German Healthcare Insurance System - Good/bad

[GHook93]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

 

[deltex1]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

Sounds good...do they still have the ovens?

 

[GHook93]

Sounds good...do they still have the ovens?

Funny you should do standup!

As a Jew, I can say Germany has remedied herself and has become a country of envy again! 2nd to the US in the Western world.

 

[LoneLaugher]

Your description of it sure looks good. What's not to like?

 

[Rikurzhen]

What's not to like?

No profit? I don't want to be cared for in a system where people are not trying to find ways of doing things better, faster, healthier, etc. Look around your world, how many products or services do you use in your life which were developed by non-profit motivated people? I can't think of any in my life. Even the internet which began at CERN has been vastly improved by profit motive.

A complete decoupling between costs and premiums. Premiums are set at a percent of your income. Does auto insurance work that way? Does home insurance work that way? This completely guts price signaling and lowers efficiency in the system. I want to be charged at a rate that reflects my actuarial risk and then be pooled into a group of similar people. I want to be rewarded for living a healthy life. I want to be rewarded because my parents choose well when they married. I don't want to be penalized for someone else choosing to live an unhealthy life or making poor mating choices.

The better solution is to do away with comprehensive plans and go to health accounts, with mandatory contributions, coupled with catastrophic coverage for the big ticket items.

 

[GHook93]

What's not to like?

No profit? I don't want to be cared for in a system where people are not trying to find ways of doing things better, faster, healthier, etc. Look around your world, how many products or services do you use in your life which were developed by non-profit motivated people? I can't think of any in my life. Even the internet which began at CERN has been vastly improved by profit motive.

A complete decoupling between costs and premiums. Premiums are set at a percent of your income. Does auto insurance work that way? Does home insurance work that way? This completely guts price signaling and lowers efficiency in the system. I want to be charged at a rate that reflects my actuarial risk and then be pooled into a group of similar people. I want to be rewarded for living a healthy life. I want to be rewarded because my parents choose well when they married. I don't want to be penalized for someone else choosing to live an unhealthy life or making poor mating choices.

The better solution is to do away with comprehensive plans and go to health accounts, with mandatory contributions, coupled with catastrophic coverage for the big ticket items.

Are you familiar with how credit unions work in America?They are considered non-profit, yet they have nicely compensated employees, work off a private market model, seek to beat their bottom, doing this all while striving to maintain great customer service and competitive products. Competitive products are readily apparent. Only a fool does not get their auto loan from a credit union. Depending on the credit union, but generally customer service is high.


Credit Unions in the US are very similar to the German non-profit health provider system, they have nicely compensated employees, they are NOT government run, they work off a private market model and seek to exceed their bottomline. If they don't exceed the bottomline they go out of business and Germans go to the next provider.

 

[Rikurzhen]

What's not to like?

No profit? I don't want to be cared for in a system where people are not trying to find ways of doing things better, faster, healthier, etc. Look around your world, how many products or services do you use in your life which were developed by non-profit motivated people? I can't think of any in my life. Even the internet which began at CERN has been vastly improved by profit motive.

A complete decoupling between costs and premiums. Premiums are set at a percent of your income. Does auto insurance work that way? Does home insurance work that way? This completely guts price signaling and lowers efficiency in the system. I want to be charged at a rate that reflects my actuarial risk and then be pooled into a group of similar people. I want to be rewarded for living a healthy life. I want to be rewarded because my parents choose well when they married. I don't want to be penalized for someone else choosing to live an unhealthy life or making poor mating choices.

The better solution is to do away with comprehensive plans and go to health accounts, with mandatory contributions, coupled with catastrophic coverage for the big ticket items.

Are you familiar with how credit unions work in America?They are considered non-profit, yet they have nicely compensated employees, work off a private market model, seek to beat their bottom, doing this all while striving to maintain great customer service and competitive products. Competitive products are readily apparent. Only a fool does not get their auto loan from a credit union. Depending on the credit union, but generally customer service is high.


