There is no doubt: the statutory health insurance companies are sick. In the current year, the deficit will amount to 17 billion euros, the highest deficit ever. The cash registers urgently need to be “operated” if they are not to become a case for the intensive care unit.
The Freiburg economist Bernd Raffelhüschen, known for clear, unvarnished statements, therefore wants to ask the contributors to pay. “We can no longer afford the system. In the future, patients will have to pay more out of their own pockets,” the professor told Bild. Without significant changes, the contribution rate would increase from currently almost 16 percent to up to 22 percent of gross wages by 2035.
Health insurance patients would also get medical bills
The economist, who teaches in Freiburg, makes suggestions that would fundamentally change the current system. Patients with health insurance should take on up to 2000 euros a year themselves before the health insurance pays. In addition, insured persons should pay for injuries in risky sports such as skiing in full themselves. According to the economist, smokers or overweight people should also contribute more to the costs of their treatments themselves.
If Raffelhüschen had its way, patients would receive a bill from the doctor – as is usual with privately insured people. You would have to submit this to your cash register. They would then take over the majority, depending on the deductible of the insured. Low earners should be supported by the state with grants. That would burden the federal budget, not the coffers.
Raffelhüschen underestimates the bureaucratic effort
What Raffelhüschen proposes is a model for responsible citizens. His approach: Even patients with health insurance should know what costs arise with every doctor’s visit. They find out when the bill flutters into their house because the doctor no longer bills the cashier directly. In addition, the insured themselves should help to reduce costs. For example, anyone who buys a drug in the pharmacy without first consulting a doctor does not charge the health insurance company.
All of this is consistent. Raffelhüschen just seems to underestimate the associated bureaucratic effort. This begins with the determination of who is exempt from the deductible in whole or in part for social reasons and who is not.
Calculation of the reasonable deductible hardly feasible
It’s easy for recipients of citizen’s income, also known as Hartz IV. But does only the income from work count for low earners or are other incomes also taken into account? For example, an insured person who lives in their own house is financially better off than someone else who still has to pay rent on the same salary. One can imagine how many officials would be busy calculating the amount of the reasonable deductible for millions of health insurance patients.
Sending the medical bill to the patient would also cause difficulties. It is doubtful that every insured person quickly forwards the bill to the cash register. Then the medical practices would have to send out many reminders, which in turn increases their costs. The billing between the doctor and the insurance company is much more cost-effective.
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Self-responsibility is important, but the Raffelhüschen model leads to a nanny state
Raffelhüschen’s proposal to burden the insured with the costs of an unhealthy lifestyle or the consequences of dangerous sports is understandable. Anyone who pays attention to their health and does not want to prove their courage on icy slopes or with a paraglider finances the consequential costs of the unhealthy lifestyle or dangerous hobbies of others with their health insurance contribution.
Asking the perpetrators of preventable illnesses or injuries to pay directly is therefore not a far-fetched consideration. The only question is which lifestyle is classified as permitted by the health insurance company – i.e. by the state – and which as forbidden. How much can you deviate from the ideal weight in order not to have to pay your doctor’s bill yourself? Or do recreational footballers also have to pay if they strain or even fracture while fighting for the ball?
Personal responsibility is good and important. But the Raffelhüschen model, if implemented consistently, leads to a nanny state that dictates what we eat and drink and what sports we are allowed to do. A healthy lifestyle with salad, still water and at most light gymnastics as physical activity is not what most people imagine as a comfortable life.
Insured people are more likely to be victims than perpetrators
Raffelhüschen’s proposals start with the insured. They should not only pay more, but also learn how expensive every visit to the doctor is. However, it would be obvious to first subject the healthcare system to a “check-up”. After the USA, the Germans afford the most expensive healthcare system in the world. But they are not healthier than others.
The fact that our healthcare system is so expensive and is becoming more expensive is not primarily due to the insured. Politicians play a decisive part in this with their almost inscrutable cooperation with the interest groups of doctors, hospitals, the pharmaceutical industry and health insurance companies. The insured are more likely to be victims than perpetrators.
