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OPINION AND ANALYSIS

OPINION: Scholz is already out of step with Germany – it’s time for a change of course

Olaf Scholz has seen his popularity ratings plummet in Germany amid the Ukraine crisis. After a promising start, the Chancellor has retreated into Merkel-era habits that no longer match the country he is leading, writes Brian Melican.

Chancellor Olaf Scholz
Chancellor Olaf Scholz (SPD) at an April cabinet meeting in Berlin. Photo: picture alliance/dpa/AFP/POOL | John Macdougall

Contrary to what many commentators are saying, what’s most surprising about Olaf Scholz’ precipitous fall in popularity is not how quickly it has happened – but rather how slowly.

Both among German voters and our allies abroad, Scholz had, until very recently, been given the benefit of the doubt to a very generous extent. After all, it would be simply unrealistic to expect him to magic away in six months Germany’s sixteen years of accumulated backlogs: a stalled green energy transition, the chronic unattractiveness of public service jobs, potentially crippling overdependence on strategic rivals Russia and China…

No one expected any of this to get solved overnight, and at least it looked like Scholz and his coalition were making a good start. So there was a huge amount of goodwill.

In what seems like an eternity ago, back in early February when the Ukraine war was still a “Ukraine crisis”, Joe Biden welcomed Olaf Scholz on his first official visit to the White House and, despite the fact our Chancellor refused to make clear that Nord Stream 2 would be cancelled if Russia invaded Ukraine, called Germany a “reliable partner” and did his best to keep his frustration in check.

It was sensible, grown-up politics: instead of trying to strongman Scholz with a public shaming, Biden worked behind closed doors to get him on side. Most of Germany’s allies, despite increasing exasperation with our shilly-shallying, did likewise.

‘Man of the hour’

This approach paid off: in his Zeitenwende speech in early March, Scholz appeared very much the man of hour, cementing the impression I and many others have of him as someone who, while not wholly devoid of dogmatism, is nonetheless willing to change positions in the face of good arguments. Russia’s invasion of the Ukraine led him to reassess his stance to date, find it wanting, and correct it accordingly.

His honesty and solemn undertaking were rewarded with plaudits from our allies – and with an unexpected bounce in popularity among voters who, it turns out, had also been doing some thinking and had overcome their long-held distaste for military matters.

READ ALSO: Zeitenwende: How war in Ukraine has sparked a historic shift in Germany

Yet it’s been downhill from there on in. Essentially, Scholz’ speech wrote a hefty cheque that his actions since have not cashed. In the far-reaching nature of the foreign and defence policy shift he announced, Scholz displayed the strong leadership which he prides himself on delivering, only to then lose the courage of his own convictions.

Instead of using the momentum his volte face gave him to grasp the bull by the horns, he shrank back from any immediate measures which might prove too radical: no heavy weapons for the Ukraine; no embargo on Russian gas; not even any further major speeches. Yes, Germany has changed its stance and yes, Germany is supplying Ukrainian forces with much-needed material. Yet the overall impression – not just among Ukrainians, but among our allies and even the general public – is that it is still too little, too late and that, as ever, Germany is reacting in a sluggishly over-bureaucratic manner. The result is widespread dissatisfaction with Scholz’ government and, naturally, with Scholz himself.

In Scholz’ inability to make good on his pledge, there are three factors at play. One of them is beyond his control; the other two are of his own making.

READ ALSO: OPINION: How many massacres will it take before Germany turns off Russian gas?

Inherited problems

Firstly, Scholz is hamstrung by circumstances. Even those of us in favour of supplying heavy weapons to the Ukraine have to accept the damning assessment of every informed professional who has examined the Bundeswehr in recent years: our own forces are operating on a bare minimum. This severely limits what we can offer. And this inability to defend even ourselves, let alone our European allies, has been twenty years in the making. The same is true of Russian gas: while I argue for an immediate embargo, I do not deny that this would have serious effects on our economy and society – and that, here too, there is no magic wand that can be waved over two decades of criminally negligent energy policy.

Olaf Scholz and Angela Merkel

Chancellor Olaf Scholz (SPD) hands flowers to former chancellor Angela Merkel as she leaves office. Photo: picture alliance/dpa | Michael Kappeler

This is the situation we are now in. How we got here, however, throws an unflattering light on Scholz, who was, until he became Chancellor, Finance Minister in yet another Merkel administration which allowed defence budgets to remain below par, Bundeswehr procurement to go to pot, and our dependency on Russian gas to go from around 40 percent to 55 percent.

This is the second factor in Scholz’ current failure: although he has, commendably, identified past mistakes and promised a different approach, he is still proving unable to surmount his own habits and instincts. Even where other options would now be open, Scholz is still applying the methods of the Merkel years – delaying, delegating down to committees, and hoping problems solve themselves – in circumstances which he himself has publicly identified as radically different.

READ ALSO: ‘Too little, too late’: Scholz under fire for inaction on Ukraine

Here, the issue with the Marder IFVs is symptomatic: Rheinmetall has literally dozens of these armed people carriers sitting around which could be refurbished at relatively short notice, either to be sent directly to Ukrainian forces or cascaded down to the Bundeswehr to replace any supplied to Kyiv.

Scholz is sticking to the unconvincing line that Ukrainian soldiers couldn’t be trained to use them in time – in spite of the obvious fact that the country’s forces have already lasted longer than anyone thought they would and that the war is now clearly going to drag on. Zeitenwende politics this is not. I’m not alone in expecting proactive executive action here: Scholz has a problem when MPs in his own coalition generally well-disposed towards him such as Marie-Agnes Strack-Zimmerman repeatedly take to the airwaves to denounce his “prevarication”.

No sign of a Zeitenwende

And that is the third factor at play here. Regardless of actions taken or not taken, in stylistic terms, Scholz is not living up to his own hype. This is what, in my view, is denting his popularity the most. No one is expecting miracles, but having come to power implicitly promising to explain and justify his policies more than his predecessor Angela Merkel – who preferred to preside, sphynx-like, over proceedings – Scholz has now, after a promisingly communicative start, retreated back into the Chancellery. His silence, both on the Ukraine and on other pressing issues (especially Covid policy) is leaving too much room for interpretation – and dissatisfaction.

German tanks at a military training ground in Saxony-Anhalt

German tanks at a military training ground in Saxony-Anhalt. Photo: picture alliance/dpa | Klaus-Dietmar Gabbert

No doubt, Scholz is hoping to himself “do a Merkel”, keeping a low profile and becoming entrenched to the point where Germans cannot imagine life without him and so eventually come to adulate him. Times have changed, though – and as the Chancellor who coined the term Zeitenwende (“change in times” or “turning point”), nobody should be more aware of that than Olaf Scholz.

Germans are changing with the times, and now expect more than aloof Merkel-style management of our various national weaknesses: they want the sustained, systemic change Olaf Scholz said he stood for. And the change needs to start (or perhaps: start again) at the top with him. Scholz can no longer count on the benefit of the doubt.

READ ALSO: OPINION: Germany has been forced to learn the lessons from its post-war pacifism

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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.

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