The Law of Governing Bodies, Administrative Corpses and Ailing Citizens
– Illustrations from Germany –
Bodrum Turkey, 22nd of May 2009 Forth Annual Meeting of the
Property and Freedom Society
I.
The older we get – and, of course, the more we study – we learn a lot about the world we live in. Step by step we understand more about our nature. And we discover its secrets, the ways things work. Within this process, one day, we often find that there are mighty powers behind all different appearances. And some of us even believe in the existence of an almighty creator who has foreseen all this and who has planned all incidents, all factors, all details working one for each other, forming the wonderful unit of this miraculous earth. And in addition to this, we realize as well the functions namely of our own bodies. We are amazed at seeing the perfection of its organ’s cooperation and interplay, the intelligence of a central nerve system for example – or the meritorious strength of a liver. At one point the most of us feel a great humbleness, no matter if they think all this was made by god or by accident.
In comparison with these impressions it really brings us down to take a look at the system of public health care in Germany, because its components and modes of operation perform in a definitely different way. We see a system that claims to be made perfectly and we see political and administrative people improving it from day to day. But in the end it is nothing but a very, very expensive bureaucratic chaos that is paid by innocent and unsuspecting citizens and that delivers far less medical service than could be if it was organized by the people themselves. Let’s take a closer look at the system’s details to see how destructive the deadly socialist ideas have influenced the structures this “public health”.
II.
Within the last four decades the legislator has written 12 books of social law in Germany. The first of these 12 “social law books” formulates the chief aim of them all, right in its section Nr. 1: The first and foremost task and mission of all book is to bring “social justice” to all citizens (which, by the way, was the same determination of value in the preamble of GDR’s constitution of October 7th, 1949).
The fifth of this impressive social dozen is the book that deals with the health and with the holding ready of medical care for the insured. Here we find the tragic mixture of economic aspects on the one hand and medical treatments on the other that constantly misguides its insured and its economic conditions over all into heavy indebtedness.
III.
According to this law each and every resident of the republic who signs a contract of employment instantly becomes a compulsory member of the public health insurance. His principal also takes part in this legal construction. He is not allowed to pay the whole wage directly to his employee. Instead of this he has to deduct 15.5% of the employee’s wage and he then has to transfer this sum immediately – at the end of each month – to the health insurance company that his employee has chosen to be responsible for his health.
At this point we should take a closer look at four characteristics of the system before we go an. These four interim remarks are those: (1) We should look at the term “health insurance company”. We should (2) make clear what it means to say that this company is “responsible” for the employee’s (respectively: insured’s) health. We ought to become (3) aware of that system not being a real, truthful insurance. And we have to face the fact (4) that even these roundabout 250 public health insurances at least from the beginning of the year 2009 are nothing else than remote-controlled financial units of a new giant administrative masterpiece called “Health Fund”.
- A health insurance company in Germany is not a “company” in the
sense of a free and private corporation. It is nothing else but a
government body. It has sovereign powers over its members and
consequently the right to issue administrative acts. In case a
principal decides not to transfer the monthly contribution of the
mentioned 15.5% he will suffer punishment according to criminal law,
even if his employee agreed to do so. The punishment laid down by law
for this crime, by the way, equals the punishment laid down for the
procuration of women under the use of arms. (Obviously, we do not
have to ask for the first time in history, why a system that is said
to be as glorious as this, needs to take people under its wings by
the thread of force). Regarding all that, we can conceive that this
system, so to say, is dead serious about really collecting in all the
contributions of its insured. - Saying that the system is “responsible” for the health of its
insured is not only a euphemistic wording. Again, this is – at
times in the bitter and double sense of its meaning – meant deadly
serious. In the first section of the fifth social law book we read
that an insured is “jointly responsible” for his health. This
means in an argumentum e contrario (so to say regarded from the other
side of the mirror) that the insured no longer is responsible for his
body himself. He is only one out of a group of responsible persons
and bodies who care for his own health, body and life. - This brings us to the third interim remark. This public health
insurance system is not a health system equal to seriously calculated
actuarial theory. The risk of getting sick is not being set into
relation to the amount of one’s insurance premium. Instead of this
the size of a contribution only depends upon the income bracket. This
again simulates poor people not facing major hazards to human health
whereas those insured with higher incomes are fictitious bad risks.
