Americans gushing about German healthcare system

apparently NPR (u.s. national public radio program) is doing a series about various european healthcare programs.

NPR Americans Gushing About German Healthcare System

these people are gushing about the german healthcare system. health insurance (for germans and perm. residents) has only been compulsory since april 2007.

i pay almost €400/month for health insurance. and the bit about 'everything is free.' don't people know that nothing is 'free' in germany. somebody pays for it. like _me_.

But the merit of the program is that you pay into the public system by percentage, not flat rate making it more affordable for those (families in particular) who are making lower wages.

That's a pretty fair report. It should have asked doctors and pharmaceutical companies what they think about the heavy regulation but otherwise it paints a good picture. I pay about 500 euros a month for health insurance for a family of four (but Frau Merkel picks up half the tab since I'm a artists).

In the States, I paid over $300 a month and got diddly squat for it and that was over 10 years ago as a young single male. The co-pays sucked and the in plan options were limited unless I wanted to pay over $450 a month for expanded choice out of plan. I mean when your choice of ob-gyn (for the ladies) included Dr Harry Beaver you know they were scrapping the bottom of the barrel.

When I was working in the States ('87 - 2001), I never paid more than $100 a month as a single female. Sometimes I paid nothing at all (working for a health insurance company) and the most recent company (in 2001), only $40 a month. Even when I was a freelance IT contractor, I only paid $100 a month.
So, jeez, EV, where did you get your insurance?

One thing is indisputable: German pharmacies suck.

Very much a rose-tinted glasses view, only near the end was the private system discussed at all, up till then the impression was given that everybody had to pay into the state system.

For me, this was the ultimate statement:


Oh, really, what about the half million (and rapidly rising) people who are uninsured because the private companies won't take them and the public system, for whatever reason, also won't take them. There is, not surprisingly, a rapid increase in bankruptcy amongst these people at present.

i was never really able to 100% verify this. but (at least prior to april 2007), i was told, that if you opted out of the public system and went into the private system, if you decided to go back to the public, they did not have to accept you. i don't know if that is still the case.

but i know for the private system in germany, that if you have a pre-exisiting condition, you have to pay out of pocket for this if you have re-occuring problems.

when i lived in the u.s., as a freelancer, i never paid more than $75/month for health insurance. as a single person. i was in an HMO. which i guess most people look down on, but i never had problems getting appoints, getting check-ups, and paid very little for medication.

i think deductibles are good. it keeps people from abusing the system. germans crawl to the doctor for every creak and pain. which is one reason why the €10/quarterly fee was introduced.

a €250 yearly deductible would discourage german hypochondriacs (of which their are legions) from abusing the system and forcing people like me to pay an obscene amount of money.

RMA do you have any stats to support your statement about bankruptcies?

When I was working in the States ('87 - 2001), I never paid more than $100 a month as a single female. Sometimes I paid nothing at all (working for a health insurance company) and the most recent company (in 2001), only $40 a month. Even when I was a freelance IT contractor, I only paid $100 a month.
So, jeez, EV, where did you get your insurance?

Wow Kitkat, how did you do that. We were in the US between 1998 and 2001. It took me ages to even find an insurer and when I finally did the premiums started off at $500/month. I won't even get into how crap the system was but suffice to say I'd rate the NHS higher. German health care has been excellent for me, easy to make appointments, seen within a reasonable time, prompt treatment.

<i>a €250 yearly deductible would discourage german hypochondriacs (of which their are legions) from abusing the system and forcing people like me to pay an obscene amount of money.</i>

It always interests me how different peoples experiences can be. I noted when we lived in the US that most people we knew spent an inordinate amount of time (and money) at (and on) medical appointments. I'd have rated those US citizens (DC) area as hypochondriacs far quicker than I would the Germans. What does crack me up here though are the Kreislauf illnesses - I really thought people were taking the piss when I first heard it mentioned.

Yeah I think people should just avoid the boring ex-pat whinging. Sure Germans have kreislauf but in America you'd be surprised at the number of people who have "headaches". It seems every culture has their schein illness -- a French friend says there it's the liver.

Also I find it pretty rich when Americans whine about Germans going to the doctor so much when, if you peered in their purse, you'd discover half a dozen anti-depressants.

quote leylah
i pay almost €400/month for health insurance. and the bit about 'everything is free.' don't people know that nothing is 'free' in germany. somebody pays for it. like _me_.

wait till you need an op or something and ask them how much , then tell me 400 isn't cheap


Could you enlighten us a little ??