Credit Unions in the US are very similar to the German non-profit health provider system, they have nicely compensated employees, they are NOT government run, they work off a private market model and seek to exceed their bottomline. If they don't exceed the bottomline they go out of business and Germans go to the next provider.

Credit unions are not capital intensive industries. Hospitals require multimillion dollar MRIs, other expensive equipment, etc. That money has to come from somewhere. There is a disparity between Canadian and American MRI per capita ratios. I ran down these numbers a few years back, so they're likely no longer current, but for America to match the Canadian MRI per capita level, we'd have to scarp about 8,400 of our 10,000 MRI machines. Obviously we have for-profit health care and what I see is an idealization of non-profit status for philosophical reasons but no one is looking at the other side of the equation, what are the benefits which arise when people invest their money into trying to deliver health care in better, faster, more efficient, cheaper, more pleasing ways, any way which could turn a profit. Profit is very often the engine of innovation.

So how do American patients intersect with America's MRI infrastructure compared to Canadian patients dealing with their non-profit MRI infrastructure? Are there benefits to Americans which are created by profit? Sure, easier access, more timely access, probably more frequent use in order to develop more detailed diagnoses.

 

[theHawk]

Its a good idea in theory. In practice however, the US is much different than Germany. For starters, Germany doesn't have the tens of millions of freeloaders the US has.

 

[2aguy]

For starters, Germany doesn't have the tens of millions of freeloaders the US has.

Or a political party that wants to import more people to use the system...for their votes...

 

[Bleipriester]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

This is not very correct. There is not a single non-profit insurance company but the companies are bound by conditions set by the government. For example there is a unitary insurance contribution. However, if someone has no health insurance for some reason, treatment will not be denied.

There are two kinds of health insurance companies: Public and private ones.
The private insurance is preferred by the medical practices, they earn more and the privately insured must directly pay out of pocket and gets his money back later from the insurance company. This is why the private insurance requires an high income, while the public insurance companies cannot reject people.

 

[GHook93]

Its a good idea in theory. In practice however, the US is much different than Germany. For starters, Germany doesn't have the tens of millions of freeloaders the US has.

BS they take care of Greece and Spain! Not to mention they are getting flooded with Africans and Muslim dr reloads at a worse base then the US!

 

[Statistikhengst]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

Well, since I am insured under the German Health Care system, which has been around for more than 120 years (yes, it started in 1883), I can tell you that most of this information is correct, but not all of it.

1.) Yes, seniors are paid for. Kids go on their parents' policies. My child's care is split, costwise, between my policy and that of my ex. But the cost is subsidizied in some part by the Federal German Gov't.

2.) Mostly correct. There are more than 160 HMOs - some of them are state run, indeed, some are a hybrid between state-run and private, and some are entirely private. There are HMOs that specialize in certain professions, for instance, rooflayers, etc. German HMOs ARE for-profit.

3.) Yes, co-pays are low, but actual costs per capita are somewhat in the middle of the spectrum. Most are between 11%-14%% of your brutto, not netto. The monthly "Beitrag" depends on your income. If you are employed by someone, indeed, your employer pays 1/2 of your costs. If you are an independent business person (which is my case), then you pay it all yourself. Dental is a separate policy.

5.) 5 is linked to 2. This is why there are hybrid HMOs: if you want to switch to a private "Krankenkasse" (HMO), you can do the hybrid thing and your employer still pays 1/2 of your costs, assuming that you are an employee. German law allows people to change HMOs regularly, if they so wish. You can switch from a "gesetzliche Krankenkasse" (state run or hybrid HMO) to a private HMO at any time. The reverse process is more difficult. To change HMOs, you need to give 2 months notice.

6.) Half-true: yes, no network limitations. No, there are deductibles, esp. for Dental or Hospital visits, but those costs are a spoon in the bucket compared to US-American deductibles. My daughter will be getting double corrective braces this week and the cost will be pretty high, but the deductible helps.

