How capitalism kills us

For ten months, politicians have been conjuring up the impending health collapse, but they have watched idly as the care landscape became poorer by 20 clinics in just one year. What is a contradiction for ordinary mortals, lobbyists like the “Bertelsmänner” sell as necessity and progress. They prefer not to talk about profit maximization, all the more about efficiency, specialization and centralization. The minister of Health is happy to listen to you, AS IS Karl Lauterbach, who would be satisfied with half as many hospitals as before. For this to happen, the federal government is putting together “rescue packages” for the big fish, leaving the little ones to sit on dry land and continuing to eagerly promote bed dismantling.

The Great demise in the hospital landscape is by no means a new phenomenon. According to the Federal Statistical Office, the lights went out at almost 500 locations between 1991 and 2018. At the time, Germany still had more than 2,400 hospitals, two years ago there were only 1,925. plenty of beds have also disappeared from the picture: in the order of 170,000. This all happened in times when politicians never tired of warning of the “demographic catastrophe”, of a flood of aging and ever-aging people who would bring social security systems to the limit of their burden. On the other hand, there was little to nothing to hear about the fact that the tendency to become ill increases with older age and that therefore the widest possible supply structures would actually be available.

But you learn from mistakes and what could be a better reason than an aggravated crisis. We have been experiencing this for ten months in the form of the SARS-CoV-2 pandemic, about which the federal government says above all that it threatens to bring the health system to its knees. So what would be better than to not only stabilize the System, but to expand it with a view to future recurring emergencies such as the current one, i.e. to make it crisis-proof in the best sense? What happened instead? Not only has Hospital death not taken a break in the coronary year 2020, it has even accelerated. While ten houses closed on average every year from 2015 to 2018, this time it was twice as much, namely exactly 20. the closure took place 17 times in the period from July to the end of the year, eight times in December. Only three cases ended before the outbreak of the crisis.

Shrinkwithe without end

The Association Of Common Property in Citizens' Hands (GiB) has disaggregated the losses on its website. In Bavaria alone, where the head of the government Markus Söder (CSU) presents the toughest course in the country in terms of the containment of the virus and points the finger at all possible “culprits”, four locations were handled: in Parsberg, Waldsassen, Vohenstrauß and Fürth. Only in North Rhine-Westphalia with five: in Winterberg, Bochum-Linden, Essen-Altenessen, Essen-Stoppenberg and St. Tönis. Baden-Württemberg has three, in Rhineland-Palatinate and Saarland two have each ceased operations, in Saxony, Saxony-Anhalt, Brandenburg and Schleswig-Holstein one clinic each has ceased operations. According to GiB, almost all of the houses had emergency rooms, intensive care beds, surgery and internal medicine, treated corona patients or kept their backs free at neighboring clinics. And 2,144 beds and 4,000 jobs were lost as a result of the measures.

And the thick end is yet to come. In September, the Federal Audit Office (BRH) had calculated that ten percent of the clinics were acutely threatened with insolvency, which corresponds to 190 houses. Another 40 percent wrote red numbers. In their report, the auditors complained of fundamental shortcomings in hospital planning and financing in Germany and called for a change in the Basic Law that brings together the responsibilities between the federal government and the Länder. “There is hardly any planning for the future, for example taking into account demographics, morbidity and medical progress,” warned the BRH, the federal states responsible for the provision of capacities “have been insufficiently complying with their investment commitment for years.”

Löchriger rescue parachute

With the increase in Corona cases since autumn, the situation has worsened. On 18 December, the German Hospital Society (DKG) made a call for help to the Federal Government. The usual billing system is not in a position to compensate for the financial consequences of this crisis for the clinics, the association complained. A “complicated and small-scale alternative” is being criticised as part of the second so-called rescue parachute for clinics, which was set up in November. These new regulations “do not cover more than 75 percent of German hospitals and bring (…) " We are very concerned that without comprehensive and short-term effective liquidity assistance, hospitals will not be able to maintain their capacity in the coming months.”

