Spa Cuts Are Water Torture for Germans

BAD LIEBENWERDA, Germany —  Feeling a touch arthritic? An American doctor might send you stumbling to an aspirin bottle. But here in Germany, the national health program may put you up for three weeks at a spa, like the one in this village of 6,000, where you will be pampered with mud packs, whirlpool bath soaks, fragrant walks in piney forests and expert massages.

Hay fever? Americans do antihistamines. But here in the land of the economic miracle, your doctor may see to it that you go seriously horizontal amid the cool, trickling stalactites of a cave and enter upon a course of “breathing gymnastics.”

Husband and kids driving you nuts? Germany offers “mother-recovery cures” to burnt-out hausfraus who want to sit alone by a lake for a few weeks, bask in thermal waters and leave it to an attendant to report to their homes each day and get dinner on the table.

Germans have long taken Kuren, or cures, earnestly, especially since imperial times, when Europe’s queens, czars, court composers and poets promenaded in splendid “cure parks” and “took the waters” at spas such as Baden-Baden in the Black Forest. After World War II, the arrival of new political structures brought on the democratization of this aristocratic tradition, making regular spa visits the prerogative of practically any working stiff or worn-out retiree.

Volcanic mud, sulfurous water, algae--Germany puts much stock in the curative powers of these simple resources, and today there is an assumption that everybody should benefit and the state should help pay. German workers don’t even have to use vacation days to go to a spa. They can take virtually unlimited sick leave.

Or at least they could.

Now, however, they find even their beloved spa benefits besieged as the chill winds of economic stagnation blow across Germany. Eleven percent of the work force is officially unemployed, the nation now ranks 25th on the World Economic Forum’s competitiveness list, and Bonn must wrestle with a yawning budget deficit that defies the government’s goal of participating in a historic European currency unification, scheduled to begin in 1999.

Chancellor Helmut Kohl’s government has been looking all year for ways to trim the state’s financial fat, casting gimlet eyes over everything from farm subsidies to military contracts.

The threatened cuts may look mild from American shores, but they have touched off a massive case of NIMBY syndrome here.

“Everybody knows Germany needs radical change, but nobody wants it for themselves,” says Angelika Volle of the German Society for Foreign Affairs. “The attitude of every single person here is: The situation is so bad that everybody but me has to do something about it.”

Perhaps on no other field is this economic battle so poignantly waged as that of the spa, with its columned thermal baths and Old World elegance. To the budget cutters in Bonn, the spa--often equipped with such dubious health enhancers as casinos, chamber orchestras, dance floors, even ski slopes--may be the ultimate symbol of welfare-state excess. But German spa operators are fighting back with statistical claims that spas not only lengthen lives but even save the state money.

“Whenever politicians need an example of unneeded health treatments, they turn to spas,” says Andrea Eisenbaum, spokeswoman for the German Spa Assn., a trade group. “But this isn’t right.”

Each day, deep under the weird, steeple-shaped rock formations of the Bavarian village of Pottenstein, asthma sufferers gather in the clammy gloom of a dolomite cave, hoping to ease their labored breathing. They lie on waterproof chaises, wrapped in fleecy blankets, reading and listening to Walkmans as cold water drips down on them from the rocks overhead.

“They’re not supposed to sleep,” advises cave attendant Josef Deinleim. “They’re really supposed to breathe.” And he heaves and huffs, demonstrating the correct form.

Alan Leff, chief of pulmonary medicine at the University of Chicago Medical School and editor of a 2,200-page compendium on asthma, says there is no evidence that lying in a wet cave can relieve the disease--”in fact, it could make things worse,” he says.

But don’t tell that to the people of Pottenstein. Village brochures boast a 70% recovery rate, attributed to Pottenstein’s unusually moist air, both below and above ground.

“It’s soothing for the lungs and the bronchial passages,” explains Andreas Berner of the village recreation office. “You can notice the difference when you drive to Nuremberg.”

In fact, a visitor to Pottenstein might be forgiven if he didn’t immediately notice the curative air: There are too many distractions in the way.

Tiny Pottenstein has a castle, two museums, half-timbered inns boasting house-brewed beer, a slide billed as the longest in Europe, a gazebo with an oom-pah-pah band, swans, paddle boats, an indoor swimming pool, a sauna, hiking trails and a trout hatchery where you can order a piece of smoked fish awash in garlic butter. Not satisfied with all this, the village is now building a natural swimming pool, enclosed by cliff walls.

All of which is certainly good for the soul, but for the body? What about all that garlic butter? Or those waitresses at the cafe right next to the mouth of the cave? Every time a patient emerges blinking into the sunshine and orders a cup of coffee, they inquire, “Some cream and cake to go with it?”

It is precisely these goings-on--the blending of obscure, if not dubious, “health treatments” with obvious holiday fun--that have Bonn’s budget cutters gunning for the Kur.

“Spa costs increased by 73% from 1991 to 1995,” says Max Theo Gassner, director of the social insurance department of the Bavarian state Health Ministry. In 1995--the last year for which statistics are available--spa visits cost the federally administered pension and health plans more than $8 billion, he says. The number of spas increased during the same period by 30%, Gassner adds.

Part of the increase is justifiable: East Germany had just merged with the West at the time, forcing upward adjustment of all the national statistics. But most of the sector’s growth had nothing to do with either unification or health, Gassner says.

