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.

The U.S. has a system that does have a poor cost-benefit ratio. I mean, 40 million people lack insurance; another 30 million or so are underinsured. The people who are insured do have to worry whether they are able to pay the bills. People become bankrupt because they cannot pay the medical bills, and there are vast differences in the quality of care depending on how much you are prepared and able to pay. I think the system is not working well.

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.

In 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.

I 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.

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.