Germans Confused Over U.S. Healthcare Debate

Their public healthcare system reached a record surplus of $5.28 billion last year and is one of the oldest systems in Europe
The Lund Report

March 14, 2012 -- BERLIN -- As the Republican presidential candidates try to outdo each other over criticizing the Obama administration’s healthcare plan, several German healthcare officials who watch the debate in the United States are in disbelief as to why the American public doesn’t want a national plan.

Their reactions come as the German public healthcare system reached a record € 4 billion ($ 5.28 billion) surplus for 2011.

"For me as a German, what I cannot understand is that you make the question of health insurance an ideological question,” said Wolfgang Zoeller, a Bavarian politician who has spent the last 22 years in the German parliament or Bundestag.

Americans talk about whether having a national health plan “is going in the direction of Socialism or Communism,” Zoeller said in an interview in the Bundestag. The nearly 70-year-old politician said he’s far from being a Socialist, noting that he had recently voted to reduce bureaucratic problems surrounding Germany’s inheritance tax.

“For me the question of a national health insurance is a humane question. I would like that every person, regardless of his or her age, income, pre-conditions or financial possibilities, be helped if they are sick.

“Otherwise you have the famous phrase: Because you are poor, you have to die earlier. And I don’t want that,” Zoeller said.

Germany has one of the oldest public healthcare systems in Europe and while the rules can get complicated, it’s based on a simple principle: If you make more money, you pay more into the system. The premiums are based on a percentage of your income. That’s why, as the economy booms here, the national insurance system is producing strong surpluses, Zoeller and others say.

Under the German scheme people who make less than the equivalent of $58,212 per year are required to have health insurance on the public plan. Those earning more than that can insure themselves on the national health plan -- and pay the top rate -- or they can opt for private insurance which is mainly for high wage earners and self-employed people.

Still most Germans are on the national plan, though many complain that they get second-class service compared to those with private insurance, which pays doctors more.

The legal requirement that people be insured – which is under attack by many in the United States – is accepted in Germany – not only by left-leaning parties, but by pro-capitalist ones. The current German health minister, Daniel Bahr, is a member of the pro-business Free Democratic Party and strongly supports the system.

“Not every S is about socialism,” said Ann Marini, a spokesperson for the Statutory Health Insurers in Germany.

“It’s not a socialism principle. It’s a solidarity principle,” she said. The idea is that everyone is in a big pool and feels connected to the community, she said. Marini said it’s really tough for people in Germany to understand the debate in the United States.

“In Germany we have a society that has certain rights and responsibilities for each of its members,” while in America it seems that there’s a strong tendency toward individualism.

“You (in the U.S.) have risks but you also have opportunities….but for us it’s clear. Health is a risk that cannot be placed on the shoulders of the individual.”

Marini is even more confused as to why Americans don’t accept a national health plan because she views the United States as a much more religious society than Germany, where people may be a member of a church, but hardly ever go.

She notes that most religions teach people to “love their neighbors” as a central part of what spiritual life is about. When this principle has such a central religious function – and the United States is so religious – “then why can’t you get it across that people should contribute a bit to support others, for example in health insurance.”

Image for this story by Armin Kubelbeck under a Creative Commons -- Attribution Sharealike 3.0 Unported license.

News source: 

Comments

Comparing Obamacare to Germany's national health system is comparing apples to peaches. Obamacare is not a national system, it's an order from the heavy hand of government, an order that it's citizens buy a product/service from a private-for-profit company, a product which exists for the same reason all other private companies exist, to make money and nothing else, or else they are criminals. That is to say, ... you must take YOUR money , money YOU worked hard for, out of your pocket each and every month, twelve months a year, for your entire life and, .. against your will,.. hand it over it to a private party, for a service we, and not you, mandate you have,.. and in the process enrich private business... in order to be a legal resident. Germany is not the U.S. and as far as I know they don't govern by our Constitution, which protects the free-will of every American and protects against intrusive government.

in spite of your rant I am happy to have my tax dollars pay to save your life or ensure you don't have an acute event that leaves your family, employer, etc., at risk. The provisions of health care and education are differnent form other consumable commodities given the devastating financial consequences associated with disparities in market economies. I hardly think that Otto Von Bismark was a modern socialist ---and he authored the current health plan that is successfully employed in Germany.

