Health and welfare

Insurance and services

By the end of the 20th century some nine-tenths of the population was covered by statutory (public) health insurance, and the country ranked among the world’s highest in terms of the proportion of health care costs covered by the government—about 90 percent of all incurred costs. Reforms in the early 21st century made health insurance compulsory for all people living in Germany. Although the vast majority of Germans remain covered by the government-sponsored health system, employees above a certain salary level or self-employed persons may decline public insurance and purchase full private insurance that is as comprehensive as the government-sponsored plans. Once an individual opts for private insurance, however, it is difficult to return to the public program. Those participating in a government health scheme also may purchase supplemental private insurance. Contributions to government health insurance, which amount to more than one-tenth of wages or salaries, are shared by employees and employers.

Medical care in Germany is excellent, and even rural areas are well served. Hospitals are usually operated by municipalities or religious organizations or as proprietary institutions owned by one or more physicians. The conquering of tuberculosis, once endemic in Germany but now rarely encountered, was a triumph of the health system. The extensive health care system that operated in East Germany—where universal free health care, medication, child care, nursing, and pensions were funded by an obligatory state insurance system—was reorganized from the exclusive management of the system by the trade unions to alignment with the various employment, health, and retirement insurance systems of western Germany.

Introduced by Otto von Bismarck in the 1880s, Germany’s old-age pension program provided retirement benefits that were funded by a combination of worker, employer, and government contributions. The program became unsustainable as it was structured, however, when longer life expectancies and lower birth rates reduced the worker-to-pensioner ratio in the late 20th century. A series of reforms were undertaken in the early 21st century to reduce the government’s share of the pension load, while preserving existing benefits through additional worker contributions. Tax incentives were provided for workers who chose to invest in private or occupation-based pension plans, and the retirement age was increased to 67.

Additional benefits

Germany also provides several special systems of coverage for groups such as war widows, orphans, and farmers. Unemployment insurance is funded through deductions from wages and salaries. Allowances are made for families with one or more children. Additional public allowances are granted to persons suffering disabilities from wartime injury, whether as military personnel or as civilians. Some small indemnification has been made to property owners whose holdings lay in former German territories now outside the country.

War reparations

Under agreements concluded with 12 European countries, Germany has paid compensation to the nationals of those countries who were victims of Nazi oppression or to their families and successors. In particular, the government has assumed the immense financial responsibility of making restitution to the Jewish victims of Hitler’s Germany. Claims for property confiscated during the Third Reich have been honoured, and Jewish refugees and expellees from that era, the vast majority of whom reside abroad, have been paid indemnifications and pensions. Massive reparations have been paid to Israel in the name of the Jewish people at large. East Germany ignored all such claims until 1990, when the transition government of Lothar de Mazière undertook similar restitution. In 2000 the German government, more than 3,000 German companies, the Evangelical Church in Germany, and a number of other institutions and governments established a multibillion dollar fund to compensate those forced to perform labour during Nazi internment. These roughly one million rapidly aging people, living primarily in central and eastern Europe, were among the last large groups of victims of the Nazi era who had received no previous payments or support from Germany. The fund was intended both to provide some restitution to the forced labourers and to shield German companies from potential individual lawsuits.

Standards of living

Western Germany’s standard of living is among the highest in the world. The distribution of wealth compares favourably with that of other advanced countries. Powerful incentives to save are offered by the state not only in the form of housing subsidies and tax concessions but also through bonus saving schemes. For those whose income does not exceed a certain level, savings of up to a fixed amount kept in a bank or savings institution for seven years are granted a generous bonus by the government. The accumulation of capital assets is encouraged under a plan whereby workers below a certain earning level who agree to pay into a longer-term savings agreement, such as a home-savings contract, are given a “worker savings grant” by the state.

Earning power for both workers and employers assures an adequate income to meet the cost of living. There is no exaggerated difference between the compensation for blue-collar workers and white-collar employees, although upper levels of management earn generous incomes and benefits. Because a major portion of tax revenue is derived from excise levies and the value-added tax—as in most EU countries—low- and medium-income workers collectively bear a greater relative tax burden.

The absorption of the eastern German population and economy had no more than a marginal effect on living standards in the regions of the western sector despite a rise in unemployment, a housing shortage, and tax increases. Even the exorbitant costs of unification, which brought about a tax increase, seemed to cause few changes in western Germany. The deutsche mark held its strength and grew even stronger. By contrast, the introduction of the mark in East Germany in July 1990—far from being the “magic bullet” hoped for—tended to have a depressing effect. The eastern population with its much lower earning power suddenly had to pay Western prices for food and other commodities. The wholesale shutdown of former state factories and enterprises caused vast unemployment in industrial cities in Thuringia, Saxony-Anhalt, and Saxony and resulted in much hardship and discontent that persisted long after unification.

During its 40 years, the East German government produced a society in which employment was guaranteed and in which most of the requirements of life were often provided free or at low cost. The demands of work were different than in West Germany and were relatively lax; competitiveness, initiative, and individuality were not qualities highly prized or rewarded. The working population was even more ill-suited than workers in Poland, Czechoslovakia, or Hungary for the plunge into a free market economy—largely because eastern German workers needed to learn new technologies, were under new management, had to accommodate the rules and culture of West German labour unions, and were forced to compete with their western German counterparts. But, unlike other former Soviet bloc countries, East Germany had a prosperous neighbour that bailed it out. As a result, in the two decades that followed reunification, the standard of living in the east rose dramatically. Household incomes almost doubled over this period, although unemployment remained significantly higher in the east than in the west, and a wave of migration resulted in a brain drain, as tens of thousands of people left the east for destinations in the west and abroad.