Germany: Health Care for All
Most Patients Happy With German Health Care
by Richard Knox

Morning Edition, July 3, 2008 · Mention European health care to an
American, and it probably conjures up a negative stereotype — high
taxes, long waiting lines, rationed care.

It's not that way in Germany. Very little tax money goes into the
system. The lion's share comes, as in America, from premiums paid by
workers and employers to insurance companies.
German health benefits are very generous. And there's usually little
or no wait to get elective surgery or diagnostic tests, such as MRIs.
It's one of the world's best health care systems, visible in little
ways that most Germans take for granted.

Checking In With An Old Friend

Juergen in der Schmitten was a medical student when I first met him 17
years ago. Now, he's a 42-year-old general practitioner in a suburb of
Dusseldorf.

On one particular night, Juergen was the doctor on call for the
region. Any German who needs after-hours care can call a central
number and get connected to a doctor.

Around 11 p.m., a woman with a fever called Juergen. She wanted him to
make a house call. They talked for maybe five minutes, in the end
agreeing that she would come into his office in the morning.

A situation like this would be unlikely in the United States.
Americans might not get through to a doctor at all, let alone have a
discussion about whether the physician should make a house call in the
middle of the night to treat a case of flu.

The Patients' Perspective

Sabina and Jan Casagrandes say they've had really good care from the
German health system. And they've used it a lot.

Sabina is American, Jan is German. They live in a fourth-floor walkup
with their two little girls in Cologne, an ancient city on the Rhine
in western Germany.

'I've probably been very expensive for the health insurance system
here,' Sabina says. 'When I was 33 years old, I had a giant lump on my
neck all of a sudden, where your thyroid is. And it was a big tumor.'

It took two operations to remove her cancer. Luckily it was curable
with surgery and radiation. Sabina says she had the best care she
could imagine.

'Then I came home to my little daughter, who I couldn't really lift up
because of my neck having been cut open,' Sabina says. 'So I asked my
doctor, 'What can I do?' And she said, 'Well, your health insurance
will pay for someone to come help you in the house.''

Sabina's health insurer paid a friend to shop, cook and even help care
for the baby until Sabina was back on her feet. That's not unusual in
Germany. In fact, under the country's system for long-term care,
family members can choose to be paid for taking care of a frail elder
at home if they want to avoid nursing home care.

Coverage For All

The health care system that took such good care of Sabina is not
funded by government taxes. But it is compulsory. All German workers
pay about 8 percent of their gross income to a nonprofit insurance
company called a sickness fund. Their employers pay about the same
amount. Workers can choose among 240 sickness funds.

Basing premiums on a percentage-of-salary means that the less people
make, the less they have to pay. The more money they make, the more
they pay. This principle is at the heart of the system. Germans call
it 'solidarity.' The idea is that everybody's in it together, and
nobody should be without health insurance.

'If I don't make a lot of money, I don't have to pay a lot of money
for health insurance,' Sabina says. 'But I have the same access to
health care that someone who makes more money has.'
But she acknowledges that nearly 8 percent of her salary is a sizable
bite.

'Yes, it's expensive. You know, it's a big chunk of your monthly
income,' Sabina says. 'But considering what you can get for it, it's
worth it.'

Actually, it's about the same proportion of income that American
workers pay, on average, if they get their health insurance through
their job. The big difference is that U.S. employers pay far more, on
average, than German employers do — 18 percent of each employee's
gross income versus around 8 percent in Germany.

More Added Benefits In Germany

Moreover, German health insurance has more generous benefits than U.S.
policies cover. There are never any deductibles, for instance, before
coverage kicks in. And all Germans get the same coverage.

For instance, the Casagrandes' insurance covers an expensive medicine
Jan needs for a chronic intestinal problem. He says if they moved to
America, they might not be able to buy insurance at all because of
their pre-existing conditions — a nonproblem in Germany.

'He says for himself — or for us — the health care system in the
United States is the major reason why we have never moved there, and
never will move there. Because both of us have chronic illnesses that
have to have a lot of medical attention, and we would go broke,'
Sabina says, translating for Jan.

Jan adds something else. 'It's also the No. 1 reason in the United
States that people personally go bankrupt,' Sabina translates, 'which
would never happen here ... never!'

Coverage For The Family

On the other side of Germany, in Berlin, we meet another couple who
know both the American and German health systems.

Nicole and Chris Ertl own Tip Toe Shoes, a children's shoe shop in a
well-off area of the German capital. The Ertls sell high-quality
European shoes — tiny Italian sandals, French and Danish boots and
clogs in wonderful colors.

Chris is from San Diego, Nicole is German. She also works part time as
a physician therapist and gets her health care through her job like
the great majority of Germans. Like the Casagrandes, she's happy with
her coverage.

'It's a good deal!' she says. 'It's really good because it's a
package.'

It's a package many Americans might envy. Nicole pays a premium of
$270 a month for insurance that covers her children, too. Nicole pays
a single $15 copayment once every three months to see her primary-care
doctor — and another $15 a quarter to see each specialist, as often as
she wants. She pays no copayments for her children's care —-and her
insurance even covers her daughter's orthodontia bill.

'They always have good care,' Nicole says, 'because for kids,
everything is free. The drugs, it's always free' until they turn 18.

Different Rules For The Self-Employed

But even though her insurance covers the kids, it doesn't cover her
husband. Because Chris Ertl is self-employed, he has to buy insurance
on his own, from a for-profit insurance company.

About one in 10 Germans buy this so-called 'private' coverage. It's
not just for people who are self-employed. Civil servants and anyone
who makes more than $72,000 a year can opt out of the main system.
It's a kind of safety valve for people who want more and can pay for
it.

But most people don't opt out. Chris says that's because there's a
fundamental difference in the way Germans view health care and the
government's role — which, in Germany, means refereeing the system and
making sure it's fair and affordable.

'The general opinion in Germany is always that the government will do
it for us, everything will be OK,' Chris says. 'In the States, I think
you grow up knowing that no one's going to help you do anything. If
you want health care, go get it.'

It's important to remember that the German government doesn't provide
health care or finance it directly. It does regulate insurance
companies closely — the nonprofits in the main system and the for-
profits where Chris gets his coverage. So Chris' insurer can't raise
his rates if he gets sick or jack up his premiums too much as he gets
older. The government also requires insurers to keep costs down so
things don't get too expensive.

'Where am I better off medically?' Chris says. 'I would probably say
Germany.'

In some ways, Chis Ertl's coverage is better than his wife's. He gets
his choice of top doctors — the chief of medicine, if he wants. If he
goes into the hospital, he gets a private room. When he goes to the
doctor, he gets a free cup of coffee and goes to the head of the line.
All this embarrasses him — and annoys Nicole.

'When he goes to the doctor, he has a lot more service,' she
complains.

Germans really hate any hint of unfairness in health care. The
fundamental idea is that everybody must be covered and, preferably,
everybody should get equal treatment. So the fact that 10 percent or
so can buy some perks is an irritant — something Germans complain
about but manage to put up with.

But it's unthinkable that 48 million people wouldn't have health
insurance at all — the situation in America. As an American, Chris
thinks that's shameful. 'It's terrible,' he says. 'It's unbelievable.
It shouldn't happen.'

Germans, he says, would never tolerate that. And their system has been
working pretty well for 125 years.