I agree that it is a poor comparison, mostly because the Obama plan was cobbled together with a huge amount of lobbying by the current beneficiaries of our healthcare system, by which I do not mean the patients, but the pharmaceutical and insurance industries, who do not wish to remove their greedy snouts from the federal trough. I definitely would feel differently about paying taxes for a functioning system that made sure everyone got taken care of than I do about being forced to financially support an ethically bankrupt system of private insurance and ending up still leaving many people high and dry in terms of affordable or available healthcare. Germany is a "single-payer" model similar to most Western democracies, and it certainly has not bankrupted the state or damaged healthcare options with "rationed" healthcare. In fact, their health outcomes are far better than ours, while their costs are much lower. And by the way, I lived in Germany for a year, and I can assure you that their constitution is just as supportive of individual rights as ours is. You are innocent until proven guilty, you're protected against unwarranted search and seizure, you have the right to free speech and free press and all the freedoms we enjoy, including the freedom against government intrusion into your private affairs. And it was tremendously easy to get healthcare, and I found it just as good or better than what I was used to in the USA. I'd love it if we imitated the German model here, and I totally understand why the Germans are baffled - it works for them and it would work for us, if only we can get the moneyed interests to stop buying off our representatives and have a real look at successful models like the Germans have developed.

The only problem with the healthcare reform act is that it still leaves us far behind what residents in other advanced nations have. The first commenter implies that other indutrialized nations' citizens don't have the great free choice we have in the US. Nonsense. The free choice on the health care issue in the US currently, is that we have chosen not to address the reality of almost 50 million people without proper access to healthcare. Our current system indeed says that if you are poor the rest of us are fine with you suffering more and dying earlier. That is indeed a twisted and inhumane sort of "freedom of choice." Indeed the US is not Germany. On this one issue, I would not hold that up as something to be particulary proud of.

Otto Von Bismark?? Germany?? That's rich. You should know better than the rest of us that German politicians in the 1930's didn't always make the best decisions

You may think you don't pay taxes now to provide health care to others - and you would be wrong. Roughly half of all the dollars being paid in the US today are for three big programs - Medicare, VA and military care. While there are small portions of that care paid by individuals - these programs are primarily funded via taxes. In addition, we all pay additional taxes to pay for the costs to society of caring for people in multiple ways - whether it be the costs of health care for prisoners; the costs of mental health care in various institutions or indirectly in the form of tax exemptions for nonprofit health providers like hospitals. Some portion of the taxes we pay essentially funds health benefits for government employees and to some extent for government contractors. I pay significant taxes and have for years and know that there are all sorts of inefficiencies that occur - in both the public and private sectors. As a per cent of income I pay more than many because I have not had much income other than the pay I and my spouse have earned. So I feel I have a right to be concerned about this as much as nearly anyone. But this idea that our health care system is being "socialized" by ObamaCare is mythical. There are many things about the law that I do not particularly like - but frankly the way it is structured just repackages some of the funding - arguably is perhaps a little less "socialistic" than what already exists. Even Ayn Rand at the latter stage of her life received taxpayer funded health care... Patrick Pine

The above commenters should read "The Healing of America" a highly readable book byT.R. Reid, columnist for the Washington Post, that compares our "system" with those of other developed and developing nations. Although the comparison becomes increasingly embarrassing, the conclusion is that we can easily use the experiences of other nations who spend roughly HALF as much on healthcare per person and achieve far superior outcomes in health for their citizens to design a superior product for Americans. What we have now is no systematic approach at all - that allows those temporarily without insurance to suffer or die needlessly. As a physician I have experienced this directly, and am ashamed for our nation that we have not done better. Don LaGrone, M.D.

