Health Care: The German Perspective
Otto von Bismarck: Not socialist.
Forget all this nonsense about socialized health care. The first head of state to propose a national health system was at the other end of the political spectrum. His name: Otto von Bismarck.
The system established by Bismarck in 1883 (you can find some background on it here) has since been updated. But it remains popular not only in Germany, but also in France and Belgium, where it was established during the German occupation and kept on after the war.
Peter T. Sawicki, a physician from Cologne, reflected on assumptions that underlie the German health care model in last week’s issue of the New England Journal of Medicine. Here’s part of what he had to say:
“Most people in Europe believe that a strong community is a central driving force for both a good health care system and a prosperous society. Adequate medical care can be so expensive that few can afford it on their own. But if the risks are divided among us, optimal medical care can be offered to all. Communal responsibility is not an unrealistic ideal. Healthy people’s communal support of the sick is in their own interest, since one day they may need an expensive treatment for which they will have to rely on the working healthy — and if not, at least they are spared the worry that they will be on their own at a time of need. Such an approach is not communism or socialism but simply common sense.”
The German system is mostly private, though government plays a big role. It’s also very different from the health reforms currently being discussed in the U.S.
You can find Dr. Sawicki’s full essay here.
John G. Carlton is an editorial writer who covers health care, science, the environment and public utilities. Before joining the editorial page, "Doc" was the newspaper's medical writer for four years. He has also worked at newspapers in Connecticut and New York. He's fond of heavy sarcasm and light anti-tank weapons. He lives in west St. Louis County with his wife, Martha Madigan, their daughter Ana and an overly enthusiastic Australian Shepherd dog, Savannah. 
In Von Bismarck’s system, 1/3 of the premium was paid by the employer, with 2/3 of the cost borne by the worker. It initially applied only to low-income workers and some government employees … I’m guessing, because the articles I glanced at didn’t say, that it didn’t provide “universal coverage” to people regardless of “employment status” or “immigration status.”
Today, your “mostly private” German system is 77% government funded. I guess it depends upon what the meaning of the word “mostly” is, eh?
For the record, Germany has both public and private health insurance systems. The public system enrolls about 90 percent of the population and gets generally high approval ratings.
German patients are free to seek care at any hospital and from any doctor. The public system is funded by a payroll tax equal to about 15 percent. Employees pay about 8 percent and employers pay the rest (though Uwe Reinhardt argues that the employer share is actually paid by workers in the form of lower earnings than they would otherwise receive).
The public insurance system is run by nonprofit insurance companies called sickness funds. Private insurance is run by for-profit health insurance companies.
Here are some links to some articles explaining the German system. Before you read them, please bear this in mind: No health care system is perfect. Every country’s system has strengths and weaknesses.
By the way, my interest in the NEJM piece is in the contrasting views of social obligation toward health care it illustrates, not in touting the German (or French or Canadian or Dutch) health systems.
http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/lauterbach.html
http://www.npr.org/templates/story/story.php?storyId=91971406
http://www.justlanded.com/english/Germany/Germany-Guide/Health/Introduction
http://www.civitas.org.uk/pdf/cs17.pdf
http://www.med-kolleg.de/german-health-system_e.html
Also:
http://www.forbes.com/forbes/2009/0921/health-obama-germany-health-care-model-that-works_print.html
…”“Most people in Europe believe that a strong community is a central driving force for both a good health care system and a prosperous society.”
Most people in Europe also believe it takes a village to raise a child and from each according to his ability and to each according to his need.
It makes one wonder why Ellis Island had people lining up to come to the USA and why we are being invaded by millions of illegal immigrants seeking to live under our inadequate system, doesn’t it?
The government worshipers have been in power for nearly a year. Most of the population is now dependent on, or part of, the dysfunctional government bureaucracy. If you leftists know what is best for everyone else just implement your changes and take ownership of the results. Show us some more of your “common sense” solutions for the bankrupt Great Society.
Conveniently omitted from this article is the fact that Germany has a loser pays tort system. So do the other countries that Obama cites as models, namely Canada and Great Britain.
A# - brush up on your American history! The wave of German immigration occurred about 5o years before Bismarck. People who came through Ellis Island post Bismarck; they were escaping famine and repressive social and political systems. If you look closely at the current ‘invaders,’ there will be few Western Europeans among them.
Wow! Expect our government to function effectively to benefit taxpayers and watch the pejoratives fly! Let special interests write laws that absolve them of accountability for financial collapse, let auto makers who build cars no one wants, exempt developers from paying taxes on improvements most ordinary people can’t afford, give contracts to companies that send our jobs abroad, etc. That’s ‘free enterprise’ even though it’s supported and bailed out with my tax dollars? Actually, it’s feudalism - the repressive social and political system our ancestors left.
We could use a moratorium on the terms like right wing, left wing, liberal, conservative and progressive. Examine ideas on their own merit instead of putting them into categories that predispose us to predictable reactions. No one ‘worships’ government. Some distraught persons choose to see it as some restrictive authority. To others, in a free and democratic society, it’s us – Americans safely and securely living and working together in freedom and mutual respect.
John - I read with interest the Forbes article to which you linked. In it, they describe a German man with Lou Gehrig’s disease, who required care which cost $370,000 a year. Because of difficulties with his private insurance plan, he says he wishes he’d elected to use the government plan.
Now, let us transport this man to reality, United States version, year 2009. We are slashing budgets at every level of government. We’re kicking poor people off Medicaid because the state can’t afford it. This guy is consuming healthcare enough to cover 350 kids - and despite all that, he is mute, bedridden, and is likely to die within 3-5 years of diagnosis. So who do you think Jay Nixon is going to cut off, the guy with ALS, or 350 poor kids?
Sorry to put it so crassly, John, but that’s the reality of a government program. Premiums will be set politically, with appropriations from general revenue to make up the difference. When we can’t afford the appropriations anymore, they’ll start cutting. Then, it just becomes a question of whose ox will be gored.
“The high costs of “defensive medicine”– expensive tests, medications and procedures required to protect doctors and hospitals from ruinous lawsuits, rather than to help the patients– could be reduced by not letting lawyers get away with filing frivolous lawsuits.” ~ Thomas Sowell
http://townhall.com/columnists/ThomasSowell/2009/11/03/the_costs_of_medical_care?page=full
YES — conveniently omitted was the fact that lawyers are killing us.
Here’s another illustration of what I discussed in my previous comment, this time from the Daily Mail of London:
http://www.dailymail.co.uk/health/article-1224776/Over-65-Why-doctors-think-giving-latest-cancer-drugs-just-waste.html