I'm happier with the German health insurance now that I'm on the public system, but when I was on private it was a disaster for us financially. After that experience, I am convinced that private insurers need to be kicked out of the health business, period. It sounds like it's bad news in the states, and I know for a fact that the prices of everything get jacked up when a private insurer is involved. I like the canadian system, and will never again sit around and listen to complaints about it. Moving to Germany was a shock - gave me the kick in the ass I needed to really appreciate how good canadians have it.

well, even if one does not take everything M.Moore showed in "Sicko" for gospel, there were a couple of cases there where one could rightly say, that this would not happen in Germany. Having said that: there is still enough injustice in the German system (with about 300-400 thousand uninsured people living in Germany right now), the system is far too complex and expensive to be able to survive without major changes etc. I would probably rather look at the Netherlands and the Skandinavian countries if I want to find a well working health care system...

Looking around the world and comparing systems I know of at least a little bit, I would say that probably the most efficient system from a point of view of cost-mamagment are tax funded health care system available for everyone with a simple, basic health care which makes sure that nobody dies or suffers because he/she has no insurance at all. And then you offer private health insurance on top of that with different coverage and service levels in order to fulfill the needs and wishes of people with better income...

Funny enough: I know a numbe rof German doctors who travel regularily to the UK and work for a couple of month as replacement doctors there and who are very happy about the good salary they receive and all... on the other hand German clinics/hospitals are putting great hope in the new European directive that people who are member in one European memberstate's public health insurance can go for treatment whereever they want within the EU and have a claim that their own insurance covers the same costs they would have incured at home, because they believe that battalions of Brits who don't want to wait another 6 month for a surgery or so will stream to Germany to get their treatment/surgery here (while of course the German dentists dread that their clients will go to Slovakia in order to get their teeth fixed there for half the price...). So, a lot is in motion right now and I am not sure if Germany can work as a lighthouse to the US or any other country for that matter...

Cheerio

Living in Montgomery County, Maryland and it was some standard HMO. What you got was some extraordinary deal or zero services with huge co-pays! BTW, woman paid less and families were screwed!

I always laugh about the standard argument that having Universal Health limits choice. My response is who the hell has choice now? I paid extra for the bigger list of choices of Docs and Dentists and a limit on the co-pay. I think my co-pay topped out at 50 for visits, 150 for emergencies and 75 for an ambulance. I know people who had the same provider and were paying up to 250 co-pay for normal work. I also visited several practices on the standard list and no thank you! I would not trust my life with them and waiting room times were just absurd.

@KäptnKnitterbart, I've just spent about ten minutes Googling, but I'm not the best Googler in the world and so far this is all I've found.


It's from a Fokus article dated 02.02.07.

I've seen a couple of programs on the subject this year and the number of people without insurance was variously estimated at between 350,000 and 500,000 but everybody agreed that it was climbing rapidly. The point has not been lost on the government which has reacted by requiring everybody to have health insurance as of 2009 (many self-employed people, especially those not earning too well, shut their eyes to the problem and didn't take out insurance) and they have also forced the private insurance companies to introduce an equivalent to the GKK insurance which anybody can apply for and they must be accepted. The Catch 22 to the whole thing is, that they can charge up to the maximum that the GKK charges and that's about 500€ / month! So there are still going to be a lot of uninsured people running around next year!

As far as the insolvency is concerned, I couldn't find any statistics on the numbers, but it doesn't take much to trip you into it, if like many people you are living quite well on a day-to-day basis, but don't have much in reserve. My wife had an accident a couple of years ago where she had a fall and landed on a stone vase on the floor which broke and left and a sharp wedge about 30 cm long. This pierced through her back, just missing the spine and other vital organs, but she had massive internal bleeding. As it turned out there wasn't a lot of surgery other than sewing up the wound, which was about 10 cm wide, but she was under X-ray, ultra-sound and MRI and God knows what else and spent three days in intensive care. The bill for that little lot came to just over 18,000 €. If we hadn't been insured, things would have been very uncomfortable. A relatively simple stroke, with no complications, will see you running up a bill of 10,000 € in no time.

I had public health insurance in Germany for 6 years, and now live in the US. The German system is much, much better. I never had any complaints about the German system while I was there.

