Health insurance in Germany continues with no change if you lose a job. We do know very well that people who become unemployed are at an increased risk of becoming ill, and therefore becoming unemployed is about the worst time to lose health insurance. So therefore, everyone who loses a job remains in exactly the same insurance system he is in.
Karl LauterbachIn Germany it's impossible to go bankrupt for medical bills, because even if you are bankrupt, ... the social solidarity system pays for your medical bills. The idea is, if you do have financial problems and a lot of worries for other reasons, you do not need to have another burden in not being able to pay medical bills.
Karl LauterbachI think from an economics point of view, it is important that the money that is spent for health care is well spent - what is the cost-effectiveness of the money that is used? - because if the money is well spent, many people benefit from the system, and it is also a good market for finding employment. I do not see a reason why we should limit ourselves when it comes to very qualified and humane employment opportunities if there is no waste and if there is medical need.
Karl LauterbachThe quality of health care in Germany is not as good as people sometimes believe it to be. We have problems with chronic diseases. The German system allows too many hospitals and specialists to treat chronic diseases. We do not have enough volume in many institutions to deliver good quality, and we do have fairly strict separations ... between primary physicians, office specialists and hospital specialists. But I think the quality problems can be solved in the next couple of years, and we have made major progress in diabetes, coronary artery disease and pulmonary disease care.
Karl LauterbachI think we have in Germany too many sickness funds. We started with more than 1,000 sickness funds. But the fewer sickness funds there are, the less bureaucracy and the easier the system is to operate. But it is important that the best sickness funds survive.
Karl LauterbachI think, unfortunately, many opinion leaders in Germany - including government officials, politicians, social service bureaucrats and so forth - they are in the private system, and they get paid the private insurance by their employer. So for them this is the best of two worlds: They have some more expensive and privileged access, but they do not have to pay for it themselves. This is a system which is both inefficient and unfair at the same time, but it is defended by those who profit from this system, and this includes many opinion leaders and many politicians.
Karl LauterbachI think the Scandinavian health systems are better when it comes to preventative care than the German system, because in the Scandinavian systems, the government is really more active in defining treatment, goals and defining health priorities. The German system is a competitive system with little government intervention. The price for this is that the government cannot set a health agenda. And the Scandinavian systems have little competition, so you often do have waiting lists. But on the other hand, you then have the government which can push for prevention.
Karl Lauterbach