by Stella Canessa
“From that equal creation [all men] derive rights inherent and inalienable, among which are the preservation of life, liberty and the pursuit of happiness.” Every five-year-old studies this well known phrase of the American Declaration of Independence that has long guided people from all over the world to America, the land of hope. A stark contrast to that is its healthcare system. The American government, as one of the only countries in the Western world, doesn’t guarantee its citizen public healthcare. This article is a part of a series, comparing two extreme cases: the U.S. and Germany, and how their different healthcare policies influence social wellbeing.
In 1870, Otto von Bismarck introduced public, universal health insurance in Germany -- making it almost 150 years ahead of the United States in providing every citizen with legally mandating health insurance. While the system has naturally changed dramatically since then, every German citizen is still covered by health insurance today.
Mandatory public healthcare
Health care is undoubtedly a citizen’s most basic right and, therefore, the so called “solidarity system” (Solidaritätsprinzip) guarantees health care coverage in Germany. Workers are legally obligated to pay 15% of their wage to the public health fund (of which half is directly subtracted from their gross income and the other half paid by their employer), which then redistributes the money to health care providers . There is no discrimination against age, health, gender or other pre-existing conditions; in addition, the contribution percentage is the same for every worker: High earners pay more than low earners. This system generates enough income to the public health fund to guarantee health insurance to the unemployed, students, pensioners, and children.
All public health insurance companies are required to provide the same basic benefits. For example, they must provide in-patient hospital stays regardless of duration, doctor’s appointments, and pharmaceuticals. Medication coverage has some nuances, however – the most basic medicines, such as cough drops, are not covered, and insurance usually covers only part of the medication costs for more expensive drugs. However, patients can request to be exempt from additional contributions, which is the case for ⅓ of all health care recipients.
The alternative to public health care is numerous private providers. While public insurance is legally mandated for workers earning under 57,000 Euro yearly, people earning more can chose to replace this coverage with private health insurance. As in the U.S., private insurance companies discriminate contribution rates against age, health, and the amount of benefits you wish to receive. Public health insurance in Germany is so well-received that only 10% of all Germans chose private insurance over public in 2016.
Assets and drawbacks
The evaluation of the system depends greatly on the counterpart that we compare it to. Since I will make an elaborate comparison to the American system in the second article of this series, I will for now focus on the European context, a more challenging contestant.
While Germany’s health care spending is among the highest in Europe – 11.3% of its GDP – a recent study by the consulting agency KPMG has revealed its inefficiency. KPMG examined 24 European healthcare systems for their efficiency. Nordic countries, such as Norway, Sweden, and Denmark, are the pioneers of healthcare systems; Germany, on the other hand, made it only to the lower-middle of the list. German patients receive lower quality care than do their European peers: 9% of heart attack patients died within a month of their hospital release, while in Nordic countries, only 4% died.
German citizens frequently complain, “I just called my doctor and got lucky with an appointment just 4 months from now!” Long waiting times for non-emergency appointments and in doctor’s offices are common complaints and one of the largest downsides of the system felt by patients in their everyday lives.
Lastly, the healthcare system recently suffered a credibility shock with a corruption scandal over organ transplantations, which causes Germany to have a significantly low rate of organ donors (10% of the population). In a country where honesty and middle-class loyalty is engrained in society, betrayal by their own, German, doctors came as a shock. Doctors fudged the documents determining the urgency of a transplant organ of their own patients, so that they received a higher spot on the waitlist than they should’ve. They misused their power as a doctor and prioritized their own patients over people who needed transplants more urgently. The social outcry after this scandal only slowly receded and still today, 5 years later, most Germans are reluctant to become donors.
However, despite these drawbacks, the German state grants its citizen discrimination-free universal healthcare covering a wide array of treatments and medical needs. Does the U.S.?