The healthcare system is not a KaDeWe buffet, is it, BVKJ President Hubmann?

The ninth episode of "Kindergarten Health Policy" takes us directly to the German Pediatricians' Day in Berlin. There, Dr. Michael Hubmann, President of the German Professional Association of Pediatricians (BVKJ), discusses the state of pediatrics—but, as always, it's about much more than that. This podcast series addresses the bigger picture: the question of whether our healthcare system will remain a self-service store—or finally get a strategy.

How to get started? A look back at the conference itself: a mix of continuing education, annual press conference, and political assessment. Topics such as the primary care system, antibiotic stewardship, and community-based prevention demonstrate that pediatrics and adolescent medicine isn't just talking about vaccination schedules and routine checkups, but is thinking systemically. And: It's acting. At the Children's Health Summit in Berlin, the so-called "pact" was signed again—in person. Also present were Holetschek, Storm, DGKJ, DGSP, and the German Medical Association. The message: Children's health must be considered in every debate.

Then it's time to get down to the nitty-gritty – namely, financing. Finance Minister Klingbeil's draft budget is setting off alarm bells in both the Ministry of Health and the health insurance funds. The billions of euros that are supposed to be provided will come in the form of loans – and raise the age-old question: What about non-insurance benefits?

Michael Hubmann sums it up in his typical way – with an image from football television: "It was like the time Lothar Matthäus was sent to a stadium, but no one spoke to him." The accusation: evasive maneuvers instead of honesty. Politicians should be allowed to say: We don't have the money. Period. Then at least we could deal with it.

Health Minister Warken receives support from Hubmann. Her commitment is noticeable, but she is already being held back in the cabinet. Where exactly is her parliamentary group, Hubmann asks. And what is the strategy in Mauerstraße? He can't find one.

Hubmann's conclusion: Our healthcare system is stretched to the limit, but no one dares to tackle its core. Emergency services reform, emergency medical services reform, primary care system – all urgently needed, all enshrined in the coalition agreement. But hardly any of them is making any progress. Instead: patchwork, fear, and lobbying pressure. Outpatient care, in particular, is at risk – not just financially, but structurally.

Hubmann warns: If politicians don't act, many practices will simply close early. Not out of malice, but out of exhaustion.

A central theme: the all-you-can-eat principle. For decades, insured members were led to believe they could put together their own meals like a buffet at KaDeWe. But now, as resources are shrinking, the courage to control demand is lacking. Hubmann sums it up succinctly: "If you buy 27 white shirts, your wife at home might at some point say, 'Hey, are you serious?'" But no one in the statutory health insurance system asks that question. Yet that's exactly what's needed—also to avoid oversupply.

What does that mean? The principles of cost-effectiveness must also apply to the demand side. Patients must be held partly responsible for their use of services – not in a punitive sense, but with clear rules and limits. And: Anyone who decides to visit a specialist despite clear medical advice might have to pay for it themselves. This is entirely without ideological fury – but rather as part of a mature discussion about proportionality.

At the end, interviewer Nößler ventures a bet: Which reform will come first? Hubmann is clear: The emergency medical reform could be implemented this year. The primary care system is closer than many think – even if the ministry is currently acting more as a deterrent than an incentive. The emergency services reform, on the other hand, is a real challenge: too many responsibilities, too much fear. And yet, Hubmann says: "Actually, everything should come at the same time."

With this episode, Denis Nößler bids farewell to his role at Ärzte Zeitung—and thus, formally, to this podcast format. "Kindergarten" will continue, however. In what form remains to be seen. But the conclusion of this episode is clear: The challenges are too great to end the discussion now. (Length: 46:14 minutes)