Strange! While no other casualty is too great for the government in the face of the health emergency that has been summoned, they cut out tens of billions of euros for short – time work, to support banks and companies or to rescue Lufthansa and for this they themselves whistle for the “Black Zero” and the “debt brake”, they skimp precisely at the most important place for crisis management-the hospitals. This fits in with another “negligence”: for example, before the second Corona wave, no major efforts were made to attract more nursing staff to the clinics and nursing homes. As a consequence, thousands of intensive care beds disappeared from the statistics in the weeks leading up to the start of winter, simply because there are no forces available to take care of the beds.

Lauterbach thinks ahead

If money apparently does not play a role for the political crisis managers, why did they not avert the closures of trams in the short term with appropriate emergency subsidies in order not to lose even more resources? The Argument that the resolution had already been passed far earlier is not really convincing. With Corona many things became possible that seemed impossible before, and if the federal government had been willing to save the houses, a way would certainly have been found. According to GIB spokesman Carl Waßmuth, closure decisions or corresponding plans for around 30 other clinics are already available, including large locations in Hamburg, Dresden and Berlin. Especially in metropolitan areas, above-average numbers of Covid-19 cases occur. Since the System is already supposed to reach its limits, why does politics allow it to be deprived of even more substance in the near future?

The answer to such questions can be found in strategy papers of the Bertelsmann Stiftung or the Academy of Sciences Leopoldina. They are among the most influential lobbyists in the effort to reduce, specialize and centralize the supply structures. They whisper to government and parliamentarians that with a concentration on a few full – service providers and a manageable number of specialist clinics, patients are best served-and some politicians sell the neoliberal prescriptions in public as a pure benefit. For example, the so-called health expert of the SPD, Karl Lauterbach, is probably the shrillest violin in the corona panic orchestra. In June 2019, he acknowledged a post by the “Bertelsmänner” on Twitter with this assessment: “everyone knows that we should close at least one in three, actually one in two hospitals in Germany.”

More quality due to balding?

Six weeks later, the Gütersloher no tax Association presented an expertise that recommends a reduction of the general clinics from 1,400 to 600. This could avoid “many complications and deaths,” “as well as better equipment, more specialisation and better care by specialists and nurses,” it says. The conclusion comes in the most beautiful new speaker: “The reorganization of the hospital landscape is a question of patient safety and must above all pursue the goal of improving the quality of care.” Promptly Lauterbach spoke again: “The basic tenor of the study is true”, but one should not close quite as many houses and “there must be no profit maximization through hospital closures”.

There is no more eye-washing. Because, of course, it’s all about maximizing profits, especially through the five leading players on the market, which are called Rhön, Sana, Fresenius, Helios and Asklepios. Together, they already run well over 400 clinics in the country, and each competitor, whether state or private, whether sealed or swallowed by fusion, promises them more patients and more returns. The Leopoldina, who also understands Corona’s fear-mongering, envisages an even more radical cut. As early as 2016, in a thesis paper, it recommended that the number of general hospitals be evaporated from 1,650 to 300 super hospitals at the time. The model should therefore be Denmark with the target of a hospital per 250,000 inhabitants. The word “close to home” is searched in vain on 21 pages, instead there is plenty of fine-coloured ness: “A corresponding reduction (…) and the increase in medical staff in the remaining homes would lead to more adequate patient nursing staff numbers, thereby significantly increasing the quality of care and reducing overburdening of medical staff.”

Citizens against Profiteering

Such concepts not only seem absurd, they also do not go down well. Public property in the hands of citizens has had more than 1,000 people questioned by the Forsa Institute as to whether they consider the dismantling of clinics to be useful. 88 percent did not see this as such, only nine percent supported it. 96 percent found that patient care was more important than the cost-effectiveness of the operation. Behind this attitude is a completely different understanding of health care as health economists, and the majority of local health policy-makers maintain. The citizens want facilities that are available for the event of illness and are adequately financed for this purpose, and not profit centers that want to earn maximum money from as many sick people as possible.

Among the advocates of the business approach is Reinhard Busse, who teaches management in health care at the Technical University of Berlin and has contributed to the Bertelsmann study. Speaking at Mitteldeutscher Rundfunk (MDR) eleven months ago, he said: “We don’t have enough sick people to run all the hospitals.” This raises the question of whether the situation under the pressure of the pandemic should not now be a “better” situation and with it the mood of those who have spoken to the hospital kahlschlag until then. But behold, their positions and arguments have not changed, and by no means is it wasted a thought that greater capacity could get through the crisis better.

