The wonders of German health insurance

OK, I am going to cause trouble here. If the Democrats really want to get their act together about universal health coverage, they should stop looking at Canada as the solution for the US. They should look to Germany where it seems to work. I used to believe the propaganda that universal health coverage was not to the way to go, that the US has the best medical care. With different employers offering different types of coverage, it what is a good way to attract good people.

I had really good ins in the US with my employer paying for everything except the co payment. After being here a year I'm convinced that this is bar far a better system than what we have.

The the problem in the US is that even though the gov’t spends (remember the gov't has NO money of it's own, it's our money) an incredible amount of money on health care, 35% is wasted on administration. Why should we the gov't the opportunity to waist even more money. Here in Germany, admin costs are about 9%.

One of the great things about the medical here is that it covers dental. In the US, even the best dental coverage is not that good

I do have a problem with the cost of medication for the US. I think it is unfair for the US citizens to pay these enormous prices for medication and subsidize other industrial countries. I think the burden should be shared more.

Even if the US adopts the record keeping alone we would save tons of money. Having all information on a computer chip about patient information) is amazing. In the US, every time you change doctors or insurance you have to fill out forms and this and that. But with HIPPA, forget it.

Any thoughts?

Jesus fucking Christ on a pogo-stick.

A few. European-style socialized health-care is good in that it covers everybody but it sure as shit ain't cheap if you are amongst those who can afford to cover yourselves. What is your out of pocket costs? I pay 400% more than I did in the US for less coverage.

Been here the same amount of time and used the system here on a few occasions. Is it better for the 1/6 Americans who don't have standard health care? Yes, better for the rest? No.
Have you seen the teeth around here? Seriously, this isn't a joke or meant to be insulting. It's true.

I agree. Perscription medication is too expensive in the US (but again, if you are insured, even the expensive stuff has only about a $10 co-pay). Contrast that to the outrageous price of anything over the counter here in germany vs. the US.

We agree there.

Oh joy. Another "America versus Europe" thread.
With this and Crotch Farts, today could well be the day we beat the current posts-per-day record...

the problem I have with the German Health System is as follows. In most cases its very good but there doesn't seem to be that much incentive for some of the doctors to actually solve the case. It seems, in fact, like they get more money by doing a few scans and taking a few visits to solve the problem. I'd be very happy to be corrected on how the system avoids this possible 'abuse' but that seems to be one quite large flaw that I see.

There are a load of things that could be improved with the UK system but as far as I can see there is no incentive for the doctor to keep doing excessive scans and visits knowing that (s)he will actually be earning more from it.

10€ to go see a doctor, when there might not be anything wrong with you. Or more importantly there might be something wrong with you, but you dont want to just have a check up when its going to cost you 10€.

The German model is not something anyone should be copying.

I don't normally get involved in these USA vs. Rest of World threads, but this thing with the teeth interests me.

Now, I have okay teeth, my wife too, most of my friends do. If I look at my wedding photos the (mostly) German guests all have very bright white smiles. I can post some for you if you like. My mother (English) has good teeth (most are her own) and my Father before he died had good teeth, although he did have a full set...

Okay, if I go out on the street I may see some bad examples, but when I was in the US meeting everyday people I have to say that I never ever thought, ?gee this man/woman has excellent teeth?.

And yet, the myth seems to perpetuate. ?Europeans have rotten teeth?. I personally think it?s like one of those school yard jokes that once enough people have said it enough times it must be true... A bit like WMD?

Really odd that anyone of intelligence can seriously say (without inspecting every mouth in Europe) that Europeans have bad teeth.

Odd and perhaps a little sad too.

And from the European view point the US health service appears somewhat draconian, no insurance, no care. From an English point of view the German service seems expensive, but then in Germany you get treatment a lot quicker and the standard is (IMHO) much higher. Although I believe that caring in hospitals is one of the few constants that carry on all round the world.

Yeah good point on the 10? thing. Hands up anyone who knows an OAP who isn't going to the doctor to see about a minor alliment because of this charge...

I think the introduction of this charge was a step backwards from proactive care and early diagnoses.

