Kali Tal

Musings on Sicko

I'm not sure where people are getting their information about the German health care system, but I believe it's incorrect.

I'm a retired U.S. university professor (and U.S. citizen) now living in Germany. I didn't have an ax to grind about the U.S. health system when I moved here because, as a state employee, I was covered by an excellent insurance plan in the U.S. The plan covered 80% of my expenses when I went to plan-approved physician, and 70% when I selected my own physician. As a member of the upper-middle class, I wasn't bogged down in the HMO systems and I can pretty securely say that I had just about the best insurance program and access to care that it's possible to have in the U.S.

After moving to Germany I realized, within a year, that the German system is hands-down better than the U.S. system in every way possible. I didn't expect it to be better, but it was. Here are the differences:

In the U.S. I paid $320/mo for my insurance policy. When I went to the doctor, I paid 20% or 30% of the costs, which get pretty high for those of us who have chronic (but in my case not serious) health issues. I paid approximately $250/mo additionally for medications purchased under my insurance plan, and an average of $50/mo as my part of the fee for doctor visits. Over a 10-year period I had a couple of emergency room visits and a surgery, and my total out of pocket costs for those came out to $3,500 (20% of an expensive surgery is nothing to sneeze at.) I figure my total health care costs were approximately $600-650/mo. In addition, I paid my taxes which (at my salary of about $55,000) amounted to about 33-35% (federal, state, and local)... none of which went to my own medical care.

Now... let's see what happened when I moved to Germany... In Germany (where I am not employed), my husband earns about half of what I did in the U.S. Because of our low income, he pays under 10% in taxes. My better-paid friends pay up to 35% in taxes, though I hear it can go higher if you earn a lot more money. Here, though, we get medical care included in our tax payments (12.7% of one's income a year under our plan), so that reduces the 35% quite a bit, meaning that we actually pay far lower taxes here than we would in the U.S. overall.

I'll give you two stories about access to medical care here. The first is as an uninsured person -- a "private patient" as they say here. When I first arrived on a tourist visa I developed a serious retinal condition. I went to the local doctor (office in our apartment building). His nurses decided that my case was too serious for him to handle and he sent me to an "expensive" (they warned me) clinic down the street in the prestigious Axel-Springer building. I went to the specialist, with no appointment, and waited for almost an hour in her waiting room. She saw me, gave me a thorough examination with the latest equipment, and gave me two prescriptions with the order to return in 2 days. Although I was worried about the cost, obviously my health was the primary issue, so I continued to go to this clinic as a private patient, for several months while they treated my problem. Some weeks I was there 2-3 times. I never waited more than an hour, and usually less than 15 minutes. In the end, she mailed me a bill which I was terrified to open. In the U.S., such treatment would have been in the many thousands of dollars. The bill read: "672 EU".

It got even better after I got married. I am covered on my husband's insurance policy and the amount he must add to his payment each month is minute and more than compensated by the tax break the German government gives him because I'm not employed. In effect, I get my medical care for free and we now get an additional several hundred dollars a month out of his (admittedly small) paycheck.

Doctor visits have a quarterly co-pay of 10 EU, and if you visit a specialist, it's an additional 10 EU per quarter to see each of them. Thus, if I go to my primary physician and see four specialists a year -- no matter how many times I see them! -- the cost is never more than 200 EU per year. Pretty amazing. On average, I wait a far shorter time in European doctor's offices than I waited in the U.S. In addition, I've never had a problem getting an appointment with a German specialist, though the date might have been as much as 2 months away in non-emergency situations. The wait time was similar for getting into the offices of U.S. specialists, or even worse. (For example, in Tucson, I was told that not a single endocrinologist was accepting non-diabetic new patients for the foreseeable future -- I had to wait 6 months and go to Phoenix to actually be diagnosed and treated.)

The level of care here is superb. In the U.S. I made a point of going to the best doctors no matter what they cost -- health, after all, is everything. I'm not naive about the field of medicine and have some background in physiology myself. It is clear to me that I get the best care possible here. And, just like U.S. doctors, they are careful -- in my case, they needed to rule out a brain tumor and they did not hesitate to send me to get an MRI, even though the possibiliy was remote.

Germans do complain about the quality of their health care, but it's important to remember that their complaints are relative to their own system... not to the U.S. system. I, too, would whine about a 2-hour doctor office wait... unless I'd been used to sitting for 4 hours. And I, too, would object to the 10 EU co-pay being raised from once a year to once a quarter (effectively quadrupling my health care costs) unless I'd been used to paying more a month than a German visiting four specialists pays in a year. Likewise the cost of medications might seem high at 5-10 a prescription (though many are free!) ... if I hadn't been paying $20-40 per scrip in the U.S.

In the interest of honesty, I will say that when I started going to the university medical clinic for my eyes, to see the best specialists in the country, I did find longer wait times -- sometimes up to 3 hours. But this is an exception since it is a teaching hospital and the specialists are overburdened. Unlike in U.S. hospitals, I found that the younger specialists are directly supervised by the senior specialists, and I have never had an office visit to this clinic where I wasn't examined personally by the head doctor. It was unusual to find my care was not relegated to interns or residents, as it is so often in equivalent U.S. teaching hospitals (where I've spent more time than I'd have liked).

As for the "collapse" of the German medical system... any examination of the figures shows this is absurd. Costs are indeed increasing, and taxes are rising in different areas, but again, they are nowhere near what most of us pay in the U.S. and we get so much less for our money.

This is why Americans should travel -- a brush with the European health care systems can be very illuminating, and an illustration of what we should be demanding from our own government. For all the hue and cry about the dangers of socialism I hear from both right wingers and libertarians, I simply can't see the reality of it here in Germany. Germany's not perfect, but in many aspects -- and particularly in serving the broadest spectrum of its citizens medical needs -- it is indeed better.

If you need still more reassurance, just take a look at the relative health of the German vs. the U.S. economy. On virtually every relative measure, Germans are healthier, live better, and are better educated than their American counterparts. It really is pretty embarrassing when you think about it, given our relative access to resources.

I'm not, of course, talking about the living conditions of the richest 5% of the American population -- the rich live well wherever they may be. But if you measure the quality of life of the other 95% of both societies, you might well be astonished at the results.

Of course health care is a right -- it's certainly one of the crucial foundations of "life, liberty and the pursuit of happiness" (or "property" if you prefer that version). And the U.S. is virtually the only developed nation that refuses to recognize that right. I find it sad when I hear Americans screaming loudly that people don't "deserve" accessible health care unless they can afford to pay exorbitant prices for it. And I wonder how durable their "get tough" attitude would be if they were faced with illness of a loved one or their own serious illness. It's a lot easier to say that strangers should die on the street, but a lot harder when it's Aunt Molly.

There is, of course, no convincing the hard core libertarian ideologues, who insist that selfishness is at the root of all human endeavor. But anyone who believes in empathy, in compassion, and in communal responsibility is going to have a hard time making an ethical argument against universal health care.

Posted by kalital at July 19, 2007 5:08 PM

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Comments

Posted by: Canuck at July 19, 2007 6:21 PM

Posted by: Kali Tal at July 20, 2007 11:03 AM

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