SHARE
COPY LINK

UKRAINE

OPINION: Germany has scuppered Nord Stream 2 but there are questions left to answer

After Russia officially recognised two rebel-held regions of Ukraine as independent states, Germany mustered the strength to call an indefinite halt to Nord Stream 2. Better late than never, writes Brian Melican, but why was the pipeline project allowed to get this far in the first place?

A sign for Nord Stream 2
A sign for Nord Stream 2 with the slogan "Committed. Reliable. Safe." Photo: picture alliance/dpa | Stefan Sauer

If, as the old dictum goes, a week is a long time in politics, then a month is an eternity – especially when one of the politicians in play goes by the name of Vladimir Putin. Just a month ago, I wrote about Germany’s willingness to give the Russian president not just the benefit of the doubt, but seeming carte blanche to ride roughshod over Eastern European nations’ right to self-determination – and about our apparent unwillingness to stop the crazed pipeline scheme poised to finally render our gas supply wholly dependent on Russian imports. Now, on 22/2/22, Nord Stream 2’s number is finally up.

READ ALSO: OPINION: Germany is in a muddle over Russia – and it only has itself to blame

The snap decision to halt Nord Stream 2 has not come one second too soon. And, oddly enough, we have Putin himself to thank. Essentially, in suddenly deciding to recognise breakaway Ukrainian regions long under his control as “independent” last night, he has finally done enough to make our leaders in Berlin wake up and smell the samovar. After all, with Russia firmly in the grip of a megalomaniac authoritarian now so patently intent on redrawing the boundaries of Eastern Europe, even the most Moscow-friendly SPD government politicians now have to recognise that it would be nothing short of unconscionable to flick the switch on the new pipeline – one which would up the percentage of Russian gas in our imports to way north of 50 percent, making us eminently blackmail-able, deprive Ukraine of much-needed transit fees from Russian gas currently flowing through pipelines across its territory, and would be perceived as treachery by our allies in Europe and North America.

Eleventh-hour realism

For all this sudden bout of eleventh-hour realism in Berlin is welcome, the delay in decisive action here – and the lengths to which we allowed Putin to go prior to it – remain quite simply scandalous. Even when approved in 2005, the pipeline was controversial: many energy sector experts never thought it essential to Germany’s gas supply, especially given that we were already (on paper at least) committed to a green energy transition; moreover, the environmental damage was always going to be non-negligible and the costs high. All this should have been enough to rule the pipeline out from the start, even in those geopolitically more relaxed times before Russia went renegade. Yet work went on apace as the Grand Coalitions and the CDU/FDP administration of 2009-2013 inexplicably kept backing the project despite increasingly vocal concerns raised here and abroad.

The fact that Russian aggression in 2014/2015 and its annexation of Crimea were not seized upon as another pressing reason – and an ideal excuse – to kill off this wholly unnecessary project before it got anywhere near completion will undoubtedly be the subject of a parliamentary enquiry. Many MPs in the new intake were still in school when work began on Nord Stream 2, not in the Bundestag, and so will quite rightly demand to know how it can be that the pipeline was actually finished in September last year (just as they were being elected) and filled with gas before it was stopped at the very last possible moment. Surely, they will ask themselves, somebody could have and should have done something earlier.

So Angela Merkel will need to come out of retirement briefly to explain how, after her predecessor Gerhard Schröder had approved the pipeline just weeks before switching from the Chancellery to the Kremlin payroll, she allowed German foreign and energy policy to continue on and on down this damaging dead-end path for so long – even as she led a European sanctions regime against Russia in the wake of its incursions into the Ukraine. Her Foreign Minister, then Vice-Chancellor Sigmar Gabriel, one of Schröder’s protégés, will also have some squirming to do as young MPs from his own party, the SPD, ask him to explain his unwavering support for the project in office – support he has toned down since retiring to a transatlantic think-tank. His predecessor in the Foreign Ministry, Frank-Walter Steinmeier, may also have some questions to answer – little more than a minor inconvenience for him, no doubt, given that he is still active in Berlin politics, having just been re-elected as nothing less than our president. And they will definitely want to talk to Manuela Schwesig, freshly re-elected as Minister President of Mecklenburg-Vorpommern, to find out why she helped misdirect state funds into a supposedly charitable organisation set up for the sole purpose of completing the pipeline in the face of US sanctions.

