Hinrichs K
University of Bremen.
J Health Polit Policy Law. 1995 Fall;20(3):653-87; discussion 689-94. doi: 10.1215/03616878-20-3-653.
The statutory health care scheme represents the most ambitious branch of the German social insurance system because it entails interpersonal redistribution on a large scale. The stability of this centerpiece of the German welfare state thus depends on a "culture of solidarity" to maintain the legitimacy of these redistributions. In this article, the present debate on restructuring the welfare state in general is analyzed. However, the focus is on the ongoing struggle to further reform the health care system. Influential political actors proposals to depart from universal access to a comprehensive range of health care benefits based solely on medical need and from the earnings-related mode of financing stand in stark contrast to empirical results on insured persons' willingness to support the existing system. Findings from qualitative interviews show that a culture of solidarity still prevails among insured persons. It is argued that lasting political attempts to shift the balance between solidarity and self-reliance in favor of the latter could weaken this moral infrastructure of the welfare state and, as a consequence, the statutory health insurance system could lose its plausibility and attraction. Such a development would ease the reconstruction of the social security system by privatizing parts of currently public expenditures and reducing the scope of interpersonal redistribution.
法定医疗保健计划是德国社会保险体系中最具雄心的分支，因为它涉及大规模的人际再分配。德国福利国家这一核心部分的稳定性因此取决于一种“团结文化”，以维持这些再分配的合法性。在本文中，对当前关于福利国家总体结构调整的辩论进行了分析。然而，重点是正在进行的医疗保健系统进一步改革的斗争。有影响力的政治行为体提出的建议，即背离基于医疗需求的全面医疗保健福利的普遍覆盖以及与收入相关的融资模式，与被保险人支持现有体系意愿的实证结果形成鲜明对比。定性访谈的结果表明，团结文化在被保险人中仍然盛行。有人认为，持久的政治尝试将团结与自力更生之间的平衡转向有利于后者，可能会削弱福利国家的这种道德基础结构，结果，法定医疗保险体系可能会失去其合理性和吸引力。这样的发展将通过将目前公共支出的部分私有化并缩小人际再分配的范围，来缓解社会保障体系的重建。
