our website: How close are we to saving Germany's public health insurance system, Mr. Dahmen?

Health insurance costs may surge without urgent 2026 reforms

Janosch Dahmen: What the commission presented on Monday is a well-founded assessment of the problems and potential solutions. If the federal health minister now uses this toolkit consistently and decisively, she has the means to stabilize—or even reduce—health insurance contributions.

our website: Which of these measures can and should be implemented quickly?

Janosch Dahmen: Beyond the recommendations for cutting costs in hospital groups, the pharmaceutical industry, and reducing overuse and misdiagnosis, returning to a revenue-based spending policy is absolutely sensible. This means health insurance expenditures would only rise in line with wage growth—and thus with the revenue from insurance contributions. That's fair and transparent.

our website: That would mean capping reimbursement rates across the board—hospitals, pharmacies, outpatient doctors, and medications.

Janosch Dahmen: Yes, and the commission didn't just set this as a goal—they provided very concrete proposals for implementation in all these areas.

our website: According to the commission, this could save €5.5 billion by 2027. But we'd still be €10 billion short of stabilizing contributions. The biggest recommended measure—fully funding health insurance for citizens on basic welfare through tax revenue—is supposed to bring in €12 billion annually.

Janosch Dahmen: All parties in the Bundestag now agree that insured individuals shouldn't have to pay for something that is actually a state responsibility. But this debate must also address how these €12 billion will be offset. The obvious answer lies in another of the commission's recommendations: raising taxes on harmful substances like alcohol, tobacco, and sugar, whose excessive consumption costs society around €150 billion a year in related expenses.

our website: Among the 66 measures, were there any unexpected proposals?

Janosch Dahmen: No, most of them have been known for years. Rising contributions aren't some law of nature—they're the direct result of political inaction.

our website: If these solutions have been known for so long, why didn't you implement them during your time in the traffic-light coalition government?

Janosch Dahmen: The coalition did push through key initiatives like hospital reform and major digital health laws, which could have made the system far more efficient. But Minister Warken recently rolled back parts of the hospital reform, which, according to economic research institutes, will now cost an extra €9 billion a year. And on digitalization, progress has stalled for a year. Yes, everyone now has an electronic patient record, but it's barely used and largely empty. On the day the coalition collapsed, the Health Committee had a ready-to-vote emergency care reform—experts and even the CDU agreed it was urgently needed. Not only would it improve care, but it could also save €5 billion.

our website: These are deep structural reforms—yet the measures just proposed are focused on quick cost savings. Shouldn't we be thinking about both at once?

Janosch Dahmen: Absolutely. The coalition lacks an ambitious timeline. Their commission isn't expected to deliver a second report on comprehensive structural reforms until the end of the year. At this point, it's doubtful whether any of it will even be implemented in this legislative term.

our website: Even the small austerity package passed at the end of 2025 faced pushback from doctors' and hospital lobbyists. How soon can we expect an agreement now?

Janosch Dahmen: So far, the health minister has remained frustratingly vague. But to keep contributions stable in 2027, concrete measures must be implemented by this summer. Bold reforms, by the way, don't mean taking from those who already have little—they mean taking on the powerful lobbies that rake in billions in the healthcare sector every year: the pharmaceutical industry, hospital corporations, and the alcohol, tobacco, and sugar industries. The conservative Union has shied away from this confrontation so far. The bill is being footed by policyholders and businesses through rising health insurance premiums and higher payroll taxes.