One does not have to be a specialist in the arts of actuarial theory
to understand that this construction gives a funny bunch of stimulus
and incentives to all compulsory members. And within this dimension
it is probably the hour of birth of the war on corruption that eats
up so much resources of the system. - As I said, the latest administrative masterpiece of German
health policy is a so called “Health Fund”. Imagine all public
health insurances collecting in all contributions from all insured –
via their principals – and them all again being bound by law to
pass on all that money to this one and only, gigantic general health
fund. This is not an administrative nightmare – it is law in force
in Germany since the 1st
of January 2009. And it is the executed reality in my country that
this general health fund subsequently pays out these collected sums –
according, of course, to certain quota allocations that guarantee
social justice coming into being – to each single public insurance
company again. (I suppose, a lot of specialized experts will have to
travel to an awful lot of meetings throughout the country again and
again, to find the right mathematical formula for the real
social-justice-cash-flow. And I am rather convinced they will also
have a lot of fun doing this…).
However, a system such as this speaks of “public health”, but it creates – and this is my thesis – nothing else but private sickness. It sets back the individual into the loneliness and isolation of his own body. It falls back into the undeniable fact that physical pain and grief are strictly personal occurrences. The intellectual misconception of a public that could be kept healthy by authoritarian political and administrative arrangements without asking for the will of each and every individual, leads inevitably astray. Why is that so? Because the public simply has no body! It’s as easy as this. You can’t shake hands with the public, you can’t look into the public’s eyes and the public cannot catch a cold. Only human beings can, because only human beings have their bodies. So, if you make a policy for the health of a subject (named “public”) that has not body, you can’t at the same time make a proper policy for those who really do have bodies.
All these public health ideas simply got on the wrong intellectual track. And it is not my subject today to deal with the question if those who personally profit from that lost their orientations either by mistake or willfully. But the German health system sets an example for the symptoms and functional disturbances of any public health system that is simply based on such sort of incorrect axioms. Let me proof this by describing the ways the German system searches and finds the adequate therapy for a sick and suffering individual.
IV.
Since you are not asked basically and in general whether you want to be insured within this system, it is no wonder that you are – as well – not asked what kind of therapy you want to receive, in case your own body does not work properly any longer. The system has its answers for you. The system cares for you. Remember: You are only “jointly responsible” for yourself. Consequently, you are not the only owner of your body. Your co-owners want to exercise their co-determination rights concerning your body to constitute the mentioned fiction of a “public body” that shall be cared for.
The priority legal technique to make sure that a patient is not to be asked about what kind of treatment he wishes is, of course, the construction of it all being put into public – and not into private or civil – law. None of the members of this system is invited to express his views or opinions on the proceedings. Everyone is simply forced to participate in it by law.
Now, if an insured is under medical treatment he has – consequently – no right and no chance to close any private contract with his medical doctor concerning the contents of the proceeding. The doctor on the one side is participating in a health insurance plan. He himself is compulsory member of a special chamber of doctors. This chamber of doctors again is constituted as an administrative body under public law with sovereign rights in relation to every single doctor. And the patient on the other side is – as mentioned – only part of the administrative body called “public health insurance”. Both, neither the patient nor the doctor are asked about what they personally and individually think to be the right way of medical treatment in each single case. Instead of any private agreement between these two parties simply the written law of our fifth social law book and the supplementary implementing regulations (that are invented by the administration to fill the many gaps) rule the courses of events inside every doctor’s room. The patient does not get what he wants. He gets what the experts and specialists of his public health insurance – and, of course, the mighty general health fund in the background – find to be “necessary”.
