Suggestions for Spahny

Jacinta’s 4-point plan for improving the German health service


I think I am not alone as a Brit abroad to have been slightly surprised to discover that the United Kingdom is not, in fact, the only country in the world to have some form of socialized healthcare. And I am sure I am not the only Brit living abroad who now finds the way the NHS is viewed as some form of state religion vaguely puzzling at times.

Now, don’t get me wrong: I think British people are right to be proud of their National Health Service, which, for all its flaws (and it’s certainly in danger now!) is a hugely noble socialist project in a cruel, cold country which has never really embraced the necessity of a welfare state. The NHS is an ambitious, socialist, utopian dream come true – imagine how Andrew Neil or Piers Morgan would sneer at it had it been first suggested by Corbyn in the run-up to December’s General Election!

One thing that does frustrate me, though, is that we Brits seem only to be capable of comparing ourselves with the USA and literally nowhere else on Earth! It seems to me like British people think there are only two systems – the NHS system and the American “each man for himself, it’s a dog eat dog world, then you get cancer the hospital charges you $100,000 for treatment and you die in poverty” type system. I would go so far as to say the melodramatic comparisons with the United States combined with this view of the NHS as a religion and its workers as Saints has done little to protect it. A more selbstverständlich acceptance that profit and healthcare don’t mix, that even the poor deserve to live, that healthcare is a human right and not a charity, would serve my home country better I feel.

The Germans have a very selbstverständlich attitude towards their healthcare. I feel that probably most Germans, certainly most Germans I know, think that healthcare doesn’t need to be socialist, but should be solidarisch. People in work pay a certain portion of their wages to their Krankenkasse of choice, and their employers pay a certain amount too. Meanwhile, and this is important, people out of work get the costs taken over by the Job Center or Agentur für Arbeit. Furthermore, anyone who earns over 4,800 euros, has “Beamte” (civil servant) status, or is self-employed, can choose to go private. Refugees get basic medical treatment when they arrive in the country, but once they are part of the welfare system, they’ll get a health insurance card and the same treatment as everyone else (theoretically, at least.)

The system is seen as basically quite efficient and fairly humane. It’s rare to hear someone claim, with specific reference to healthcare, that Germans are healthy and hard-working and refugees are lazy and sick hypochondriacs. Think about the Pegida rallies – there were a lot of complaints, but foreigners going to the doctor too much wasn’t one of them.

However, there is another thing you won’t hear mentioned much. The uninsured. To be quite frank, the German indifference to the uninsured people living in this country is as alien to me as the British worship of the NHS. Estimates say that around 140,000 people have no health cover in Germany – my gut tells me it is far higher.

One of the things I can never understand about my German friends is their claim that it is impossible to not have health insurance in this country. A German friend of mine, let’s call her Sandrine, said to me recently: “Oh, but we’re not allowed to have no health insurance in Germany! It’s not like America. It’s basically forbidden.”

Well, let me tell you: something being mandatory to have does not mean it is easy to get! And it is really bloody easy to live in Germany with no health insurance. Undocumented people, homeless people, semi-homeless people, housewives in an abusive relationship who have just arrived, self-employed people who are doing a lot of/a bit of Schwarzarbeit, students who have just lost their jobs, people who are unemployed but not not organized enough to go to the Job Center so they are just living off money their partners give them every now and then, every single British person who lost their job due to Corona but doesn’t qualify for Hartz-IV…..THE LIST IS ENDLESS. Nice Sensible German People are always slightly puzzled as to how you can end up with no health insurance in this Sozialstaatparadies we call Deutschland, well Nice Sensible German People I AM COMPLETELY BAFFLED HOW YOU CAN LIVE IN THIS COUNTRY ALL YOUR LIVES AND NOT MEET ANY UNINSURED PEOPLE! Do you ever go out, like ever?

Imagine you are a nursery school teacher or nurse who thinks she’s at high risk of getting corona. A German person, I am not even bringing homeless foreigners into it now. Your doctor doesn’t think you’re high risk, but you think you are. Your doctor won’t sign an “Attest” to prove you are high risk, your manager keeps on asking you to perform tasks which you see as dangerous and unnecessary in these Corona times. After a few fights, you resign. Now, because you resigned, you won’t get your benefits for a while – which means, that, for a while, you won’t have any health insurance. IT REALLY IS THE EASIEST THING TO HAPPEN IN THE WORLD.

(A shout out here, by the way, to EU citizens who were in the country legally, getting by doing sex-work or dog-walking or whatever, and after seven years of being here get hit with a hefty bill from the AOK because it is, actually, illegal to not be health insured. I dunno. That’s seven years of not going to the doctor and paying for it, it doesn’t seem fair to me!)

Some people in Germany think we should introduce a National Health Service here, and I am inclined to agree. At least for the duration of Corona, and possibly ever. But failing that, I have a few helpful suggestions for my main man Jens Spahn and I’m sure you’ll agree they are all brilliant:

  1. Let’s get rid of all the different Krankenkasses – like what the fuck is the point? I am with AOK, and it’s blatantly the best one, although they do waste too much money on ads. But let’s put all the Krankenkasses together, AOK can be the boss, and we call it a Solidaritätskrankenkasse, and then we’re done with it
  2. Get rid of private insurance, get all the richies back into our Solidaritätskrankenkasse, and make them pay fairly high fees. They can afford it, can’t they? Not crazy high, just like €600, €700 would be fine.
  3. Stop making people show their cards when they go to the doctor’s. I think it should be like this: you HAVE to have health insurance, but you don’t need to prove you have it. So, if you don’t have your card on you, you can go anonymously. In this way, undocumented people, homeless people, and dog-walkers flatsitting who got caught out by Corona can all get cared for.
  4. GIVE EVERY KID IN GERMANY KINDERVERSICHERUNG – like seriously, Spahny, if you don’t listen to any of my other ideas at least listen to this one! Yeah Familienversicherung is nice and all but considering every kid in Germany has a family and the ones whose families are too poor/disorganized/self-employed hot messes to get their health insurance sitch in order ARE NOT TO BLAME FOR THEIR PARENTS FUCK UP. My solution is give every kid a health insurance card with their Kindergeldbescheid. Valid for 18 years. Maybe 19.

I find it strange that the Nice Sensible German People I know are often complaining about Germany’s healthcare system being two-tiered – divided into the publicly insured and the privately insured. I think the big difference is between the insured and the uninsured and I truly, truly believe that the numbers will be getting higher and higher and higher due to Corona. As far as I’m concerned, Germany could do a lot, lot better than this.