The head of the Association of Statutory Health Physicians (KBV), Andreas Gassen, has ignited a contentious debate within Germany’s healthcare system by proposing a radical overhaul of funding mechanisms, advocating for a return to patient-paid fees and significant tax increases on unhealthy goods. Gassen’s suggestions, revealed in an interview with the Rheinische Post, challenge the current system and highlight the increasingly precarious financial state of Germany’s statutory health insurance.
The core of Gassen’s proposal involves reintroducing a modified form of “practice fee” which was abolished in 2012. He envisions a “practice fee 2.0” whereby health insurers directly collect a fee from patients, suggesting a levy of ten euros per quarter. Gassen justified this by drawing a comparison to everyday expenses, calling it “the price of a kebab”. This proposal is likely to be met with public criticism, raising concerns about potential barriers to access for vulnerable populations. Critics argue that reintroducing patient fees, even in a modified form, disproportionately impacts lower-income individuals and those with chronic conditions requiring frequent medical attention.
To further bolster healthcare funding, Gassen is also strongly advocating for a suite of targeted tax increases. He specifically called for the implementation of a sugar tax, modeled after the systems in place in Scandinavian countries, alongside substantial increases in existing taxes on tobacco and alcohol. He posits that even a modest increase – two euros per pack of cigarettes – could generate approximately seven billion euros annually. Central to his plan is the stipulation that revenue generated from these taxes must be ring-fenced for healthcare expenditure, preventing it from being absorbed into the general federal budget.
Gassen’s assertive stance underscores a growing recognition of the systemic issues facing Germany’s healthcare system, which is grappling with an aging population, rising costs and a shortage of medical professionals. However, his suggestions are likely to spark intense political debate. While proponents may argue that the measures are fiscally responsible and incentivize healthier lifestyle choices, opponents will undoubtedly frame them as regressive taxation and an infringement on individual liberties. The political feasibility of such proposals remains questionable, especially given the sensitivity surrounding taxation and healthcare access in Germany. The debate centers on whether the burden of sustaining a robust healthcare system should lie primarily with the state, insurers, or individual patients.