The necessity of a treatment is defined as (a) economically efficient, (b) adequate and (c) expedient. These are the three constituent facts that make a good and necessary treatment. Unfortunately, the standards of these constituent components which might lead to a treatment you wish are defined objectively or – to use another, maybe more precise word – they are particularized “disinterested”. That means that you personally, as a subject, might have been interested and willing to spend more money to get a certain treatment different to the average standards. A treatment so to say that is somewhat objectively inadequate. But – sorry! – the system can, of course, not take such extravagances into consideration. It has to keep in mind that all insured parties have to get their medical part of social justice as well. Even if you have paid thousands and thousands of Euros into the system over years this does not keep you away from having to pay your own special treatment once you need it.
All these theoretical thoughts and ideas are realized by a sheer unimaginable bureaucratic force. Between every single medical doctor and every single patient we find a kind of giant administrative vault, a modern dome of priceless public servants doing their indefatigable jobs – and being paid of course from the public purse of the system’s compulsory members.
Once a patient gets sick, it is –as mentioned – after all not the doctor who has to find and to describe the adequate therapy. It is the employee of the social insurance institution called “health insurance” who selects among the possible treatments. But since this employee never in his life has studied medicine he has to obtain specialist’s advice to do his job. To make sure he can find that advice our legislator has created another administrative body called the “Medical Service of Health Insurance Institutions”. Inside this highly specialized government subdivision you’ll find medical doctors who have the status of a public official. They decide about your therapy, unfortunately without ever having seen you personally. But: They read your medical bulletins very carefully. And they adjust your case with the standards that are given by another – even higher specialized – government body, called the “Advisory Committee of Common Interests” within the health system.
In those cases in which not even this Advisory Committee knows what is wrong and what is right, they can ask another administrative body called the “Institute of Quality and Good Efficiency inside the Health System”. This Institute recently founded another Foundation under Private Law (!) which helps to carry out all the work that has to be done. For example, the fifth social law book allows these institutions – as well as the Ministry of Health itself! – to entrust external specialists to give their expert opinions in writing.
If your medical standpoint is not the one of these bureaucrats, you still have the right to file your case to court. The guarantee of access to the courts can even bring you to the constitutional courts. And what they think about all that might be the subject of another lecture, in case we find a couple of hours to deal with that.
We all have to pay very dearly for that. But, as our politicians say: Isn’t health somewhat invaluable?
V.
In the end we find a through and through astonishing result of all these health politic and health administrative efforts: When the German health system was invented at the end of the 19th century, its founders aimed at a certain conception. They wanted to end the era of poor people being thrown upon acts of clemency, grace and mercy in case of illness. They wanted to enforce the poor with suable rights on the health sector.
What has come out now is a system of simply unclear fundamental-principle rights of people against their public health insurances that indeed give “necessary” medical protection. But the contents of these “rights” are indefinite, unascertained and – namely with regard to the medicine according to the position of liquid assets within the system – completely indeterminable. If you as a patient have not the means to pay for a treatment you really need and all these impressive administrative bodies within the public dome of social justice are not willing to officially approve your therapy you have no other chance than to simply beg for treatment! So this again throws people down to depend on acts of clemency just like it used to be in the 19th century. In other words: We have reached the same point again, from which we started 130 years ago!
In effect, the whole speaking of “social justice” inside a public health system has become (1) nothing else than a camouflage-term for medical unsteadiness and uncertainty; (2) a self-service system for those who enrich themselves by pretending to be able to perfectly define absolute adequate treatment-standards; and (3) a welcome method of political ruling in post-religious, modern times.
VI.
Right in the middle of our bodies there is an organ called “spleen”. I think God – or whoever is responsible for us being here – must have had a certain idea when he invented that tool for our lives. Because: If you get hurt and you lose this organ, you do not have to die (at least not for that reason). The other organs inside our body take upon the duties of that lost spleen. So in the end I can promise you this: We can learn from nature that a public health system is probably nothing else but a spleen. If we clear it away from the earth’s surface, the whole human society can live on without any damages, each and every single human being will be healthier than they are today – and: health will be far cheaper and in the consequence affordable for everyone.