Bleeding the Germans

The health reform that went into force on 1.1.04 means that old people in nursing homes with 50 euros a month pocket money, now have to spend 10 euros per quarter ?admission? to doctors? surgeries. Ulla Schmidt?s ministry is in charge of commissions and circles of experts empowered to define or arbitrarily determine concepts and services in collections of paragraphs. Accordingly, taxi transports of multiple sclerosis sufferers will no longer be reimbursed by the insurers and in line with ominous new definitions diabetics will no longer be treated as chronically ill. (Source for these examples: "Die 12 Fehler der Gesundheitsreform", (The 12 mistakes of the health reform)  http://www.bild.t-online.de/BTO/index.html).
Those not ill have the privilege of paying up horrendous insurance premiums. Anyone lightly ill must pay medicines against their cold themselves. Anyone seriously ill is brushed off without getting what he/she needs ? least of all without getting brutally ripped off in addition.

For life-saving drugs the manufacturers, for various reasons ? e.g. because it doesn?t pay the drug company, or in the case of children ? don?t have to do big studies to prove their efficacy in line with official criteria (!). In any case, the official criteria require individual proof of efficacy for every related illness as well. However, the efficacy of these medicaments, e.g. anti-cancer substances, is known to specialists and the insurers used to cover them. Now they?re dropping that cover for cost reasons. Instead of bringing in regulations which, e.g., take into account that big studies don?t have to be done for all necessary cancer drugs, before the statutory insured gets the chance to have them prescribed, they?ll be dead. Ulla Schmitt has done nothing in the area for patients (link background information:  http://www.kvberlin.de/STFrameset165/index.html?/Homepage/publikation/archiv/pe2001/pe250701.html).
On the contrary, the ability to write these costs off against tax was up to now linked to the prescribability by the doctor, whereas now costs no longer reimbursed by the insurers can no longer be written off against tax.
It is obvious that one wants the sick to die ? the effects of the present reform partly make reality of the humanity-degrading suggestions of civil servants made before the reform, no longer to pay expensive treatments for older people like (life-saving) dialysis (link:  http://www.vdk.de/de5679).
The social aspect of the Red/Green health reform is not that the age but the social criteria in regard to quality and quantity of treatment are being toughened. Poorer people already have a shorter life expectancy. This is worsened by the health reform because there will now be more cases of patients being refused a life-saving treatment or a taxi to the doctor which the insurance, thanks to Ulla Schmidt?s new regulations, refuses to cover and which patients are no longer able to pay themselves because they are too poor.
What?s left is that doctors can still count on being able to cheat without much risk of being caught. And those few times that they are caught, say like with the home visits to dead people, the case as a rule is closed for payment of a fee ? even fine is too stringent a word. They can also still do a heap of unnecessary examinations to keep the machinery in their surgeries busy.
And the administrative apparatuses like Insurance Doctors Union and Health Insurance can still keep 20% of the premiums for the task of passing this money to the doctors and pharmacists. Oh yes, let me not forget the joke that according to Minister Ulla Schmidt we now have ?for the first time? a patients? representative to defend the interests of the insured and patients. Frau Helga Kühn-Mengel will fill this most likely well-paid post with an administrative apparatus (  http://www.die-gesundheitsreform.de/hintergruende/Patientenbeauftragte/).
But according to the Social Law Book it?s actually worker representatives elected in social elections to the boards and assemblies of the statutory health insurances who are supposed to represent the patients? interests (links:  http://www.patientenkammer.de/sozialwahl.htm;  http://www.aok-bv.de/lexikon/s/index_00289.html).
Mind you, many functionaries in the orbits of the Social Democratic Party and the trade unions nesting on these well paid honorary posts in the health insurances may have done too little for patients in the past. They don?t have much power to do anything, anyway, because most things have been fixed in the Social Code.
But when SPD minister Ulla Schmidt boasts that with her patients? representative the interests of patients would be represented for the first time, it?s an admission that the legally required self-administration of the patients with the ?insured?s representatives? doesn?t work; or the other possibility is that SPD Minister Frau Schmidt knows nothing about the ABC of social insurance. In the first case one doesn?t solve the problem by leaving the expensive self-administration in place and stacking yet another new institution on top of it.
And, it?s Ulla Schmidt?s will that the health insurances wreck their finances and like the federal government heap up mountains of debt just so she can say: Look, thanks to my policies the health insurance premiums are sinking! (  http://www.faz.net/s/Rub28FC768942F34C5B8297CC6E16FFC8B4/Doc~EF2B89F12701446CC9034F4B03D0637BA~ATpl~Ecommon~Scontent.html).
The command to avoid debts if possible in the interest of solid finances in the health insurances is not only stipulated by a paragraph in the Social Law Book, which Frau Schmidt obviously doesn?t know, just as she doesn?t know the functions of the self-administration. There are good reasons for the administrative chiefs of the health insurances refusing to go along with this demand in the interests of the insured because they would have to finance expensive bank loans with their premiums without getting anything in return. There are also indications that Ulla Schmidt is redistributing finances against the insured and in favour of the cartel of pharmacists, doctors and pharmaceutical industry, who can all be quietly savour their profits from the reform.
The Greens for their part are suggesting a citizens? insurance. That?s as if one put more feed into the shark pen. The problem is not enough feed, the problem are the sharks including their SPD minister. The German healthcare system is one of the most expensive in the world, but it delivers only average service.
Anyone ill now has to do battle with the bureaucracy of the insurers, who point to the legal provisions. Bodies of grey-haired professors in divers expert groups have the honour to decide whether osteoporosis risk patients can continue to be supplied with vitamin D/calcium on insured prescription. That?s been up in the air since 1.1.2004 ? maybe a few patients will die of fractures until that?s decided.
There are some more lollies in addition to extra patient payments. The prices for all prescription medicines were raised by a fat, guaranteed surcharge of ?8.10 plus 16% value-added tax. A medicament with a buy-in price of ?0.00 would thus cost at least ?9.40 (link:  http://www.daserste.de/plusminus/beitrag.asp?iid=138)
This fat surcharge for taking a medicament out of a drawer and handing it across the counter will be felt by every insured person in future increases in insurance premiums. In a TV image campaign the federation of German pharmacists invokes the ?consultation? through its magazine called "Apothekenrundschau", which is roughly of the standard of a doctor-love-affair novel. My experience has been that questions about detailed specialised information asked in the pharmacy, e.g. about the cheapest medicines in relation to active agent (not the number of tablets or the cheapest package), are rarely answered correctly. It is insanity to gift this fat margin to the pharmacists for the usual activity we?re all familiar with of handing over medicaments, which hardly differs from the simple sales work in a drug store. Here Ulla Schmidt has clearly put the business interests of a well-heeled clientele above the interests of the ill, especially poor and seriously and chronically ill people, who are hit yet again.
With Frau Ulla Schmidt we are apparently experiencing the rebirth of a French queen who was told: ?The people are starving because they have no bread? and who replied, ?Well, if they have no bread, let them eat cake.? In the case of SPD minister Ulla Schmidt the last sentence about the cake goes like this: ?In the future, too, regardless of age and income, all will benefit from medical progress. We guarantee that everyone will have the same access to medical services.? (Speech by Ulla Schmidt at the SPD party congress on 19 November 2003.)

Translated by Diet Simon