The German Healthcare: A Two-Class-System?

Should you treat someone better because he's got more money?

Large capsule standing out from the crowd of various pills and medicine
The German Health Care System-Should you choose the red Pill or the Green one?. Kevin Hauff-Ikon Images@gettyimages

A German "Breaking Bad" would have ended a lot earlier thanks to our health care system. Just imagine Walter Weiß living in Augsburg getting diagnosed with lung cancer. Because he has an obligatory health insurance, he gets a long and rough cancer treatment until he has either successfully defeated the illness or died from it. End of story, no criminal action involved. A certain blockbuster.


Two Classes of German Health Care?

As Germany is a so called social- and welfare state, it offers every citizen "free" health care.

Nobody has to suffer or even die because he or she can't afford the hospital bills. This reaches back to Reichskanzler Otto von Bismarck in 1883, who developed the German health care system. He didn't do this because he was a big Menschenfreund or even a socialist - in fact, he did it because he was the opposite of a socialist. He put the health care in charge because he wanted to avoid the workers rioting and make the first step before the real socialists could come in charge.  Therefore, the social security system has a quite long tradition in Germany and also in most other parts of Europe. But besides all the good sides of this system, there are also some Schattenseiten: The German health care system is sometimes said to be a two-class-system.


Free Treatment 

What some conservative and populist politicians in the USA called "socialism" is simple reality in Germany: You must have a health insurance.

Unlike other countries in the world like e.g. Denmark, the German health care system isn't completely "free" because it is not financed by taxes. More like France or Belgium, every citizen has to be a member of an insurance company and pay a monthly amount for his health care. If you are employed, you only have to pay one half while your employer pays the other half.

In case you are unemployed, you don't have to suffer - also as a receiver of social welfare (see my article about Hartz IV), you will get your insurance paid by the state. Therefore, everyone has at least this national insurance called Gesetzliche Krankenversicherung (literally: legal sick-insurance) so that you are able to go to a doctor, to a hospital or get an ambulance for free if needed.


National vs. Private Health Insurance    

Besides this national health insurance, one can also become a member of a private insurance. In that case you’d have to pay the hospital bills yourself at first but you would get the money back from the insurance company afterwards. At first sight, both possibilities seem legit. But when looking closer, one might get the impression that the  German health insurance system is promoting a two-class-society. The reason is simple: Private health insurance is usually way more expensive than the national one. It might not seem this way in the beginning, especially when you are young. But over time your monthly insurance fees grow significantly eradicating the former cost-differences. The national insurance provides you with a bed in a hospital and a free treatment - but only on a basic level.

For almost every medication you need you will have to pay a small Selbstbeteiligung (a share) between 5€ and 10€ and you won't get a single bed in a hospital but you’ll rather have to share it with up to 2 others. As a privately insured patient, you could get your own room and even get treated by the Chefarzt, the head physician or if that one is busy by the Oberarzt, the senior physician. The doctors themselves are said to like privately insured patients - their insurances pay quicker than the Gesetzliche Krankenversicherungen. That's why sometimes private patients won't even have to wait as long as the others to see a doctor. While private insurances and doctor’s offices deny such a special treatment of privately insured patients, several recent studies have found this to be true.  


There's no way Back

But there is also another side of the coin: Once you’ve been a member of a private health insurance, it is very difficult to return to the Gesetzliche especially if you are or have been self employed.

 If you earn less money for whatever reason and happen not to be able to afford your private insurance any more, you'll have another serious problem. One way to return to the Gesetzliche is by somehow getting registered as an unemployed again and stay unemployed for a whole year. Another way would be to find an employment and stay under 50,850€ per year with your income. But this only works as long as you are younger than 55 years. After that there’s no way back. 


Why I left my Private Health Insurance

I was privately insured when I started working. I was trained as an administrative worker, a so called Verwaltungsbeamter im mittleren nichttechnischen Dienst. As working for the state had some benefit -they e.g. pay half of my health related costs, so that the insurance would only have to cover the other half- I slipped into a private insurance. I didn’t think much about it at 18 and found it rather interesting to see what health treatments actually cost. Germans normally have no idea what sums are being moved around in the health system. But as I left that promising career -I wasn’t made for Sisyphus work and didn’t like to spend my life surrounded by smiling and happy faces all the time- I returned to my father’s insurance which despite his solid income was a Gesetzliche Krankenversicherung. Now that I’m self employed and could change to a private one again,  I am too scared off by friends stuck in one and by all the reading I do. There might be others that indeed benefit from a private health insurance, otherwise why would they still exist, but it’s just not for me.

And I also believe that a two class system is not the way to go when it comes to health care. After all we are all human. Should money be the main criterion to decide whether one should get treated better when it comes to our health?