Thursday, July 03, 2008

Solidarity = We're all in it together

More notes on Germany's health system -- highlights from today's Morning Edition on NPR:

* The health system is not funded by taxes; however, the government DOES regulate the non-profit (and for-profit) insurance companies to keep costs down, and also regulates what doctors can charge.

* Before you start worrying about the poor doctors, they are still the highest-paid professionals in Germany (higher paid than lawyers and architects; entrepreneurs can still earn much more, depending on how successful they are. There are millionaires living the German dream, even!) The doctors earn about 1/3 of what their U.S. counterparts earn. (Oh, and they don't have to pay ridiculous malpractice insurance premiums, because the German legal system is also regulated and there aren't lawsuits for malpractice going on all the time. If a doctor commits malpractice, depending on the severity, they lose their license and the patient harmed is paid; no need to tie up the legal system unduly. And German doctors didn't accrue hundreds of thousands of debt getting their eduction, so they aren't having to pay all of that off.)

* Each worker pays 8% of their salary into the health system. The employers also pay 8% per worker. It is based entirely on what you earn. If you earn more than 72,000 Euros, you can opt out of the required non-profit insurance and you can buy private (for-profit) insurance. Right now I have pretty good health insurance, although they don't cover everything. I have some kind of deductible ($500? $1000?) and I have to pay a co-pay each time I visit the doctor, as well as for medications, etc. The cost for my health insurance is a set rate, not based on my salary, but right now it comes to about 3%, and my employer puts in 9%. I would be more than happy to have that increased on my part (and decreased on the part of my employer) if I knew that a) I would always have access to high quality health care whether employed or not, b) I would be able to go to the doctor whenever I feel like it and not be charged and c) everyone else in my country was also paying in based on salary and also covered. I KNOW that 8% can come to a lot of money for some of you, but just remember that you won't have any other medical-related out-of-pocket expenses.

* The non-profit insurance provides a level of care equivalent or better to many places here in the U.S. You can even call your doctor in the middle of the night and reach him personally at home (not some service) and ask for a home visit to help care for your flu (unheard of here) or you can call him personally at home on a Sunday afternoon and he can arrange to see you in the clinic that very day (as happened to me once). By the way, I was just a tourist travelling through. They glanced at my insurance card (travel insurance) and took care of all that ailed me. I didn't have to pay a single penny out-of-pocket. It turns out that my travel insurance is one of those "pay first and we will reimburse you" types. So, the German doctor probably was not paid for the care that he rendered to me (I did not realize that at the time, but learned it over a year later). If you were badly injured in Germany, they would care for you without asking any questions about insurance.

* Private insurance entitles you to see any doctor you want, even the chief of medicine, get a free cup of coffee, jump to the head of the line, and get a private room in the hospital. (All according to today's show.)

One of the things said in the show was by a man who is familiar with both the German and U.S. health care systems (he's German, married to an American woman). He said that in Germany no one would ever go bankrupt trying to pay for healthcare, and that the healthcare system was one of the reasons that they would never consider moving to the U.S. And I thought of all of those personal pleas for funds --- all of the requests to leave a few dollars for little Suzie or little Johnny so that they can the operation they need; or please donate to St. Jude's or to the Ronald McDonald house, etc., etc.

It's not that I don't think it's great that Americans are so charitable, and that we give money to organizations to help others, but so many fall through the cracks that way, because St. Jude and Ronald McDonald can't possibly help every single person out there (and they focus on kids at any rate). And yes, there are lovely Make-a-wish foundation gifts and these great TV shows where they make over someone's house to help them out because they're good people who have fallen on hard times, and Oprah gives tons of money to people; but there are still so many who fall through the cracks. And we are the wealthiest nation on earth! (Holding onto that distinction by a thread at the moment, but still....)

Universal health care would cover everyone. It doesn't break the bank. It shouldn't even raise your taxes, if we fund it like Germany. Yes, the insurance company will need to be non-profit (shouldn't they all be?) and costs will need to be regulated, but aren't the lives of 48 million Americans worth it? We're spending billions a day on a war in Iraq in order to avenge the death of 3,000 Americans, but we won't spend any money so that the poorest among us can have a half-way decent quality of life?

In my many discussions with people about this, the most startling thing I've been told is that part of the "fun" of being an American, and the whole underpinning of the American Dream, is not just that any of us can have whatever we can achieve through our own hard work (bollocks, but I won't get into that now), but that one can have something that is more than what other people have. It's not just keeping up with the Jones's, it's BEING the Jones's and staying ahead of everyone else. (I've also been asked by some why they should give up their "hard-earned" money to help someone else -- when I get over the shock of hearing this, I think, because it will make our country better, stronger, and SAFER. Poverty fuels crime.)

I don't know if that's really true. The idealist in me, the part of me that wants there to be good in everyone, hopes that it isn't true. I KNOW that it isn't true for all of the Jones's out there, although it might be true for some. But can't we all get over our desire to have something more than others around us, and realize that each person having access to the same level of care would actually serve ALL of us, and make this an even better place?

Wednesday, July 02, 2008

Watch what you eat!

Monterey Bay Aquarium has a list of seafood you should seek out, and seafood you should avoid, either because of the damage done to the environment, or the damage done to us (by eating too much mercury.

How do they do it?

Have you ever wondered how it is that Germany can have a better (really!) healthcare system than the United States and still manage to spend half of what we do per person? This fascinating story at NPR will tell you. By "better" I don't mean that they have superior physicians. We have the best medical schools in the world, excellent doctors, excellent nurses and other healthcare providers, and we have wonderful hospitals and equipment etc. Germany has all of that as well, but the difference is that it is available to everyone. (We could argue about which medical schools are better; I've heard that the U.S. ones are, both from American and German doctors/medical students, but I'm sure there are those who would disagree. I have no personal knowledge about that.)

NPR is doing a series comparing medical systems in Europe and the U.S. There's even a link so that you can check individual costs across countries (Check out the interactive graphic!)

This is the year when we all need to be thinking about how healthcare in the U.S. can be improved, made more cost-effective and efficient, and how it can be made available to EVERYONE. Yep, I said it. I'm a crazy liberal, who thinks that all of God's children (and everyone else's children) should have access to good health and dental care. While we're at it, I also think they should have access to decent food, safe neighborhoods and good schools.

So let's get hoppin' ...