One of the sticking points in attempts to form another grand coalition government in Germany is the country’s mixed public-private health insurance system.

The Social Democrats campaigned on merging the two. Their argument is that the one in ten Germans with private insurance (mostly people with yearly incomes over €50,000) get better care: shorter waiting lists, more services.

Angela Merkel’s Christian Democrats have so far resisted the center-left’s push for reform, arguing:

• A single, government-run insurance program would be a step toward a British-type National Health Service, which few in Germany want.
• Competition between public and private insurers keeps both sharp.
• Private insurance premiums — €37 billion last year — fund medical innovation.
• Because doctors can charge private patients more for the same service, the current system keeps costs down for most patients. The 10 percent of Germans with private insurance pay about 25 percent of all doctors’ fees.

Social Democratic Party leaders caved on the issue in the first round of talks but are now getting pushback from their regional branches and members. They may yet demand reform as the price for supporting Merkel.