Germans Confused Over U.S. Healthcare Debate

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.

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

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.

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!

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.

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.

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 .

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?