7.) Very reasonable wait times, if at all. When I had a slipped disc and also when I seriously injured my foot in a stage accident, I was treated immediately. The longest I have ever had to wait in a doctor's office has been 20 minutes, ever. But then again, I hardly ever need to go see a doctor.

Now, as for the unemployed and Hartz IV people, it is true that the entire country picks up the tab. Because Germans see basic health care as an inalienable human right and not a free market commodity. However, once a person is back to working, then they are back to paying their health insurance as well.

The German system is a pretty solid system and the HMO's are in the black, not in the red.

@GHook93

Feel free to shoot me any relevant questions.

 

[Statistikhengst]

Sounds good...do they still have the ovens?

Funny you should do standup!

As a Jew, I can say Germany has remedied herself and has become a country of envy again! 2nd to the US in the Western world.

Yepp.

Modern Germany is one of the most forward-looking, advanced, open and friendly countries in the world.
Germany also has the best telephone cell network in the world, the highest rate of computer coverage, the most advanced rail-system in the world and the most accessible public transportation system anywhere on the planet. German products are most definitely on par with good US products, that is for sure.

 

[Mindful]

Sounds good...do they still have the ovens?

Funny you should do standup!

As a Jew, I can say Germany has remedied herself and has become a country of envy again! 2nd to the US in the Western world.

Yepp.

Modern Germany is one of the most forward-looking, advanced, open and friendly countries in the world.
Germany also has the best telephone cell network in the world, the highest rate of computer coverage, the most advanced rail-system in the world and the most accessible public transportation system anywhere on the planet. German products are most definitely on par with good US products, that is for sure.

Customer service is in the stone age.

 

[Mindful]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

This is not very correct. There is not a single non-profit insurance company but the companies are bound by conditions set by the government. For example there is a unitary insurance contribution. However, if someone has no health insurance for some reason, treatment will not be denied.

There are two kinds of health insurance companies: Public and private ones.
The private insurance is preferred by the medical practices, they earn more and the privately insured must directly pay out of pocket and gets his money back later from the insurance company. This is why the private insurance requires an high income, while the public insurance companies cannot reject people.

German hospitals practice the most surgical operations in Europe. Don't know about the rest of the world. To make money for the hospitals.

 

[Bleipriester]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

This is not very correct. There is not a single non-profit insurance company but the companies are bound by conditions set by the government. For example there is a unitary insurance contribution. However, if someone has no health insurance for some reason, treatment will not be denied.

There are two kinds of health insurance companies: Public and private ones.
The private insurance is preferred by the medical practices, they earn more and the privately insured must directly pay out of pocket and gets his money back later from the insurance company. This is why the private insurance requires an high income, while the public insurance companies cannot reject people.

German hospitals practice the most surgical operations in Europe. Don't know about the rest of the world. To make money for the hospitals.

Most hospitals in Germany are underfunded and overworked. Sometimes, doctors work 30 hours at a stretch and they often have official 24 hours shifts.
Krefeld rzte gegen 24-Stunden-Schicht

 

[GHook93]

Your description of it sure looks good. What's not to like?

Devil could be in the details methink!

 

[GHook93]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

Well, since I am insured under the German Health Care system, which has been around for more than 120 years (yes, it started in 1883), I can tell you that most of this information is correct, but not all of it.

1.) Yes, seniors are paid for. Kids go on their parents' policies. My child's care is split, costwise, between my policy and that of my ex. But the cost is subsidizied in some part by the Federal German Gov't.

2.) Mostly correct. There are more than 160 HMOs - some of them are state run, indeed, some are a hybrid between state-run and private, and some are entirely private. There are HMOs that specialize in certain professions, for instance, rooflayers, etc. German HMOs ARE for-profit.

3.) Yes, co-pays are low, but actual costs per capita are somewhat in the middle of the spectrum. Most are between 11%-14%% of your brutto, not netto. The monthly "Beitrag" depends on your income. If you are employed by someone, indeed, your employer pays 1/2 of your costs. If you are an independent business person (which is my case), then you pay it all yourself. Dental is a separate policy.