Nord Stream 2

Manuela Schwesig (SPD) visits a Nord Stream 2 construction site in 2021. Photo: picture alliance/dpa/dpa-Zentralbild | Jens Büttner

An abject failure

Yes, Nord Stream 2 is an abject national failure in which almost every leading German statesman and woman of recent decades has had a hand. The fact that it will now, mercifully, not go into service and allow Russia to further destabilise the Western alliance on which we depend for our security, cannot erase this from our record. It will, however, allow us to start rebuilding trust with our key military and economic partners – notably France and the US, both of whom had, as we pressed ahead with the pipeline regardless, began to doubt our morality and/or sanity of late. It will also offer reassurance to countries in the Baltic we are pledged to defend: after we delivered 5,000 helmets to the Ukraine (and nothing more) a few weeks back, the likes of Lithuania were, understandably, starting to wonder just how serious we are about hemming in Russian aggression. Better late than never.

READ ALSO: How will the Nord Stream 2 freeze affect Germany’s gas supplies and prices?

There will be those out there who will argue that this is all part of some clever ruse, a last-minute switcheroo in which Russia, thinking it was about to get us hook, line, and sinker, now finds itself with an expensive and quite useless rod lying out of reach on the Baltic seabed. This would, however, be overstating the case. Germany simply allowed Nord Stream 2 to get far too far, depleting its reputational credit and lulling itself into a false sense of energy security instead of going green as planned. Now, just as our nuclear power plants have gone offline, we are scrambling to get neglected off-shore wind projects going again, and Russia has throttled deliveries through existing pipelines, we find ourselves in bleak mid-winter with historically low gas stores and a pipeline that won’t go on stream. This is not strategy – or certainly not good strategy – and a March cold-snap could make the wait for spring feel interminable.

So while a week or a month may indeed feel like a long time in politics, the real eternity here was the unbroken 17-year period in which Nord Stream 2 enjoyed Berlin’s backing. We now have less than 17 months to break our dependency on Russian gas for good.

Member comments

  1. Let’s just hope Europe won’t go cold in the intervening time it takes to find an alternative to Russian gas, nuclear has been ruled out which leaves renewables the best option.

Log in here to leave a comment.
Become a Member to leave a comment.
For members

OPINION AND ANALYSIS

OPINION: Why it’s becoming harder to get a doctor’s appointment in Germany

Germany's health service is known as one of the best in the world but securing a timely appointment with a doctor is getting harder. A creaking system and the culture around excessive doctor visits are part of the problem, argues Brian Melican.

OPINION: Why it's becoming harder to get a doctor's appointment in Germany

Germans have always been known for being health-conscious – some would even say hypochondriacs. That has its down-sides (see Covid…), but also some notable advantages. One is the ability to go to any doctor’s practice and request treatment, skipping general practitioners, referrals, and all of the attendant bother.

As a result, in any well-to-do area of a major German city, you’ll have a bewildering array of medical practitioners within walking distance, from general physicians (Allgemeinmedizin) and orthopaedic practices (Orthopädie) to ones that will have you Googling (HNO stands for Hals-Nase-Ohren – ears, nose, and throat – by the way. You’re welcome.)

The strength of this patient-choice system is that it allows people to manage their own care. So if one doctor can’t see you, you go and find another. And if you’ve moved towns or fall ill away from home, you can still access care. In theory, this spreads demand and keeps people with non-urgent complaints out of casualty wards. Yet in practice, the system is now creaking audibly. 

In recent months, I’ve tried to get appointments for several routine procedures with doctors’ offices I have been visiting for years – and the earliest I could get anything was, to my surprise, now several months off. Both dentists and dermatologists are currently, it would seem, planning their schedules for September and October. And when a rather unpleasant case of shoulder pain struck earlier this year (fittingly, just ahead of my 39th birthday…), the earliest appointment I could get at any of the three(!) local orthopaedic practices was at least a month off.

This isn’t just me getting unlucky here. In a recent representative survey, only 25 percent of respondents reported having no trouble getting a doctor’s appointment. The rest are having to wait anything between two weeks and two months – and I’m clearly now one of the 15 percent who report even longer delays. 

I’m not alone in thinking – knowing – that it didn’t used to be this way. So what has gone wrong? 

READ ALSO: Seven things to know about visiting a doctor in Germany

Structural changes in medical practice: fewer doctors working fewer hours

First off, there are changes afoot among Germany’s niedergelassene Ärzte – literally ‘settled doctors’ with surgeries, called so in order to distinguish them from hospital medics. For one, these doctors are getting old and retiring – just like the population they serve (or rather: have served). And as younger cohorts are less numerous, physicians looking to pass on their practices are having difficulty finding takers – especially in disadvantaged urban areas or out in the sticks.

