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For Federal Health Minister Jens Spahn, care is “the social question of the 1920s”.
And the CDU politician is pushing ahead with his plans for a nursing care reform - despite the numerous problems in the fight against the corona pandemic.
Spahn submitted a working draft in March.
It provides for financial improvements for people in need of care, their relatives and for those employed in the facilities.
The most important point is a reduction in the co-payment for home residents.
In order to be able to cope with the additional costs without a significant increase in contributions, Spahn is demanding a permanent subsidy from the state budget for statutory long-term care insurance.
This should initially amount to 5.1 billion euros per year.
Because without increasing tax subsidies, the costs of the planned reform would mean that the 40 percent mark for social security contributions drawn by the grand coalition as an upper limit will be broken as early as 2022.
Calculations by the Scientific Institute for Private Health Insurance (WIP), which are available exclusively to WELT, show, however, that Spahn's nursing reform plans threaten to become much more expensive for taxpayers in the medium term than the minister had calculated.
According to this, the federal grant would have to amount to 5.8 billion euros in the starting year and then increase to 14.2 billion euros per year by 2030.
Overall, this would result in additional costs of around 90 billion euros for the taxpayer over eight years, as the WIP finds in its analysis.
Source: WORLD infographic
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For its calculations, the institute used an annual increase in personnel costs of three percent, which drives “care-specific inflation”.
Personnel costs make up around two thirds of care costs, material costs one third.
In fact, in line with the trend in recent years, the increase in personnel costs could be even greater.
The pressure to improve wages and working conditions for nursing staff remains high.
The fact that Spahn had already implemented cost-driving improvements with his “Nursing Staff Strengthening Act” of 2018 is mostly overlooked in the debate about the nursing emergency.
It is mainly due to the dynamics of personnel expenses that the personal contribution that those in need of care have to pay for inpatient care also increases accordingly.
In the past year, the average co-payment for pure care was 786 euros per month.
Together with accommodation and meals, this results in a total of 2015 euros.
Source: WORLD infographic
With the care reform, the minister wants to at least soften the connection between the dynamics of personnel costs and the increasing personal contributions.
A step model is planned.
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After a year in the home, the long-term care insurance should in future take over a quarter of the co-payment, after two years half and after three years then 75 percent.
This results in a monthly relief of an average of around 600 euros per month for long-term home residents.
The advancing aging of society is another cost driver in long-term care insurance.
And the relief promised by Spahn for those in need of care will have an even greater impact the more unfavorable the ratio of contributors to recipients will become in the next few years when demographic change accelerates.
Source: WORLD infographic
The financial gap calculated by WIP for the years 2022 to 2030 of around 90 billion euros as a result of Spahn's care plans is based on the assumption that personnel costs will continue to rise and also includes a “demographic effect”, which was 700 million euros in the first year alone to book.
In addition, it is assumed that the upper limit drawn by the grand coalition for social security contributions of 40 percent will also be maintained in the coming years.
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The gap to be closed by the taxpayer would double again to 180 billion euros if one assumes that in the 1920s, revenues climb three percent more slowly than expenditure - as has been the case in the past 20 years.
And yet the contribution rate would remain stable.
Then the federal grant in 2030 would be almost 35 billion euros.
"Increasing tax financing sooner or later results in an increase in the tax burden," warn Lewe Bahnsen and Frank Wild from the Scientific Institute of Private Health Insurance, the authors of the study "Financial Effects of Plans for a Nursing Reform 2021".
However, such an additional burden makes no sense either now or later, since the burden on the younger generation would be further increased if the debt level is already high.
Spahn's improvements are popular
Jens Spahn, however, seems determined to implement his expensive plans - and thus to continue the course of his predecessor Hermann Gröhe (CDU).
With a three-stage nursing reform, he ensured that nursing expenses soared by a good 50 percent between 2013 and 2017.
Gröhe not only increased the benefits for all those in need of care and made them more dynamic, but also expanded the group of benefit recipients because he introduced a new level of care for people with dementia.
Despite the contribution rate increase that was also decided at the time, the long-term care fund slipped into the red.
The long-term financial problems of the statutory long-term care insurance remained unresolved.
Spahn also wants to score again, especially with popular performance improvements.
Corona offers a welcome opportunity to rely on tax subsidies for financing on a permanent basis.
Because already last year, when the economic downturn caused financial problems in all social security funds, the grand coalition reacted with a "rescue package for care": In 2020, the statutory long-term care insurance got the pension insurance for the first time, as has always been the case, and for two decades also the statutory health insurance tax-financed federal grant.
For this year, the health insurances even consider a federal grant of 4.5 billion euros to be necessary.
They are also pushing for permanent tax revenue.
And the Minister of Health also senses the opportunity to turn the originally unique Corona aid into a steadily gushing source of finance.
Should it come to that, however, the private long-term care insurance does not want to accept without complaint that only those who are legally insured with public money are depressed.
The study states: "If the tax subsidy is justified by reducing the excessive financial demands of those in need of care through the co-payments, private long-term care insurance would also have to receive a tax subsidy in the interests of equal treatment."