Of course you can get fairly cheap group health insurance in the US if you're young, healthy, low-risk, have a high deductible and/or copays, and don't get sick. Some problems here: there is no minimum standard for what conditions/treatments insurance companies have to cover, and the insurance companies hold all the cards. They can cancel your policy if you're costing them too much, and then good luck getting someone else to cover you. If you have a pre-existing condition and lose your health insurance for whatever reason, you're screwed. (I was once denied payment on a claim for bronchitis, because I had also been treated for bronchitis the year before. When you phone the insurance company to complain, they just stonewall you, hoping you'll give up.) Most policies cover in-network providers much better than out-of-network ones, so you might not be able to see the best doctor for your condition without paying extra. Many insurance companies don't allow patients to go to a specialist without seeing their GP first.

The people who are most at risk are hourly employees who are often not provided health insurance through their job, and then have neither the time nor the money to go to the doctor until things get critical. If you do have health insurance through your job, and then lose your job, you can keep your insurance if you pay for it until you get a new job that might provide insurance, but that's often unaffordable for people who are unemployed. If your new job provides insurance through a different company, you might have to change doctors if your doctor isn't in the new company's network (or continue to pay extra for going out-of-network.)

Our family has excellent health care coverage here through my husband's job; it's roughly equivalent both in services and cost to what we had in Germany. But my husband is a well-paid professional. In Germany everyone gets this kind of coverage, regardless of their income.

400 euros/month is expensive. i've been operated on here quite a few times and the whole thing was a nightmare. no one is accountable. they screwed up so many times that i'm on a special list at the major hospital in my city. if i go to the emergency room, they take me first. i almost died 2 times because of their screw up. i'll take the u.s. system anytime. doctors are 100% accountable.

BTW, something like 45% of US healthcare spending is by various levels of governments, e.g., Medicare, Medicaid, VA hospitals, free clinics.

They shouldn't be using Germany as a good example of a health care system. It is incredibly overpriced here.

Not when you factor in the continued receipt of salary or significant portion thereof for the duration of medical disability.

Is the system perfect? Hells no. Is it good? Well, it took care of me for months back in 1995, surgeries I needed and could never have afforded in the US -- neither the surgery itself nor the three months of rehab and inability to work to pay the bills.

woof.

One can agrue the various merits of the health systems in Germany versus the USA. But I think one key point is that in Germany you are far less likely to be left without health care due to the social system i.e. the social safety net has a lot less holes. In 2004 some 45 million were said to have no insurance in the USA.

I wonder what kind of insurance this lady had.

Absolutely, MunichNeil. Of that 45 million uninsured, 9 million are children.

That figure is people without health insurance at a given time, which does not mean they don't have access to health care. A significant number of the uninsured are eligible for Medicaid (government-provided health insurance for the poor) but don't sign up either out of apathy or ignorance, are young people voluntarily choosing to go without health insurance, or are people in the US illegally.

The article posted by MunichNeil has nothing whatsoever to do with health insurance or lack thereof, rather with a sheer shocking neglect of a human being already in a hospital.

And how many people in Germany are without health insurance at any given time?

@ciazia I have read that there are as many as 300,000 without health insurance in Germany, a relative few one could argue.

Having experienced 3 different health systems - UK, Germany and US - I would put the US right at the very bottom of the pile from the outset. Germany was good but expensive although I never really used the system that much and the reports heard and read were not all that great. The UK system was fine as I never really needed it, but when my parents both had to experience their "Critical Care" units (they have private health coverage but had to use NHS facilities) I realized that I was very lucky indeed that I did not have to.


The thing is that if you have no health insurance in Germany it generally means you are below the poverty line. In America it is almost considered the norm

The numbers alone speak volumes, regardless of what Conqi says:

.6% uninsured in Germany
14.8% uninsured in the United States

That said, the idea that health insurance is "free" in Germany is, of course, a fallacy. I pay around €200 a month for the public insurance, and an additional €60 a month in private add-on insurance for hospitalizations and extra dental.

But what I GET for that money - no deductibles other than the €10 per quarter, see any doctor I want, have the best of the best if hospitalized (head of department doctor, guaranteed private room, on the private ward with an average 1:3 nurse/patient ratio, and lotsa dental stuff on top) - is WAY better than I ever had in the States, even paying $400 a month with a PPO plan. Plus I have the peace of mind that my insurance company in Germany isn't going to do everything in their power to bilk me (as I have experienced twice in the States.)

I merely pointed out the US figure is misleading, and in many ways it's not an apples-to-apples comparison between the US and Germany. One might ask how many would be without insurance in the US if the German system (including the requirement to have health insurance) prevailed there. One can talk as long as they want about the number of uninsured in the US, but as I have pointed out it's not a monolithic group.

