The current debate about the future of Health Insurance reveals the tensions inherent in
the ongoing change of the public-private mix. The report of the Advisory Committee
to the Department of Health (1998) speaks of the health service as a ‘cost factor and
future industry/growth industry’. This hints at two conflicting logics: Since the 1970s
the expansion of health services has primarily been seen as a cost factor. Following the
logic of the welfare state cost containment became an overriding goal. Speaking of
health as a growth industry of the future, by contrast, indicates the logic of the market:
of satisfying the demands of growing numbers of people who are prepared to pay more
for their health, of boosting ‘production’ and of creating jobs in the process. This could
be a major contribution to filling the service gap in the German economy and
especially to providing more jobs for women. The question is whether the two logics
can be reconciled. Can a growing health industry be run and financed under social
insurance, preserving the standards of quasi-universalism, non-discrimination and
solidarity-(contribution-)based finance?