Hello and good morning.
I’m reading the post election results, in most cases very happily, and I see that Health Care is a mover and shaker in America of late. I also see a lot of questions and an awful lot of models put forward for consideration.
No one figures health care is going to go away anymore, even the party of Blatant Evil has seen the light. To get elected, you’re going to have to offer folks a chance at seeing a doctor.
I’m in Germany, and while it probably isn’t the BEST system out there, it’s a good model to get an idea from.
Lets start here.
The Euro has approximately the same purchasing power as the dollar. A load of bread costs roughly the same here or there. Minimum wage, here, is at 8.75e per hour.
Now, the setup.
EVERYBODY must be insured in Germany, it’s the law. There is no getting around it. If you work, you pay a portion of it as does your employer- these are called the “Social expenditures” that every company pays for every worker. Should a person become unemployed, well, everyone must be insured, so the unemployment office pays your insurance premium (And the employer portion) until you can do so on your own again. There is never a moment in time when you or your family is not insured.
Now, what does that look like and what does it cost?
First there are the “Gesetzlichen Kassen” which simply means the government run health insurance companies. The AOK “Allgemeine Ortskrankenkasse” is joined by quite a few “Private Kassen” the private companies offer a few perks- people get the top doctor to look at them on rounds, they might get a private room, small things like that. But they pay more for it and even the private companies must offer everything the government offers.
So, there is choice. How about choice of doctors? I have my own catalog of ills, so I need steady visits with an orthopedic surgeon, about 12 a year, regular visits with a top dentist, about 6 a year, I see my GP between 3 and 12 times a month. I can go to any doctor I wish, no matter where they are.
All of this costs me nothing. I just made an appointment with my Ortho, he’s really good and really busy and I’ll have to wait almost three weeks to get in. The appointment with a Neurologist is going to take longer. But that’s because there are only so many specialists in any given town. To see my GP, no waiting except the usual half hour in the waiting room.
None of this costs me any money above my premium. In the past two years, I’ve had a complete upper bridge put in, an operation to remove a large section of intestine (Diverticulitis), two CT scans and an MRI- after the OP, I spent a week in the hospital. I came out to find out I could no longer work for a long while as I healed. That was not an issue. None of this cost me anything except that I paid ten Euro a day for the first ten days of a hospital stay. That is it. No itemized charges, and by law, if my finances suck, they have to take whatever I can offer in payment, even if it is 5e a month. I cannot refuse to pay, but the family will eat as I settle my debts. (That is socialism, I’m afraid.)
Premiums are tied to income. My wife and I get this for the price of about 200e a month. The kids are gone, but Germany REALLY takes care of kids and families. With four children when they were still at home, we might have tacked on less than a third of that to cover all of them. (@280e)
So, how does that look? It’s a family insurance plan. EVERYTHING pediatric is at no charge. All medications are free of charge until the child hits 16, possible prosthetics or shoe inserts may have a very small co payment. However, there is also the possibility of lowered costs if your income is lower and of course, payments must fit your budget, not your doctors. Once the family costs for medications and other ancillary needs reaches a certain sum (It was 80e last time I looked) it is capped for the whole family and all medicines after that are free of charge. (Germany also price controls their Pharma purchases.)
I wear glasses. Once every two years I can go down and pick a new frame. If I don’t like the “KassenBrillen” I can pay more for prettier ones, however, what is offered is by no means ugly. There is choice. The point is, if you are on the skinny side of things financially, you will still get good glasses.
If you are off work sick, yes, you receive 67% of your pay.
It’s not Shangri-la, but compared to what I had in Portland, Or. working for Caterpillar and my wife for Nike, it’s the cat’s meow. There is no office co pay, nothing like that. I show up sick, show my insurance card, I get helped.
Societal costs. Well, I had to look it up, in 2012 every legal resident of Germany was covered and cared for and the Insurance companies ended that year with a 2 Billion e surplus. And 2018? It’s a three Billion e surplus projected. That means every citizen, resident and yes, even refugee was medically insured for everything and the system MADE MONEY!
What you do not see here and have not seen since the late fifties, is families ruined financially by sickness or injury- there are no begging bottles asking for help for this or that condition…. anywhere. There is a dignity given to everyone here, you do not have to beg if you get sick, you won’t be put out of your home, your children will ALWAYS get care. Always.
That is what health care for all looks like in a nation that took the “Social capitalism” route. You must also remember that the idea that the government must provide for “Human Dignity” is in their very constitution and all through the construction of their health care system. That was written after the devastation and lessons of WWII and yes, America had a huge hand in drafting it.
I think as the father of a large family, and as an aging person now, that is the biggest benefit. That dignity. I wish America would move in that direction as well.
I’m a layman, if you have any questions, I’ll do my best to answer them in the comments- but this is, indeed, what working health insurance looks like!
(Oh and doctors seem to drive REALLY expensive cars and own REALLY nice houses here too, so, no, they are not working for starvation wages.)
Respect
P.H.