The system of social security established in Germany by Bismarck proved unexpectedly durable, surviving for many decades; now, finally, it is facing financial collapse.
Instead of investigating the question: „why is this the case?“ recent governments have tried in vain to hold up this collapse by the use of such fiscal measures as the raising of the mandatory contributions to state health insurance, the reduction of public services, and the „capping“ of public spending.
The simple but crucial fact which has escaped the attention of our politicians here is that the factor which they have chosen to make the basis for all such calculations and interventions - namely, income from labour - no longer has the future before it that it had in Bismarck’s day.
Bismarck could, in his era, make, with impunity, income from work the basis of all social-political calculations, because such income enjoyed, at that time, a fixed and clear relation to social productivity - no work; no products.
That is to say, income from work then formed an exact mirror of what was produced in society. Which is to say that what Bismarck used, in the last analysis, to finance the German social security system was social productivity.
If we, today, take the step of shifting our basis of calculation explicitly away from „income from labour“ and onto „productivity“, then there is no reason why the system should not continue to function in the future as it has in the past.
In this case, however, the contributions made to said system would no longer be contributions measurable on an individual basis; this would mean that the payments made by the system to its beneficiaries would have likewise to be, rather than individually calculated, paid out at a single general „flat rate“.
A further advantage of a productivity-dependent financing of our social security systems would be that, in this way, also those goods and services which are produced in countries with low average wages and imported into Germany would come to make up part of the contribution to the social security system.
It is furthermore thereby ensured that also that added value which arises from capital sums, commissions, speculation, and income from property and real estate etc. will make its contribution to the financing of the social-security net.
Both in government circles and in society in general we see frequent serious confusion between the idea of someone’s being „unemployed“, or „out of work“, and the idea of his or her performing no „gainful labour“.
A person of so-called „independent means“, who lives in grand style exclusively from money inherited from his parents certainly doesn’t do any work, and is, in this sense, plainly „out of work“ in the most literal sense of the term; and yet such a person tends not to be referred to, either in the official language of government or in everyday parlance, as one of the „out of work“, that is, the „unemployed“.
Likewise, to take the very opposite case, a citizen whose work-capacity is employed in purely voluntary, unpaid service but who does indeed devote him- or herself body and soul to work for some local association or for his or her immediate social environment; such a citizen will tend, despite all this, to be referred to and looked on as „out of work“ - indeed, on all too frequent occasions even as a „social parasite“ - although the fact plainly is that the citizen in question is only „out of gainful work“, that is, engaged in no „gainful labour“.
All the more anomalous are the double standards just described in view of the fact that it is often the „unemployed“ in the sense of those not engaged in any „gainful labour“ who preserve many areas of shared social life - technical support agencies; volunteer fire departments and other emergency services; political parties and associations - from total collapse.
The useful social function fulfilled, on the other hand, by those persons of „independent means“ who don’t work, but whom no one thinks of referring to as „unemployed“, tends to be limited to providing usable material for the gossip columnists of the so-called „society“ sections of our newspapers......
Moreover, the factor „work“ itself is tending to forfeit, due to the ever-faster progress of automation, the key importance it once had. „Full employment“ in the sense traditionally attached to this term is an idea which we must now give up.
The instruments recently improvised in Germany in order to try to restore, even if only in appearance, the statistics re persons „in employment“ which we once knew - the coercion of those drawing job-seekers’ allowance into establishing themselves as „one-person businesses“ or „Ich AG’s“, or into accepting jobs at absurdly low wages - have proven to be flops.
Indeed, quite aside from the evident political and economic inexpediency of such measures, it is surely ethically and morally indefensible to coerce those drawing unemployment benefits into transforming themselves into „mini-enterprises“ for whose services no market really exists or into accepting „gainful labour“ where the „gain“ is so minimal as to support no reasonable daily existence.
Equally morally indefensible is the practice of obliging those applying for unemployment benefit or social security to use up, before they become eligible for receipt of these latter, all the financial resources they possess; it is impermissible - certainly at least in cases where the situation of neediness is not one which the prospective recipients have brought upon themselves - that recipients of unemployment benefit be turned, for this reason, into second-class citizens.
Health / Health Insurance
The main categories of cases in which health insurance is called upon to bear cost-burdens are:
Funding of Health Insurance
Where there is adopted, for the funding of health insurance (HI), a system partaking both of the principle of social solidarity and of the principle of specific causation of specific illnesses, the principle of purely „solidary“ funding of health-care costs would find application in cases of type 1 (personal/biological disposition), type 3 (accidents occurring without the involvement of artificial elements) and type 5 (provisions made against possible future illness); the principle of specific causation, on the other hand, would apply in respect of cases of type 2 (use of alcohol, tobacco etc.) and point 4 (accidents with involvement of artificial elements).
