Socialism Is the Best Prophylaxis’: The German Democratic Republic’s Health Care System

 The German Democratic Republic (DDR) was a socialist state created in East Germany in 1949 as a democratic, antifascist response to World War II and the subsequent restoration of monopoly capitalism in West Germany. 

The DDR symbolised a new Germany in which land was redistributed, production means were socialised, and the agricultural system was collectivised. 

It developed an equitable education, healthcare, and social system and ensured that men and women have equal rights. 

It fostered amicable and tightly knit commercial links with other communist regimes and demonstrated political and material solidarity with nations and organisations fighting for their independence in Latin America, Asia, and Africa.

The avowed goal of the DDR was to construct a society founded on the values of justice and equality. 

With public ownership of the means of production as its foundation, the nation grew into a powerful and efficient industrial state that utilised its economic surplus for the benefit of its citizens and ensured their social security. 

The DDR ultimately achieved its primary sociopolitical objective, which was to satisfy the expanding material and cultural requirements of its citizens.

Why reexamine the achievements, ideals, and institutions of the DDR thirty years after its collapse? 

What can we learn from its alternative economic methods in the contemporary world, where the dominance of capitalism has aggravated the issues of inequality and poverty and caused more frequent crises? What exactly did socialist democracy look like? 

What contradictions resulted from the implementation of a planned economy on a daily basis? What lessons can we learn from the demise of the DDR?

In this series, Studies on the DDR, the Internationale Forschungsstelle DDR, and Tricontinental: Institute for Social Research hope to encourage a new engagement with the history and guiding ideas of the DDR. 

Our objective is to reevaluate the legacy and experiences of this communist construction endeavour. 

We choose the German term DDR, which stands for Deutsche Demokratische Republik (English: GDR), because it frequently serves as a positive reference point in many parts of the world, particularly in the Global South.

This instructional series on the goals and realities of the DDR addresses facets of daily life, provides information about the country's social achievements, and investigates the political and economic foundations of this socialist state. 

By reflecting on the lived experiences of daily living, which are typically left out of the prevailing narrative due to the crushing victory of capitalism and the domination of the market economy, we hope to contribute to the ongoing debates among progressive groups. 

After all, millions of people around the world continue to battle for gains that were once a given under socialism but were lost with its demise.

With Germany's reunification in 1990, the DDR's economy was decimated. It was viewed as a model of shock treatment for the austerity policies that were subsequently imposed on other nations, not just former socialist ones. 

At the same time, the DDR was delegitimized politically, judicially, and morally. The publications in this series refute the myth peddled by both new and old foes of socialism that the fall of the DDR proved the inevitable failure of socialist policy and economy. 

By describing the facts of life in the DDR and validating the experiences of DDR people, we wish to remind the reader that alternatives to capitalism existed and continue to exist.

This second volume in the Studies on the DDR series examines the development and expansion of the DDR's health care system in the decades after World War II.

 In the context of limited economic resources and severe competition with capitalist West Germany, the DDR was able to create a revolutionary approach to medicine that prioritised people above profits and emphasised the significance of social duties in disease prevention. 

The historical experience of constructing an effective, universally accessible health care system might serve as a reference point for those striving to create a society organised for and by working people.

Health Care in a Sick System

The manner in which a culture tackles health issues indicates a great deal about its overall character. 

Social and political factors are reflected in the importance placed on people's health, the amount to which individuals are protected and treated equally, and the degree to which health treatment is tailored to people's actual requirements.

Yet, health policy cannot be confined to the medical care system alone. It is inextricable from working conditions, diet, housing, and education; the nature of social interactions; leisure and cultural behaviour; and a number of other determinants of the physical and mental health of individuals. 

During the early development of capitalism in Germany, the correlation between these aspects was already being studied. 

The work of the German physician Rudolf Virchow (1821–1902), the creator of modern pathology and a pioneer of what was then known as "social hygiene," exemplifies this (Sozialhygiene).

 

This area, often known as social medicine or public health, examines the relationship between people's health and their social circumstances. 

In his early writings on the plight of the English working class, Friedrich Engels also presented proof of this link.

