An interview with the doctor and author Bernd Hontschik about the mistakes of politics, the lessons from the corona pandemic and alternative models of general interest.
Mr. Hontschik, if you were Minister of Health, what would you do first?
First of all, the biggest problem: economists have taken command and medicine has been marginalized. Soon it will only be a means to an end. I disagree with the whole direction that the big ship healthcare is heading. If the direction is not right, the most beautiful reforms are of no use. The health care social system deteriorates into a health economy. Dividends are generated from the health insurance contributions of the solidarity community. That has to stop. Social systems cannot be optimized. You don't sell the fire department to investors and then watch how jobs are cut because it hasn't burned for a long time.
Bernd Hontschik on Corona: Health has never been a priority
There is the wildest speculation about Covid-19. Sometimes it sounds as if the virus was invented to frighten people or to control them better. How do you see the connection between the virus and the actions of politicians?
You can't invent a virus . There will always be new viruses. However, this was ignored and the only way to cope with an emergency and authoritarian rule was when it was too late. For some politicians, however, governing in an emergency does not seem so uncomfortable. Now they are allowed to do so and cut out breathtaking sayings such as that health is a 100 percent priority. That outrages me. Health has never been a priority, let alone 100 percent! It had no priority with the night flight ban, not with hospital infections, not with glyphosate, not with the speed limit, not with the energy turnaround - and certainly not with the appreciation and payment of the nursing staff.
What would an alternative corona policy look like that you would advance as a minister?
There is no alternative anymore. Until six months ago there would have been alternatives. A few hundred million breathing masks and protective clothing should have been stored. Companies, kindergartens, schools and universities should have been provided with pandemic plans and exercises, hospitals and homes included. Look ahead and take precautions, that's it. Instead, we made children and the elderly the biggest losers. But what should you think of a government where the family minister is not part of the so-called Corona cabinet?
Corona: Let appease and not mislead the population
As Minister of Health, what would you do if something like something broke out somewhere in the world in December in Wuhan?
I would send three of my best people there straight away. With their current information, I would make broad preparations for living with the virus, not against the virus : with distance rules, hygiene measures, breathing masks and without mass events. Above all, I would let the appeasement and appease soothe and not mislead the population again and again: At the end of January, Health Minister Jens Spahn spoke of a “mild infection” compared to the flu. At the beginning of February, he claimed that there were sufficient intensive care units with good equipment. On February 26, he publicly opposed the cancellation of major events. On March 14, Spahn countered "rumors" that the federal government was planning to restrict public life. It is inconceivable that a health minister appears this way!
Dr. med. Bernd Hontschik is a surgeon and publicist. Among other things, he is known to FR readers through his column “Dr. Hontschik's Diagnosis ”, which appears every 14 days on Saturdays.
© Ute Schendel
So you think that in March the politicians responsible gave economic priority over health. How can you prevent this in the future?
This is a permanent learning process for everyone involved, because we have never had anything like it. According to Corona : For me, that also means that economic considerations must never push medicine against the wall again. Whether Bergamo, Ischgl or Tirschenreuth, those responsible everywhere feared first of all for the economy, not for health. In order to then sell the shutdown as "no alternative", we were brought up to the daily apocalypse, fearful, meaningless numbers published with horror images from intensive care units and with the same setters in all talk shows.
Hontschik on the Corona crisis: "I fear that we will soon have to draw a bitter balance"
How could you have done it differently?
When considering how dangerous a virus is and how dangerous it can be to combat it, you should keep an eye on everything. Right from the start, educators, psychologists, social scientists, youth welfare offices, family doctors, nurses and others have to be brought into the crucial bodies. What I am thinking of here is what the opinion leaders currently call collateral damage. It's a trivialization! Man is not a collateral to a virus! Unfortunately, no one has given enough thought when the decisions were made. What really amazes me is the overwhelming approval that our state and federal leaders have received. I fear that we will soon have to draw a bitter balance.
It is said that the pandemic has shown how well the German healthcare system works. Isn't that true, at least in relation to Corona?
Getting sick is bad for your health. Westend Verlag, Frankfurt 2019, 160 pages, 16 euros.
