This morning I had my regular dentist appointment. It didn’t turn up anything noteworthy. I don’t floss well, so there was a bit to do for the dental technician to get my teeth cleaned nice and well. Maybe I’ll improve my floss routine for the next few weeks a bit again just to gradually have my motivation for it fizzle out afterwards. On the bright side, I don’t have cavities. Overall, my dentist always expresses satisfaction with my overall dental health. I do have what he calls “abrasions”, though. That’s because I clench my jaws while I’m asleep - probably also when I’m not asleep. But at night is just the most convenient time to put in a dental splint as I have a habit of not eating or talking during that time. The check-up appointments with my dentist usually also serve for letting them have a look at the state of my bite-guard. This led to a slightly awkward situation for me as I had to tell my doctor I had decided to move to some generic product from the internet over the custom-made appliances he had hooked me up with the previous years. You see, in 2025 I bit through a total of 3 separate splints. There is a point to be made just about the sheer amount of plastics I swallowed because of this circumstance. But the real reason behind me looking for alternatives was the price point. On Amazon, I can get a pair of bite guards for 20€. That’s 10€ each. And those aren’t even the cheapest option. I just went with them because they somehow seemed a bit more trust-worthy than the others. Generally speaking, however, I don’t have high standards. It’s fine for me that they are bulky - I can get used to that. To be honest, at the rate I bit through the professionally-made models my doctor anyways went with thicker and thicker models. They are also more rubbery, so I think there might be fewer parts coming off that I will swallow at night. Amazon also has fully custom-made ones for less than 100€ on offer for anyone that is skeptical of the generic thermo-plastic ones. Now compare that to what the dental guards I got from my dentist cost me: Each one came in at around 450€, putting me at roughly 1350€ for one year. That is 45 times the amount I now pay for the one from Amazon. And so far, they seem to have similar durability. It’s still 4.5x the amount of custom-made “free market” offerings. It just didn’t seem cost-effective to me to pay this much money for something that might as well just be a piece of wood to keep my jaws separated.

At crossfit I have a buddy who works as a dental lab technician. When I told him about my struggles and that I would go with a dental guard from the internet he was surprised. “If it’s paid by the insurance anyways why even worry about the price?” he asked me. I pointed out that I get to pay the money out of pocket (at least initially). But even if that wasn’t the case, the money would need to come from somewhere. Insurance companies don’t print Euro bills in their basements to my knowledge. For a while now, there has been an ongoing discussion in German media outlets that our health system is too expensive. Well, German health insurers are complaining frequently and premiums go up every so often that it’s hard to lose track of the topic. Let me quickly outline the situation as it presents itself to regular citizens like me. At the core of the German health system is the division between public health insurance and private health insurance. Employees must have health insurance, so most of us Germans come into contact with the system. There is multiple options on either side of the public/private divide that can vary in what services are covered under insurance and other bonus programs. However, you are only free to choose to go into private health insurance if your yearly income exceeds 77,400€ (as of 2026). The most noticeable differences in everyday life between the two forms are:

1. Doctors are more happy to take you when you have private health insurance because the can ask (AFAIU) up to 2.3x the price for the same service as they can bill publicly insured patients.
2. For publicly insured patients, doctors are interacting directly with the insurance company to get compensated. If you are a private patient, on the other hand, the first recipient of the doctor’s invoice is you and it’s also you wiring the money to the doctor, not the health insurance. You will ask your insurance to reimburse the money to you.

Point one indicates there is a pricing catalog for each form of therapy doctors can prescribe and enact to their patients Everyone doctor only can ask a certain amount of money for a procedure because every insurance is only going to pay exactly what is written in that catalog. And yes, this system is absolutely causing certain procedures to be over-prescribed.

From point number two you can already derive which category of insurance I am in. While it is more inconvenient, I do think being able to see the invoice and having to act on it is a good thing. It influences personal behavior and reduces the risk for mistakes or even fraudulent invoices. On the other hand, private health insurers also need to validate incoming reimbursement requests, potentially leading to more effort and costs on their end. I hear that the newly rolled-out German electronic health record service also has a feature to access the invoice information. It may be doubted, though, whether without any active involvement in the invoice settlement process people will look closely at what doctors are billing their insurance.

But aside from a more or less believable spend control aspect, why is the German health insurance space designed the way it is? I didn’t research this really, but the availability of different companies to choose from indicates to me that the idea is to somewhat bring market dynamics and competition into the space. As was brought up earlier already, with everything being priced according to a centrally defined catalog, this is kind of a tough goal to achieve.

Personally, I was never with an insurance that my parents hadn’t already picked for me, though. Maybe that is just due to my own laziness, however.

So, from what I understand, once you cross a certain income threshold, the government starts trusting you enough that you can graduate from a fully-imaginary toy market to a slightly-less-imaginary toy market when it comes to choosing your health insurance company. I will freely admit that, politically speaking, I am an opponent of egregious over-spending. I also believe in the concept of distributing life’s inherent risks across all members of society fairly. Phrased differently, nobody should die of a curable illness because they are lacking the money for medication. But in between, there is a wide spectrum of cases that are not as easily categorized into one of the two extreme ends “preventable death” vs. “unnecessary over-spending”. To bring these two points into balance, sure, why not try with a market model to rationalize spending if possible? E.g. Prophylaxis is an area that also makes an extreme amount of sense - invest small earlier to prevent high costs later. Economics is telling us clearly that overspending on prevention on the individual level statistically amortizes across the whole population. Unfortunately, applying statistics quickly gets us back into unethical territory. It hasn’t been too long ago that women in private health insurance had higher premiums than men just because of their gender. Only in 2013 the European supreme court ruled that health insurances always have to follow an “Unisex Tarif” model. So, apparently health insurance companies are in most cases restricted from performing risk analysis on their customers. Unlike with banks, I don’t think there is much money to be saved in service costs if the company restricts itself to only customers that know how to use the internet. I may want to research this, though.

Speaking of things I want, I don’t know where I want to go with this. I don’t think there really is a market, nor do I think there should be a market for how we handle individual health matters. What I believe to be true is that it will always be the case that more money buys you more. In a world where all the patients that are now in private health insurance were to be merged back into public insurance it is still very conceivable to see private extra insurances becoming the norm to have access to better treatment. Sure, one could try to forbid this by law. Then only the very rich who can afford private doctors (and maybe people with connections or unafraid of bribery) will have preferential treatment. But I can’t even tell you if I think that is an improvement over what we have currently.