As far as health care is concerned, Bavaria, as viewed from Reiner Luyken's look-out in Achiltibuie, may seem to his Scottish Review readers well-nigh perfect, except in one important aspect. Reading his assertion that the 'insurance-based social security and health system, whereby benefits reflect contributions, is valid all over Germany' (my italics), I wondered whether a reader with no experience of the German health system might be somewhat taken aback. Can Mr Luyken really mean: the more you pay in, the more you get out?

At a macro-economical level this is bound to be the case, since if nobody paid insurance contributions, there would be considerably less money in the pot. Here, then, 'contributions' actually means: the nationwide sum of contributions annually. At ground level, however, the system, like the NHS, thrives on the solidarity of its participants. Those with higher incomes, who therefore pay higher insurance contributions, do not receive more or better benefits, but are treated with the same kindness as all other patients.

The German 'system', by the way, is a national or statutory health insurance scheme financed not only through the means-tested contributions of employees channelled to the Krankenkassen (which are non-profit making medical insurance companies, and in fact public bodies), but also by employers' contributions and a national annual contribution by the taxpayer, set from 2017 at €14.5 billion. Contributions by employees and employers (currently set at 7.3% each, although the Krankenkassen are apt to ask for a top-up – from employees only – of around 1%), as well as the already mentioned ring-fenced sum allocated annually from taxes, flow into the national Health Care Fund. Its job it is to collect and distribute the total sum to the Krankenkassen (distributions according to numbers of insured and their specific needs – e.g. companies who can show they insure a greater proportion of older members are likely to receive more than companies with younger participants). The criteria and processes for the division of the total income are complex and, as one might expect, subject to perennial controversy. The federal ministry of health publishes much of the data on its website.

My – inevitably simplified – description might serve to make the view from Achiltibuie seem even rosier than it already did through Reiner Luyken's somewhat fondly focused telescope. I must therefore add that 10.5% (8.8 million) of those who are currently health-insured in Germany do not participate in the 'system' as described, but have instead chosen to insure themselves privately (and here it really would be correct to say: the more you pay in the more you get out). It is also thought that several hundred thousand people live in Germany without any medical insurance at all. Although no reliable figures are available, it is likely the number who are vulnerable in this way has increased as a result of the refugee crisis.

Iain Galbraith
Wiesbaden, Germany

Hands up all those for whom Catherine Czerkawska’s article on identity crisis resounds loud and clear. And how many are of such divergent ancestry? Not me for one – my Scottishness is half Tummelside Perthshire and the other half Glendale Skye – but I am equally as fervent a Scot as I am a believer in my country’s belonging to an international community of European peoples.

For the past 46 years, I have lived and worked in Italy, which in the eyes of some, I am sure, disqualifies me from weighing into the debate. To allay such doubts, however, I have allowed my right to vote in the United Kingdom to lapse while never giving serious thought to applying for Italian citizenship since, for years after stepping off the train in Turin, that would have meant giving up my UK (and hence Scottish) identity, by which I claim the right to express my tuppence-worth here.

Of the many differences that set Scotland apart from England, being a part of Europe is now the most significant. Proclamation by referendum alone raises it to the ranks of the independence issue with a timing that underpins its relevance – too late from indyref to be a coat-tail effect but sufficiently later to attest that those in favour of independence are still in place. That potential was understood by Alex Salmond whose failure was his inadequacy to explain the currency issue to an unusually sophisticated and demanding electorate. Salmond’s vision however is amply vindicated by that same sophisticated and demanding electorate voting with the same courage and forthrightness as before, for Scotland to follow a diametrically opposite path from England towards its future – eventual independence.

I have often cringed at Britain’s peely-wally consideration verging on the disdain of the highly moral principles on which the Community is based and from which it draws inspiration, and how that projects as a 'oh-well-I-suppose-if-there’s-really­-nothing-better-I-may-as-well...' approach. It annoys continental Europeans no end and triggers the knee jerk reaction of 'do the English think we’re a latter-day colony?' You either belong or you don’t, but just like any form of association you take the rough with the smooth. You don’t claim the moral high ground and then give the cold shoulder to the moral issues such as they may be, as witness the English government’s request that Brexit signify free circulation of goods but not of people.

Just as Carlo Azeglio Ciampi, the late Italian president of the republic once famously remarked 'I am a European citizen born in the land of Italy', so do I declare myself a European citizen born in the land of the Scots.

Donald Bathgate
Turin, Italy

Cafe is SR's readers' forum. It is open for short pieces on any subject and replies to other pieces. Send your contribution to rachel@scottishreview.net

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