Its only €10 a quarter though. Try Sweden where its €10 a go for the GP and €25 for a specialist. Every time!

I don't really have a problem with the €10 thingy

I prefer the UK model, where you get NHS treatment for sure. And for those that can afford and want it, Private Insurance is available.

Just to add, it is illegal (although it is reported to occur rarely) in the US for a hospital to ask during an emergency if the patient has insurance or not, and they can not turn away a patient to another hospital. That being said, the thought that the US is Draconian is a perpetuated myth when it comes to health insurance. Insurance is very cheap in the US, the problem is that most middle class and above people have insurance. The probelm is that the poor people in the US choose not to have medical care. They could pay for it, but they would rather play the odds and risk not having health problems. Should the government become more stream lined and efficient and require health insurance, the answer is Yes. Is the German medical system or physicians equivanant to the US---NO!!! Sorry, this may offend people, but I should point out that anyone who wants to study medicine in Germany can. This is due to the Basic Law and you have incompetent students in the system who get through, and the lack of training is becomin a larger and larger problem. I can give more specifics if someone wants to disagree, but I am not here to rake the German Medical System over the coals, just to say that in NO WAY is it one to be emulated.

agree in principle although its annoying when people book a time and then don't bother turning up. Just anomila rate of 50p or a pound may help with this issue, although then you'd have a problem with house calls. Generally I like the UK system (although my Dad is an NHS GP so I'm biased)

Went to doctors in sweden (me being an english citizen) they was gonna charge me EUR140 and that was just to see the doctor. Luckily the nurse fucked up and said at the begining that it was gonna cost EUR14 so out of kindness they stuck to that price.

Nice people those sweeds.

But to be fair i think if i had the english form 'E111' it would have only cost me EUR14 and then i guess the english government would have paid the rest. But dont hold me to that cos i dont really know.

Huh? Anyone who wants to study medicine and has a sufficiently good grade in their Abitur can study medicine.

exactly

Found out yesterday that while am out here in germany on my 1 year uni placement, Uni have my health insurance covered for up to 5million Euros!!! Is it possible to spend 5 million on health care!

They say if i become ill, i guess it has to be serious, they will send someone out from england to bring me back (by air ambulance if necessary) all within 24hours of me saying i want to go back to england. Cool or what! Never been in a helicopter!

yeah but just cos am english is no reason to charge me 10 times the amount.

@Mystery Man
They must have an Abitur, but the sufficient mark does not decide whether they can study medicine or not, it will decide where in Germany or how quickly. So a really poor Abi results in them studying in another University and they may have to wait two or three years at most to enter, but they have the opportunity and the schools can not prevent them. This frustrates many of the professors here in Germany that there is no discrimination of the students potential before they enter resulting in many students who just are not competent.

Brokenm, you still have to pass the uni course. They don't just hand them out like lollipops.

As far as I know though, really bad Abitur results will mean a looong time on the waiting list, which does act as an effective deterrent in all but the most extremem cases. And anyway Showem is right, if they really really want to study medicine then they should be given the opportunity: standards are maintained in the Uni.

Actually they do almost hand them out as lollipops. The German students for most of the work just have to attend. They are given a score, but the requirement to sit for an exam is just if they have the schein or not, not of the score. I have dealt with this situation personally. You tell the students they did a practical course completely wrong and they need to do it again and they will say...no I tried once and that is enough. You can not not give them a schein no matter if they did not understand and absolutely failed the material. They do have to pass to examinations that are independent, but the examinations are not that difficult and if you use that as the only level of knowledge, then you will have incompetent physicians. Personally I believe that medicine is not a difficult field and that most complaints people have a German physcian will have no problem solving and helping. But if you ever have something strange or not easily diagnosed or treated. It is better to have the Chefartzt looking at you which requires private insurance here in Gemrnay

I don't think it was specifically because you were English! It's beacuse you weren't covered by the local system and weren't covered by any recipricol agreements with your home country (because of lack of E111 - not that I ever usually get around to getting an E111)

@mysteryman
My point is not to state that someone should or should not study medicine, as I also mentioned I don't think that medicine is a difficult field and should be only for the priviledged. But I was describing the difference in the quallity of the medical system. If you want to bring down the cost of medical care in the US you can also increase the number of students therefore physicians, but you will worsen the average quality. So I like the German system except for one problem. That there is no real choice of your physician, and I not talking about a primary care physician. Or ranking of the physicians!

