What American Healthcare Can Learn From Germany

[xchrom]

http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

?n3q8xb

***SNIP

All Americans are now required to have health insurance or to pay a fine, and insurers cannot deny coverage to anyone, regardless of pre-existing conditions. Obamacare has also created subsidies for those who can’t afford to buy health insurance and has implemented limits on out-of-pocket costs.

There are, of course, a few key differences. Co-pays in the German system are minuscule, about 10 euros per visit. Even those for hospital stays are laughably small by American standards: Sam payed 40 euro for a three-day stay for a minor operation a few years ago. Included in that price was the cost of renting the TV remote.

And nearly five million Americans fall into what’s called the “Medicaid gap” in states that aren’t expanding the government health insurance program for the poor. These individuals make too much to qualify for the state’s existing Medicaid program (typically just a few thousand dollars a year for childless adults), yet too little to qualify for the federal government’s subsidies to buy health insurance on the new exchanges, so they will remain uninsured. In Germany, employees' premiums are a percentage of their incomes, so low-wage workers simply pay rock-bottom insurance rates.

The sickness funds are Germany's version of a “public” health insurance system, and it covers nearly everyone. But a small segment (13 percent) of the population, generally the very wealthy, can opt-out and instead go with the private Krankenversicherung, which follows rules more similar the pre-Obamacare U.S. individual insurance market.

[Nye Bevan]

1. Good to see that even under capitalism it is possible to have effective universal health care.

Germany is about as capitalist as they come, and is very big on free trade, yet has generous social benefits, low unemployment, and universal health care. I think there's a message here for the "WE NEED TO GET RID OF CAPITALISM!!!!" crowd.

[LWolf]

3. We need to get rid of capitalism.

Since you called people out.

[HughBeaumont]

5. We need to get rid of "Capitalism As Is".

What passes for Capitalism nowadays is nothing more than rebranded Feudalism. The less regulation, the weightier the employer's boot is on labor's neck.

Germany's CEOs (and the CEOs of nearly every industrialized nation other than the U.S.) also don't make 300 times what their average worker does.

[rhett o rick]

7. What part of capitalism provides universal health care? nm

[Nye Bevan]

9. The part where taxes on wages and profits pay medical providers,

would be my guess.

[Puzzledtraveller]

2. Aw, babies!

[laundry_queen]

6. LOL that was my first reaction too!

Although, with regards to the article, as a Canadian I'm not very fond of a 2-tier or private system. Or of co-pays at all. I still think single payer is the way to go.

[Puzzledtraveller]

8. Same here

I'm a Medicaid caseworker and I believe single payer is the way to go, if not because I believe it is the better of the system but eventually we will have to. I have been fairly critical of the ACA. Being someone who actually interviews individuals and families applying for for programs under the ACA, as it is in my state, expanded Medicaid and the HBE (market place) I can say that there are far too many instances where people are still left without coverage or have coverage that they cannot afford to use. While it looks good on paper I believe it leaves too many out in the cold. After many of it's short comings have been revealed the claim had become that it was necessary as a single payer stepping stone. Some of our prominent Dems even uttered the same but I believe that was only after some of their constituents negatively impacted by unintended consequences of the law began to get media attention. There seems to be two camps here, those that believe the ACA was cleverly part of an inevitable single payer push and those that do not. I have been a medicaid caseworker for 5 years and I have coworkers who have 20 to 30 years as caseworkers who cannot disagree more. Color me pessimistic but I believe the ACA forever entrenched for profit health insurance.

[laundry_queen]

10. If not forever, then likely for a long, long time.

Which I find very depressing for my American friends. I agree with everything you have said.

[jwirr]

11. A question about Medicaid in your state. Do your clients have to choose an insurance plan like

Humana or Medica?

[Puzzledtraveller]

18. We have 4 providers they can choose from if they are Medicaid eligible and approved.

It is more like picking a provider than it is plans as their is only 1 plan effectively as each provider must provide the same level of coverage. The differences in most cases are minor and usually just specialty services to entice some applicants to choose one provider over another. The major point as far as selecting providers beyond that is the size of the network. Our largest are Passport and Humana CareSource, the other two are WellCare and Coventry Care. Most of my clients request Passport and Humana.

[jwirr]

20. Than it is much like when BlueCross/BlueShield used to administer Medicaid here in MN. That system

worked for my family and we had a very severely disabled child.

[DetlefK]

4. I never understood why insurance fees are so high in the US.

I'm a young male living in Germany and I pay €90 a month for the minimum-plan (sickness-insurance + long-term care insurance) of the public health insurance.

- There's a fee of 10 euros that goes directly to the doctor. It has to be paid when you visit a doctor for the first time during a yearly quarter.
- Physician? Simply flip out your insurance-card. (Basic exams, like blood-tests, x-ray, ultra-sound, are covered. Vaccination shots are covered.)
- Ophtalmologist? Insurance-card. (For glasses, the lenses are covered, the rims most of the time are not. Extra tests, e.g. for glaucoma, are not covered.)
- Dentist? Insurance-card. (Basic grey tooth-fillings are covered, fancy white tooth-fillings are not. I belief, wisdom-teeth-removal is covered as well. One professional removal of dental plaque per year is covered.)
- Emergency-room? Insurance-card. (Got stitches, was fully covered.)

All in all, on average I spend about 100-200 euros per year on treatments/medication that is not covered.

I don't even know, how much my insurance-company spends on me: I pay my fees, they take care of all of the rest. I almost never actually see a medical bill.

[antigop]

12. Specialists' incomes have soared --- NY Times article

http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html

Ms. Little’s seemingly minor medical problem — she had the least dangerous form of skin cancer — racked up big bills because it involved three doctors from specialties that are among the highest compensated in medicine, and it was done on the grounds of a hospital. Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones.

