Following electoral setbacks for his party, CDU leader Friedrich Merz has signalled a possible change of course on Germany’s health insurance system. The “coexistence of private and statutory health insurance” is viewed by many people as a “fairness problem”, Merz said on Monday after meetings of the CDU’s party leadership bodies in Berlin. He said he recognised the problem and was open to changes. However, the Chancellor did not provide any details. The coalition partner SPD signalled support for changes, while the CDU’s sister party, the CSU, opposed them.
Merz said there were “good reasons for both systems”, but added: “If the population sees this as such a massive problem, and I share that assessment, then we have to change something about it, and that is exactly what we will discuss.”
The Chancellor said that a perception had become firmly established among the public that “those who are privately insured immediately receive every service, while those with statutory health insurance have to wait weeks and months”. He added: “We see the problem.”
The CDU leader also stressed that the coalition’s planned health reforms would have to be applied to private health insurance “with equivalent effect”. “We have not done that so far, and we will have to make up for that,” he said. Merz did not say what model of health insurance he had in mind.
A spokesperson for the Chancellor subsequently clarified that Merz was not planning a fundamental change to the existing system. “The Federal Chancellor has not called the health insurance system into question,” the spokesperson told the Funke newspapers. Merz had made clear that the federal government was taking seriously the widespread public perception of unequal treatment, “but that there are also good reasons for the existing system”.
Ending the coexistence of private and statutory health insurance would represent a departure from a long-standing position of Merz’s party. The CDU has repeatedly and clearly supported the dual system of statutory and private health insurance. The party has so far firmly rejected a state-run unified insurance system, such as the “citizens’ insurance” model proposed by the SPD, Greens and Left Party.
Christos Pantazis, health policy spokesman for the SPD parliamentary group in the Bundestag, offered to hold talks with the Union on implementing changes. So far, there has been no majority in favour of a “fundamental system change”, Pantazis said. “It is all the more remarkable when the Federal Chancellor himself describes the coexistence of statutory and private insurance as a justice problem.”
The SPD lawmaker added: “If the Federal Chancellor’s statements today mark a change of thinking on this issue, I expressly welcome that. Then we should now talk to each other about it.” Pantazis said the coalition could take a “first concrete step” as part of the upcoming nursing care reform by discussing a “financial compensation” between the private and statutory systems in order to strengthen the latter.
Stephan Pilsinger (CSU), deputy chairman of the Bundestag’s Health Committee, spoke out in favour of maintaining the current system on Monday. “I do not assume that Chancellor Merz has the abolition of the fundamentally proven dual health insurance system in mind,” the CSU politician told Focus.
“We should leave the debate repeatedly initiated by the left about abolishing private health insurance to the Greens and the Left Party,” Pilsinger said. “It would not shorten a single waiting time and would also be extremely difficult to implement, both practically and constitutionally.”
Patient advocates welcomed the possibility of moving away from the existing system. “Obviously, the Federal Chancellor has recognised that the coexistence of private and statutory insurance is deepening the division in society,” said Eugen Brysch of the German Patient Protection Foundation, according to the AFP news agency. “Now those insured are waiting for concrete proposals.”
The German Medical Association, however, criticised the idea. Its president, Klaus Reinhardt, called it “dangerous” to question private health insurance (PKV), which he described as “the most stable pillar” of the healthcare system. He said that revenue from private health insurance could be used to finance “staff, equipment and other resources that are used to provide care to both privately and statutorily insured patients”. Reinhardt stressed: “A healthcare system without private health insurance means healthcare with less money for everyone.”
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