If US employers paid the same amount for health insurance as German employers do, more small employers might be able to offer health insurance than currently do. Of course, Germany doesn't have the ambulance chasers the US plaintiffs bar does- (BTW, an uncle of mine is one of them).

I guess the question is what plan Obama or McCain will implement once one of them is elected. I can see the left in the US expecting averything for 'free' Your thoughts forum?

There is a "significant" number eligible for Medicaid who apply and get turned down or end up with unmanageable bills due to the whole system delaying everything and claiming you were not eligible at the time you needed to the care. I have seen it, experienced it and got lumped with a $4000 bill because of it.

If you think Medicaid is this magically accessible system that you can take advantage of at any point in time - Think again

That's not what I said, Crawlie. I said there are a number of people who are eligible but aren't signed up.

Re-read my post. You will find your answer as to why some of the "eligibles" are not signed up... You will see that I understood your point very well. It is not a simple "walk up and get free stuff", and many get denied. Just do a simple Google search and you will find more than enough information on the subject FOR EXAMPLE

That's a bureaucratic/administrative problem and should be fixed because coverage should never be denied to those legally entitled to it. BTW, around one-third of all those without health insurance fall into this category- being eligible for Medicaid or other public assistance programs but not signed up.

Obviously, but that is still the reality and is something that still gives the figures validity.

And it is no different to the Health Insurers who, for years, paid substantial bonuses to their employees who found ways of cancelling policies/claims or whatever. Another Google search will give you what you need HERE

When I read shit like that then you can give me my 480 Euros a month German system any day of the week

I heard on NPR a couple of months back that part of the problem with the Medicaid backlog is people who have claims through private insurance companies which refuse to pay the claims until the patient applies for Medicaid. Many of these people have no chance in hell of getting Medicaid, they are clearly not eligible, but they have to apply because of the private companies.

There is currently also a problem with Medicare, in that doctors are reducing or eliminating their caseloads of Medicare patients because private insurance companies pay more for their services than Medicare. Some say they can't even afford to practice on Medicare fees:


So what we have is Americans paying for their own private health insurance on the one hand, and paying taxes for this failing federal system as well. Or alternatively paying on their own for health care, because they don't qualify for any federal programs and don't have private health insurance, and also paying taxes for the failing federal system.

Is there anyone who thinks this should go on?

I've never heard of anyone paying that much for insurance. Maybe it's a hicksville thing. My insurance for my whole family is somewhere around $130 a month, and when I was single it was sometimes as low as $30. I've always had excellent doctors and excellent care. Even for things where I'm not fully covered, it still even works out fine. I had some very expensive, somewhat long term treatment that was only covered 50% by my insurance, so my copays were rather large. Fortunately, I have an out of pocket maximum, so once I'd payed $1000 for said treatment (for various copays over the course of six months), everything thereafter was covered 100% with no copays. I've seen several specialists over the last few years from things ranging from dermatology to obstetrics, and I've had some of the best care I've ever experienced with my current (shock, horror) HMO.


It sounds like you did not have an employer that provided insurance, and that's the downfall of the US system. Smaller employers cannot afford to contribute to health care costs, so they don't offer it. I personally haven't had an employer that couldn't provide health care since I was a teenager, but there was a time when I didn't have any health care. Fortunately for me, I had no medical problems. I did qualitfy for medicaid (or medicare...I don't remember which is which), but I couldn't afford the $240 monthly payments.

I also had the opposite experience than you with German health care. They tried to claim I had a pre-existing condition to get out of paying when it wasn't a pre-existing condition (though in the end they did cover it), and I also had some very useless and very criminal doctors. You'll find good and bad health care quality everywhere.


Or you can simply have a job that covers it. Of course, that's not always possible for people whose field is mainly full of small businesses or if they are uneducated and unskilled, but the very large majority of people, despite their age or physical condition, automatically get health care through their employer.

The article is a statement on the state of the health system in the USA. This simply does not happen in Germany.

13% of the American population access Medicaid. The 16% I quoted are those who do not/cannot. The fact that you think they are just too ingnorant to look after their health is interesting. Can you support this? Was the woman lying on the floor one of those ignorant people or were those walking past her the ones just thinking "ahh she is just too ignorant...she will get up in a minute.."

Frankly, MunichNeil, I think you just want to twist what I said because I don't simply fall in lockstep with what you intended to be criticism of the US.

