The Germans don’t worship their health service – that’s why it’s better than ours

A decentralised system that is not prey to party politics has given the country a great advantage

In judging our Covid-19 performance, we naturally compare it with that of other countries. The most telling comparison is with nations whose predicament is closest to ours. Enormous countries, such as China, Brazil and the US, are not closely comparable. Nor are much poorer countries, or more thinly populated ones.

The natural comparisons are Western European, and even here, there are important differences. The Scandinavian countries, with their small, well-extended populations, are not so close to the British experience, although we should learn from their medical systems. The nearest comparisons, surely, are quite densely populated neighbours with roughly similar populations and GDP, urban concentrations and large international airports. That means France, Italy, Germany and, perhaps, Spain.

The eventual Covid-19 post-mortem will no doubt unearth mistakes that are uniquely British, but if you look at the story so far, you will see that neither Britain, France, Italy, or Spain has done markedly better than one another. In deaths per million of the population – a more meaningful comparator than total numbers – we, at 684, are the worst of these four; but the others are bad too (Italy 582, France 462. Plucky little Belgium, by the way, seems to be the world’s worst, at 851). The only one in a different league is Germany, at 110.

Why might this be? First, Germany had the “luck” to get an early case of the coronavirus. A female business traveller from Shanghai arrived on January 16 and fell ill with the virus. She was treated at the Munich Schwabing Hospital. A consequent cluster of 16 cases was identified. On February 13, at the country’s Science Media Centre, a huge press conference reported the scientific findings in detail. The press release warned that “every day the spread is not controlled, the likelihood that the epidemic will develop into a pandemic increases”.

But the mere fact of a disease being identified does not mean the authorities know what to do about it. The Germans did. I am no expert on Germany, but here are a few factors.

Expertise. The Munich hospital has a special unit for highly contagious life-threatening infections. Its chief physician spoke at the press conference. So did the professor who had developed one of the first tests for Covid-19, as did the president of the Robert Koch Institute in Berlin, the government’s public health institute. Lockdown was quicker than in Britain, but less draconian and more targeted.

Testing (mainly for flu) is a more established part of life in Germany than in Britain. It has gone on apace throughout Covid. Also, where the NHS closed down, the normal German health system kept going. Patients with Covid were not, as they were here, told to stay at home unaided. They were constantly monitored. If their oxygen levels dropped too low, they were admitted to hospital. The needs of care homes were not ignored. No patient was sent to a care home unless it could provide 14 days’ quarantine.

Media. Far more German journalists are well acquainted with science than are their British counterparts. They give the public clearer facts and fewer scare stories.

Dispersal. Unlike Britain, Germany is a country of many different centres, with associated airports – Berlin, Munich, Cologne, Frankfurt and so on, rather than London, London and more London. So there was less danger of a sudden explosion of the plague.

A related fact is that the country is federal. Sixteen states, rather than the central government, are responsible for most aspects of health care. This sometimes slows things down, but it also means that, compared with Britain, there is more local “buy-in”, more local players who get going, rather than waiting upon a distant bureaucracy.

This creates a good spread of service across Germany. There were plenty of labs for testing, for example, in plenty of places. There was no appalling rush. When Britain finally got round to test and trace, the Government commissioned Serco to run it from a single call centre in Scotland. As the former health secretary, Jeremy Hunt, points out, you are more likely to comply with tracing from a knowledgeable employee of your county council than a call from a student hundreds of miles away. In Germany, the “corona-detectors” are a respected body of local experts.

Good politics. Many in Britain have grown rather fed up with the German Chancellor, Angela Merkel, what with her ambiguous speeches and her hostility to Brexit. Her star has gradually waned even at home. Nevertheless, she is a scientist by training and an experienced, steady person. She can command respect in the crisis, precisely because she is not, in any detailed sense, in charge of Covid policy. Rather than having to pretend she has all the answers, she can exercise moral authority.

Mrs Merkel is in this enviable position because – astonishing to British eyes – she runs a country in which health care is not usually high on the list of political controversies. In Britain, the health secretary – currently Matt Hancock – has to run all hospitals and the fifth largest workforce in the world. At the same time, he has to spend days in the House of Commons being assailed by accusations that he is trying to “sell off ” the NHS and similar nonsense. The German health minister (an able man called Jens Spahn) has infinitely less power, but – no offence to Mr Hancock – can do more practical good. His role has not been to try to run a vast, unmanageable empire, but simply to oil the wheels of a system which already works, by putting in more government money – covering the costs of testing, and paying for ICU beds to be kept available.

Why is Germany free of what Mr Hunt calls “the political poison” of our system? Not because Germans don’t care about health – they actually spend a higher proportion of their GDP on it than we do, and they have better health outcomes. It is because they have never bought the doctrine that a particular health care system is sacred.

The origins of good health care for ordinary Germans lie in mutual funds in the 19th century, set up to help pay for funerals. These developed into much more sophisticated, competing systems of health insurance, underwritten by the state, but not run by it. Employer and employee both contribute. An unemployed person has his health care paid for in his unemployment insurance. Almost no German citizen falls through the net.

The providers are also various. Government-run hospitals are outnumbered by privately run ones and others run by charities (many, for instance by the Order of St John). Because the money follows the patient, the providers have good incentives to provide. Indeed, the problem in Germany is too many hospital beds.

In Britain, the health service is an object of high emotion. Behind the praise often lies a fear that it is precarious. In Germany, there is little emotional commitment to the service – rather as, here, there is little intense feeling for Sainsbury’s or Waitrose. Instead of high emotion, there is a high level of confidence. This may help explain why so many more Germans than British have returned to work, although Covid numbers jump upwards from time to time. Psychologically and medically, the German way is better for the national health than is the thing we call the National Health Service.