Every imaginable miseries are heaped onto the poor's heads. If the population of major cities is excessively crowded, it is the wealthy who occupy the smallest amount of space.

 […] They are provided with wet houses, cellar dens that are not watertight from below, and leaky attics. 

Their homes are constructed such that humid air cannot escape. They are given soiled, torn, or rotten clothing and food that is contaminated and indigestible.

 […] However, even if they are able to overcome all of these obstacles, they will become unemployed at a time of crisis if their meagre employment opportunities are revoked.

How is it possible for the lower class to be healthy and live long lives under such conditions? 

What else might be anticipated besides high mortality, an unbroken sequence of epidemics, and a gradual decline in the physical condition of the working population?'

- Friedrich Engels, one of the scientific socialism's founders, was born in 1845

Under capitalism, health protections must be constantly defended in opposition to economic interests. 

The private sector primarily determines public health policy, which are being moulded by market forces. 

The pandemic of COVID-19 has dramatically shown the grave shortcomings and unresolved issues of contemporary health care systems. 

Several states lack lucid, science-based decision-making structures. Private economic interests impede collaboration based on solidarity within and between states. 

Political and commercial leaders compare the number of fatalities to the amount of money lost. 

The living and working situations of the lowest income worldwide make them the most susceptible to the epidemic. 

They are frequently denied access to immunisations and medications. Priority is given to the protection of private patent rights over comprehensive care for the populace. The masses of the Global South are essentially left destitute.

It is asserted that the overall efficacy of health care systems in the Global North demonstrates their superiority, yet their potential is not completely harnessed, nor is their success entirely attributable to economic power or positive medical traditions.

Instead, minimum standards and basic care were achieved via the decades-long battle of trade unions and other democratic organisations. After this, the same forces have been required to defend these gains against the persistent pressures of the private sector. 

In addition, the health care systems of wealthier states are boosted by medical personnel recruited from economically weaker nations. 

This, along with the continuous exploitation of the Global South, exacerbates the disparity between North and South growth. 

Nowadays, the private capitalist sector is solidifying its hold on health care systems, especially in Western economies, causing health and disease to become increasingly commodified and profit-driven.

Instead of being an accountable system, health care has become a mishmash of corporate fiefdoms whose primary goal is to maximise profits for venture capital investors. 

A physician must operate as a gatekeeper in a profit-driven health care system, determining whether to provide or withhold health care. 

A health care system based on profit is an oxymoron, a contradiction in terms. Once care is motivated by profit, it is no longer actual care.

American cardiologist and co-founder of the International Doctors for the Prevention of Nuclear War, Professor Bernard Lown (1921–2021) (IPPNW)

Since 1991, the number of private hospitals and beds in Germany has risen dramatically, continuing the trend of increasing commercialisation of inpatient treatment that began in the Federal Republic of Germany (FRG, sometimes known as West Germany) in the mid-1980s. 

This trend accelerated in 2003 with the introduction of a billing system based on diagnosis-related groups, modelled after the US model. Under this approach, hospital cases are categorised into many classes in order to identify the 'products' patients receive and to calculate payment.

 As a result, decisions about hospital care and length of stay are increasingly based on what can be invoiced commercially as opposed to medical criteria. 

As a result, the quality of health care is deteriorating as treatment becomes increasingly dependent on patient finances and public health services are cut.

Already in the early days of the German Democratic Republic, the conflict between private-sector interests and universal health coverage for all members of society was recognised (commonly referred to as East Germany). 

During its 40-year existence, the DDR was able to establish and expand a fundamentally distinct health care system. By the end of the 1980s, the DDR had risen from an initial position of considerable economic disadvantage to a ranking among the 20 greatest industrialised nations in terms of economic production and living standards. 

According to some World Health Organization metrics, including as the physician-to-population ratio, infant mortality rate, and tuberculosis decrease, the well-being of its 16 million residents was reflected by favourable, even leading figures. 

This was the case despite the unsatisfactory structural state of many health facilities, the lack of medical supplies, and import limitations on medicine and technology - all of which were the result of Western economic sanctions.

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