Health politician on reforms: “We cannot afford an erosion of the welfare state”

taz: Mr. Yüksel, in your opinion, what are the central questions of justice that the black-red reforms of the health system must now answer?

Serdar Yüksel: It is very important that collective agreements in the care sector remain strong and that this collective protection continues to be financed. We have had 40 percent wage increases there in the last ten years and that was sorely needed. The second thing is the waiting times: they are too long for those with statutory health insurance who need a specialist quickly. The third area is ensuring child and adolescent health. Overall, we need to change direction – away from disease management and towards health maintenance. It is also clear to me that the money that is collected, for example, through a sugar levy or the alcohol and nicotine tax, should not remain in the Ministry of Finance. This money belongs in a completely renewed prevention law.

He sat in the North Rhine-Westphalia state parliament for 15 years before being directly elected to the Bundestag in 2025. Before entering politics, Yüksel worked as a nurse.

taz: In view of the announced cuts in health insurance benefits, the head of the National Association of Statutory Health Insurance Physicians threatened to expand private consultation hours, i.e. self-pay appointments, at the weekend. What ideas do you have for the problem of waiting times?

Yüksel: 70 percent of patients who go to a specialist don't belong there. They could receive good care from a family doctor without any problems and he can then easily control who should see a specialist.

taz: The truth is that general practitioners' practices are often just as crowded.

Yüksel: 40 percent of patients who go to their family doctor only need a new prescription. But if someone has been taking the same blood pressure medication for 20 years and nothing has changed, then they don't need to sit in the waiting room every three months. Why don't we switch to long-term prescriptions?

taz: Because family doctors bill quarterly?

Yüksel: Exactly and we have to get away from this quarterly logic, which by the way only exists in Germany. This could eliminate up to 40 percent of doctor visits in one fell swoop. And then the family doctor also has more time for longer discussions and for analyzing social factors of illness - the family or professional situation. This is also part of the idea of ​​moving away from disease management and towards health maintenance.

Appointments for self-payers The health insurance reform stipulates that in the future doctors will be able to bill fewer services through the health insurance companies in many areas. The head of the National Association of Statutory Health Insurance Physicians, Andreas Gassen, told the editorial network Germany on Sunday that he therefore assumes that those with statutory health insurance will increasingly pay for appointments and services themselves in the future. “People with statutory insurance who choose this option will then be treated like a private patient outside of statutory insurance, but will have to pay the costs out of their own pocket as self-payers,” explained Gassen. “Nobody can expect practices to just carry on as before in the face of the cuts.”

Criticism of “paywall medicine” Vice Chancellor and SPD leader Lars Klingbeil made it clear on the sidelines of an event in Potsdam that “such a proposal cannot be made with us”. He referred to the appointment guarantee agreed by the coalition for specialists who should receive statutory health insurance patients. The health policy spokesman for the Green parliamentary group, Janosch Dahmen, told the German Press Agency that the model threatens to create a new payment barrier. A development towards “paywall medicine” is highly problematic from a medical and socio-political point of view. The board of the German Foundation for Patient Protection, Eugen Brysch, questioned the legality of the alley initiative: The KBV has a legal mandate to secure health insurance appointments. “Instead, the chief lobbyist refers to private payment.”

The health insurance reform, with its full name Statutory Health Insurance, Savings and Stabilization Package, will gradually come into force from January 2027. Among other things, it provides for a higher co-payment for medication and a mandatory independent second opinion for operations for patients. Medical services, including prevention, are being budgeted more heavily. KBV boss Gassen speaks of fee cuts amounting to three billion euros. The areas of ENT, orthopedics, cardiology, radiology and rheumatology are particularly affected. (taz/dpa)

taz: Right now we have to save again, this time on nursing care insurance. Here too, the government has put together an austerity package that has not yet been fully agreed. A commission should discuss structural reforms for months. Is that necessary?

Yüksel: I have nothing against expert commissions per se. But when it comes to care, we don't actually have a problem of knowledge, but rather an implementation problem. If you put the right people together, you can have all the suggestions on the table in one afternoon.

