The bad reputation of social security is not fair.

After all, more and more pensioners are living longer and longer, the sick also have better chances of recovery, and outpatient and inpatient care can also improve the quality of life of the very old and the weak.

But it is also clear: In an aging society, none of this can be financed through the pay-as-you-go system.

Statutory health insurance (GKV) provides a clear example of this.

At the beginning of the century, when there were four times as many health insurance companies as there are today, the system fell into its deepest financial hole to date.

After that, the balance of income and expenditure turned into a record surplus within years.

Christian Geinitz

Business correspondent in Berlin

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    Back then, benefits were cut and the federal grant was introduced.

    This stabilized the situation until the system slipped back into the red after the financial crisis.

    This was followed by an economic upturn in which the statutory health insurance scheme achieved huge surpluses.

    It was not until 2019 that it plunged back into a deficit, and since then the financial situation has been getting worse: In 2020, the coffers were just under 2.7 billion euros.

    That was the worst reading since the 2003 monster deficit.

    Corona is not to blame for the deficit

    This is not due to Corona.

    It is true that the income from the health fund, from which the health insurers receive their money, grows less rapidly during the crisis.

    Corona expenditure also depresses the balance sheet because the fund does not receive all pandemic costs from the federal government.

    Accordingly, a surplus turned into a deficit in 2020.

    If you look at the health insurance companies in isolation, the corona costs are limited.

    In 2020, your spending on health care services rose no more steeply than in normal years.

    That was because many expensive services were postponed or canceled.

    In the first quarter of 2021, the replacement and guild health insurance funds even made surpluses.

    The underfunding of all types of insurance together amounted to 160 million euros.

    A year earlier it was 1.3 billion.

    Increasing federal subsidies are not enough

    The comparatively mild corona shock does not change the fact that the system is running out of money. The federal government is reacting to this as usual: it reaches deep into its pockets, or better: into the pockets of taxpayers, in order to fill the financial gap. Even in fat years, the GKV system is not self-sufficient, i.e. from the premium income. A federal grant has been needed for 17 years, starting with one billion euros. Since 2017, it has amounted to 14.5 billion euros per year. Even this warm rain was not enough in 2020, so the grant was increased by a further 3.5 billion.

    In the current year, the finance minister's transfers will increase by 5 billion to 19.5 billion euros.

    That is still not enough, because the total funding gap is around 16 billion euros.

    That is why the funds have to pay a property levy from their financial reserves, and the additional contribution has also been increased.

    Corona, the health insurers estimate, is only responsible for 4 of the missing 16 billion euros.

    The federal grant will increase further in 2022: by at least 7 billion euros, but probably even more.

    Because in the sense of the "social guarantee", the government has promised that the additional contribution may not increase any further.