable to medical progress—which we want and need to ensure high-quality care. If better care costs more, it’s important to finance it fairly. To do that, we need a systemic change!
The head of a major health insurance company recently proposed closing the financial gap through radical cuts: patients with public health insurance should pay for “all dental care” themselves—or take out private supplemental insurance. A sign of desperation?
One of many absurd proposals that have been haunting the debate for some time—and are rightly facing a lot of pushback. These proposals all aim to dismantle the protection provided by public health insurance. But this won’t make people any less sick. The only result is that they’ll have to pay out of pocket. So does that mean people with less money who can no longer afford dentures won’t get them anymore? That would simply be antisocial. Healthcare must not depend on one’s financial situation. A health insurance executive should know that.
Is it possible to close the health insurance funds’ financial gap without raising premiums?
First of all—and as agreed in the coalition agreement —there should be higher payments from tax revenues for recipients of the citizen’s income. These expenditures are currently not sufficiently covered; we’re talking about several billion. In addition, some of the expensive laws mentioned from the time of former Health Minister Jens Spahn need to be scrutinized. However, statutory health insurance can only be financed in a truly secure and sustainable manner if we transform it into a universal health insurance system .
Hans-Jürgen Urban is an executive board member of IG Metall, responsible for social policy.
Why does universal health insurance bring more money into the healthcare system?
Citizens’ insurance broadens the base for financing health care. Civil servants, pharmacists, politicians, and lawyers—they’re all included. As a result, more money flows into the system. That’s the basic idea behind citizens’ insurance: fairer and more solidly funded.
Where else is reform needed?
There are other issues: for example, raising the contribution assessment ceiling and including other types of income. So far, health insurance contributions have been levied only on earned income. But if someone earns a lot of money from investment income or rental income, that isn’t taken into account. In the future, this money should also be subject to contributions—of course with exemptions so that low and middle incomes aren’t burdened.
The SPD and the Greens are open to universal health insurance, while the FDP is strictly opposed to it. The coalition agreement makes no mention of it. What are the chances for this idea?
The FDP may be against universal health insurance, but the idea enjoys enormous support among the public. The AOK’s research institute recently published a survey on public support for various reform ideas for statutory health insurance. In the survey, three-quarters of those with statutory health insurance expressed support for including all citizens in a common health care system —the core idea behind universal health insurance. Even among those with private insurance, only just under a third opposed it.
Would merging all statutory health insurance funds be a first step in the right direction?
The term “single-payer system” is often used to stir up opposition to universal health insurance. But that’s not what universal health insurance is about at all. The key is that privately insured individuals are included and participate in the solidarity-based system. This can also be achieved gradually, for example by giving civil servants the option to enroll in statutory health insurance as well.
Why is the division between statutory and private health insurance unfair?
Because it undermines the fundamental principle of solidarity in our welfare state. Privately insured individuals have higher incomes and often lower health risks. Yet they remain isolated within their own group. This is neither in keeping with the times nor fair. With universal health insurance, we would have a system that creates a balance based on solidarity throughout society. Our motto: Universal Health Insurance: Good Benefits—Fairly Financed!
