High-Income Earners Reject Universal Citizens’ Insurance

Dirk Ziems

More comprehensive exams, shorter waiting times and sometimes lower premiums than for statutory health insurance: most beneficiaries of private health insurance advantages are healthy people with a high income. But which party does this target group vote for? concept m has examined exactly this question.

After talks for a “Jamaica coalition” between the Christian Democrats (CDU/CSU), the pro-business liberal Free Democratic Party (FDP) and the Greens (Bündnis 90/Grüne) have failed, CDU/CSU and the Social Democrats (SPD) are now negotiating about the political future of Germany. The parties have very different views on asylum and migration policy; but the universal citizens insurance, demanded by the Social Democrats, has become a contentious issue as well. SPD demands the abolishment of the dual health care system in order to put an end to Germany’s two-tier health care system.

Health inequalities across the voter spectrum

German market research institute concept m has interviewed citizens on their party preferences and asked them for a self-evaluation of their health. It is striking that compared to people who are enjoying subjectively good health (“very good”, “good”), those in rather poor health (“poor”; “rather poor”, “satisfactory”) tend to cast their ballot for the Social Democrats, the Green Party or the Left Party (Die Linke). According to the study, 20 percent of those in bad health vote for the Social Democrats compared to 17 percent of those in good health. Another remarkable result is that more than half of the interviewees voting for the Social Democrats, the Greens, or the Left Party respectively report being in poor health. These parties favour a new solidary universal citizens’ insurance. CDU/CSU, FDP, and the far-right Alternative für Deutschland (AfD, Alternative for Germany) want to stick to the current dual system of statutory and private health insurance. Supporters of these parties mainly self-evaluate their health as good, which makes them in turn belong to the group that tends to benefit the most from private health insurance schemes.


Social gradient in health

The study has shown: the lower the socioeconomic position, the worse the health. Taking into account the financial backgrounds in this equation, a significant correlation can be observed: the lower the income (monthly net income per household), the higher the number of those who rank their health as rather bad. Income enables people to access various material resources, a low income can therefore have a negative impact on general life, housing or working conditions (e.g. bad working conditions, cheap and unhealthy food, limited access to the health care system), which can in turn put people’s health in danger. At the same time this means that high-income earners have more opportunities to influence their health in a positive way. Both factors play a role to get accepted by private health insurance providers. Good health makes the premiums drop and a high income is a formal criterion (at least for employees) to get accepted into a private health insurance scheme.


High-income earners tend to vote FDP and CDU

Accordingly, high-income earners expectedly have a tendency to vote for parties that want to keep the current health care system. There is a wide income gap between the voter groups. FDP voters take the lead with an average monthly net equivalent income (weighted income by number and age of people in the household) of €1,678, followed by CDU/CSU at €1,561. Voters of the Greens (€1,326), AfD (€1,319), and SPD (€ 1,293) have a visibly lower net equivalent income. Voters of the Left are at the bottom of the league with €1,115. Significant differences therefore show between CDU/CSU or FDP voters on the one hand and supporters of SPD and The Left on the other hand. Compared to these groups, non-voters have the lowest income.


Parties satisfy their voter groups when it comes to health

The parties actually satisfy their voters in terms of their health care policies. It is only consequent for CDU/CSU and FDP to stick to the current health care system considering their voters who tend to be healthier and high-income earners. For voters of SPD and The Left, however, a solidary universal citizens’ insurance would probably be more advantageous than the present system. All in all, it is the state’s responsibility to ensure security at all times and throughout crises. It remains highly questionable nevertheless whether the Social Democrats will be able to stand their ground regarding this topic in the upcoming negotiations. The coming weeks will tell.

About the study: In September 2017, concept m interviewed 1,000 citizens across Germany in a study with survey and market research firm SSI. Among other questions, the respondents were asked about their party preferences and to self-evaluate their health.



Joanna Czock Projektleiterin concept m

Joanna Czock

Rochus Winkler Co-Founder and Shareholder concept m
Rochus Winkler


Dirk Ziems
Dirk Ziems ist Experte für tiefenpsychologisches Marketing und berät auf Basis von Markt-, Medien- und Kulturforschung weltweit Unternehmen und Konzerne in zahlreichen Branchen und Ländern. Als Mitbegründer der Global Research Boutique Concept M und der Marketingberatung Flying Elephant begleitet er Themen wie die Adaption von Erfolgsprodukten in neuen kulturellen Kontexten, das tiefe Verständnis neuer Konsumgenerationen in China und USA, die Transformation der Werbekommunikation in der neuen digitalen Medienwelt oder die Neuorientierung der Brands in Post-Corona-Zeiten. Dirk Ziems ist auch als Gastdozent an verschiedenen Universitäten tätig.

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