Something to learn from Germany?

The Germans have been capable of making big mistakes (don’t mention two World Wars) or border controls and they are losing WW3 against CO2. But they may have gone the right way in public health policy, as this paper suggests. The starting point is the Covid-19 response and that leads to the basic structure of the health system that was  not nationalised along the lines of the British NHS and Australia post Gough Whitlam.

Germany does not have an NHS-style one-size-fits-all approach, but an insurance-based system. Everyone has to have health care and the government bears the cost for poorer patients. Everyone else can choose – also depending on one’s income – on whether they want to sign up to a statutory health insurance or private insurance (which about a quarter of Germans have signed up to). But even in the statutory system, there is competition between different insurance plans and individuals can pick their preferred plan. The health sector’s revenue comes from the premiums paid by patients as well as their employer – not through state funding. It certainly has not hurt health insurances who have been “swimming in money”.

When it came to the Covid-19 response, the epidemiological figures look very good compared with other places and the lockdown has also less strict than in other European countries so people continue to be able to pretty much go wherever they want as long as they are alone or engaged in an essential activity (such as work).

The power of decentralization comes through in the testing regime.

With a mixture of government agencies, private enterprise, and research organisations working on expanding testing capabilities – indeed, the January test was made possible by a private biotech entrepreneur. The Robert Koch Institute is coordinating the effort, but it is not an omnipotent authority. It’s also worth noting that healthcare is the remit of Germany’s state governments, not the central administration in Berlin. [It is supposed to be the same in Australia but the expansion of the Commonwealth bureaucracy has subverted Federalism (again). See also Education.]

Importantly, when it comes to testing, Germany does not have a centralised diagnostic system, but a network of local authorities. As Christian Drosten explain, “Germany does not have a public health laboratory that would restrict other labs from doing the tests.”

That, however, is precisely what has happened in the UK, where testing was centred on the Public Health England laboratory – which has, according to a new report from the Adam Smith Institute, been “slow to approve additional tests, and has as-yet not approved private sector testing”. As the report’s author Matthew Lesh notes, “the UK’s COVID-19 testing has been dangerously slow, excessively bureaucratic and hostile to outsiders and innovation”.

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13 Responses to Something to learn from Germany?

  1. stackja

    NHS-Attlee-Bevan legacy

  2. notafan

    Too early to be confident about any country’s response.

  3. Gertrude Struber

    Centralized testing and approval of therapeutic products can avoid duplication of effort and enforce national standards. But it is not without problems. Bureaucratic overreach is the poison that comes with all centralized regulation. If Jim Selim were still alive, you could ask him about how that could happen in Australia’s therapeutic goods industry.
    Clearly the US CDC/FDA has been responsible for a disaster due to its under-responsive reaction to the emergence of COVID-19. The result has been a critical unavailability of approved testing equipment.
    Medical care and medical insurance are very expensive in Germany. It is probably too early to declare Germany a gold standard in therapeutic product management.

  4. Bruce of Newcastle

    Germany has a large mu slim population. Some news reports (not in the MSM) have been suggesting that cultural and religious aspects of the Turkish and MENA immigrant portions of the population haven’t been on the same wavelength as the rest of the country regarding coronavirus precautions.

    In countries like France the authorities have basically abandoned attempts to get the mu slim areas to do the right thing, as there have been riots and violence when that has been attempted. Yet the coronavirus does seem to be present in those communities.

    In Germany therefore I think there’s a large group of the population where virus measures are going to be ineffective. Furthermore there will be very little official reporting from that demographic because of progressive sensibilities. Which may represent a bit of an iceberg for overall health outcomes in Germany and other countries in Europe with similar demographics.

  5. Rafe Champion

    Thanks Gertrude, I doubt there is a gold standard, we just have to fight the unending war with stupidity, bureaucratic inertia and the vested interests of all kinds that generate inefficiencies and wasted resources. The thing is to minimise the opportunites for the vested interests and centralised national bureaucracies are bastions and breeding grounds for all of them.

  6. Jim Rose

    Rafe, I did some research a few years ago for a consultancy about health insurance and social insurance.

    Switzerland was the ideal because it combined a tax credit for low income people and a mandate to buy insurance in a competitive private market. That may sound familiar because that was what Obamacare was supposed to be.

  7. notafan

    BoN

    One gets the feeling that the French and Germans both will shrug their shoulders if certain neighbourhoods are decimated by the bug (which of course is not real in the first place).

  8. Chris M

    Germany’s numbers are grim – 6500 extra infections per day with not much sign of tapering yet. Sudden and massive rise in numbers; a 6% death rate based on 14 day window. We have nothing to learn from them this time.

    Remember only the big cities in the Eastern states of AU went bonkers with the lockdown stuff. You guys (WNS, VIC, QLD) need to get the cops and politicians on a collar and under control.

  9. BorisG

    I doubt there is a gold standard

    Maybe South Korea and Taiwan come close. Especially the former, as it had to battle an, early, sudden and substantial outbreak.

    If Australia turns the corner in two weeks, it will also be close to the gold standard. But with much bigger social and economic cost (but fewer deaths).

  10. Suburban Boy

    Germany has 3.2 times Australia’s population.

    Germany has reported 80,000 cases compared with Australia’s 5,445, or almost 15 times. Considering that Germany is around a week ahead of Australia in infection, Germany’s number of infections a week ago was 42,288, which is almost 8 times Australia’s current number.

    But numbers of cases are notoriously iffy, so let’s look at fatalities. Australia has had 28 and Germany has had 1,017 or 36 times as many. Again assuming a lag of one week, Germany’s Covid-19 deaths a week ago were 253, or 9 times Australia’s current tally.

    Allowing for the difference in population sizes, and allowing for a one-week lag in numbers, Germany has reported 2.4 times as many cases and 2.8 times the number of deaths.

    What exactly is it that we have to learn from Germany?

  11. John A

    Gertrude Struber #3392288, posted on April 4, 2020, at 12:46 pm

    Centralized testing and approval of therapeutic products can avoid duplication of effort and enforce national standards.

    Gertrude, all that this does is shift the location of the inefficiency from the apparent duplication to the bottleneck of a single effort, with the concomitant risk of a single point of failure.

    Duplication of effort in a free enterprise context is more conducive to finding workable solutions faster, because more people, with different ideas and approaches, are addressing the problem in parallel.

  12. Rafe Champion

    Jim can you say briefly what went wrong with Omabacare?

  13. Hay Stockard

    Well our overlords have,certainly learnt a lot from the old East Germany.

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