Yes, the German healthcare system is still pretty good. Over the course of my professional life I have often felt that I was part of a large, functioning system, despite the fact that there was more and more sand in the gears due to savings and privatization. Corona has mastered our healthcare system so far. But nobody should boast about it - except for those who have done it. I am impressed with the efforts of our medical staff. It is scandalous that there were more than 20,000 infected nursing staff and doctors, hundreds of which required intensive care, at least 60 even died. There is still a shortage of protective equipment! It made me quite disgusted that in Bavaria, with the help of fresh emergency laws, doctors were "compulsorily obliged". Wasn't there just applause? You could donate Lufthansa applause every evening on the balconies, but instead invest the billions in subsidies in the care sector instead.
There will be no world after Corona - only one with the virus
Let's get to the "World after Corona": What would be the three most important major health care reform projects that you, as Minister of Health, would tackle?
First of all, I would like to contradict you: there will be no world after Corona . There will only be one world with Corona . The most important lesson to be learned from the past three months is that only a governmental organization has the resources and capabilities to deal with such a situation. And that would be my first and most important project: the provision of general interest belongs in the hands of the state. Charity would have absolute priority for me. Private clinic groups are to be expropriated and compensated by repurchase. In healthcare, all profits have to stay in the system instead of going public. Collective bargaining agreements would again apply everywhere, and medical and nursing staff could finally expect good working conditions.
You would have to deal with enormous resistance. Who else do you want to mess with?
My second project would be to introduce citizens' insurance. With private health insurance, the well-paid tenth of the population says goodbye to social solidarity. It can not go on like this. If you want, you can buy your privileges with supplementary insurance. I would pursue the concept of solidarity-based citizens' insurance. Nobody needs more than a hundred health insurance companies, one is enough. You can see that in the health fund, which already includes all of our health insurance contributions. From this fund, they are then divided according to an extremely complicated key and passed on to the various statutory health insurance companies - it couldn't be more bureaucratic. Health insurance companies shouldn't compete, what for? They are not supposed to make a profit, but to finance the costs of general health care, nothing else.
After the corona pandemic: Obscenely high profits from pharmaceutical manufacturers should be a thing of the past
And what would be the third project?
My third project ends the separation of inpatient from outpatient medical care. Anyone who is still propagating hospital closures has not understood anything. General practitioner medicine, general medicine must take center stage. Around this base are grouped nursing support points, specialists of all kinds and inpatient facilities. Resident and hospital doctors treat their patients together. Integrated care concepts have absolute priority. Hospitals are divided into categories, from the small 50-bed house of basic care to university facilities with all special departments. The financing is not based on flat rates per case, but is based on the order or the size of the hospital with flat-rate budgets. The fulfillment of the social mandate is paid, not a specific medical act.
Is there anything else that would be just as important to you?
Yes of course! My fourth project would be the reorganization of the pharmaceutical sector. Research is carried out at the universities. That is what they are there for and I would equip them generously. Research is part of public services. I would issue a positive list of medications that are essential for regular care. The prices were set by the state, making obscenely high profits for pharmaceutical manufacturers a thing of the past. And I would bring pharmaceutical production back to Europe as soon as possible.
Is that going to be different in Corona healthcare?
How do you assess the chances that your reform projects or at least parts of them will be realized in the period after Corona?
Dr. med. Bernd Hontschik is a surgeon and publicist. Among other things, he is known to FR readers through his column “Dr. Hontschik's Diagnosis ”, which appears every 14 days on Saturdays. FR
To be honest: low. Instead, I already feel that everything should continue as before. Take the VW boss: he uses the short-time work benefit as if he owned the cash desk of the employment agency. He pays dividends to shareholders because you have billions in reserves. In the same breath, he demands state purchase premiums for his climate-damaging cars: brazen, insolent, understood nothing! The state is only called when there is a crisis. Is that going to be different in Corona healthcare ? My little hope of improvement is based on the fact that now everyone really could see how a healthcare system works. I believe that all four projects on which I would build my health policy, namely nonprofit, citizens' insurance, integrated care concepts and circumcision in the pharmaceutical industry, have long since had a very large majority in the population.
So in the end a little optimism?
Yes of course. We all understand now more than ever that health cannot be a game ball for the stock exchange and lobbyists. It has become a new social consensus in the last three months that health care is a matter of general interest and that general interest is an original task of the state. Let's see how long this new consensus lasts - that will be the touchstone.
Interview: Stephan Hebel
The pandemic continues to keep people in suspense. All developments on the situation in Germany can be found in the Corona news ticker.
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* fr.de is part of the nationwide Ippen-Digital editors network.