If someone does not realize that they are eligible for Medicaid and does not sign up for that reason, that is an example of not signing up "due to ignorance", i.e., being ignorant of the fact that they are eligible for it. Like it or not, that accurately describes some of the uninsured. I know this for a fact because I used to do tax returns on a volunteer basis for some individuals in that particular situation, and I always urged them to sign up. I did not say that every person uninsured was eligible for Medicaid but not signed up for it due to a lack of awareness about their eligibility for it- in fact I pointed out there were other reasons why people can be uninsured, so how about actually paying attention and reading for comprehension? Google for more articles on Medicaid.

The tragedy at the hospital in New York, as I pointed out above, has nothing whatsoever to do with Medicaid, a lack of insurance, or anything to do with insurance in the first place. It's a case of wanton neglect. Note that the article says nothing about insurance yet you inaccurately use this tragedy for the purposes of demogoguery. The victim was supposed to receive care, that she did not was the fault of the hospital staff at a facility operated by the City of New York. Furthermore, common sense would tell you that an article about a single incident cannot possibly be a comprehensive look at health care in the US, nor is the incident "representative".

Ohh get off your patriotic high horse. It was not a criticism of the US in general (or of you), rather of the health system. I am not trying to twist what you say. I simply do not agree with you and say that after having read what you say.

Secondly you often use opinion backed up by "a lot of people" or "many" etc to support your view but do not give any hard facts. Then when confronted with facts you soften your view or state "I did not say...I just pointed out that there are some people". Its very difficult to argue the facts this way.

Thirdly this article I showed was not a once off in the US. Google for more articles. In any case its not personal. I agree with many things you said e.g. like Germany cannot be compared so easily to the US. Nonetheless they have serious problems here in my opinion that need to be solved. Its not a presidential campaign issue for nothing.

let's assume for a second the health care models were exactly identical in the u.s. and in germany. my feeling is germany might be the healthier choice of a country to live in for most people (who have regular jobs and aren't rich). it's just a feeling i'm not going to back up with any statistics, but it seems like the average german has more vacation time and works fewer hours than her american counterpart. i think that in itself is a huge health care issue not to be underestimated.

Yes, you did try to twist what I said:

How exactly is the NY tragedy related to the number of people that use Medicaid? The hospital was a public one run by the City of New York.

Rather hard to suggest that your criticism is not one of the US health care system if you claim the NY tragedy was "representative"- it's not "typical" or "the norm".


Here is what I said:

Once again, it's hard to know exactly how many people do not know they are eligible for Medicaid; however, it's not unreasonable to think that some don't know their rights, in addition to my own anecdotal experience. You can take your own advice and Google for more information if you don't believe me. Funny how you demand hard facts, but refuse to provide any yourself to substantiate your claim that the incident in NY is the norm in the US. And, yes, you did attribute something to me that I did not say- you either deliberately misrepresented what I posted or didn't bother to try to understand a post that dared to disagree with you. Go back and read for comprehension, please.


But you claimed it was "representative" meaning the norm, and provided no proof for such an expansive claim. Of course, tragedies like this happen, but they are definitely not the norm- in fact, the US health care system is rated first in the world for responsiveness. And once again, you erroneously conflated the incident in NY (a matter of care not being provided due to the neglect of a few individuals) with the issue of some people not having insurance- perhaps you aren't aware that most pyschiatric care in the US is provided by governments and it's not as if the victim was not cared for because she lacked Medicaid or other coverage for the psychiatric conditions for which she was admitted, and that seems to be what you inaccurately and misleadingly implied. Furthermore, emergency care is provided whether a person has insurance or not (maybe you aren't aware of that or do not want to admit that).

As cinzia has ably pointed out, there is quite a bit of scope for reform in the US health care system; however, MunichNeil's portrayal of it is not accurate.

Yes you did...no I didnt...yes you did. Come on. Thats just a childish argument.

You can check the figures I used they are facts and they are accurate. You are brining this down to Medicaid. I am not. Fine I agree for arguments sake: We dont know how many are too "ignorant" to get themselves Medicaid. So what.

Like Cinczia I said the system has a problem but you take my comment personal becuase I brought up the case in NY - which is not the only case. It may not be typical but it is a syptom of a wider problem in the health system in the USA.

