Las Vegas Sun

September 19, 2019

Currently: 76° — Complete forecast


Germany has socialized health care, here’s one look at how it works

I’m not so sure a socialized health care system is such a bad idea. I lived it, and I’m certainly no worse for wear.

During the 1990s I lived in Germany, both as an American Army brat and as a German citizen.

My mother gave birth to my youngest sister in a German hospital. My sister is 18 years old and heading off to college. Infant mortality is lower in Germany than it is here.

My grandmother (we call her Oma) had a hip replaced when she was 86 years old, shortly after my grandfather (Opa) died at age 90 — hardly proof that the elderly population is left out in the cold by a social system looking to save money. Oma waited just a week to have the operation and healed beautifully, regaining her mobility. Although she has slowed down, she is still active at 93.

One of my mom’s sisters is a home health care nurse for the elderly. She will retire in a few months at age 60 (in Germany, they still have pensions).

And once when I had a severe cough, my mother called up our town’s doctor and within a couple of hours, I was sitting in her office waiting for my appointment.

I didn’t have to go to an emergency room, I didn’t have to wait six weeks to see my primary care physician (as I did here in Las Vegas). I saw my doctor that day.

I paid my co-payment, which is similar to what I pay today with my HMO plan, learned I had bronchitis, got a prescription and then headed to the pharmacy, which in our town was next door to the butcher and the bakery.

I bring this up because there is a lot of rhetoric decrying a push toward a socialized health care model as Congress considers legislation reforming the system.

A little background on Germany’s health care system: Everyone has health insurance, and the premiums paid are placed into a pool and distributed among the 200 nonprofit insurers from which Germans can choose. Parents don’t pay for their children’s health insurance, probably as an encouragement to increase the country’s lagging birthrate.

As a group, the insurers negotiate prices with medical professionals. Those too poor to afford insurance have it subsidized. The nation’s health care spending is about 10 percent of its gross domestic product. By comparison, the United States’ spending is 16.2 percent and rising. In 2007 and 2008, 86.7 million people were without insurance at some point, according to research by health care advocate Families USA.

My health care experience in Germany ended 10 years ago when I returned to the United States, so I wrote to my cousin Veronika, a nurse at a surgical unit with 30 beds in Bavaria. Not only does she work in the system, but she also pays taxes that go toward providing her health insurance.

She shared her thoughts on the system — good, bad, otherwise — and I’ll share them with you (for the record, I translated the letter from German to English).

Her monthly income, before taxes, is 2,000 euros, or $2,900. From this, she pays 8.2 percent in a health payroll tax, up to about $1,300 a year. There are people in the U.S. who pay this per month.

“Personally, I find this totally OK,” she said. “It’s not necessarily cheap, but it’s also not overly expensive. Anyway, everyone has to pay into it.”

If she becomes ill, she must see her primary care doctor.

“If it’s something urgent or threatening, one will, in most cases, receive an appointment one to two days later, but then must wait a very long time (in the office). On average, about one or two hours. In the hospital it is also like that.”

That may not seem like a long time to those of us used to waiting hours for an appointment we scheduled a month ago, but she said the wait for something such as a computer tomography can take over a month — again, not too different from here, unless you visit the test-heavy emergency room.

In Germany, everyone pays into the health care system, although if you are among the wealthiest 10 percent, and make more than 6,000 euros a month (about $8,600), you can elect instead to buy private insurance. About 10 percent of the German population is privately insured.

This is where there is a disparity in care, Veronika tells me.

“If one is privately insured, one must wait much less longer in the waiting room,” she said. “In a practice, (those with private insurance) wait, for the most part, no more than half an hour. The reason for that is the doctor will be paid a lot more by the private insurer than the public system.

“Therefore, in Germany there is also a second-class society in the health care system debate, which the public feels is very unfair. Everyone who can’t afford private insurance will be treated worse.”

She says private insurance is expensive, although she’s not sure how much it costs.

As a nurse in the surgical ward where everything from appendectomies to hip replacements is done, she’s noticed the difference in treatment from the medical staff between someone who has private insurance and someone who doesn’t.

“A privately insured will be visited every day by the head doctor,” she said. “The publicly insured will mostly be visited by a physician assistant.”

Doctors are paid about a third less than their American counterparts, but they also pay far less in malpractice insurance.

There will always be a disparity in treatment so long as there are different payment models. In the U.S., there are doctors who won’t accept certain health plans, leaving many patients without access to care.

Of course, for Americans to accept a social system, they would have to leave behind the prevalent me-first mentality.

By the way, if you’re going to tell me to leave this country if I don’t like the current system, I’d just like to point out that as an American citizen (as well as a German one) I have every right to be here, as I assume most of you do, too. I would simply like the hysteria that masquerades as informed debate to stop.

A version of this column appears in this week’s In Business Las Vegas, a sister publication of the Sun.

Join the Discussion:

Check this out for a full explanation of our conversion to the LiveFyre commenting system and instructions on how to sign up for an account.

Full comments policy