Show me the facts. Death rates, birth problems, bodged operations, whatever. Then explain to me why European doctors are amongst the most sought after?

To be honest the comment "anyone can study medicine" is faintly ridiculous. So what do you need in the US? Doctor tattooed on your forehead?

Doesn't that work out to around 32 million people? About the population of Australia??? For the guardians of the freeworld this seems like a huge figure to me.

@Paul

Where do you find that statistic that European doctors are the most sought after? In addition, I only spoke about the quality of training of German physicians. Personally I believe that British physicians are well trained and some of the best in the world, but I don't think that you are accurate when you state that German physicians (or do you really believe that after the EU that Germany=Europe) are themost sought after. Ridiculous or not, in the US (even tough this standard is declining) the idea of people having to prove themselves to attain positions (except political) that deal with delicate supposedly intellectual decisions is well adhered to. For instance, to enter medical school you must have high marks in University as well as score well on an entrance exam. Whether this admits the best qualified physicians into the system, I too would disagree. But it does result in having a basic level of competence which increases the value of the average ability of a physician. And the idea that anyone can study medicine is a major philosophy of the German society. It is adhered to and maintained in the University system and it is taken very serious by the faculty that any student who wants to can study medicine.

Australia has about 18 million. And one sixth of the US population is more like about 47 million.

Then the population of Canada.

Maths was never my best subject. Which ever way you look at it, that's a lot of people not getting any medical care...

Canada and Australia put together perhaps

QUOTE
Any thoughts?
A few. European-style socialized health-care is good in that it covers everybody but it sure as shit ain't cheap if you are amongst those who can afford to cover yourselves. What is your out of pocket costs? I pay 400% more than I did in the US for less coverage.

I pay about 250 a month for much more coverage than I had under a good ins. in the US. My wife's dental bill would have come to 6500 in the US but only about 2200 here. And the work that was done is quite good.

QUOTE
After being here a year I'm convinced that this is bar far a better system than what we have.
Been here the same amount of time and used the system here on a few occasions. Is it better for the 1/6 Americans who don't have standard health care? Yes, better for the rest? No.

It is better for all children in that it cost nothing or meds and doctors. In the US lets see.

I can't choose this doctor because he does not take my ins. Or he did but no longer does.

I have to pay for this medicine because it is not on APPROVED list (What the HELL does that mean)

Oh, you need to go to the hospital. Sorry 150 for the ride. We don't cover that
Just had a c-section. Sorry you must leave after two days.

Just graduated from the University. Good for you!! No job yet, that's too bad. You also have no ins.

QUOTE
In the US, even the best dental coverage is not that good.
Have you seen the teeth around here? Seriously, this isn't a joke or meant to be insulting. It's true.

Not worth a reply.

QUOTE
I do have a problem with the cost of medication for the US.
I agree. Perscription medication is too expensive in the US (but again, if you are insured, even the expensive stuff has only about a $10 co-pay). Contrast that to the outrageous price of anything over the counter here in germany vs. the US.

Wrong. most ins. companies have a scale. 10 for generic maybe 15 for some, 25 for others. Must be on an approved list

QUOTE
I think it is unfair for the US citizens to pay these enormous prices for medication and subsidize other industrial countries.
We agree there.

However, the flipside is that no other country has more drug manufacturers with thousands of employees andhuge profits. I assume that this is the reason that no top politician isseriously tackling the drug cost issue in the US. Many people think that only because we pay more for drug sin the US we haveinnovations in medicine.However, most of today's innovations are marginal andwe could very well live without them (see nexium), and most of the realinnovations come from small companies that then are bought by one of the bigpharma companies.

AT THE END OF THE DAY

All the quality improvement measures, benchmarking, etc, in the US produced a
huge administrative overhead of now about 35% compared to Germany's 9%. My take is, let there be some inefficiency in the system but give access to everybody and spend more money on actual care than administration.

