The recently passed “hospital reform” in Germany means a drastic cutback in the healthcare system. Federal Health Minister Karl Lauterbach (Social Democrat, SPD) stated publicly after the adoption of the measures by the Bundestag (parliament): “It is quite clear that in ten years at the latest we will have a few hundred less hospitals.” Allegedly, there was “not the medical need” for them. According to Lauterbach, one in three hospital beds were already empty, and there were also too few staff.
While hospital and patient associations have sharply criticised the reform and the associated hospital closures, it is supported by all the parties represented in parliament. Criticism here rarely goes beyond secondary financing issues between the federal, state and local governments in implementing the reform. All parties agree on closing hospitals and cutting care for broad segments of the population in order to free up funds for rearmament, and stepping up police and state powers at home.
The Left Party is playing a pioneering role here. While the party had still campaigned with the slogan “Every hospital counts” in the last state elections in eastern Germany, it is implementing the cutbacks wherever it is in government at state level.
This is clearly evident in Bremen, the smallest German state, where a coalition of the SPD, the Greens and Left Party has formed the state government since 2019. Since then, Claudia Bernhard has held the office of Senator for Health (state minister), and her central project is to make the state-owned hospitals profitable at the expense of employees and patients.
In 2021, in the midst of the COVID-19 pandemic, the Bremen state government announced it would cut 440 full-time positions and reduce the number of beds at the Gesundheit Nord (Geno) hospital group accordingly. With around 3,000 beds, Geno is one of the largest municipal hospital groups in Germany.
In 2023, Bernhard was one of the first to demand the cancellation of COVID-19 tests at hospitals, supposedly because they were no longer useful.
Last year, plans were announced to reduce the size of the hospital on the left bank of the Weser, which led to protests by staff. It is now clear that the hospital network will no longer operate in four locations in the future, but only three. The heart centre, which is the core of the site on the left bank of the Weser, will be partially integrated into the Bremen-Mitte site. The move is planned for 2028.
At the same time, Geno announced that it wanted to break even from 2027. To achieve this, management and the Senate (state government) announced further savings. Among other things, further mergers are planned. Multiple services within the network are to be merged, which will inevitably result in job cuts. The areas affected will be food supply, laboratory, sterilisation and logistics.
Bernhard’s claims that this was merely a “relocation” are a deliberate deception. The Marburger Bund doctors’ association, for example, fears that a total of 120 doctor posts will be cut at the Bremen-Mitte and Ost clinics. As a result, more patients would be cared for by significantly fewer doctors after the closure of the Links der Weser clinic.
This is precisely the approach of the hospital reform of Lauterbach and the federal government. And that is precisely why Bernhard is one of the most ardent supporters of the reform.
In an interview with taz on October 17, she praised the reform effusively and rejected any criticism of it. The hospital reform was “not an austerity programme and must not be understood as such,” she declared cynically.
She warned urgently against the failure of the reform, as this would make cuts throughout the states more difficult. “If the reform fails now, that would be disastrous. Then it will be much more difficult for us real politicians in the states to make any changes,” said the health senator.
In the same interview, she boasted that she had commissioned a “report on hospital restructuring” after taking office in order to put pressure on hospital management in Bremen to “voluntarily” implement “cooperation and mergers” (i.e., job cuts). Lauterbach’s reform would increase the pressure here, and that would be an advantage, she claimed.
Bernhard explicitly spoke out against a healthcare system that is oriented towards people’s needs and free from profit interests. She considered it “naive” to want to keep the hospital system “completely free of economic constraints.” That would not work, “in any political system.”
She then said she would push the reform through despite enormous opposition: “Oh yes, I still expect a great deal of resistance.” But she was “convinced that we, as a small federal state, have a good chance of implementing the necessary restructuring in an exemplary manner.”
Bernhard’s statements and her career show the thoroughly anti-working-class character of the Left Party. Bernhard only joined the party in 2007, after it had already been in the Berlin state government for six years, inflicting unprecedented social cuts in a coalition with the SPD. These policies attracted Bernhard and enabled her to rise quickly in the state party.
The SPD-Left Party-Green coalition in Bremen has ushered in another drastic austerity programme for the coming year. Among other things, this includes savings in personnel expenses for public sector workers. According to initial plans, around 80 jobs are to be cut, with the exception of police and judicial personnel. Funding programmes are to be cut by €3 million and there are also to be reductions in social benefits.
The state government had suspended the debt brake for the current 2024 budget. Bremen has ruled this out for the 2025 budget. “We have to get our finances in order despite a weakening economy and lower tax revenues,” noted Finance Senator Björn Fecker (Greens).
The social attacks go hand in hand with attacks on refugees and democratic rights. As the first “structural measure,” the Senate press office announced the redistribution of underage refugees. In order to save money here, the aim is to rely on “increased efforts by the state” and “consistent procedures” to redistribute young people to other states in the future, i.e., to deport them.
Thuringia, where Bodo Ramelow, the only “Left Party” state premier, remains in office after the state elections in September, has also backed Lauterbach’s reform. With the adoption of the Thuringia Hospital Act amendment at the beginning of the year, Ramelow’s Left Party-SPD-Green government laid the foundations at the state level for the planned hospital reorganisation and their classification according to service groups.
The acting minister for health, Heike Werner (Left Party), claimed that the hospital reform was primarily about cooperation and networking and announced that there would be no hospital closures in Thuringia. This is obviously a lie. The truth is that even before the reform, a large proportion of hospitals in Thuringia were already facing an uphill struggle, and the latest decisions will only make this worse.
Last summer, the largest hospital in the state, Jena University Hospital, reported a considerable financing need. The state’s 32 hospitals and polyclinics, as well as more than two dozen research institutes, employ around 7,000 people. The Regiomed hospital chain, with sites in Neuhaus, Sonneberg and Hildburghausen, has already filed for insolvency in Thuringia, as has the Sternbach Clinic in Schleiz.