Good Distribution, Bad Delivery, and Ugly Politics: The Traumatic Beginnings Of Germany's Health Care System

Abstract

In December 1931, a major reform of the Bismarckian health care system in Germany was passed into law. It was soon abrogated by the Nazi regime, but it was resuscitated largely intact after World War II to become the basis of the German system today. Intense class, professional, and partisan conflicts about health care’s multiple objectives of quality, equality, and economy preceded the 1931 reform. For the most part, ironically, organized labor and capital lined up against organized medicine, challenging doctors’ clinical autonomy, in efforts to bring health costs under control and thus deal with the Weimar Republic’s severe fiscal crisis. But the 1931 reform, brokered by the Catholics’ Center Party under Heinrich Bruning, resulted from a profound shift in these relations as medicine and labor lined up against big capitalists on the details of the reform that left physician autonomy intact. In doing so they contributed to the inflamed class conflict that was the downfall of the Weimar Republic.