How much would universal health care cost taxpayers

Higher tax subsidies in the statutory health insurance are no solution


Representatives of the statutory health insurance fear massive premium increases due to the sharp rise in expenditure. The Federal Ministry of Health is therefore planning a record subsidy from the federal budget. The PKV Association warns of permanent billions in subsidies at the expense of taxpayers.

05.05.2021 - The statutory health insurance companies expect a deficit of around 19 billion euros for 2022. The demands of the cash representatives for higher tax subsidies sound correspondingly alarmed. In media reports, reference is often made to the additional costs caused by the Corona crisis, but according to the GKV, only around 20 percent of its current deficits are related to Corona. "We are currently seeing with concern the political tendency to push many additional billions of euros into the GKV as federal subsidies in the wake of the Corona crisis - and in the long term, not just during the pandemic," explains the director of the Association of Private Health Insurance (PKV ), Florian Reuther.

The latest initiative comes from the Federal Ministry of Health: According to a report by the FAZ, Health Minister Jens Spahn (CDU) plans to almost double the federal grant to a total of 27 billion euros - a historic high. The tax funds are intended to stabilize the additional contribution to statutory health insurance and limit the total social insurance contribution to a maximum of 40 percent.

Higher GKV federal subsidies not appropriate for the generations

"Higher federal subsidies would not solve the financial problems of the statutory health insurance, but only hide it," warns Reuther. “That means additional national debt and, as a result, higher taxes. And health care is becoming dependent on the finance minister. There was a threat of supply according to the cash situation - in competition with other important goals such as climate protection or digitization. In addition, the competition between private and statutory health insurance would be massively distorted. ”The sole focus on higher tax subsidies is also incomprehensible. “There are much more effective and system-compatible ways of relieving health insurance financially,” explains Reuther. "For example, around 2.4 billion euros per year would be free in the system if the state were to lower the VAT on pharmaceuticals to 7 percent."

Health care is dependent on the finance minister. There is a risk of supply according to the cash situation - in competition with other important goals such as climate protection or digitization.

Florian Reuther, Director of the PKV Association

Tax financing would be neither sustainable nor intergenerational. Because this would only shift the burden of current health expenditure and impose it on the following generations. The President of the Federal Social Court, Rainer Schllegel, also takes this point of view: "Because if we finance today's social benefits on credit and shift repayments and interest payments to the future, we will let future generations pay for our current consumption," the Handelsblatt quotes him .2021)

This mortgage is all the more serious because the number of people of working age will drop significantly over the next few years. At the same time, however, more and more members of the baby boom cohorts are retiring and then paying significantly less health insurance contributions, while their health costs rise sharply with age. Increasingly higher loads are thus distributed over fewer and fewer shoulders. Current figures from the OECD show that Germany already has one of the highest tax and contribution rates in an international comparison.

Because if we finance today's social benefits on credit and shift repayments and interest payments to the future, we will let future generations pay for our current consumption.

Rainer Schlegel, President of the Federal Social Court, Handelsblatt dated May 12, 2021

The development of the last few years has already shown the financial risks associated with tax subsidies for statutory health insurance. As a supposedly temporary support, the first federal subsidy of 1 billion euros to the GKV was decided in 2004 because their premium income had fallen during the economic crisis at the time. Five years later - then because of the financial market crisis - it was already 7.2 billion and a year later even 15.7 billion euros. Now it is - this time due to the Corona crisis - already over 20 billion euros. Per year. These experiences should be a warning to financial politicians and taxpayers: once the gates for tax subsidies to the statutory health insurance are open, they no longer close, but keep pushing open.

Demography: Pay-as-you-go financing is reaching its limit

The problem: In the face of demographic change, the pay-as-you-go financing of the statutory health insurance is increasingly reaching its limits. The first baby boomers will retire from 2025 - the ratio of contributors and beneficiaries will change at the expense of the younger generation in employment.

The Scientific Institute of the PKV (WIP) has calculated what consequences these demographic changes will have for the GKV. Due to demography alone - without any other cost increases - the federal subsidy would have to be increased to 30 billion euros per year by 2030 if the previous statutory health insurance contribution rate of 14.6 percent and the average additional contribution rate of 1.3 percent are not to increase further.

But this sum would not be enough by far, because there are also the steadily rising health costs. If the income and expenditures of the statutory health insurance increase in the future to the same extent as in the past 20 years, then around 83 billion euros from the federal budget will be needed in 2030 to keep the statutory health insurance contribution rates stable. So more than four times the record grants this year (FAZ from

"Tax grants only create a financing illusion"

The WIP writes as a conclusion: “The GKV is under increasing financial pressure. Permanently higher tax subsidies should not be the solution, because they would expand the already intransparent financing structure. Tax subsidies only create a financing illusion and make the statutory health insurance dependent on the budget situation of the federal government and thus on the finance minister. Spending structures are distorted and responsibilities blurred. "

The scientists add: “As tax financing rises, the fundamental advantage of a statutory health insurance system that is largely independent from a budgetary point of view is disappearing more and more. For GKV insured persons, the actual costs of their risk of illness are obscured by the lack of transparency. Statutory health insurance policyholders must be clear that the financial difficulties of the statutory health insurance system continue to exist and that sooner or later there will be renewed discussions about premium rate increases or even more unpopular reductions in benefits. "

  • FAZ: "Health insurance contributions could soon increase by 40 percent".

Against the background of demographic developments, further expansions of benefits in pay-as-you-go social security violate the principle of sustainability. Because regardless of whether they are financed by taxes or contributions, they are at the expense of future generations.

Tax financing also contradicts the dual health insurance system consisting of statutory and private health insurance. Because private health insurance does not receive any tax subsidies. On the contrary: According to calculations by the RWI business institute, those with private insurance make a disproportionate contribution to the tax subsidies to the statutory health insurance. Although they only make up 10 percent of the insured in Germany, as taxpayers they contribute more than 20 percent to the financing.


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