No pre-existing condition exclusions, no rescinding policies when you get sick, and limiting private insurers' profit margins to 15% are some of the things Obamacare has in common with the German system. Another is mandated coverage which was not Obama's wish but the private insurance companies', who correctly argued that the insurance pool must be very large in order to keep premiums low. Despite the obvious fact that it's in everyone's best interest that everyone has health care, Pres Obama chose to entice, not force, people to buy coverage by keeping rates low. Interestingly the very same insurance companies who play by Germany's rules and make handsome profits doing so screamed bloody murder and refused to play along in the US without a mandate. Carol Simila

COPY THIS GERMAN SYSTEM,INCLUDING HIGHER EDUCATION FOR ALMOST FREE. I GUESS THE AMERICANS HAVE NOT REACHED THAT LEVEL OF IQ. MICHAEL ROETTGEN

I was in Berlin for a conference a few years ago. The doctors were on strike at the time. I was also told that many were leaving to work in Sweden, preferring the long dark winters to the frustrating conditions of work in Germany. Rather than quote bureaucrats and politicians in the system, perhaps it might be more informative to obtain the opinions of German patients and physicians.

"Submitted by Anonymous on Thu, 03/15/2012 - 10:32. Otto Von Bismark?? Germany?? That's rich. You should know better than the rest of us that German politicians in the 1930's didn't always make the best decisions" ha ha ha. please get your facts right! Bismarck lived 1 April 1815 – 30 July 1898, therefore was not a politician in the 1930's...

My family all still live in Germany. My aunt has had several medical issues relating to an automobile accident. She has struggled to get good medical care from the beginning. 3 to 4 people in one room, no privacy. Waiting weeks upon weeks to see doctors. We would do well in this country to really look at the European utopia and re-evaluate our goal to become a more socialist society. America is known for its independence and having the ability to choice what’s right for each one, not a mandated list of strict rules and regulations that have no personal or very little input. Ed

My mom is elderly and had cancer. No problems at all to get in asap and get treatment. Also other problems came up, chronic this time and severe. The doctor even comes to her house.

It is interesting to me that early in our nation's development, we recognized that our children needed a basic education in order to ensure the success and vitality of a growing nation. Every child in the United States has the opportunity to a publicly funded basic education. Why then do we not see that the health of a nation is as important. Interestingly enough the health system we have is so expensive that it has now crippling our ability to provide the 12 year education we were so committed to. A public education comes from the public paying for schools. Starting with the first community fundraiser to build a school and hire a teacher. Healthcare has become so expensive that education system can not afford health premiums for teachers and government funding has been cut to shift the money to healthcare. Our schools are closing and classrooms are over-crowded, our education system and our children are now failing and falling behind. This is not the sign of a powerful and viable society. It is sign of our coming demise. We are now unable to take care of our young, our old and our sick. Every person should have the opportunity to access preventive, basic and emergent healthcare, Every person should be paying into a publically funded national health system. And why not have options to buy into additional coverage plans. Every parent in the US knows their children has access to an basic 12 year education and they can choose to buy into private school if they want, and choose to buy a higher education. Why not do the same for healthcare? We are allowing our country/society to SLOWLY DIE; fiuguratively and literally at the same time! Heather Wilson, BHA

It is interesting to me that early in our nation's development, we recognized that our children needed a basic education in order to ensure the success and vitality of a growing nation. Every child in the United States has the opportunity to a publicly funded basic education. Why then do we not see that the health of a nation is as important. Interestingly enough the health system we have is so expensive that it has now crippling our ability to provide the 12 year education we were so committed to. A public education comes from the public paying for schools. Starting with the first community fundraiser to build a school and hire a teacher. Healthcare has become so expensive that education system can not afford health premiums for teachers and government funding has been cut to shift the money to healthcare. Our schools are closing and classrooms are over-crowded, our education system and our children are now failing and falling behind. This is not the sign of a powerful and viable society. It is sign of our coming demise. We are now unable to take care of our young, our old and our sick. Every person should have the opportunity to access preventive, basic and emergent healthcare, Every person should be paying into a publically funded national health system. And why not have options to buy into additional coverage plans. Every parent in the US knows their children has access to an basic 12 year education and they can choose to buy into private school if they want, and choose to buy a higher education. Why not do the same for healthcare? We are allowing our country/society to SLOWLY DIE; fiuguratively and literally at the same time! Heather Wilson, BHA

Let's stop pretending that America's healthcare system is the best in the world. Yes, it is among the most advanced in the world, but when it comes to overall outcomes, out per capita spending is higher while the health outcomes are lower. As the wealthiest country in the world, we should be appalled at our infant mortality rates- especially compared to other industrialized countries. Our system needs an overhaul and just because other systems have flaws, doesn't mean we can't improve upon them.

