Germany created the first national health insurance scheme, and its turbulent history has carried many lessons for all other countries. Health care financing—like all social security financing—redistributes wealth and inevitably is caught up in class politics. Cost-sharing by patients is not a neutral device in social engineering to improve efficiency, but it is a gambit in distributive politics. Health care involves the wealth and power of the doctors, and they become militant and successful forces in social politics. The forces for higher spending are stronger than the forces for restraint. Only exceptional political will by government can control costs.

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