Most political folks believe that the SPD Party vote on the coalition (results come on Monday) will pass, and the new government will fall into play real quick. The one key element of this government will be the new guy in charge of the health ministry. CDU member....Jens Spahn.
Spahn is on a short list of people who would replace Merkel (whenever it occurs). He's also on the lesser favored list of Chancellor Merkel (at least various insiders hint that).
Over the past week, Spahn has come public to state his key three agendas for the future of healthcare in Germany. The topics: rural care (there is a serious perception in Germany that if you live in rural areas....you get less than adequate care), lack of nurses, and the odd problem of doctors seeing private health insurance people ahead of the public insurance people.
So to explain these particular problems:
1. Three avenues exist in Germany for healthcare. If you make less than a certain amount (it used to be around 40,000 Euro a year), you had no choice...you participated in public insurance, period. For those making over the 40k situation, you could go with no insurance or a private policy. In general, the private policy folks had a better deal if you were under the age of thirty, and you could find a designed policy to cover certain key things....like very little under out-patient costs. The private policy folks also paid hefty amount once they got up past fifty years old...more so than the public insurance folks.
But there was one key element. Private insurance companies tend to pay real quick. That's not so true with the public policy. So doctors were very happy when a private policy guy showed up and wanted an appointment. The doctor and his staff knew that they'd get paid within four weeks.
Naturally, there is resentment by the public insurance crowd (amounting to three-quarters of the nation) and that there should be NO dividing line. Spahn intends to fix this. Personally, he may think that he can fix it....but the doctors aren't going to be that stupid. Whatever solution you see....it'll be a fake agenda item and convince people that the trend has been halted.....when its still going on.
2 The rural care. Well....every single major community in Germany has a major hospital and doctors/surgeons tend to prefer living in metropolitan areas. No shock there. The rural regions? They have hospitals, but to be honest....these are areas where you'd probably not find the top doctors or programs.
You as a German could pick up your bag and get your ticket for care at a major hospital unit....that's not a problem. But would you want to go and drive a hundred kilometers from your house for some surgery, when you have it within twenty?
Again, it's a perception thing.
3. Finally...the nursing shortage. This goes to three key elements. First, crappy respect across the whole sector. Doctors don't really respect nurses in the same manner that you mind find in the US. It's partly historical....partly the doctor mindset in Germany....and partly the education factor. This leads onto the second element....once you get your nurse certificate in Germany....you are set for the rest of your life. Even if there are major trends occurring every three years in the field....you will probably not ever attend newer certification seminars or classes. If you did get enthusiastic? Well....it won't lead to better pay, and most nurses don't want to pack up and move every five years. So you come to the last element....the group of folks wanting to get into the field. It's just not an overwhelming draw in Germany to be a nurse.
The solution? Foreign nurses. Yeah. From Czech, Hungary, Poland. The new immigrants from Iraq and Syria? There's talk of programs being built to bring a fair number of the immigrants into the field. Nurses from the Philippines? Well...yeah, there is a training program sponsored there, with language classes and a visa deal worked out. It's not a huge number but every year....several hundred make their way into Germany.
In this case, Spahn has a tough problem. German nurses are realizing their value elsewhere, and quietly leaving (going beyond the border). He can't change the doctor mindset. So the only real area is expansion of foreign nurses and maybe creating more certification or re-certification programs.
The coalition agreement spells out the plan that the SPD agreed upon. The issue will be....just how far beyond that point will Spahn venture. The other curious thing....in the next two to four years....if Spahn is successful, will this all lead onto him being the Merkel replacement?
Spahn is working against two key women who figure to be the eventual Chancellor. Julia Klockner. (set to become the Minister of Agriculture) and AKK (Annegret Kramp-Karrenbauer), the new CDU Party chief.
There's virtually zero chance that the next Chancellor will go beyond these three names. So they will be working day and night....trying to get public TV time, and convincing the public of good intentions or positive accomplishments.
In Spahn's case....he's got a loaded deck and a fair number of problems. But any repair to the system is better than no repair.