Federal Health Minister Prof. Karl Lauterbach:
Madam President! My dear colleagues!
Please let me begin by expressing my heartfelt condolences to Rainer’s family. He was always an important contact for our house, an important adviser. We will miss him.
The legal regulation for the financial stabilization of statutory health insurance, which we are discussing today, is due to the fact that there was a large deficit in health insurance during the last legislative period. On this scale you can say: historical. It came about as a result of demographic change in our society and better technology, but also because there were no structural reforms here.
This is not criticism, but is due to the fact that other priorities were in the foreground: fighting the pandemic. So it’s an inherited deficit. But we will fix that together. We need to get rid of it in the spirit that we’re not blaming it, we’re going about it together.
In doing so, we have been guided by three basic principles.
I want to put the most important basic principle in the foreground – we will not shake that during the entire legislative period -: we do not want any cuts in benefits. At a time when people are threatened by war, inflation, rising energy prices, possibly recession, cuts in health care are unaffordable. This is suggested to me over and over again. I reject this. We have to stick together at a time like this. It is unacceptable for people in such a phase to experience cuts in the area of health and restrictions in the range of services. We won’t go along with that. We are taking this basic principle into account with this reform.
I also ask for the support of the whole house. We have to offer people this security: Even in times of danger and change, you can rely on healthcare.
Second. It is right that we first tackle efficiency reserves before we increase contribution rates. There are many efficiency reserves in this system. We address some of the important efficiency reserves here. I will give a few examples later. What cannot be gained through efficiency reserves must then be distributed fairly. The burdens that then remain must be borne through tax revenue, but also through moderate increases in contribution rates, also with the involvement of employers. I say that explicitly; because the additional contributions are paid equally. It cannot be that employees and taxpayers pay all the contributions and employers do not contribute. A fair distribution across all shoulders is right, and the strongest shoulders have to carry the most.
Why are there still efficiency reserves here? How can that even be? I’ll give an example: The health insurance funds have very different amounts of reserves due to the distortions of competition that existed in the past. There are health insurance companies that have high reserves and there are health insurance companies that have very low reserves. Of course, this distorts competition. Thus, these reserves must first be allocated to the supply.
If we don’t do that, then what could be seen now, when this was announced, will happen: the health insurance companies, which have a lot of reserves, will massively increase their own pension provisions for board members, for example. These are actually also health insurance companies – I really don’t want to get into a polemical debate on comparisons here – where the board members earn significantly more than the Federal Chancellor. This also needs to be thought about.
So, the age provisions are too high. Remunerations are paid here that are incomparable to what the normal GKV insured person earns. I think it is right to reduce these provisions, especially at a time when we would otherwise have to adjust the contribution rates or burden the insured.
I would like to give a few examples of where we have raised efficiency reserves, but this does not mean that the supply is worse. An example is: We are adjusting the care budget in the hospital. The care costs are now – that’s good – reimbursed directly via cost coverage. However, parallel to the care budget, there is still a residual constant in the flat rate per case. Thus, the care is billed twice there. We fixed that. That’s just fair and right. This does not make the supply any worse.
Another example: In the field of drug therapy, we have ensured that the very high prices that new drugs come onto the market with are no longer valid. That can only happen in this form in Germany anyway. We are the most innovation-friendly pharmaceutical market in all of Europe. The pharmaceutical companies want to change a lot, but they don’t want any other reimbursement system in Europe, only ours. We’ve reduced the period in which these high prices remain unchanged to six months. That’s just fair. It is unacceptable for a price that has been proven to be too high to remain in the inflated form for longer than six months. That’s just unfair. This is an efficiency reserve that is due to lobbying pressure in recent years. We have eliminated that. At a time like this, we have to stand up for the insured, for the consumers, for the taxpayers, for the contributors – with all due respect for the lobby groups that call on us every day. We dared to do that with this reform and will continue to do so. In the event of unauthorized attacks, we will withstand lobby pressure. We owe that to the insured, to the people in Germany. Otherwise the contribution rate will increase unnecessarily. That is unacceptable.
Not everything could be compensated for by raising efficiency reserves – I could give other examples – in the end there was still something left that we have to distribute fairly. We’re charging the taxpayer. The subsidy increases by 2 billion euros. We are working in the short term with a loan of 1 billion euros in order not to exceed the debt limit. And we are increasing the contribution rate by 0.3 percentage points. That’s not unfair either. In contrast to the use of tax funds, the employers pay half here, so the employers are taken on board. – Yes, even those with statutory health insurance. But there are only 0.15 contribution rate points more.
That’s all. To put it in a nutshell, the vast majority of this reform, namely 90 percent, will not be paid for by increasing the contribution rate on the employee side. 90 percent! We have expected 10 percent from employees and employers. I think that’s acceptable. It’s 10 percent for them, 90 percent is generated from other sources.
I’m coming to the end. One can state the following here: After the reform is before the reform. In the long term, we need a major structural reform of health insurance and the way we pay for it. I have now mobilized efficiency reserves, which will in no way lead to a deterioration in supply, but in the long term we will of course have to carry out a reform, and we are working on that. We must make the contributions for unemployment benefit II recipients fairer and increase them.
We need to make the federal subsidy dynamic. It cannot be that, although people are getting older, the federal subsidy is not made more dynamic. We are still working on this reform. I ask for your understanding that we will first increase the efficiency reserves, then we will start this reform. We will cross this bridge, we will achieve it.
In the short term – I would also like to say this – I will put forward proposals at this point with regard to the considerably increased energy costs due to inflation, which leads to additional burdens in hospitals and in care due to personal contributions. But we have to see them separately: raising efficiency reserves – today’s reform – a financial reform – tomorrow’s reform – and eliminating the burden of own contributions in care and in hospitals – the reform that will also be presented shortly. This is how we will do it together.
Please support these reforms. Spare us polemics. Let’s think about solutions together.
Thank you for the attention.