It does not matter if the procedure is big or small, learned in a decade of training or a weeklong course. In fact, minor procedures typically offer the best return on investment: A cardiac surgeon can perform only a couple of bypass operations a day, but other specialists can perform a dozen procedures in that time span.

That math explains why the incomes of dermatologists, gastroenterologists and oncologists rose 50 percent or more between 1995 and 2012, even when adjusted for inflation, while those for primary care physicians rose only 10 percent and lag far behind, since insurers pay far less for traditional doctoring tasks like listening for a heart murmur or prescribing the right antibiotic.

[subterranean]

23. In the U.S. there is no regulation of medical or drug costs.

In contrast to every other developed country, hospitals and pharmaceutical companies in the U.S. can charge as much as they want, whatever the market will bear. And costs have been rising much faster than the rate of inflation. That is reflected in the cost of insurance.

Another reason is that insurance companies are profit-making corporations whose main obligation is to their investors, not patients. I doubt any executives of German sickness funds get paid over $10 million a year, but that is common for insurance company CEOs here.

[Ilsa]

13. I was at a conference several years ago and asked the

President of the AMA if the PBO committee for healthcare/insurance reform had examined other nations' programs to see what worked well. All he could say was something like "We don't want the system they have in England," as if they were the only developed nation with healthcare.

It was very frustrating to know that at the highest levels of government, they'd rather reinvent the wheel.

[Nay]

26. It's more insidious than that. Because the powers that be know that most

Americans don't know ANYTHING about other countries, they can boldly tell everyone that America is exceptional, America has nothing to learn from any other country, etc. And then they can impose a "health insurance system" that cheats the populace and makes gobs of money for insurers, doctors, hospitals, etc.

Those guys know everything there is to know about how other countries run their healthcare. They simply don't want US citizens to have anything like it because it would reduce the $$ going to the wealthy.

[Grins]

14. There may be a small error

"Co-pays in the German system are minuscule, about 10 euros per visit."

That may be the error. Unless things have changed, the co-pay is paid only once during any quarter. Go in January, pay the co-pay. Go again as often as needed until the end of March and you pay nothing.

Co-pays in Germany were mentioned in a terrific book, The Healing of America, by T. R. Reid. He describes an interview with a doctor in Germany who was very upset that her patients had to pay a co-pay each quarter, and hits him with: "Can you imagine if they had to pay a co-pay on every visit?"

Reid didn't tell her.

Get the book. It's a fun read. Compares health services in the U.S. with those in the UK, France, Germany, Canada, Japan, China, and a real fun one - India!

[Grins]

15. Forgot to add this...

That plague ship called the Heritage Foundation used Germany as its model for their health care plan, the plan that became Romneycare, and now Obamacare, because it also protected the insurance companies. Germans get insurance coverage for incidental care/perks. It is not primary coverage for doctors or hospitals.

[subterranean]

25. I read that too. Excellent book!

A key point that he made is that we already have elements of all those healthcare systems in the U.S. We've got a system like the UK for veterans, Canada for people on Medicare, Germany for those who work for large corporations, and rural India for people without insurance.

[tclambert]

16. But they must have long waits and sub-American treatment and death panels!

Right? At least, the right wingers will say so, and our insurance corporations will make TV commercials to that effect.

[ProSense]

17. Interesting piece. Still,

There are, of course, a few key differences. Co-pays in the German system are minuscule, about 10 euros per visit. Even those for hospital stays are laughably small by American standards: Sam payed 40 euro for a three-day stay for a minor operation a few years ago. Included in that price was the cost of renting the TV remote.

<...>

The mandatory German insurance can also get rather expensive. Sam pays 355 euros a month for her sickness fund because as a freelancer, she’s responsible for both the employer- and employee-paid portions. And in one 2010 survey, nearly as many Germans (16 percent) as Americans (17 percent) said they spent a lot of time on medical paperwork or disputes.

...that's a lot, nearly $500 per month.

Excellent article, though. Shows the pros, cons and challenges of each system.

[subterranean]

19. $500 a month is a bargain by American standards

especially considering that there is no deductible and very small co-pays. That would be considered a "Cadillac" insurance plan in the U.S., or "Platinum" under Obamacare.

[ProSense]

21. Well,

"$500 a month is a bargain by American standards especially considering that there is no deductible and very small co-pays. That would be considered a 'Cadillac' insurance plan in the U.S., or "Platinum" under Obamacare."

...that maybe true, but how many Americans can afford to pay $500 per month? Millions of Americans are paying a lot less under Obamacare.

[subterranean]

24. I'm paying a little less than that now.

That's better than my situation before the ACA, but I also have a $5,000 deductible ($10,000 for the family) to meet before the insurance covers anything other than preventive checkups. Yes, it's good that many Americans now have insurance with affordable premiums. I'm just saying that to get insurance comparable to the standard coverage in Germany and other countries, most of them would have to pay a lot more. Unfortunately, the ACA does little or nothing to control medical treatment and drug costs. Until that happens, we'll continue to spend more and get less.

[ProSense]

22. Also, in an equivalent single-payer system

that amount would be in the $100,000 to $150,000 income range.

Financing plans have suggested an additional payroll tax of about 5 percent, and an additional 5 percent and 10 percent tax for the top 5 percent and 1 percent, respectively.

The annual tax would look something like this:

$25,000 - $1,250
$50,000 - $2,500
$75,000 - $3,750
$100,000 - $5,000
$150,000 - $7,500
$200,000 - $20,000
$250,000 - $25,000
$350,000 - $52,500
$500,000 - $75,000
$1,000,000 - $150,000

There would also be a small financial transaction tax and a mandated 7 percent payroll tax on all employers.

http://www.democraticunderground.com/10023829497