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The Basic Law under the black-red-gold standard. On May 23, 1949, the Parliamentary Council meets for the last time for solemn signing. Photo: dpa
After the experience of the Nazi dictatorship, there was no majority for nationwide health system. The Federal Constitution's competences in this area have been restricted to the indispensable minimum. Two days before the final vote on the Basic Law, on May 6, 1949, the Parliamentary Council made final, but not very promising, motion to include medical self-administration in the priority legislation of the federal government. The proposal came from Hans-Christoph Seebohm (1903 to 1967) in the ninth session of the plenum. Seebohm was delegate of the Lower State Parliament in the Parliamentary Council, member of the German Party and from 1949 to 1966 Federal Minister of Transport. In my experience, which I also had the opportunity to gain as the health minister of my country, it is absolutely right not to regulate the provision on the right of doctors, dentists etc. to self-govern at the state level, but to provide for federal framework legislation. And Seebohm went on: I would therefore like to ask you in the interests of the medical profession, which is the only way to restore your medical regulations, which you have worked out over decades and which has only been defaced in the past by compulsory regulations, give the medical profession the opportunity to exercise their right of self-administration within the framework of such federal law and to come together again to form uniform doctor's regulation, etc. There was no longer any discussion of this proposal. With show of hands, the majority of the delegates, under the leadership of Konrad Adenauer, spoke out against federal regulation of medical self-administration. The Basic Law, which was promulgated on May 23, 1949 and was strongly influenced by federalism, restricted the priority legislation of the federal government in the health sector to measures against publicly dangerous and communicable diseases in humans and animals, admission to medical and other medical professions and the medical trade, the trade in medicines, healing - and narcotics and poisons. It was only in the context of its responsibility for social insurance that it became the responsibility of the federal government to ensure uniform regulation of statutory health insurance physicians. Presumably, Ludwig Sievers, President of the Lower Medical Chamber, who was also the chairman of the Association of Statutory Health Insurance Physicians at the federal level, was involved in Seebohm's application in the background.The application also corresponded to resolution that the first post-war doctor's day in Stuttgart on 16./17. Adopted October 1948: The 51st German Doctors' Day calls for uniform German Doctors' Ordinance, which incorporates the essential provisions of the Reich Doctors' Ordinance. He asked the future West German government to draw up guidelines that are authoritative for the legislation of the individual countries.
Konrad Adenauer , the President of the Parliamentary Council, puts his name under the Basic Law. Photo: dpa
However, at the time of the Stuttgart resolution, important preliminary decisions on the future allocation of medical self-administration had already been made. The constitutional convention on Herrenchiemsee, which met in August 1948 on behalf of the Prime Ministers of the federal states, had already judged the later Basic Law that the health care system should be largely matter for the state administration. However, it was not specified what exactly should be understood by the term health care. At least admission to the medical profession should be federal competence. But even this assignment was hardly discussed by the Parliamentary Council on September 1, 1948 in Bonn in the committee for questions of jurisdiction. Here the Bavarian delegate Wilhelm Laforet (CSU) tried to enforce the position of his state government that admission to the medical profession should also be regulated by state law. In doing so, however, the Hessian delegate Fritz Hoch (SPD) drove him into the parade as supporter of more centralized solution: You are going back even further with the doctors than is the case in the past or today with the craft and any other profession. I consider it completely unthinkable that someone who is doctor in Bavaria and wants to move to the Hessian area has to have new license just to be able to practice his profession. That's unthinkable, and I think the whole medical profession would make fun of us. Walter Strau (CDU), also from Hesse, accused the doctors of trying to regulate the approval at the state level for reasons of safeguarding the vested interests of the refugee doctors. After the surrender, the doctors ran away in heaps from the east, so that today the east is largely bare of doctors in the country [. . .] in every village in the west there is university professor as doctor who ran away in the east. As result, we have an overcrowding in the medical profession in the West, and not just in Bavaria. But this problem cannot be solved by restricting admission to the profession. Laforet finally accepted at the committee meeting on Nov.October 1948 federal responsibility for admission to the medical profession on the condition that medical self-administration, including compulsory medical association membership, would fall under the responsibility of the federal states. The vote of the 51st German Medical Association in October 1948 did not seem to have impressed the members of the Parliamentary Council . The medical professional representatives realized too late that targeted lobbying in Bonn would have been more effective than public declaration of intent. If we want to get chance at all in Bonn, it is high time the Basic Law was in its second reading yesterday, wrote the managing director of the Association of the West German Medical Associations, Rolf Schlgell, to Herbert Britz, the first chairman of the Marburger Bund, to Cologne. The attempts of the working group to influence the Parliamentary Council with their ideas were unsuccessful. In mid-December there was response from Bonn that further attempts were probably superfluous because the legislative process was already too far advanced. But the medical professional representatives did not want to give up completely yet. In Bonn, their delegates tried to convince members of the Parliamentary Council of the need to transfer medical law from the competence of the federal states to the priority legislation of the federal government. In his function as chairman of the Marburger Bund, Britz formulated corresponding petition to the parliamentary groups in the Parliamentary Council in January 1949. However, Strfeuer also came from within their own ranks. The President of the Bavarian State Medical Association, Karl Weiler, used his relations with Bavarian delegates, including Wilhelm Laforet, in the Parliamentary Council to persuade them to reject federal competencies in medical law and against intentions that were too centralized in circles, especially those of the North German medical profession. At the meeting of the main committee on February 9, 1949, in which the final reading of the Basic Law was prepared, Laforet spoke out, as before, against the inclusion of medical law as part of federal competence. Only the two representatives of the Center Party and the KPD sat in the main committee for inclusion in the priority legislation. On May 8, 1949, the Parliamentary Council passed the Basic Law with 53 votes to twelve after several amendments. The three western military governors gave their place on May 12th, and the federal states also voted in favor of the draft, only Bavaria voted against the Basic Law because it did not appear to be too federalist, albeit with the ability to recognize the Basic Law if two thirds of the federal states ratified it which was the case. The Basic Law was promulgated on May 23, 1949. Thomas Gerst