5.) 5 is linked to 2. This is why there are hybrid HMOs: if you want to switch to a private "Krankenkasse" (HMO), you can do the hybrid thing and your employer still pays 1/2 of your costs, assuming that you are an employee. German law allows people to change HMOs regularly, if they so wish. You can switch from a "gesetzliche Krankenkasse" (state run or hybrid HMO) to a private HMO at any time. The reverse process is more difficult. To change HMOs, you need to give 2 months notice.

6.) Half-true: yes, no network limitations. No, there are deductibles, esp. for Dental or Hospital visits, but those costs are a spoon in the bucket compared to US-American deductibles. My daughter will be getting double corrective braces this week and the cost will be pretty high, but the deductible helps.

7.) Very reasonable wait times, if at all. When I had a slipped disc and also when I seriously injured my foot in a stage accident, I was treated immediately. The longest I have ever had to wait in a doctor's office has been 20 minutes, ever. But then again, I hardly ever need to go see a doctor.

Now, as for the unemployed and Hartz IV people, it is true that the entire country picks up the tab. Because Germans see basic health care as an inalienable human right and not a free market commodity. However, once a person is back to working, then they are back to paying their health insurance as well.

The German system is a pretty solid system and the HMO's are in the black, not in the red.

@GHook93

Feel free to shoot me any relevant questions.

Will do, thanks for the direct input.

 

[GHook93]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

This is not very correct. There is not a single non-profit insurance company but the companies are bound by conditions set by the government. For example there is a unitary insurance contribution. However, if someone has no health insurance for some reason, treatment will not be denied.

There are two kinds of health insurance companies: Public and private ones.
The private insurance is preferred by the medical practices, they earn more and the privately insured must directly pay out of pocket and gets his money back later from the insurance company. This is why the private insurance requires an high income, while the public insurance companies cannot reject people.

German hospitals practice the most surgical operations in Europe. Don't know about the rest of the world. To make money for the hospitals.

Most hospitals in Germany are underfunded and overworked. Sometimes, doctors work 30 hours at a stretch and they often have official 24 hours shifts.
Krefeld rzte gegen 24-Stunden-Schicht

How is that any different than in the US?

 

[Mindful]

When people talk about the healthcare Insurance system, both sides rarely mention the German system. To the right it sounds too much like Obamacare, to the left it doesn't sound enough like free Single Payor.

What American Healthcare Can Learn From Germany - The Atlantic

Here is how it works:
(1) All children and the elderly (over 65 I believe) are paid for by the government. Think of medicare for minors and seniors.
(2) All Germans must get health insurance. They can choose between 160 non-profit (yet non-goverment) health insurance provides. Again these we would like non-profit private insurance provides. Think of it like credit unions. They have a bottomline, decently compensated employees, but they don't make a profits.
(3) Co-pays are low, and premiums are set at a percent of one's income. The person's employer pays half and the person pays half.
(4) The government covers the premiums while one is unemployed. I know the right attitude. Lazy people won't work in order to get insurance. For get food, rent and other necessities, they won't seek a job because they want insurance. Illogical.
(5) Each person has the option of opting out and getting private insurance if they choose, but their employer does not have to pick up 1/2 the tab.
(6) There are no network limitations.No deductibles.
(7) Good wait times

This is not very correct. There is not a single non-profit insurance company but the companies are bound by conditions set by the government. For example there is a unitary insurance contribution. However, if someone has no health insurance for some reason, treatment will not be denied.

There are two kinds of health insurance companies: Public and private ones.
The private insurance is preferred by the medical practices, they earn more and the privately insured must directly pay out of pocket and gets his money back later from the insurance company. This is why the private insurance requires an high income, while the public insurance companies cannot reject people.

German hospitals practice the most surgical operations in Europe. Don't know about the rest of the world. To make money for the hospitals.

Most hospitals in Germany are underfunded and overworked. Sometimes, doctors work 30 hours at a stretch and they often have official 24 hours shifts.
Krefeld rzte gegen 24-Stunden-Schicht

How is that any different than in the US?

I'm not talking about the U.S.