Deman­ding Health Care for All: Act Two

Foto: flickr, Mike Herbst

By the time we fina­li­zed our first deman­ds, the muni­ci­pal elec­tions of 2016 were just around the cor­ner.

Lea­ding up to the elec­tion, we reached out to the par­ties par­ti­ci­pa­ting in the elec­tions, and asked them what they plan­ned to do about pro­vi­ding healt­h­ca­re to all of us, not just some of us. The par­ties that cur­r­ent­ly form the government respon­ded posi­tively, gene­ral­ly speaking, but with a cer­tain vague­ness about pro­mi­sing to “fill the gaps.”

After being elec­ted, the new Red-Red-Green Coali­ti­on decla­red their intent to imple­ment some kind of anony­mous health coverage into their coali­ti­on con­tract. No con­cre­te solu­ti­ons were agreed upon so the Ber­lin Sena­te Depart­ment of Health, Care, and Gen­der Equa­li­ty invi­ted a num­ber of civil socie­ty orga­ni­za­ti­ons to a round­ta­ble in order to collect infor­ma­ti­on on pos­si­ble stra­te­gies to deve­lop anony­mous health coverage.

We joi­ned a secon­da­ry round­ta­ble that inten­ded to give input from peop­le actual­ly affec­ted by the lack of health coverage to the first round­ta­ble. At first the con­ver­sa­ti­ons revol­ved around what we can’t do. Some of us were para­ly­zed by the com­ple­xi­ty of the issue. After reflec­ting for some days on all the things we can’t do, Soli­da­ri­ty City Ber­lin took a minu­te to step back and think.

How could it be that poli­tics is defi­ned by vague limi­ta­ti­ons and abs­tract obsta­cles an admi­nis­tra­ti­ve natu­re? It didn’t feel right that we weren’t pushing for the maxi­mum we could think of from the get-go, that we were actual­ly retrea­ting befo­re the batt­le ever began.

So as we faced a tech­no­cra­tic road­block and we moved around it. We con­tac­ted ever­yo­ne invol­ved in both round­ta­bles as well as orga­ni­za­ti­ons poten­ti­al­ly inte­rested about the pro­po­sal we our­sel­ves deve­lo­ped. We cri­ti­ci­zed the limi­ta­ti­ons that had alre­ady been esta­blished and pro­po­sed alter­na­ti­ve solu­ti­ons and offe­red the results of our very own rese­arch amongst tho­se who will need the anony­mous health coverage.

And while we cer­tain­ly did not get all we would have loved to see, we were at least able to impact the nego­tia­ti­ons and to rai­se awa­re­ness on the pro­blems an anony­mous health coverage can pro­vo­ke if not plan­ned well. After the inse­cu­ri­ty of step­ping into the field of tech­no­crats, we have to say it tur­ned out that an alli­an­ce of ever­y­day peop­le can actual­ly gene­ra­te their own poli­cy pro­po­sals.

This is what they came up with:

  • The con­cept should offer an anony­mous health card or – as an alter­na­ti­ve – a «Kran­ken­schein» for one quar­ter. A Kran­ken­schei­ne is a pass that allows poten­ti­al pati­ents to see heath care pro­vi­ders, and are typi­cal­ly given on a case-by-case basis. Kran­ken­schei­ne given per case/illness delay the medi­cal tre­at­ment and pose an unne­cessa­ry hurd­le to tho­se see­king health ser­vices.
  • For such a solu­ti­on an open, unfi­xed finan­ci­al coverage of the pro­ject is vital. Cur­r­ent­ly the­re are no relia­ble num­bers or pre­dic­tions regar­ding how many peop­le will need the anony­mous health coverage in Ber­lin. Hence, the amount of money nee­ded in a limi­ted fond can­not be pre­dic­ted. Addi­tio­nal­ly the limi­ted fund solu­ti­on would put an extre­me pres­su­re to con­trol the orga­ni­za­ti­on that dis­tri­bu­tes the health card/Krankenschein. The poten­ti­al deni­al of card/Schein without a tho­rough medi­cal exami­na­ti­on has been pro­ven to be extre­me­ly pro­ble­ma­tic in the past. Flücht­lings­rat Ber­lin, the cam­pai­gn “Health for Refu­gees» (Gesund­heit für Geflüch­te­te) and the net­work «EQUAL» from the Uni­ver­si­ty Osna­brück have docu­men­ted over years the pro­blems that resul­ted from case-based Kran­ken­schein dis­tri­bu­ti­on with limi­ted finan­ci­al back­up for refu­gees.
  • Peop­le need coverage accord­ing to the regu­la­ti­on for Ger­man health insuran­ces (Regel­ver­sor­gung) without the limi­ta­ti­on from §4 and §6 Asyl­bLG. The exclu­si­on of chro­nic as well as psy­cho­lo­gi­cal ill­nes­ses is not based on any medi­cal argu­men­ta­ti­on. The attempt to force peop­le out of the coun­try by deny­ing them basic medi­cal coverage is con­tra­ry to the basic human right for health and does the urban com­mu­ni­ty a gra­ve injus­ti­ce.
  • The­re has to be a libe­ral per­mis­si­on sys­tem sin­ce ille­ga­li­zed peop­le fre­quent­ly lack the papers to pro­ve their sta­tus. Addi­tio­nal­ly, the pro­gram should cover not only ille­ga­li­zed peop­le but also for examp­le Euro­pean refu­gees (like the Sin­ti and the Roma) who are fre­quent­ly exclu­ded from the health system,as well as Ger­man citi­zens who «fell through the cracks of the sys­tem». Refu­gees who have limi­ted coverage based on §4 and §6 Asyl­bLG should have the right to use the anony­mous coverage for health pro­blems that are exclu­ded from their insuran­ce.
  • The dis­tri­bu­ti­on has to be orga­ni­zed by a non-sta­te insti­tu­ti­on that alre­ady has con­nec­tions to the com­mu­nities that will use the sys­tem. The peop­le who will be using the sys­tem should be inclu­ded in the pro­cess of imple­men­ting it. In order to deve­lop a func­tio­n­ing sys­tem that inclu­des the expe­ri­ence of the peop­le affec­ted, an advi­so­ry board should be imple­men­ted.
  • Trans­la­ti­ons are a vital ele­ment for a suc­cess­ful tre­at­ment, they should be inclu­ded in the finan­ci­al plan­ning of the pro­ject.
  • The­re will be finan­ci­al resour­ces nee­ded for sen­si­ti­vi­ty trai­ning for medi­cal per­son­nel. Our sam­ple inqui­ry has shown that in some situa­ti­ons struc­tu­ral racism, com­mu­ni­ca­ti­ve pro­blems, as well as dif­fe­rent medi­cal cul­tures lead to con­flicts which in con­se­quence pre­vent peop­le from see­king the tre­at­ment they need. Rai­sing awa­re­ness for the­se pro­blems amongst medi­cal per­son­nel would be an easy way to sol­ve this issue. In this con­text, it should be addres­sed that refu­gees might suf­fer from par­ti­cu­lar health issu­es, such as Post Trau­ma­tic Stress Dis­or­der (PTSD).
  • The pro­ject needs to inclu­de an infor­ma­ti­on cam­pai­gn for tho­se who will be able to use the health coverage. Pro­jects in other cities had dif­fi­cul­ties to spread the know­ledge on the ques­ti­on who exact­ly can get what kind of coverage through the anony­mous health coverage.

Is the cur­rent plan ever­y­thing we need? No. Is it a good start? Sure. Time to pack up and go home? Abso­lute­ly not. Alre­ady due to the pres­su­re Soli­da­ri­ty City Ber­lin and other orga­ni­za­ti­ons have gene­ra­ted, the government has been forced into fil­ling in gaps of coverage. If we hadn’t been the­re not only to deve­lop pres­su­re, but to demand our own pro­po­sal that we think sol­ves the pro­blem, whe­re would a solu­ti­on come from?

Now is the most cri­ti­cal time. Begin­ning in Sep­tem­ber, the city of Ber­lin will nego­tia­te its bud­get plans and even the best of pro­po­sals with the big­gest group of fans will not beco­me rea­li­ty without decent fun­ding. If we don’t con­ti­nue to gene­ra­te pres­su­re and to mobi­li­ze peop­le, then what is to gua­ran­tee that this alre­ady wate­red-down pro­po­sal will not just fall off the table alto­ge­ther?

This is why we have to con­ti­nue pushing the enve­lo­pe, con­ti­nue deman­ding more, and con­ti­nue fighting har­der.