The party DIE LINKE criticises the fact that privately insured persons are not part of the community of solidarity and therefore demands an obligatory insurance for all citizens in the SHI. It is questionable, however, whether privately insured persons under the umbrella of the SHI would strengthen the solidarity principle.

In the SHI, solidarity means two things: on the one hand a balance of low and high risks. This is because people insured contribute regardless to their individual risk. On the other hand, social compensation is achieved by the fact that the individual contribution is paid as a fixed percentage of earned income or pension instead of a premium that corresponds to the average expected SHI-expenses. The solidarity principle could only be strengthened by the integration of so far privately insured persons, if they lower average risks than the insured in the SHI system, or if they have above-average level of contributory income.

So far, however, there has been a lack of scientifically based studies that compare the risk characteristics of privately and statutorily insured. There is evidence that at least civil servants have a comparatively unfavourable age structure and would therefore burden the risk balance under the SHI umbrella. The findings on the average level of income of privately insured that would be subject to contribution in the SHI system also show a mixed picture. Without an additional expansion of the contribution assessment base, it is doubtful that those previously privately insured will be able to ease the burden of social compensation in the SHI system.

Regardless of whether the entire population is compulsorily insured in the SHI, the ageing of the population leads to an increasing burden on the solidarity compensation in the pay-as-you-go system. Members of younger cohorts will have to shoulder significantly higher contributions than members of older cohorts. At the same time, this also means that contributions to the solidarity-based balance will increase from cohort to cohort. However, this intergenerational load shift cannot occur in funded health insurance schemes. Moreover, the integration of so far privately insured cannot help to eliminate the causes of the disproportionately strong growth in expenditure in the SHI system.