That part of the health insurance system which is to be funded on a purely „solidary“ basis will draw its funding from a portion of general tax revenue set aside for the purpose specifically of health insurance funding.
That part of it which is to be funded rather according to the principle of the specific causation of illnesses and injuries will draw its funding from a surcharge added, with a view specifically to the financing of this part of the health insurance system, to the VAT due on individual products.
Example: the costs accruing to the social health funds as a consequence of the smoking of cigarettes are to be calculated and distributed across the prices charged for each individual packet of same.
This tax-contribution to general health-care costs will be re-calculated and re-set, or re-distributed, at intervals which appear appropriate (e.g. every two years).
The most sensible procedure would be to integrate into this same system of funding that form of health insurance which is currently classified as „nursing care insurance“.
Nursing Care Insurance
The hitherto-applying separation of „nursing care insurance“ on the one hand and health insurance „proper“ on the other is not a rational separation and tends to lead to costs being pushed back and forth between the different parts of the health insurance system in a manner which makes no sense either for the insured persons or for the social health funds themselves.
What Health Insurance Should Provide
The principle guiding the actual provisions assured by health insurance must be the principle of what is, at any given time, actually medically possible.
There must be no question of lack of money bringing with it, for anyone, lack of proper medical treatment, where this is needed. This should also apply to needed dental treatment. Inasmuch as proper nourishment depends on the condition of the teeth, to make such treatment dependent on income is to make nourishment itself dependent thereon - an attitude expressive of a deep contempt for one’s fellow man and corresponding to a modern form of slavery !
Savings in the Health Sector
The whole system of the prescription, and the reckoning of the costs, of drugs and pharmaceuticals needs to be rethought from the bottom up.
The system must be made more efficient without this meaning that the medical treatment currently available be in any way compromised; indeed, any changes introduced must go rather to restore that level and quality of medical provision which has tended, in recent years, to be eroded.
Systems must be created under which no unnecessary prescriptions will any longer be issued, without this meaning the banning of necessary medical measures. Given the special position of trust enjoyed by doctors and chemists, any fraud perpetrated by these latter in respect of fees for the services and goods provided must be pursued with the utmost strictness and severity of the law.
To the boundless striving after profits which currently characterizes the pharmaceutical industry bounds and limits must after all be set, possibly by means of the establishment and development of large-scale state-owned pharmaceutical enterprises which will constitute salutary competition for these latter.
Where doctors provide bad or erroneous treatments or prognoses, the fees claimed therefor should be refused them by the health insurance funds concerned. It is high time that the hospitals too introduced an efficient, modern system of administration and documentation. The system of „purchasing management“ which we have elsewhere raised as a desideratum for public authorities should also be put into practice in hospitals.
Efforts should be made to promote and encourage measures likely to preserve good health or to accelerate post-illness recovery wherever these are likely to lead to a reduction in cases of sickness and in the money expended thereon. Care should also be taken to apply here a genuinely synoptic and holistic view of the matter, since a key underlying cause of illness is indeed a generally inadequate quality of life.
Health insurance authorities might also contribute to the lowering of their costs by evaluating each of the invoices for treatment costs submitted by doctors in terms of other invoices received for similarly-diagnosed complaints. Those doctors who prove thereby to be doing their work inefficiently should then be prompted by means of all appropriate measures available (training courses, reductions of said invoices unilaterally, by the health insurance funds themselves) to approximate more closely to the standard generally applying.
Current demographic developments no longer permit a system of state pensions based, according to the principle of the „contract between the generations“, on the sum total of individual wages or salaries.
The only solution seems to be the introduction of a basic „flat-rate pension“. It remains unclear, however, just how the transition to this basic pension is to be funded.
With the introduction, indeed, of a basic income belonging by right to every citizen qua citizen, the whole pension problem, and everything connected with it, ceases to exist, inasmuch as the „basic income“ here in question itself functions, as it were, as a „basic pension“.
The final, „phase-out“ phase of the old state pension inspired by the „contract between generations“ idea could, however, be funded by such methods as: a time-limited tax on legacies; a tax on luxury goods; or a system of setting off the „basic citizen’s income“ due against the pension being paid.
The introduction of a „basic citizen’s income“ would also make obsolete the whole complex of problems associated with current „welfare payments“ such as are made even to those ineligible for unemployment benefit. Only in certain exceptional cases - as, for example, sudden homelessness, or the need to provide temporary accommodation for people recently released from prison - would such payments continue to be necessary.