Medical care is required at all

Life without medical care

Peter Schuster still remembers that he was happy that a car hit him. Not that he wouldn't have preferred not to have had an accident - that's not the point. But when Mr Schuster came to the hospital with a broken tibia, three years ago, the hospital asked him to pay 5,000 euros in advance: no surgery without advance payment.

Because a broken shin is not considered an emergency. They're painful, yes, but they're not a threat to life or limb. And as long as that is the case, Mr. Schuster has no right to medical care. So that's why Mr. Schuster was happy: because he was hit.

The accident driver's insurance had to pay for the operation of Mr. Schuster. And so it could be operated on. Not immediately, but for free. And that's the bottom line. Because Mr. Schuster has no health insurance.

80,000 people live outside the system

Actually there is a social pact in Germany: Those who get sick get support from the community. Everyone pays in so that everyone is taken care of in an emergency. When the emergency occurs, others pay for the individual. Since 2009 there has been an obligation to participate in this pact.

And there are two ways of doing this: Either by paying into a statutory health insurance, whose contributions are based on income. Or by joining a private fund, whose contributions are based on age and personal risk factors. All citizens must choose one option or the other - without exception.

Nevertheless, there are people like the 72-year-old Mr. Schuster who live outside the system. According to the microcensus, there are around 80,000 such exceptions in Germany. They are all borderline cases. People who were part of the system and who cannot find their way back.

Even small treatments cost money, and major operations even more. A Berlin hospital, for example, charges 200 euros in advance for a diagnosis and an X-ray - an operation would cost another 4,000 euros. Source: Kentreloar / Unsplash

How these exceptions are possible can be explained using the example of Mr. Schuster: He begins his career as a tax officer and thereby becomes a member of a private health insurance company. The state pays up to 80 percent of the costs for civil servants.

However, Schuster retained his private insurance even when he went into business for himself in 1993. Not consciously, but because that is the easiest way for him at this point. Especially since its sales easily cover the cash contributions. Insurance costs explode when Schuster and his wife get triplets, but the income is still sufficient. They are even enough for the installments of your newly bought house, although the furnishings are lavish.

Schuster's finances only get out of hand when he and his wife get divorced. The 72-year-old doesn't like to talk about this time. He only says this much: It's a dirty divorce, an expensive divorce. A divorce that drives Schuster deep into debt. Since then, Mr. Schuster can no longer pay the costs of his health insurance. First she sends him reminders, then she cancels the contract. Schuster loses his insurance cover.

"It would be nicer to have health insurance"

Nevertheless, he leaves everything as it is. Why bother when there is no need? He can't pay anyway. Not his health insurance, not his loans. Cobbler, checked shirt, blue jeans, both of which are not new, but well-kept and in good condition, only begins to worry about his health insurance when his eyes regularly go black. And when he notices that his sense of balance has left him.

That is 2014, eight years after the end of his health insurance. In his need, Schuster turns to Munich, a contact point for people without adequate access to medical care. The diagnosis: high blood pressure, a kidney that is too small and an inefficient one. There is still no need for dialysis. However, it is already foreseeable that it will exist in the future. He already needs his blood pressure medication today.

“It would be nicer to have health insurance,” says Schuster, very dryly, almost cool, even if he would never use a word like “cool” himself. But re-entering health insurance is extremely complicated in his case. Because at the age of 55 the already narrow gate between private and statutory health insurers closes once and for all (see text).

Every private health insurance now has to offer a "basic tariff"

Any change is then almost impossible. At least there are ways to get back to your old health insurance at an affordable contribution rate - albeit with reduced benefits.

Every private health insurance company now has to offer a “basic tariff”, the scope of which is the same as that of statutory insurance. But the way to get there is rocky, more precisely: highly bureaucratic. Mr Schuster has been going this way for four and a half years now.