> Public health care is affordable but often not available. Private health care is available but often not affordable.
Well, we both know that those are the same in the end. It's not like there are seperate CT scanners for private insurance patients, but the later are treated with priority as they can be billed more.
> How can these two goals - affordability and availability - be met in one system?
I think this is a problem of prioritizing and financing.
For one, I would immediately stop and forbild all private health insurances in Germany and make being member of one of the public health care insurances mandatory. Also public employees would have to pay their share for all social services. All of them, just like any other employee.
This will right away stop this whole BS with prioritizing private patients over those with public healthcare and it will also fix lots of financing issues in the long run.
Once that is done, pay the same money for everything at all places and also pay all (equally qualified) doctors the same. Obviously some kind of expert council will have to decide a fair price for everything, but in the end a CT scan should cost the same around the whole country.
If we have established this, lots of problems will solve themselves: Doctors will move out to the rural areas too, because the money is the same. Also with more money, we can pay better prices, build up new medical infrastructure and what not.
We provide and finance so much infrastructure because we find this to be a fundamental part of our society, but we fail so hard on medical infrastructure. That just doesn't fit together.