Lets forget the 45 million without insurance for a second. What about the further 25% in the states who are reported to be "underinsured" and have to pay many additional costs from their own pockets. This 25% does not exist in Germany. However again all I too am saying is that there are major problems with the system but you know that better than I do.

sorry but where did I use that word. I said it was a "statement" on the system, and surely a damming one at that.

According to this study, about 11 million people are eligible for Medicaid but aren't signed up. Perhaps some have coverage through other means, but how else would you explain that many people not being signed up for free medical insurance?

http://www.kff.org/uninsured/upload/7613.pdf


Apparently someone has a estimate as to how many (see above) so that is as close to a hard fact as can probably get on that situation.

As for the NY tragedy, I certainly haven't taken that personal, but it is very much atypical, and since it did not have anything to do with insurance, why bring it up other than to gratuitously insult the US and misrepresent the fact that it was anything but an individual tragedy?

If you can only bring yourself to say "it may not be typical" you clearly aren't interested in a realistic appraisal of either that tragedy or the US health care system in general.


At least now you bring up a real issue. Let me point out, however, that if everyone eligible for Medicaid signs up and there are no more uninsured people in the US illegally (who aren't likely to be insured in Germany, BTW) the number of uninsured drops by as much as 40%. I don't know how many people can afford some insurance, but choose not to have it, but making an issue of them is also misrepresenting the size of the problem and yet they are also counted in the numbers of uninsured.

The first step in designing policies to deal with the problems of lack of insurance and underinsurance is to get as good a grasp as possible as to the nature and extent of the problem. Misrepresenting the problems, MunichNeil, increases the chances that whatever policies are developed to ameliorate them won't solve them and/or will have undesirable side effects. The solutions developed should find ways to help those eligible for Medicaid to get on it, and those who aren't but still can't afford insurance to afford it. As for underinsurance, this may mean a requirement of a minimum level of coverage for all insurance policies, and many or most people are going to have to pay more, either in the form of premiums or deductibles, or perhaps with supplementary insurance.

EDIT: BTW, I would think that if 18 million uninsured lived in households with an annual income over 50,000 USD, and over 9 millions in households with an annual income of over 75K, it would be a good idea to know this and acknowledge that these people should be able, in most (if not all) cases, to obtain their own health insurance.
http://mjperry.blogspot.com/2008/06/are-18...-uninsured.html

You are fixated on Medicaid. I obviously cannot get you to argue the broader issue. So be it. But your point of getting those who are elligible (but too ignorant) for it is valid. That would help. Its a pity its so complicated and differs from state to state. If you need an advisors help (like you from what I understood) to get into it then I think it loses a lot of its impact straight away, right?

Saying I misrepresent the problem does not make it a fact. No matter how often you say it. I am not making a sideswipe at Americans. I am Irish and we probobly have the worst health system of all the countries mentioned on the thread. And we should be ashamed of it considering the wealth we generated in the last number of years.

I think you can judge a system on how much of the population you include with decent health care. Everything else on why others are not excluded are details/excuses/politics.

I never said (again you "quote" things I did not actually say) that the NY incident was related to insurance. Its related to the health system e.g. it includes those doctors and nurses working in that hospital and other.

The US needs those illegals - thats why they are there. Their labour is needed although their presence is not always welcome. As I believe you point out there is a better solution for coverage needed for these people. Just to remind that the uninsured here are 0.6% - illegals included.

As for you definition of underinsurance. So What? Whats you point. They are still underinsured.

I'm not disagreeing with your basic premise, but we could argue illness risk factors between the two populations all day.

Germans smoke and drink a hell of a lot more than Americans, but they get more exercise. They put perhaps a bit too much faith in homeopathic treatments, but they get better primary care. Usw . . .

Leylah -It was the case with me and as far as I know it is still the case.
If you are an employee and your pay drops below a certain level you have the right
to move from private insurance to Gesetzliche.
My private insurer was not amused and wanted copies of my payslips
before releasing me, but release me they did so I'm now happily with the TKK.
Incidentally, US citizens who are reading this - The US Government pays out
a similar amount of money per head on subsidising medical care
(Medicare, Medicaid etc.) as does the UK Government for the National Health Service -
which covers everybody!
Also - in Germany the only "uninsured" strictly speaking are foreigners with no
health insurance. German nationals such as down and outs will as
a last resort get their medical care paid for by the local authority
(an increasing burden here in Hamburg).

i just checked this out with a friend who works on the health side of the government. apparently up until april 2007, if you left the public system, they did not have to take you back. but with the reforms, it's not possible for them to do this any more.