- The Rhetoric: German health officials and health policy analysts believe the two best features of their health care system are (a) solidarity and (b) income-based (progressive) premiums.
- The Reality: (a) 10% of Germans opt out of national health insurance and enroll in private plans and (b) 80% of those in private plans are civil servants and their premiums are paid for by government (taxpayers).
- Effect on Doctors: In the general system, primary care physicians operate with as many as 100 separate quarterly budgets for the services they provide; when they hit a budget ceiling, they stop providing the service until the next quarter.
- Effect on Patients: Ordinary Germans are traveling to other countries (even the UK!) to get services they cannot get promptly in Germany.
Full report by Ron Bachman here.
Socialized health systems around the world are finding there isn’t enough money to support the amount of needed services. This occurred once the demographics shifted from young to older workers where there was far more people taking from the community pool than paying into the system.
Ron’s report is most interesting — especially for what it says about the German mentality. The Germans he talked to seem oblivious to reality. They talk as though they were living in one world when they all apparently knew they were living in another.
Very good report.
I would hate to be a non-government employee in Germany right now.
Guess what, Ken. It’s not just the German mentality that is oddly out of focus. You will find the same thing in Britain, France and all over Europe.
People tell you that everyone has equal access and how great that is and then when you quiz them about the details, it turns out that everyone knows perfectly well that there is not equal access to care.
Agree with Bruce. Europeans turn their minds off when they try to think about health care. But guess what? The same thing is true of most health policy people in the United States.
Reading your criticism of the German system reminds me that many people believe that life on earth can’t achieve perfection until the Meshach finally arrives. You talk about how 10% of the population opts out of the German public system, what percentage of the population eligible to opt out do so? What percentage of civil servants have chosen to opt out? What percentage of high income earners and the self-employed (this is 20% of the people in private insurance, and the only Germans who have to actually pay private insurance premiums) have chosen to opt out of the public system.
As for the criticizing the German health insurance system as being unfair because only 90% participate in the public system, compare that to the US system. Some 15% of the US population has no health insurance. For years Medicaid’s pitiful provider reimbursement rates guaranteed that the poor would have inadequate health care access. Conservatives, rather then lobby for better Medicaid funding, talked up HSAs, which are designed to give the maximum benefit to high income earners. High income earners who also have the fewest health care access and affordability problems. The reality is whatever problems the German system may have; its fairness problems are invisible compared to the inequality of the US system.
Have experience with a German ED clinic some years ago. I’ll take the US.
As for inequity, I got to jump a huge line waiting to see the specialist I was referred to because I was paying, you guessed it, cash.
artk, I would bet that among German Americans there is no more inequality in the US than there is in Germany.
BTW, I thought Ron Bachman did a nice job on this piece.
I agree with Nancy. Ron, you really laid it out well. You were talking to a completely different mentality in Germany. Different at least from the way most people think at this blog.
The best part of the German healthcare system is that I got to spend a week studying it in their beautiful country meeting with some very interesting people.
I also recently spent time in Hungary where conservatives ousted socialists at the end of April 2010. This followed the election of the more conservative Merkle in Germany October 2009. With Cameron’s election in the UK, it sets the potential beginning of a global trend. The U.S. Tea Partiers are not a unique force for more limited government and controlled spending.
My impression is that other than home team pride, “Europeans don’t really want to be European.” We will see how the November U.S. elections turn out to see if some of our own home-grown nonsense is defeated.
Effect on Patients: Ordinary Germans are traveling to other countries (even the UK!) to get services they cannot get promptly in Germany.
-> Sorry, but that’s incorrect. Many Britains come to Germany for heart surgeries and similar medical procedures.
In general, the German system is not that bad. Few inequalities. Patients still get a lot without co-payment, infrastructure is relatively good…
Peter – that is not what the German’s told us. In fact the heart procedures we saw in Germany were performed at a separate facility a few blocks away from the hospital and the patients were physically transferred within a fewe days down the street. The doctors were not happy doing that, but they had no choice as the surgery facility could only bed so many patients. To make room for new cases, some patients were moved before the doctors felt they really should be.
We were also informed by the hospital administrator that there were no continuing education requirements for specialists. Dr.’s just worked as apprentices under longer term physicians. Private pay patients usually were allowed to use the most experienced assistant doctor as the master surgeon was usually old and had only the title as a longeivity reward. In many cases they hadn’t practiced in awhile. If you were a “compulsory coverage” patient you got whoever was on call and one was never sure how experienced the “apprentice” was.
It was specifically at the heart center that we were told many patients were going to the UK for services.