Let's also stop pretending that an American population is comparable to those of other first world nations. This clearly is not the case and thus attempting to make a comparison is nonsensical.

I was raised a devout Catholic in Ireland. I worked as an RN there and in England. I also worked in the Third World as an RN. After relocating to the USA I was dumbfounded when I first came by the comment on a Birth Center chart - 'no prenatal care due to no insurance.' I had not seen this situation since I had worked in Bangladesh 15 years before. This is a 3rd world standard in what is supposed to be the richest country in the world. Also, it is very hard that a non-affluent mom has to go back to work so soon after having a baby. The baby needs her for longer than 2 or 4 or 6 weeks. The maternity leave in Europe provides for Paid leave for 4 months, with the right to unpaid leave for a year at least after that. Where are the Feminists on this issue? Not a peep from NOW! Never!

That's actually not true. U.S. feminist organization like NOW, Moms Rising and others have tried to address maternity leave and family leave for years. It's just everytime the Democrats have tried to pass legislation like this the Republicans stand against it. In fact the little progress we've made with the Family Medical Leave Act the Republicans are trying to overturn (like last year's example w/Republican Gov. Scott Walker). Put the blame where the blame belongs at the Republican politicians doorstep, not that of U.S. feminists.

As a friend told me, and I truly believe it. If we spent more money on preventative care and not last minute life saving measures just to extend a life of a person who is elderly by having them have numerous hospital stays, procedures, surgeries, etc. when they could have just lived out their days with medications and as much comfort care you can provide. The bottom line is that healthcare won't be getting that big buck by not providing unnecessary medical care. That is just my opinion.

I partially agree with you, but I would do some thinking about "preventative" care. Much of this in the U.S. has been screening. I've read that there are large "grey areas" in medicine, and disagreements about the effectiveness of screening and some treatments. A case in point is PSA screening for prostate cancer, which according to recent reports is about as effecive as flipping a coin. It leads to unnecessary treatment, as most men with prostate cancer will die from something else. Two books I would recommend, among many: "Over Diagnosed" by Dr. H. Gilbert Welch "Your Medical Mind" by Jerome Groopman, MD & Pamela Hartzband, MD

We all understand that what we have in the US is a mess. Those outside the US probably do not accurately understand our issues or situation, though. The questions that I think are important to ask of any potential solutions, including PPACA/"Obamacare" and single payer plans are: 1). Does it achieve better value (more achieved at lower cost), 2). Does it respect patient autonomy, and the right to seek out what is best for self and family members? 3). Does it stay out of the way of innovation and the drive for excellence? My own answer is No on all of these, for PPACA and single payer. We will always need some type of safety net, whether private, public, etc, but current efforts to provide a safety net have the potential to destroy all that is still good in healthcare in the US. I think that we can do better; MUCH better! We already have a distinct lack of choices in health care and health insurance. More choices rather than more rules makes a lot of sense to me. Our government cannot force this, but they COULD get out of the way.

Sure, you say we have a lack of choices in health care and insurance. What you ignore is how many of us have NO choices at all. We simply cannot afford it. For myself, in my 50s, with no health problems or pre-existing conditions, they want approx. $400-600 a month. I simply don't make enough for that. The number of uninsured people in the U.S. is staggering and is ridiculous and unacceptable. Lastly, if we are going to insist on keeping health care in the private sector, you can forget about health care for all, because their primary motive is always profit. Just compare the costs of medical treatment, tests, and prescription medications for the U.S. compared to those of other countries with universal health care. The differences are staggering, and it's all due to profit motives. The current system of Medicare provides care at a fraction of the cost of private care; it's quite obvious that some type of Medicare for all would be the ideal situation. Then if someone is wealthy enough and they want to purchase private insurance, go for it.