“New momentum through Corona”

In mid-2020, for example, the Bertelsmann Stiftung will again be writing with reference to its own study from pre-Corona times: “especially in exceptional stress situations such as these, we cannot afford to allocate scarce resources to many hospitals in such a way that specialist departments are insufficiently operational.“Most recently, the Thinktank provided funding in a policy paper presented with the Robert Bosch Foundation and the Barmer Institute for Health Systems Research- and long-term lessons” from Corona and concluded in it razor-sharp: “the restructuring of the hospital landscape receives new momentum through COVID-19.“It calls once again for the"reduction of local overcapacity and an increased specialization of service delivery through concentration of capacities and center formation”. In order to convey their message, the authors relied on the rather bold thesis that smaller sites were not even needed for crisis management. According to the report, only “about a quarter” of the clinics had taken care of the “lion’s share” of Covid-19 patients, “while half had a medium to low number” and “a last quarter (…) had not taken part in the corona care at all. Furthermore, ventilated patients were treated in only 350 clinics.

This account was immediately contradicted by the Association of Senior Hospital Physicians of Germany (VLK) and that of the Hospital Directors of Germany (VKD). For example, “a third” of the ventilation of Covid-19 cases would be “in primary and regular care homes.” Is. “This is a continuing campaign that has been reactivated for some time and which, if it is heard politically, puts our comprehensive hospital care in Germany, which has proved its worth in recent months, in jeopardy,” VLK President Michael Weber said in a joint statement at the end of November. The presentation by Bertelsmann and his colleagues is “going in a completely wrong direction”, here a massive structural adjustment is demanded, “which does not result from the previous experiences of the first pandemic wave”.

Spahn must profess color

A” very active and probably highly paid Lobby for hospital closures " also sees Waßmuth von GiB at work, whose association has started a nationwide Petition against these efforts. “A responsible policy would clearly reject proposals driven by profit interests.“After all that has been demanded of people in the past year, “it would be downright cynical to close more clinics, of all places,” the activist emphasized. Federal health minister Jens Spahn (CDU) must now decide: “Does he listen to Bertelsmann, Helios and the financial investors or does he make a health policy for the people – and finally personally guarantees that no hospital will be closed any more.”

This is not what it looks like. The rescue umbrella 2.0 mentioned above is not designed to alleviate the hardships of small and medium-sized houses. At the end of December, the VLK complained that only “25 percent of the hospitals concerned are covered and payments have hardly been made so far.” Once again, the large locations and strong commercial top dogs benefit in particular, which can thus further expand their distance to the large Rest. The pioneer of the “rescue package” was also TU Professor Busse, who worked for Bertelsmann and co. as an” expert " and at the same time sits on the Corona Advisory Board of the Federal Ministry of Health.

Federal Government promotes dismantling

In the GiB survey, 85 percent of respondents voted that the state should no longer encourage hospital closures. That is what politics does in different ways. Indirectly, this is done through the Diagnosis Related Groups (DRGs) with its incentives to provide the most expensive treatments possible, which favours highly specialised and rationalised clinics with the best facilities and sustainably adds to smaller rural locations with limited patient flows. In addition, the federal and state governments have a lever in hand with the so-called hospital structural fund to directly subsidize site closures. According to the law, the purpose of this is “in particular the reduction of overcapacity, the concentration of inpatient care facilities and locations, and the conversion of hospitals into non-acute local care facilities”. Eligible are therefore the ‘costs of closing a hospital or parts of the hospital and the cost of the necessary construction work’. Every year, the federal government provides half a billion euros for this, which the Länder add to 250 million euros.

A similar thrust, albeit hidden in the thicket of paragraphs, is the hospital future law, which came into force on 1 January, with which the federal government wants to provide three billion euros for modern emergency capacities, digitization and IT security – as well as for bed reduction. According to paragraph 19, paragraph 11, ‘adaptations of patient rooms to the specific treatment requirements in the event of an epidemic’ are eligible ‘provided that the project leads to a corresponding reduction in the number of beds set in hospital planning’. If there is any further evidence that Corona is to be used to rationalize and scaraway the supply landscape, here it is.