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Tuesday, August 18, 2009

German Health Care Beats U.S.: Less Rationing, Better Coverage... and with Older Population!

My comment section brings Linda McIntyre's concern about rationing. It also brings a useful link from Tony Amert. Even though Tony wrote first, his link responds well to Linda's concern:

From an American perspective, Germany’s health care system represents a nettlesome challenge. Americans now spend 14 percent of their gross domestic product (GDP) on health care, while Germany spends less than 10 percent. Yet, for all that heavier spending, the U.S. health care system has never managed to provide all Americans with secure, portable health insurance. Evidently, for many low-income Americans without health insurance, the system now rations health care by income and ability to pay.

By contrast, Germans of all ages have long enjoyed fully portable health insurance that provides what is effectively first-dollar coverage for a very comprehensive package of benefits. Furthermore, unlike U.S. patients, who increasingly find their choice of doctor and hospital limited through the technique of managed competition, German patients still enjoy completely free choice of provider at the time illness strikes. In cross-national opinion surveys conducted by the Louis Harris organization in conjunction with the Harvard School of Public Health, both German patients and physicians express relatively greater satisfaction with their health care system than their American counterparts express with their system.

The relatively low level of health spending in Germany is all the more remarkable, because Germany’s population is so much older than America’s: 15.5 percent of the German population is age sixty--five or older, compared with 12.2 percent of Americans. In fact, the United States will attain Germany’s current age structure only in the year 2020 [Uwe E. Reinhardt, "Germany's Health Care System: It's Not the American Way," Health Affairs, 13(4) Fall 1994].

Catch that date: 1994. Little has changed in national differences since then. When Linda and fellow conservatives trot out the word rationing as a reason to oppose health coverage reform, they might as well be arguing that health coverage reform will make morphine addictive and cough medicine taste bad. The United States already rations care. It's been happening since well before Reinhardt's 1994 article. Americans seem to accept rationing completely... as long as it happens to lower-income people, who obviously don't deserve health care if they're poor, since lacking money evidently indicates some punishment-worthy character flaw.

By the way, Reinhardt points out in a 2003 paper that the United States' ration-by-income scheme appears to restrict care even more severely than any of the supposedly socialist dystopias across the pond. According to that paper, Europeans go to the doctor more and get more treatments than Americans do. Compared to the OECD median, the United States has fewer acute care beds available per 1000 population, fewer hospitalizations per 1000 population, shorter hospital stays, and fewer acute care days per capita. In other words, we get less health care than over half of the industrialized world. (Yet we keep spending more.)

This data shows that America already restricts care more than most industrialized countries with public health coverage do. If you're really worried about rationing, you should be clamoring for a European-style health coverage system. After all, spending less and getting more is perfectly... rational.


  1. I also want to throw out that our current system of rationing is the worst possible method of rationing. Currently, we are penalized for going to the doctor regularly for preventative care. Insurance companies have the system setup so that any use of medical care = pain. It's very similar to how corporate boards only look at the current quarter of profitability rather than the long haul.

    Honestly, managing something like type II diabetes is ridiculously expensive for the life of the patient. Regular, preventative care easily identifies early onset insulin resistance and through a small life style change type II diabetes can be completely prevented. Right now though, if you have health insurance, you are penalized for getting yourself checked out regularly to make sure insulin resistance doesn't progress to type II diabetes.

    I haven't seen a paper that says this yet, but I would be willing to put money down that if care wasn't rationed the additional upfront costs of regular exams would be pennies on the dollar of the chronic, long term care for those that don't get preventative care.

  2. Germans are also more health conscious. They walk more, bike more, and there are very few overweight Germans by my recollection. They detest fast food. It's no surprise they are more efficient, but consider they have a 45% progressive tax rate (we should have 50 at least).

    Regarding Linda's concern, we need mandatory enrollment so everyone pays for it. No?

  3. That makes some sense, John. No free riders... and if the government mandates it, the government should offer it.

    Tony, when you do find that paper, send it our way! What you say makes perfect sense... but Republicans have made clear that perfect sense is not a voting issue for them.

  4. Dan O'Neill
    The German system IS mandatory unless your personnal income is above a government determined level. Those not above the income level are enrolled in the government plan. Those individuals PAY 14% of their monthly salary towards their healthcare costs. Those same individuals also have out of pocket expenses for healthcare.
    So bring it, and pay 14% of your monthly salary to the government for healthcare.

  5. Bring it, indeed, Dan. I'm paying over 10% of my income in insurance premiums right now and getting bupkis. I'll happily transfer that money to a federal insurance plan.

  6. [By the way, Dan, which Dan O'Neill are you? Introduce yourself!]

  7. If a single-payer or even a socialized health-care system can be made more efficient than the current "Rube Goldberg" kludge mess, eliminating frivolous profits and controlling costs, wouldn't it cost less than what we have now?

    If the above is true, then replacing the premiums we now pay with some sort of tax should result in us taxpayers having more pocket money "at the end of the week" than we have now, on the average.

    At the federal level, I'd favor getting rid of the payroll tax, making sure that we never enact a value-added tax, and then adjusting the income tax so it takes in all of the money that the federal government needs, including health care.

    Such a tax should be progressive, with a significant exemption for low-income people. The highest brackets could be tailored so as to keep people from accumulating obscene amounts of wealth, while not discouraging people who are willing to work hard and innovate with the intention of "improving their lot."

    I see potential pitfalls in failing to rein in out-of-control costs and fraud; imposing so many taxes that the code becomes Byzantine beyond any individual's ability to handle without professional help; the possibility that certain people will take "double-whammos" by paying a tax on income and then paying the same tax again on purchases (that could happen with a value-added tax or national sales tax if not carefully crafted); and tempting corporations to outsource more and more of their labor (and maybe even their entire operations).

    If our politicians could be straight with us, telling us that if we want to be rid of the worries and dangers inherent in the existing health-care system, and then leveling with us concerning what a workable system would cost and what options exist to collect the revenue, then -- and only then -- we might develop a system that's fair to everybody.

    Of course, I could be wrong. Maybe life is so inherently unfair that we only have a choice between getting screwed clockwise or getting screwed counterclockwise. But I'm not ready to invest in that theory. Hope bleeds eternal.


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