The 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.

In Germany there is ranking for contribution rate, so the cheaper sickness funds with good quality can both advertise their better quality plus their lower contribution rates and therefore be gaining members. We had about 240 sickness funds a couple of months ago; we are now down to 213, I think. In two or three years, only 50 or so will survive.

The German system is way less fair than it is expected to be, and the difference is becoming bigger. The private system, with its privilege to pay doctors and hospitals better, is basically putting the whole system at jeopardy, because many first-class hospitals and first-class physicians are wasting their time on trivial cases of privately insured and are no longer accessible for the difficult cases from the public system, despite [the fact] that the hospitals and also the education of those professionals is paid for by public money.

In the '50s and in the '60s, the private insurance system originally was a benefit for the bureaucrats in Germany. And this system became ever bigger because the private insurance industry lobbied successfully for making this system bigger. In the '70s and in the '80s, they managed to find a system where they could take everyone beyond 40,000 euros income per year but didn't have to take everyone. So they only took those that had both high income and a secure job and who was not ill at that time.

I 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.

In comparison to the U.S. health care system, the German system is clearly better, because the German health care system works for everyone who needs care, ... costs little money, and it's not a system about which you have to worry all the time. I think that for us the risk is that the private system undermines the solidarity principle. If that is fixed and we concentrate a little bit on better competition and more research, I think the German health care system is a nice third way between a for-profit system on the one hand and, let's say, a single-payer system on the other hand.

I 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.