The Long Road to Long-Term Care Insurance in Germany

ABSTRACT This paper represents a case study in welfare state expansion. It takes an actor-centered point of view and reconstructs the long process which has ultimately led to a compromise solution to the problem of providing long-term care, especially for the elderly. It describes the previously means-tested arrangement of long-term care provision and its shortcomings. Furthermore, it sketches the different stages through which the political debate on this issue has passed during the last twenty years: from the initial phase of defining the “social problem”, to the final stage when the approval of the compromise package became a question of “all or nothing”. The analysis of the politics of long-term care insurance reveals that the difficulties of reaching an agreement mainly resulted from the complex decision-making situation. It was in essence a problem of decision-making under conditions of general uncertainty.