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.
Karl LauterbachIn 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.
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 LauterbachThe 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.
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 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 same drugs are way cheaper in Germany than in America because, obviously, if all sickness funds negotiate with the drug companies for a single price, then the market power of the sickness funds is fully used. So therefore you would expect the prices to be lower for the drugs in Germany, and this is exactly what you see, at least for non-generic drugs.
Karl Lauterbach