"In Britain it's a tripartite [system] made up of the individual, the employer and the state. And so there is a sense in which you either have to find a way to make changes to the tax base to pay for it within the economy that you've got, or you have to explore a separate way of paying for it via an insurance model. Or the alternative is that you move away from the idea that the NHS is a universal service model," says Chris Renwick, senior lecturer in Modern History at the University of York and author of Bread for All: The Origins of the Welfare State. [...]
Germany has a multi-payer, dual system that is mandatory for everyone living in the country. Depending on income and employment status, citizens choose between statutory health insurance provided by non-governmental "sickness funds," and private insurers. Contributions are based on a percentage of income (statutory) and age and risk (private). The state, in its various levels of government, plays next to no role in the financing of health care. [...]
Traditionally, Germany has always had a much more generous type of welfare benefit. This is especially true of unemployment benefits whereby if someone becomes unemployed that person gets a very high percentage of his or her last income for a year. [...]
These days structural and economic changes are making it very expensive to run the welfare systems. And public policy makers, says Hogwood, are struggling to cope. "Governments think that they can't afford to maintain these old systems but they still want to retain that element of legitimacy that the welfare system generated for them because if you don't maintain that, you get a breakdown in social cohesion. You get a conflict between social groups which we're seeing now."
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