“Companies,” Gassner says, “just realized that this is a very attractive, very sure market. And you know, there is an economic law that says that if you create supply, demand will rise to meet it. These companies built one cure center after another, and according to the laws of economics, the more beds they built, the more the patients came.”

Everybody covered by the national health insurance system in Germany is entitled to a cure. If you seek medical care and say you want one, and the requisite time has elapsed since the last time you had one, your doctor will prescribe it. You don’t have to have a specific, serious ailment. It is enough to say you have too much stress or something like that. The insurance covers it.

If you have something really devastating that can’t be treated in just three weeks--for instance, if you’ve had an accident and need major recovery time and physical therapy--a doctor can prescribe a longer cure.

And by the time the average German emerges from a spa, he or she has rung up an invisible tab of about $4,000.

In Bonn, Health Minister Horst Seehofer thinks that is not only enough but way too much. No more disguising vacations as medical treatments and billing them to the state-run health plan, he says. As of this year, cure visitors must pay for a bigger chunk of their treatments themselves.

Spa inpatients must now pay $13.50 per day, instead of the $6.50 they paid before Seehofer’s revolution. Outpatients can claim only an $8 per diem for their lodgings. Everybody is supposed to use some of their vacation time now.

And you can’t take a four-week cure every three years, as in the past; now, you can go only every four years and stay just three weeks. Although the individual increases sound tiny, they can add up. Bonn hopes they will produce savings of $4 billion per year.

So far, the changes have had exactly the effect the government wanted: As soon as people had to start paying for their cures, a lot of them decided they weren’t sick after all.

“People think, ‘OK, if I need warm water for my back, then I’ll go to Spain. There I’ll have warm water too, but not all these exercises and other rubbish,’ ” Gassner says.

But while the government gauged the public’s reaction correctly, it may have miscalculated the wrath of the spa industry. The German Spa Assn., which represents more than 300 cure centers around Germany, says a third of its beds are now empty and that 150 member clinics have had to close as a result of the cuts. About 20,000 people are losing jobs, says spokeswoman Eisenbaum--just when unemployment surges into the nation’s biggest political issue and the government is supposed to be promoting job creation.

“The government has to pay these people’s unemployment benefits,” Eisenbaum argues. “It has to pay for doctors and pills for the people who aren’t getting spa treatments anymore. We are not saving one pfennig. We are spending more.”

As it turns out, the spa industry has an impressive array of statistics to back up Eisenbaum. Though you’d be hard pressed to get an American insurer to pay for your basket-weaving classes, Germans make reasoned arguments that by doing so here, the system saves itself money.

This is because Germany has a generous, state-run pension program; as long as a member stays in the work force, he and his employer keep paying premiums into the national kitty. For the system to remain solvent, workers have to be kept at their desks and assembly line posts--and out of retirement--for as long as possible. And, although conventional medicine cannot explain why, statistics across Germany show that people who go to spas tend to retire later in life.

“All specialists in this country believe that in the long run, the cure has economic benefits,” Gassner concedes.

Here in Bad Liebenwerda, the spa fulfills its economic purpose through the use of “iron mud” from the nearby swamps. Patients, most of whom complain of joint disease, lie in baths of steaming mud, walk through troughs of cool mud, soak their elbows and feet in bowls of mud and knead bucketfuls of mud with their arthritic hands. They also get massages, weight training, lectures on living with chronic disease, rides in zero-gravity slings, even basket-weaving courses to reduce the stiffness in their fingers.

“The specialty of this swamp mud is that it can store warmth and also transfer it to the human body,” says Siegfried Baumert, regional director of the RHM Group, which operates the spa. “Wherever you have problems with your joints, the blood circulation is worse than usual, and that means the temperature is lower than usual. The mud can give warmth quickly to these places without giving it to the parts of your body that don’t need it.”

Despite these claimed benefits, Baumert says that Bad Liebenwerda is suffering from the government’s austerity campaign. The RHM Group acquired the Bad Liebenwerda spa after the end of East German communism and restored it according to the government’s own projections of joint-disease incidence in this region.

No sooner was the renovation finished than the budget cuts came through and Bad Liebenwerda found itself woefully overbuilt. “It’s frustrating,” Baumert says.

Lawmakers from the spa-rich states of Bavaria and Baden-Wurttemberg are stumping in Bonn for a rollback of the spa cutbacks. Even Kohl--who takes a cure each year, in Austria--recently paid lip service to the beleaguered industry by attending the centennial celebrations of Father Sebastian Kneipp, a 19th century Bavarian priest who gave rise to an arresting new cure by sitting naked in the freezing Danube River to rid himself of tuberculosis. (Adherents say it worked.)

But the budget cutters are holding their ground. On a recent day, even though the Bavarian Health Ministry had donated floor space to a “Kneipp Fair” and the lobby was full of nuns handing out cups of herbal tea and visitors rolling around the floor on giant balls, Gassner was upstairs preaching the lean, mean gospel of change.

Instead of begging for renewed subsidies, he said, Germany’s spas should be looking for new, private markets--perhaps even in the United States.

“We have very good, acute medicine in Germany,” he says. “We’ve been looking at prices on the Internet, and we know we can do a hip replacement for one-third less than the Americans, with their crazy court system of strict liability and punitive damages.”

Already, the bolder German spas are looking for such market-driven opportunities, he says. But most remain wedded to the old, unaffordable ways.

“They are like sleeping dogs that you have to carry to the hunt,” Gassner says. “They have been in a collective system. And when you’re in a collective system, it makes you lazy.”