Yüksel: Social long-term care insurance has a birth defect: the separation into statutory and private long-term care insurance - although, unlike health insurance, the benefits are completely identical. Statutory insurance mainly covers older and sicker people, while private insurance covers younger and higher-income people. This can't work in the long term, we should combine it. At least when it comes to care, we have to create a solidarity system.

taz: The new Federal Health Minister Carsten Linnemann (CDU) has already rejected financial equalization between the two systems.

Yüksel: At this point I can only recommend that our Health Minister talk to his North Rhine-Westphalian counterpart Karl-Josef Laumann (CDU) about the questions of justice and Catholic social teaching. I am convinced that Laumann has a different insight into this.

taz: You were a nurse yourself until 2010. How did you experience the healthcare system back then?

Serdar Yüksel: The health system was already under massive pressure to reduce costs. Five years earlier, it was introduced that hospital treatments were no longer paid based on length of stay, but rather on a flat rate based on illness. This has led to a complete change of mindset in hospitals. The focus was on treatments that also brought in high profits. And there was a shift in power away from the medical and nursing service management - towards the business management of the hospitals, the hospital managing director.

taz: You have been a member of the Bundestag since last year and sit on the Health Committee. Where are we now in the healthcare system?

Yüksel: It has actually been recognized that hospital financing is not sustainable. Back then, we went from one extreme to the other with the introduction and further development of per-case flat rates. Before that, you had to stay in the hospital for three to four weeks to have the bile removed, ten days for a hernia, and almost two weeks after a birth. This has changed massively, also thanks to new treatment and surgical methods, and that is a good thing. But the logic of flat rates per case has led to patients being discharged “bloodily”. We have to move away from this logic and we have initiated this with the hospital reform.

taz: Let's look at the current laws and reform projects. What does the health insurance savings package passed in July do to the care of those with statutory health insurance?

Yüksel: This is a stabilization law and not a health care reform. The CDU leadership in particular has always said that this would be the biggest health reform of the last 20 years. But none of us health politicians have ever said that. The aim of this law was to pull the emergency brake because expenses have grown so much that it can no longer be financed.

taz: Is the SPD's social concerns drowning in the government's austerity policy?

Yüksel: I don't see it that way. If we governed alone, we could implement issues such as citizens' insurance...

taz: So the merger of private and statutory health insurance, which the Union categorically rejects.

Yüksel: Right, we can't manage that in this government. But even if we did, we would have to save money. Because more money in healthcare ultimately doesn't mean more health. We are spending more and more, now over a billion euros per day, on this health system - twice as much as comparable countries. But when it comes to life expectancy or the health situation, especially with chronic illnesses, we are simply not well positioned. That's why it was right and important from a social democratic perspective to anchor a revenue-oriented health policy. And that's why we now need structural reforms in addition to this emergency brake.

taz: How long do we have to wait for the necessary structural reforms?

Yüksel: Some of the drafts for essential laws are already in the drawer, they were already with Karl Lauterbach. But we also know that there is a certain discontinuity at the top of the Ministry of Health.

taz: That's a nice way of putting it for the fact that a health minister who had to completely learn the ropes was replaced after a good year by a politician who was unfamiliar with the subject and who also had to completely learn the ropes.

Yüksel: And this minister will certainly see one or two priorities differently than his predecessor. But the emergency reform as a very important law was just passed in the Bundestag. This year we will also receive the first draft of a prevention law and a reform of primary care. This is coming quickly.

taz: Do you hope that the Minister of Health will switch to the Social Affairs team?

Yüksel: At least he understood right from the start that we have to deal differently with Germany's largest nursing service, the caring relatives, and that we are not allowed to reduce their pension provision as initially planned. He really made a good point there. I would like him and the CDU to strengthen the welfare state in other areas too. If trust in the welfare state erodes, then trust in democracy also erodes. And we can't afford that at the moment. All politicians who are active in the areas of work, social affairs and health should not forget this.