Anyway you look at it absolute numbers are a shit statistical way of analysing (did I just spell that with an 's'? Fuck me!) the subject at hand (unless you want to overinflate the significance of the matter). Fractions are the only way to do it.

As for Amerrican medical schools. Well it would be nice if American's could attend. But the quality, or the lack thereof, of our primary and secondary schools is for another topic.

your 'QUOTES' are difficult to read

Just plain wrong. The overwhelming majority of students at the overwhelming majority of the best universities and professional programs in the world are American:

2003 Top 50 World Universities

Academic Ranking of World Universities

Rank Institution Country
1 Harvard Univ - USA
2 Stanford Univ - USA
3 Caltech - USA
4 Univ California Berkeley - USA
5 Univ Cambridge - UK
6 MIT - USA
7 Princeton Univ - USA
8 Yale Univ - USA
9 Univ Oxford - UK
10 Columbia Univ - USA
11 Univ Chicago - USA
12 Cornell Univ - USA
13 Univ California San Francisco - USA
14 Univ California San Diego - USA
15 Univ California Los Angeles - USA
16 Univ Washington Seattle - USA
17 Imperial Coll Sci Tech Med - UK
18 Univ Pennsylvania - USA
19 Tokyo Univ - Japan
20 Univ Coll London - UK
21 Univ Michigan Ann Arbor - USA
22 Washington Univ St. Louis - USA
23 Univ Toronto - Canada
24 Johns Hopkins Univ - USA
25 Swiss Fed Inst Tech Zurich - Switzerland
26 Univ California Santa Barbara - USA
27 Univ Wisconsin Madison - USA
28 Rockefeller Univ - USA
29 Northwestern Univ - USA
30 Kyoto Univ - Japan
31 Univ Colorado Boulder - USA
32 Vanderbilt Univ - USA
33 Duke Univ - USA
34 Univ Texas S.W. Med Center - USA
35 Univ British Columbia - Canada
36 Univ California Davis - USA
37 Univ Minnesota - USA
38 Rutgers State Univ New Brunswick - USA
39 Karolinska Inst Stockholm - Sweden
40 Pennsylvania State Univ Coll Park - USA

Find me one of the US institutions above that has more than a fractional international student population (despite the fact that virtually all American universities strive for diversity and typically lower requirement standards for foreign applicants and foreign applications are at an all-time high).
Here is a comparable but alternate ranking from a non-US source.

UCSB and UC Davis on the same list as MIT and Oxford? Bizarre.

[quote=boomtown_rat,Dec 15 2004, 09:30 AM]
the problem I have with the German Health System is as follows. In most cases its very good but there doesn't seem to be that much incentive for some of the doctors to actually solve the case.

There is no incentive for US doctors to form a good doctor/patient relationship. They are all on a time clock.

How many people have tried to make an apt. for a phyiscal? How long does it take? It could take weeks.

How man ins. companies have a wellness program which pays for part of a gym membership. Only one that I'm aware of.

@ butterbean

They made it to the competing list as well.

yeah, I know. am going to take the position that my alma mater is not on either because it's on the super duper top universities of the universe list.

@ JSK115


It isn't FREE. You pay for it in your taxes (50%-100% higher than in the US) plus your monthly payment to your Krankenversicherung.

It isn't apples and apples. You pay more, you get more. Well I should hope so.

Personally, I'd rather have my 100 Euro cheaper but better US insurance if it weren't for the fact that I think the gov't should cover those who don't have anything.

Of course it is not free. BUT, the money is MUCH better spent here. Yes the taxes are higher, (well, if you live in NYC it's the same as Germany (Fed+City+State). BUT you get much more for your money here than in the US. It is better spent and less waisted.

I lived in NY where I was paying 6500 in property tax. For WHAT?? Where does that money go?? A majority of it goes to pay for a piece of crap educational system.

Yeah, you will need your $100 to pay for the antibotic as your ins. company just decided not cover it anymore. It happen to me when my son need one.

