Bert Rürup: Reorganizing solidarity in the health system - the forgotten option

Dusseldorf. Chancellor Friedrich Merz (CDU) surprisingly brought up a fundamental reform of statutory health insurance (GKV). The “coexistence of private and statutory health insurance” is perceived by many people as a “justice problem”. “We see the problem,” he said, while emphasizing that there are good reasons for both systems. “But if the population sees this as such a massive problem, and I share their assessment, then we have to do something about it.”

Although a spokesman later made it clear that the Chancellor had not questioned the dual health insurance system, the genie was out of the bottle. Rightly so! If one had the task of designing a “greenfield” health system today, the existing German model would certainly not serve as a model.

However, the alternative is neither to defend the status quo nor to provide citizens with insurance. Rather, it is important to institutionally separate insurance and redistribution.

The coexistence of statutory and private health insurance developed rapidly after the introduction of compulsory statutory “workers’ health insurance” at the end of the 19th century. Private health insurance (PKV) was the market economy answer to the fact that higher earners, civil servants or the self-employed could not become members of the statutory health insurance funds.