My thoughts on this isssue are large and lengthy but i will leave it to a few things. my first comment is that by having this hodgepodge system of medicare/medicaid/social security/private payers/insurance/secondary insurances and other "free" systems, we have a multitude of price schemes. Each of is based off the other. My own hospital system gave away 100 million dollars in care last year which is absolutely amazing. I even took advantage of it while a poor college student. What this does though is basically burdens the cost of the cheaper versions on the backs of the more expensive/profit driven plans. If everyone was on one plan then our costs would go down overall. we wouldn't be paying for those who don't pay at all and prices wouldn't get inflated because of insurance and the drive for profit. I agree with the german sentiment that it isn't socialism to work together on something everyone needs. We have "socialist" things all over our society, the biggest being the military. We also have police, ambulances, fire trucks, road systems, bus infrastructure and electricity. Utilities are also under this category. Some things work better if the entire group pays for it and that will always leave some paying for a service they don't use. I almost never use the police/fire/ambulances but i get to have them if i need them. overall we spend nearly twice as much as germans and our healthcare system is way more inequitable. We may have fancier equipment but i doubt overall that germans are getting subpar care.

do we need healthare reform....... of course we do but not Obama's plan. Do I want the German's version here in the states.....of course not...It is not equal care to everyone.....I have lived under it and still have family living under it. I have seen prescriptions denied because the Dr. had met his quota for the month...however he could write one for you to pay out of pocket.....great but you are on low pension allready and not enough money to meet your needs. I have seen treatment denied in the hospital with my own mother....(btw she was 83 and had been burned in a hausefire) so please do not force this kind of care on us in the states.... Even on medicare you have a choice where you want to go and whom you choose for a Dr.... talk with the people that have to live under this kind of care...including Canada...England....if it is so good why to they go out of their country to get the care they need when they need it .

I have lived and worked in the German health care system and my entire family still does and everyone is very happy with their care. There will always be those who complain about everything. Fact is you have to pay very little for medication, and in all the years that I have worked in the health care system no physician I have worked with has ever denied care to anybody because they had met their quota, which by the way is determined by quarter and by specialty and not by month. As someone who is now working in the U.S. health care system and having experienced both I can only say, I take the German health care anytime.

The problem is that health insurance in the US is a business, 'for profit'. A small percentage goes toward patient care, while the majority goes to stock holders and CEO. No wonder they want to cut sick people out, once they have a terminal or chronic illness, because it cuts the profit. If you look at the German health insurance, it is 'non-profit'. They do have trillions in surplus now despite everyone being covered and terminal or chronic illnesses are 'allowed'. They are able to lower the insurance cost or fund another program with the surplus. The cost to the employee is 7.3% of their wage. As long as some 'fat cat' in the US makes money of health care, the system will likely be scrutinized for political gain since it will stay expensive. On the other hand, the uninsured will rack up ER costs and the tax payer will pay regardless.

As a German working in the US as a Nurse I can only wish we had a Health care System like we have at home and that counts for Dental Care ,too to many Patient have to suffer or skip their annual Check ups because their cannot afford them. I had a Dental Abscess a few month ago and was denied dental emergency care because I didn't had $1000 to put down upfront. Friends of mine made Calls all over to find one you accepts payments and we found one almost 300 miles away in Chicago. Things like this have to change not tomorrow or near Future but today. Make Health care and Dental available for every one not only for the Ones you can afford it.

