The Impact of German Health Insurance Reforms on Redistribution and the Culture of Solidarity

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.