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”.