The German Confederation of Trade Unions (DGB) has vehemently rejected proposed reforms to the healthcare system put forward by the Confederation of German Employers’ Associations (BDA), escalating a contentious debate over the future of social security contributions and patient access. The BDA’s proposals, detailed in a yet-to-be-public position paper first reported by the “Frankfurter Allgemeine Zeitung”, aim to generate billions of euros in savings within the statutory health insurance system, ostensibly to alleviate financial pressures and potentially lower contribution rates.
The employers’ association’s suggested measures are far-reaching and politically sensitive, encompassing the reintroduction of a €10 patient co-payment (“Praxisgebühr”), a 50% increase in medical self-participation and the elimination of contribution-free coverage for spouses with low or no income. These changes, the BDA claims, could yield savings of up to €50 billion annually, potentially reducing contribution rates by as much as two percentage points.
However, the DGB has condemned the proposals as a thinly veiled attempt to shift the financial burden onto patients and undermine the principles of universal healthcare. Anja Piel, a DGB executive board member, dismissed the reintroduction of the co-payment as a “dead horse” that had repeatedly failed to deliver benefits despite previous employer pushes, arguing it simply creates unnecessary administrative burdens for medical practices nationwide without generating meaningful tax revenue.
The union is advocating for a dynamic tax subsidy, arguing that societal obligations should not be shouldered solely by healthcare contribution payers. Significantly, the DGB is also demanding that the federal government repay outstanding debts owed to health insurance funds, stemming from prior interventions that raided those reserves to relieve budgetary pressures at the national level. Critics have long accused the government of prioritizing short-term political expediency over the long-term stability of the healthcare system.
Beyond immediate cost-cutting measures, the DGB proposes a well-structured and adequately financed hospital reform, focusing on supporting strong healthcare providers while simultaneously eliminating redundancies. This, Piel argues, would lead to long-term savings and ensure comprehensive emergency services and accessible specialist care for all citizens, reducing unnecessary travel and wait times, ultimately benefiting public health. The confrontation highlights a deepening ideological rift regarding the role of the state in funding social welfare and poses a significant challenge for the current government as it navigates competing pressures from employers, unions and the electorate.