Social insurances and the culture of solidarity: The moral infrastructure of interpersonal redistributions - with special reference to the German health care system

摘要

Social insurance schemes have proved to be rather stable welfare state institutions enjoying broad popular support. It is widely assumed that the high degree of legitimacy is due to the insurance analogy because those schemes provide individually equitable returns on prior contribution payments. In this article it is demonstrated that all social insurance schemes contain interpersonal redistributions on a large scale, resulting from uniform contribution rates, provisions geared at social adequacy of benefits, and unequal treatment of different birth cohorts. In Germany, those redistributive elements are most pronounced in the statutory health care scheme. It is argued that the unchallenged functioning of social insurances is dependent on a prevailing culture of solidarity. It denotes an immunity to the temptation of individual utility maximization based upon recognized moral duties which then facilitates ongoing redistributive processes. Results from qualitative interviews with persons insured with the German statutory health care scheme clearly indicate the presence of those solidary virtues. The continued existence of this moral infrastructure appears to be less threatened by progressing individualization. Rather, it might be eroded by current political attempts to shift the balance between solidarity and self-reliance which intensify mistrust in the permanence of comprehensive health care protection.