Federal Health Minister Karl Lauterbach (SPD) was visibly trying to achieve harmony in the Bundestag on Friday.

He asked several times to discuss his draft law to stabilize health insurance finances without polemics.

The "historical deficit" of 17 billion euros in statutory health insurance that is expected for 2023, which the amendment aims to compensate for, is due to demographic change, medical progress and the lack of structural reforms in the past legislature.

Christian Geinitz

Business correspondent in Berlin

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He showed understanding for this omission insofar as the fight against the pandemic had recently been in the foreground.

It is about an "inherited deficit", but it is not about criticism and blame.

That sounded much more forgiving than at the end of June when the bill was first presented, when Lauterbach had attacked his predecessor Jens Spahn (CDU) for his “expensive performance reforms” and blamed him for the disastrous cash situation.

Now Lauterbach asked all actors and all factions for support in order to “remedy the grievances together”.

But that should be difficult, as the debate on Friday showed.

Lauterbach promised that there would be no cuts in benefits to compensate for the underfunding and that health insurance members would be spared.

Although the additional contribution will increase by 0.3 percentage points in 2023 - to an average of 1.6 percent - the employees will only be responsible for half of this.

90 percent of the deficit compensation does not come from them, but rests on many shoulders: the taxpayer, the funds, the service providers or the industry.

Opposition recognizes cuts in benefits

Lauterbach's political opponents didn't want to leave it that way.

Bavaria's Health Minister Klaus Holetschek (CSU) and the health policy spokesman for the Union faction, Tino Sorge, said that the draft does contain benefit cuts.

For example in the treatment of new patients, who now have to wait longer for appointments, in the treatment of periodontitis or through cuts in the care budget.

MP Georg Kippels (CDU) added that such extensive restrictions are planned in the treatment of rare diseases with so-called orphan drugs that the innovative ability of the pharmaceutical industry is suffering.

This is a "power reduction through the back door".

Ates Gürpina from the left faction accused Lauterbach of engaging in polemics by calling his draft “Financial Stabilization Law” without stabilizing the finances.

The deficit is much too low, research institutes have calculated almost 25 billion euros.

The statement that the contributor only pays 10 percent is also wrong.

The central association of health insurance companies rightly states that the burden is 11 out of 17 billion, i.e. 65 percent, since a large part of the counter-financing comes from the cash reserves that the contributors have raised.

Speakers from the traffic light coalition, such as the health policy spokeswoman for the SPD, Heike Baehrens, accused the Union of having played a major part in causing the financial dilemma through its failed policies over the past 16 years.

Maria Klein-Schmeink (Greens) spoke of an "oath of disclosure".

The previous budget made "zero provisions" for the deficit - an argument that could of course be directed against the then Finance Minister and current Chancellor Olaf Scholz (SPD).

The FDP defends the Chancellor against criticism from the Union

Andrew Ullmann (FDP) attested to a very good job for his time in the black-red coalition.

If he had managed as badly as the Union Minister of Health at the time, the federal budget would look like the GKV finances: "We would be faced with a shambles." Ullmann admitted: "This law does not please me either." Higher contributions are due , and you have to tell the service providers "that we have to make savings despite their high-quality medical services".

Here, a different tongue sounded than at Lauterbach, who does not see any benefit cuts in the law.

The FDP man also made it clear that his parliamentary group had prevented worse interventions in the industry by not coming with the initially planned "solidarity tax" for research-based drug manufacturers.

Ullmann said that the GKV had a "spending problem because the false incentives make for an expensive but inefficient system".

Structural reforms would therefore have to be initiated in 2023.

The pay-as-you-go financing is in a worse position than private insurance (private health insurance) because it creates reserves.

At this point, differences to the SPD and the Greens became visible, who are skeptical about private health insurance and who want to raise both the contribution assessment limit and the compulsory insurance limit in anticipation of a citizen insurance.

The left openly offered red-green on Friday to form a majority for citizens' insurance against the FDP as the "promotional association of private insurance companies".

Janosch Dahmen (Greens) replied that the parts of the coalition agreement that had previously been left out, such as the dynamization of the federal subsidy and higher tax expenditure for the cash contributions of unemployment benefit II recipients, would be “discussed and decided together” during the legislative period.

This also applies to the increase in the contribution assessment ceiling.