Group break isolation: On the failure of the deregulated health care system: Systematic labor transfer to Germany, Episode 1, Munich 2022.
For the past 25 years, there has been a massive transfer of highly qualified professionals to Germany very particularly from the poorest countries in the EU and Europe; since 2012, also increasingly from civil war countries such as Syria. According to the German Medical Association (Bundesärztekammer, BÄK), a total of 402,119 physicians were working in Germany at the end of 2019, the majority of them (207,000) in the hospital sector. The number of working physicians with a foreign passport increased again in 2019 by 3,800 to 58,168. In concrete terms, this means that their training did not cost German society a cent; they did it in another country.
In 1995, only 10,651 doctors with foreign passports were working in Germany, in 2007 twelve years later there were already 16,818 and in 2017 with 45,370 already almost three times as many. A particularly massive migration of specialists to Germany was a consequence of economic crises such as the global financial crisis in 2008, the advancing integration process into the EU and the accompanying massive impoverishment in Eastern European states, as well as wars, e.g., starting in 2012 in Syria.
The austerity dictate imposed by Germany in Greece in 2015, which resulted in a massive dismantling of the public health system, led to a veritable exodus of Greek doctors to Germany. As a result, after 4666 doctors from Romania, there were already 3169 doctors from Greece, 2139 from Poland, 1774 from Bulgaria, 1243 from Slovakia, 1142 from the Czech Republic and 1511 from Italy working in Germany in 2018.
After the Eastern European “supply” of medical professionals has already been massively poached by personnel fairs and specialized agencies in the last ten years, the Baltic countries and the Balkan states are currently particularly targeted for the transfer of specialists to Germany (figures from 2018, increase in percent since 2017): From Albania 630 (up 20.9%), Croatia 499 (up 8.7%), Serbia 1128 (8.4%), Bosnia and Herzegovina533 (up 17.9), 292 (9%), Montenegro 40 (11.1%), Macedonia 470 (9.8%), Lithuania 468 (up 12%), Latvia 336 (up 9.4%) as well as Moldova 149 (8.8%), Ukraine 1637 (10.2%) and Belarus 509 (18.4%). From Syria alone, the number of doctors increased by 14.4% from 2017 to 2018 to 4156, growing again in 2019 to 4468.
Thus, Germany, as the leading economic power within the EU, benefits on the one hand from the hierarchical and completely unjustly structured EU interior: since there is one currency, but no equal wages or burden sharing for e.g. the training of poached specialists, the German state can afford to omit urgently needed investments in its education and healthcare system. The education of a student of human medicine costs the taxpayer an average of 31,690 euros per year at a German university. Instead of investing heavily in the training of a sufficient supply of doctors, Germany can instead recruit the best, youngest and most mobile workers, including free training, for its labor market. In this way, a considerable financial transfer from the poorest countries takes place. Above all, however, the shortage of skilled workers in the countries of origin has deadly consequences, especially now in times of a global pandemic. In Poland and even in the capital city of Warsaw, people were already dying in the streets at night years before the pandemic because the emergency medical system was no longer functioning nationwide due to a shortage of personnel.
The situation in elderly care is even more dramatic: In total, just under 601,000 employees subject to social insurance contributions in Germany worked in elderly care in 2019. In 2019, 14 percent of employees subject to social insurance contributions were already people with a foreign passport, and their share has risen from 8 to 14 percent in just five years since 2014. According to the Federal Employment Agency, a total of just under 82,000 care workers from abroad were thus working in Germany in 2019. Six years earlier, the figure had been just 30,000. More than half of the nursing staff worked as assistants, while around 37 percent worked as professionals, specialists and experts. Almost 60 percent of the 28,000 care workers who have recently immigrated to Germany now come from non-EU countries, including more than 10,000 from the Western Balkans alone. According to the Cologne-based Institute of the German Economy (Institut der deutschen Wirtschaft), Germany is expected to have a shortage of around 307,000 care workers in inpatient care by 2035. For this reason, the German government and operators of care facilities are increasingly relying on the transfer of nursing staff from abroad.
Nursing staff at home not included
The German Foundation for Patient Protection rightly criticizes the fact that the published figures do not take into account nursing staff from abroad in private elderly care. Up to 300,000 auxiliary workers from Southern and Eastern Europe have not yet been included in any official statistics. But without these workers – also mostly women – from Poland, Bulgaria, Romania or Ukraine, home care in Germany could not be maintained at all: Without these forces from abroad, home care would otherwise have already collapsed, warned Eugen Brysch of the German Foundation for Patient Protection (Deutsche Stiftung für Patientenschutz). After all, more than three million people in need of care lived at home.
The exploding inequality
The pandemic massively exacerbates the unjust global economic order, the resulting hierarchical transfer of labor from the impoverished peripheries to the centers, and thus the exploitative chains of production and trade. Like a catalyst. But the pandemic also brings the question of inequality all the more urgently back onto the agenda.
The arrogance with which German politicians, but also the majority of the German media, currently speak about the supposedly so strong German health care system is cynical, false and stupid; especially since this narrative is always combined with a contemptuous reference to the disastrous state of health care in Italy, Romania or Greece. The fact that the deregulation of communal health care and work structures, which has been pushed through by Germany in particular in recent decades, is responsible for the decline of many health care systems is concealed. Didn’t the austerity dictates and the accompanying dismantling of municipal health care structures in these countries come about directly as a result of pressure from the German government and its advisory councils? Without a plan for a meaningful and necessary fight against the pandemic, German policy continues to rely on a capitalist economization of the health sector. The price for the fact that the health and care system in Germany has not yet collapsed, and for the fact that even the development of a vaccine is based on competition and profit, must be paid additionally by the people of the poorest countries.
The current failure in the fight against the global Covid 19 pandemic is a failure of global capitalism: The consequence must be a radical break especially with the privatization of the health sector as well as the capitalist economization of medicine and care for the purpose of profit maximization of private, increasingly listed corporations. For this development means a health and human catastrophe for the vast majority of humanity.