|Democratic Health System and Public Health: Debates in Exile and Post-War Realities|
|The structure of the German health system, which has remained largely unchanged since the time of Otto von Bismarck (Chancellor of the German Empire 1871 – 1890), continues to remain a topic of debate.
During World War II in exile health policy debates experts were developing alternatives to the existing health care system - mainly because many German doctors and health institutions had become part of the system of registration, mutilation and extermination of hundred thousands, who had been forced to sterilization, who had been killed in the different “euthanasia”-programs for handicapped, and the medical experiments within the concentration camps.
The developed alternatives indeed played a significant role in the debates immediately following the war. Moreover, these models echoed ideas that had played a role in debates regarding the proper organization of the health system before (!) and within the Weimar Republic.
In East Germany, the ideas of the working class political movement served as inspiration for the reconstructed health system. In West Germany, the health system was reconstructed along the lines of a structural foundation that had been established before and during the Weimar Republic and consolidated under National Socialism and along the lines of the medical profession’s position of authority, which emphasized diagnostics and the treatment of the individual patient and not prophylaxis.
In sum, the Western system made health care an individual responsibility, while in the East the state assumed responsibility for health care.
Although the terms “Americanization” and “Sovietization” were employed to characterize these health systems during the Cold War and in later scholarly accounts, more recent scholarship demonstrates that these terms do not adequately describe the course of events at the time.|