Tuesday, July 18, 2017

An overview of German healthcare you might find interesting

If you're news savvy at all you've no doubt heard that the Republicans have been unable to get a new healthcare plan through Congress, and everyone is freaking out because ObamaCare is failing fast and there is no replacement on the horizon.  What I've never heard discussed is whether anyone has bothered to look outside the US to see if there is a model elsewhere we might could adopt and tweak to fit our circumstances.  Just for kicks I did, and for my subject I chose Germany.  I picked Germany for no particular reason....just the luck of the draw.  Here's what I found:

Unlike Great Britain which has a single payer system (aka Socialized medicine), Germany's is a multi-payer health care system paid for by a combination of statutory health insurance, officially called "sickness funds", and private health insurance, called "private sickness funds".   A 2015 survey found Germany had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it.  Germany has nothing similar to our HMO's.

All doctors in Germany are in private practice and are not employees of the government, and hospitals are "non-profit".  Health insurance is mandatory for the entire population in Germany.  Salaried workers and employees below the income threshold of almost 50,000 Euros ($57,700 US) per year are automatically enrolled into one of the 130+/- public non-profit "sickness funds" at common rates (no surcharge for older members, no pre-existing condition limitations), which is paid for with joint employer-employee contributions.  The fact that these funds are "non-profit" suggests to me they are run like regulated utilities are here....they're guaranteed to be able to cover costs, but no windfall.

These (private but no doubt regulated) "sickness funds" negotiate with doctors and hospitals for favorable rates, just as insurance companies do here.  The majority of Germans (89%) are covered by one of these funds.  Apparently these insurance funds just process claims, then forward them to the government for actual payment to the providers.  This is all funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level....15.5%, 7.3% of which is covered by the employer.  The indigent are also covered by something similar to our Medicaid.

This might at first glance seem high, but regardless of how you slice/dice it, after figuring in all employer/employee premiums, deductibles, and cash-out-of-pocket expenses, the average total healthcare expenditure per American per year is $9451, vs $5267 per German per year.  Total healthcare costs are 16.4% of GDP in the US, and 11% of GDP in Germany.  Germans do pay a small co-pay per doctor visit in order to discourage them from clogging up the system by going in for every sneeze and splinter.

For those making over the 50,000 Euro threshold, they can opt out of the public sickness funds and enroll in one of the 900 +/- private sickness funds.  11% of Germans prefer this private system.  These are competitively priced depending on the amount of services chosen (for example, some include dental and vision) and the person's risk and age.  Young, healthy people can likely save money by enrolling in one of the private plans, BUT, will pay much higher rates later as they age and need more medical attention.  The killer is, when that time comes, they can't just opt back in to the public system. 

The care received is NOT bargain basement, either.  For example, wait times:  83% of Germans can get an appointment with a specialist within 4 weeks, whereas 80% of Americans can get an appointment with a specialist within 4 weeks.  Wait times are slightly shorter for those with private plans.  The average hospital stay in Germany is 9 days, where in the US it is 5-6 days.  (The most common complaint here is they "sew you up and roll you out the door".)  Private hospital rooms there are not the norm, unlike here, and doctor's offices and hospital lobbies are not as lavishly furnished as they are here.  By most (?) metrics I could find (life expectancy, infant mortality, etc) Germans fared slightly better than Americans.  FYI....there are 2.554 doctors per 1000 residents in the US, and 4.125 doctors per 1000 residents in Germany.

I'll stop there.  My point is there are other countries (at least one) who have insurance coverage (vs universal single payer coverage) that we might look to for ideas.  Considering the German penchant for over-engineering everything they do, I'm sure there are many other details that I'm not aware of, but this seems like a fair overview.

Our hang-up is that many of us (ie: the Tea Party) say it's un-American to force someone buy insurance if they don't want to.  I find this to be a highly hypocritical argument as the same Tea Party-types all seem to like the Medicare and Social Security benefits they receive that they were forced to contribute to for their entire working lives.  And aren't we forced to pay school taxes, even if our kids are long since past school age?  Isn't that textbook socialism?  If we receive SS and Medicare and pay school taxes are we required to have a picture of Marx or Lenin hanging on our wall at home? *snort!*  IMO we need to get over it!

I say let's open our minds and find something better than what we have now.



  1. A simple transition would be Medicare for all. Medicare is not a "gold" plan. Everyone on Medicare has to pay a monthly premium and pay deductibles / copays. Higher incomes pay a higher premium. Those who fall below Medicare income levels are eligible for Medicaid. The greedy insurance companies still get their pound of flesh with supplemental insurance, dental and vision insurance (not covered by Medicare), and prescription drug insurance. The insured has the option of going it alone with Medicare or getting supplemental insurance at various levels.

  2. Obamacare is not failing fast. At least not until the Donald and the dimwits in Congress start fooling with its funding like withholding subsidies.

    1. Pat, perhaps you should get out and ask some small business owners and self employed business workers. The insurance companies who designed the ACA are going for max profit and raising rates 20 to 30% a year. They are also pulling out of states that do not make enough profit. This is not a political issue, it is simply people need health care and Insurance company's want to stay in the 1% top earners. The ACA needs tweaking just a little to fix it so it will work as many hoped it would. Hopefully the nitwits in Washington will pull their heads out and see that.

  3. It's a lie that Obamacare is collapsing, although for seven years the Republicans have done everything they could to kill it. The states that supported it, like Kentucky, did very well. Obamacare needs to be fixed, not repealed. Its a lie that Republicans want to work with Democrats. If they did, they'd be holding open hearing.

  4. I can already hear the voices about how this wouldn't work here, because "we're Americans" and "we're special/exceptional/different" and "if you like it so much, why don't you go back" and "socialism."

    Arguments that it would benefit everyone - because it'll be CHEAPER - will fall unto deaf ears.

  5. Obamacare is not failing fast. At least not until the Donald and the dimwits in Congress start fooling with its funding like withholding subsidies.