I think there are some widespread misunderstandings about terms like "scientific evidence" when applied to current healthcare practices in our country. Contrary to popular thinking, most medical doctors (MDs) have limited academic training in the scientific method and in the statistical analysis of data, including the analysis of multivariate data. And this deficiency leads to widespread prejudice and bigotry, in an intellectual sense. For example, is the use of acupuncture, which continues to be used in modern Chinese hospitals, along with western medicine, "evidence" of its value in pain management? Is the use of acupuncture by veterinarians "evidence" of its efficacy, and beyond concerns by the less educated that it is "all in the mind" of the patient/animal? What about the MDs (Medical Acupuncturists) and other western trained healthcare professionals who want to adopt acupuncture into their practices under the term "dry needling" with very limited training? Are these professionals motivated by the belief that the practice of acupuncture actually works? Another example: Is the use of pharmaceuticals for off-label uses justified- i.e., those applications of medications for which no rigorous scientific studies, such as Randomized Controlled Trials (RCTs), have been undertaken? There are increasing concerns that many of these uses are harmful to patient health and that they have circumvented the pharmaceutical industry's own "standard' for scientific credibility. We could go on to ask if a Phase III RCT, with about 1000 patients, really covers the full genetic variation in the population to which the drug will be administered. If the sampling is limited, how do we address (i.e., quantify) the magnitude of the risks imposed on the population by these sampling errors and the widespread prescribing and use of pharmaceuticals for which we have limited safety information. Finally, regarding the widespread use of pharmaceuticals in “conventional” medicine justified by the outcomes of clinical trials( RCTs) , a recent review published in the Annals of Internal Medicine (What's in Placebos: Who Knows? Analysis of Randomized, Controlled Trials, Ann Intern Med October 19, 2010, 153:532-535) concludes that “Placebos were seldom described in randomized, controlled trials of pills or capsules. Because the nature of the placebo can influence trial outcomes, placebo formulation should be disclosed in reports of placebo-controlled trials.” Examples, such as the ones listed above, are numerous and show us the deficiencies in our current healthcare system brought about by the persistence of widespread ignorance in "conventional" medicine. Should pharmaceuticals and surgery be the only options in our healthcare system to manage illness and to promote health? Should MDs be the only healthcare providers to assess the scientific basis for "evidence"? The current thinking is that only MDs have the know-how to make judgments on all issues involving healthcare. To me, this is a biased position and, based on the evidence, has not served our country or our people well. As a scientist with three decades of professional experience in the sciences, I believe that some changes are definitely needed to the way "conventional" medicine is being practiced in our country. In my opinion, "evidence" should be linked to outcomes. And statistical measures will help us understand these issues better. Our "conventional" system of medicine, with its high expenses and relatively poor outcomes (i.e., ranked 38th in the world), is currently lacking the diversity in thinking needed to become more effective and more economical. To be more sustainable and resilient. Let us hope for a few years of inclusive thinking to fully assess what works in healthcare and what doesn't, with practitioners from other systems of medicine (i.e. ,Asian/Chinese medicine, Chiropractic, Naturopathy) offering their own input on how we can control costs better and how we can improve health outcomes in this country. PK Melethil, L. Ac.

Poor Germans, imagining that we in the US are discussing "health policy" when we discuss "health policy." It must be very confusing for foreigners. Let me help them understand. The Democrats are discussing "health policy" but the Republicans are discussing "why we don't want an African American President." and "how can we assemble a coalition of lower income religious people and upper income secularists into a coalition to retake the White House and control Congress." That's why they call it "Obamacare" and that's why their rage against the ACA, with its staunchly conservative notion of an individual mandate, first promulgated by the Heritage Foundation as the conservative alternative to the Clinton health reforms, is so steadfastly incoherent. There is nothing here to "understand" in intellectual terms. You have to grasp the unreserved passionate racism and vicious predatory capitalism of the Republican party. You have to see that this is about the Civil War, and the maintenance of racial and economic privilege. If we were discussing health care policy, it would be easy. But THAT issue is hardly on the table at all. What is going on is a retrograde, reactionary, racist effort to consolidate political power, even as America becomes more multi-racial, less "white", more Hispanic, and less economically strong. We are living through an economic and social crisis, an inflection point, and we do not even agree on what we are discussing... but I assure you the health care debate has little to do with health insurance or health care. So will all go on discussing health care in the knowledgeable press and academic contexts, but don't imagine for a minute that those erudite thoughtful discussions have anything to do with what "Obamacare" really refers to when used on the street and in political advertising.

All a German Health Care surplus tells us is that the German people were, at minimum, over taxed by the amount of the surplus. It tells us nothing of the cost efficiency of the system. The U.S. could have a Universal Health Care system with a surplus, we would just need to tax at such rate to guarantee said surplus. I'm not against some form of Universal Plan, but let's at least understand the funding structure before we get too excited over this.

Due to our superior health care, who hardly anyone can afford, we have a higher infant mortality rate and lower life expectancy than Germany. Surprised, anyone?