Berlin
28 September 2009
With Congress back in session, debate over reforming the American health care system is once again in full swing. Supporters of universal health care want the U.S. system to be more like those in Europe, with the government taking an active role to guarantee coverage for everyone while those opposed warn that this would push the U.S. toward socialism. Germans have the oldest universal health care system in Europe and are generally pleased with the care they receive. Is there a lesson there for America?
Everyone needs a doctor
It seems no matter where - everyone at some point needs a doctor. Sometimes it is an emergency, but not always.
 |
| Ulf Geyersbach with daughters Emma and Milla |
Health care is important and the girls are covered under a family plan. And, says Geyersbach, the health care system works quite well.
"You present your insurance card, that is all - and the children get free medical care," he said. "There is no extra charge whether for regular checkups, for treatments or for prescription medicines."
Like over 85 percent of the population, the Geyersbach family is insured under Germany's public health system.
How it works
Most people use one of a variety of insurance companies. Everyone pays a percentage of their salary for health insurance, and that amount is generally matched by the employer. Premiums and services are regulated by the government.
The basics are covered - visits to the doctor, medicines, treatments - although adults are required to pay a nominal co-pay fee for some items and services.
Private insurance also available
Also covered are hospital stays. And there is another option available as well - private insurance.
At Berlin's Westend Red Cross Hospital, Daniella Krug was covered by private insurance when she had her baby. And, it is the head of the obstetrics department who comes by for a final consultation to tell her she and baby Frieda will be going home.
Private insurance costs more, and fees depend on the level of service one opts to receive. Basic care is the same for all, but private insurance pays for some extras - including a more comfortable hospital room - even one where the father stays with mother and baby. Private insurance also pays the higher fees for patients' treatment by senior medical staff.
Public officials, the self-employed and those who earn more than about $70,000 a year can choose private insurance.
Insurance for everyone
In general, everyone in Germany is entitled to and covered by health insurance, whether unemployed or switching jobs or retired.
 |
| Doctor Thomas Kersting |
"The German mentality is, 'I am insured and I have the right to get access to all the medical treatment at any time, for any disease, pain, burden that I suffer from - immediately," the doctor explained.
Germany's state-regulated, public universal health care system dates back to the late 1800s. It is a complex system of public and private insurance plans, regulated by the government but still giving individuals a good deal of choice. In general, the system gets high marks.
Some complaints
But it is not without problems. There are complaints about the two-tier system of coverage, and some believe that people with private insurance get quicker and better care, and are therefore healthier.
Rising costs and an aging population also put extra demand on the system, and this worries health providers, says Kersting.
"If your right to get certain services out of the system [is] unlimited, then of course the system cannot be financed in the future," Kersting said.
Many say cutbacks in services are inevitable, and there is constant debate about how to balance health services with rising costs, rising demand and less revenue.
Cutting back on services is not what Ulf Geyersbach wants. He sees a different solution.
"I would like to see the private insurance scheme eliminated, because I do not see why a small percentage of the population under private insurance gets privileged treatment and access to better health care than the rest of us," he said.
But Geyersbach thinks that option is not likely to be realized. He believes there is little political will for that.
Germans often talk of solidarity within society - roughly meaning, everyone is in it together - that everyone has responsibilities and no one should get left out. It is a strong feeling, but the harsh realities of costs and benefits are likely to be around for future generations.