I believe that medical care should be available for everyone including medication. I believe that this is a responsibility that every government should have foremost in its thoughts. That being said, I will not feel sad, upset, confused that a brand of antibiotics should cost one hundred dollars. This is one hundred dollars that is being used to save your son's life! How much did his shoes cost? Why is it that people complain about the cost of precription medication, but will gladly pay that amount of money to see their favorite team play at home? The medical coverage in the United States has been taken for granted by so many people, on what they believe is a "good" value for their health. Good health costs money! Now I do see the difference in paying $100 dollars for antibiotics compared to paying $300 dollars every month for AZT or Blood Pressure medication, which a growing percent of our ever growing population is requiring. This is not affordable and something needs to be done.
Now concerning the cost of drugs and which drugs are on the "list" and which ones are not on the "list" is a problem caused by physicians and patients alike. If you require a medication which can not be substituted by another effective medication, I don't believe a HMO will reject the physician's recommendation (at least the second attempt). However the difference between the cost of the drugs are that the patient and the physician want the $100 broad spectrum third/fourth generation cephalosporin that can be taken in five easy pills, rather than the ten cent penicillin which requires ten days of taking four pills a day. Most of the time both will work, but which do you think is more readily prescribed?

Yes but my point is, in Gemany there is no question what is cover for children. I will take it a step further. There are many times where you see people have rug pulled out from under them when they realize that their ins. is long taken from a specialist their son might require.

Or the insurance company changed policy and will not cover certian parts of an operation or recovery. The costs add up to about 50K, just what you have in the bank. You now have 0. How many stories have you heard about families going bankrupt because someone in the family has a cronic illness.

When your retire, your ins from your employer is usually terminated at age 62 whereby you go on medicare. Medicare...an example of how poorly the government spends our money. My father-in-law still pays hundreds for medications etc. . .

I'm 36 years old, I have the ability to go out and shop for the employer who will offer me the most in benefits. Children and seniors have little option. Yes they will not be stopped at the emergency room if they don't have ins. but if they (or their parents if they are a minor) have any money in the bank, they will pay for it.

In addition, in the US there is a maximum amount of ins. can use before ALL ins. companies will reject you and will not insure you.

When you loose your job, how about that COBRA ins!!! Great benefit there in the US, yeah right!!!

your argument may be true for many in the wealthy or middle classes but I doubt it is true for many less well off people

My point is not to equate money to health or to put a value on human suffering or poor health. My point is that many people (including me when I have to pay for medication) complain about the costs associated with this healthcare, where we forget that this is something that we should all pay and comtribute towards. Personally I don't care if they take half of my paycheck to pay for retirement and health care (but then I do not get paid that high of a salary to begin with). But I do want the people to be held accountable that it is managed properly.

Exactly!!! The US gov't spent 1.2 trillion in 03 amount of money on health care and what did we get for it!!! Just like education, the administrative costs and waist are the things that are killing the US.

And the "new tax code" Bush wants to come out with to "simplify the tax code & encourage business growth"

Know what it is?

1) Eliminate all taxes on capital gains
2) Pay for it by making state and local income tax NO LONGER deductable from your Federal return
3) Pay for it by eliminating the break businesses get for providing health insurance for their employees

Know what that means? No more health insurance coverage by employers! Wonderful...

The country deserves what it gets.

just as a favor to me - please don't start talking U.S. taxes unless you're a professional advisor (or have done your research). I always feel the need to clarify and comment, and it always ends up boring the pants off everyone. Suffice it to say you're wrong about the tax law on several counts, and it's too late in the day for me to go down that road.

back to arguing healthcare:

OK taxes aside, with the money that is spent each year by gov't on health services we still had 27 million children unisured at one time or another during the 2002-03. And several milion seniors who can't afford their meds.

Is there a logical reason why we can't insure these people witht he money collects already??

Does the name "Stefan Effenberg" ring a bell? He was sacked back in April for what he said about the unemployed (see here). Why? Who spend the most money going to games and buying the merchandise?

woof.

Update

Medical bills make up half of bankruptcies
Illnesses, medical bills account for about half of all personal bankruptcies, according to a Harvard University.
http://g.msn.com/0MNBUS00/2?http://www.msn...=EmailThis&CE=1
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Really NICE system we have in the US!!!