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.
S
I read an interesting article in the newspaper this weekend discussing the sky-high cost of the American health care system. Because they are so visible and their fees seem so high (at first glance), doctors get the rap as the primary cause of our borderline-affordable medical care nightmare. Turns out they aren't even close to being the highest paid links in the health care chain.
The story reported that the average surgeon makes $306K and a general practitioner makes on average $185K. Considering all the education they must complete and the ungodly amount of medical school debt they assume, not to mention the literal life-or-death role they play, I don't think they are overpaid at all.
And just FYI, the average nurse makes $61K and the average emergency medical tech makes $27K. I think we patients are getting off cheap!
So where are the all the big bucks going? The story suggested too much goes to administration / executive compensation. For example, the average insurance company CEO makes $584K, the average hospital CEO $385K, the average hospital administrator $237K.
Of course, the bigger insurance companies and hospitals pay WAAAAAY more than that. Aetna CEO Mark Bertolini was given a salary in 2012 of $977K, with total compensation amounting to $36 MILLION! Even the CEO of mid-sized New Jersey health system Barnabas Health made $21.7 MILLION total compensation in 2012 when he retired. They also had 20 VP's who made over $350K each.
It seems the United States' $2.7 TRILLION health care system is top heavy with administrative costs, to the tune of 20-30% or $606 per American. By contrast, health care administration in France costs $277 per person, Germany $237, and Canada $148. (And for the record, citizens of those countries all have longer life expectancies than Americans.)
Doctors here are even protesting, too. "Among doctors, there is growing frustration over the army of
businesspeople (medical coders, claims adjusters, medical devise brokers, etc) around them and the impact of administrative costs which
are reflected in inflated charges for medical services", they say.
So how can these guys justify their enormous incomes? They say "large pay packages are necessary to attract top executives who have the
expertise needed to cope with the complex structure of American health
care, where hospitals and insurers undertake hundreds of negotiations to
set prices."
Talk about job security! You make the system so unbelievably complicated very few can decipher it, then demand a King's ransom to oversee the mess you created.
But when Obamacare was in the planning stage, who did they turn to for advice and political support? The insurance companies and big hospital systems! Well DUH! (I guess they sorta had to, but still, their advice had to have been "cover your ass" biased.)
Maybe I'm getting way ahead of myself, but I'm wondering if that tiny little speck I see on the horizon coming headlong towards us isn't a single payer health care system....what its detractors call "socialized medicine"?
My foreign friends say their system works well and we shouldn't be afraid of it. Many Americans seem to think it will suck us all into a black hole of doom. Me? I have no clue.
I guess we'll just have to stay tuned.
S
I read a news story online this morning that began with the headline, "Treatment Cost Could Influence Doctors Advice To Patients". It seems that "influential medical groups....are recommending that doctors
weigh the costs, not just the effectiveness of treatments, as they make
decisions about patient care."
It's a slippery slope, to say the least.
This is the ammunition the "single payer" medical care advocates have been waiting for. They have been pointing out with limited success that the best medical care is reserved for the wealthy, or at least the more well-to-do, while the rest of us have to make-do with something less.
It's a practice that has apparently been quietly acknowledged within the medical community for some time, but it hasn't become well known to the general population....yet. I think it just stepped into the spotlight.
"Single payer" health care is a system in which the government, rather than private insurers, pay for all health care costs. It's what they have
in the UK, Canada, Australia, and many other, mainly European countries
with a hefty "social safety net", supported by high taxes.
Proponents say it is the fairest way to see to it that everyone, regardless of their economic status, can get good quality health care. Health care is a "right" we should all have equal access to, they say. Detractors call it "socialized medicine", the key word being "socialized"....think "socialist". *circle the wagons!*
On the one hand, the thought of our government administering anything sends cold shivers up my spine. I can't imagine a more worthless work force than that mob of "civil servants" in Washington today pulling in bloated government paychecks.
But on the other hand, I have friends in the UK and Canada and Australia and elsewhere who report that, all-in-all, the single payer model works well. Wait times for elective procedures are often very long, but when they finally happen they won't send the patient straight to bankruptcy.
Not surprisingly my doctor, with whom I've had long talks with about this, and I would imagine my SIL "Doc" Chris, the insurers, etc. are scared to death of it. But to an economically stagnant middle class it probably looks pretty good.
I think in the future, probably sooner rather than later, this will become a top burner political issue. And it's gonna be a nasty one.
S