A patient undergoes a consultation with his doctor.

A patient undergoes a consultation with his doctor. Photo: picture alliance/dpa/AbbVie Deutschland GmbH & Co. KG | AbbVie Deutschland GmbH & Co. KG

Even where there is no shortage of potential successors, ever fewer of them actually want to set up in business for themselves. For most young medics’ taste, there’s too much paperwork, too much commercial risk, and far too much work involved in running their own surgery. Instead, they prefer to merge with others or sell on to management companies who will, in turn, employ them (often part-time, with no annoying evenings or weekends on call). 

The results of all of this are as follows. Within the space of just one year, between 2022 and 2023, the number of surgeries fell by 1,987 – a drop of over two percent. Meanwhile, in 2023, for the first time ever, more than one third of Germany’s 150,000 non-hospital doctors were employees, not self-employed. That’s twice the number in 2013. Moreover, over the same period, the number of medics opting to go part-time has gone up by 235 percent to 60,000. This means that, if your local surgeries haven’t closed, the likelihood is that the doctors there are now working fewer hours – and so there are fewer appointments left to go round.

READ ALSO: Do doctors in Germany have too little time for their patients?

This would be bad news for any society, but it hits particularly hard in Germany. As a rapidly-ageing society with a relatively unhealthy population (high rates of smoking and obesity), our demand for medical services – often for complex chronic illnesses – is rising just as provision is declining.

Cultural differences in consulting doctors

Another problem is that Germans are accustomed to a historically high number of available doctors – and as serial worriers (and passionate sick-note seekers) make excessive use of them. Your average German racks up almost 10 consultations a year – not including visits to the dentists! The OECD average is closer to six. And the stoic Swedes, strong silent types that they are, go the doctor’s just 2.3 times a year.

Even if I wanted (or needed) to, I simply couldn’t to get to the quack’s almost once a month: I don’t have the time and they don’t have the appointments. But in conversation, I notice that others clearly do manage to find both. Increasingly, I’m wondering how many of them, unlike me, have private health insurance. 

This brings us to the third major issue facing non-hospital care in Germany. When the figures in the representative survey I quoted above are broken down, it transpires that almost 60 percent of people who are insured in the state system (gesetzlich versichert) are now waiting longer than two weeks for an appointment; among those who are privately insured (privat versichert), that figure is only 37 percent.

Doctors ‘keen on private patients’ 

Doctors are keen on private patients because their insurers pay more for the same procedures and will also cover all sorts of supplementary stuff – from the clinically-proven through to the just plain wacky. As such, practices reserve as many appointments as possible for private patients and try to keep the rest of us at bay.

Given that around four in five people in Germany are in the state system, however, this leaves the majority of patients competing for the minority of slots. If you want to see how the other fifth live, try “accidentally” clicking privat on surgeries’ online booking tools: you will now see a range of appointments available within days while the rest of us are being fobbed off for weeks or even months.

Not only is this, as my grandmother used to say, enough to make you want to join the Communist Party – it’s wildly inefficient. By restricting the hoi-polloi to slots often months off, doctors are creating their own appointment-management problems: sometimes, the complaint in question will have disappeared by the time the consultation rolls around; more often, it will have actually been dealt with – not infrequently by the same physician – if the patient presents as an acute case earlier.

As such, slots weeks away are booked, only to be cancelled later by conscientious patients (and left blocked by others), while those same patients crowd into waiting rooms begging to be seen urgently at an open surgery. (That’s how I got my shoulder looked at.)

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

The cynic in me says that, in the long run, this might not be such a bad thing. If the increasing scarcity of doctor’s appointments gets Germans thinking about whether they really, really need to be seen for yet another case of the common cold (“No, Christian, it isn’t pneumonia this time, either!”) or various nebulous self-diagnosed ills (Kreislaufbeschwerden (circulatory problems) is the day-off-work-one I love to hate), maybe it’s not a bad thing.

Swedes don’t die unnecessarily because they avoid the doctor’s: in fact, they live a good year longer than us on average. The German in me, though, says: “My shoulder hurts. Maybe I’ve got early-onset arthritis. I should probably go and get it checked out…” And even though I don’t go too often, I’ve got used to being able to see a specialist when I need one. It’s a shame that this is becoming markedly more difficult.

SHOW COMMENTS