[lotsofpulp]

Are taxes used to subsidize the "public insurers" as defined by your comment?

Otherwise, I do not understand how the risk pool could possibly work. It seems like much of the healthy and young people would buy "private insurers", and the sick and old would be denied, so they would have to go with "public insurers".

But then that would mean the prices would be sky high for public insurance compared to private insurance?

[MandieD]

One wrinkle: you have to be on public insurance if you're employed and making less than about 60k EUR/year (adjusts with inflation, more or less) AND (starting a few years ago) have been working less than three or four years. You get an exemption to the earnings rule if you're part time during the early parental years.

So that's how they make sure that most of the healthy, young people are in the public insurance system for at least a few years.

[lotsofpulp]

Sounds like people who earn more money can opt into a less costly risk pool, and people who earn less are forced into a more costly risk pool?

And because this was becoming too lopsided, they sacrificed the newest generation of higher income workers by requiring they be in the costlier risk pool for a few years?

[hef19898]

Not at all. The private insurers limit the risk pool by excluding stuff, or denying people. The public risk pool is the vast majority of the 80 million Germans. And the whole health care system is basically built around this system. Nothing is becoming lopsided, and nobody is sacrificed, because the public coverage is really good.

EDIT: Regarding public coverage, the only supplemental insurances that are actually really useful are extended pay beyond the legal limit of 6 weeks per diagnosis and additional dental coverage. Other than that, I cannot imagine a worse case than cancer, and I got chief surgeon treatment 2 weeks after the diagnosis while being in under public insurance. So the system works just fine, even in some of the worst imaginable cases.

[distances]

After a certain age you can't any longer switch from private to public insurance (exceptions exist). This is meant to prevent exactly such cases where you'd use cheap private insurance when young and healthy, and cheap public insurance at old age.

[hef19898]

Taxes are not used to subsidize the public insurers. The risk pool is, as pointed out in the sister comment, that basically the majority of Germans are in the public model.