Germany’s health care system


Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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12 Responses

  1. Avatar Jaybird says:

    Cultural homogeneity?Report

  2. Avatar Travis says:

    This makes sense.

    Someone suggested on the other thread, why not require American health insurance companies to be non-profit entities, accountable to their members rather than shareholders?

    The choices of a health care gatekeeper who must please Wall Street investment bankers in order to keep its stock price rising will always be suspect.Report

    • Avatar Ryan says:

      I’m also interested in hearing more about this. I think there are lots of necessary pieces of the puzzle – like mandates and subsidies – but what happens if we simply make it illegal for health insurance providers to earn a profit?Report

      • Avatar Jaybird says:

        Regulatory capture will most likely happen.

        It’ll be something that will apply to small and medium companies leaving only large-to-leviathan sized companies.Report

    • Avatar Jon H says:

      I think Switzerland made that switch, forcing their insurers to become non-profit, in the last decade or two.Report

  3. Avatar Knecht Ruprecht says:

    I’m frankly surprised that E.D. is so enthusiastic about the German system. I suspect he (she?) simply doesn’t understand how it works. Notwithstanding the superfially “free market” aspects, the German system is rigidly controlled by economic regulation–which is one reason that it works (to the extent that it does–no system is perfect).
    To begin with, the Krankenkassen (sickness funds) cannot raise their contribution rates at will to cover their claims paid. They are in effect subject to global budgets (that’s the cost control mechanism). So what happens if doctors perform more procedures than expected and the fund can’t pay for them all at the expected reimbursement rate? The reimbursement rate is automatically adjusted downward to fit within the budget! By administrative fiat! Try gettting that one through Congress.
    Another example: even though the Krankenkassen are forbidden from denying coverage on the basis of health history, variations in the health of the risk pool do emerge among the funds. So there’s a tidy redestributive mechanism that takes money from the funds with the healthier populations and gives it to the ones with more chronically ill patients. Again, by administrative fiat.
    I have lived under the German system and found the quality of care and the ease of access to be phenomenally good. Doctors there earn less almost by an order of magnitude, but they still are near the top of the income distribution, and the number of would-be medical students exceeds the number of available slots so radically that only the very best school-leavers have a hope o getting in. So no sign that strict cost control was leading to rationing. If anything, I was occasionally nonplussed by what I would characterize as overtreatment (e.g. an ENT who wanted to hospitalize me for 10 days for a minor surgical procedure that was arguably elective).

    To sum up, the German system is in no way shape or form less socialistic or less state-controlled than the Obama proposal. Indeed, if American interest groups would tolerate the degree of intervention that, say, German doctors and sickness funds do, the Obama plan could be a lot simpler. It may be an attractive myth (to conservatives) that the German system represents the free market in action (Bismarck certainly wanted to present it that way in the 1870s), but it’s still a myth.Report

    • Avatar E.D. Kain says:

      Honestly – I think it seems like a pretty functional system all-told. I don’t think that it’s the best, that it would work here, or that it would be better than a free market solution. I just think it’s a neat system that seems to have worked pretty well for most Germans.Report

  4. Avatar Knecht Ruprecht says:

    Cultural homogeneity?

    Five minutes in a Berlin railway station should disabuse you of the notion that Germany is anything like culturally homogeneous. Granted, it was much more homogeneous in the 1870s when the social insurance system was born, but back then the notion of German nationhood was still very weak, and there was a non-negligible population of culturally alien Poles and Slavs in the key mining districts that social insurance was designed to mollify.Report

  5. Avatar Murali says:

    I get why people think that germany might be culturally homogeneous, but how the heck did people arrive at the notion that singapore was culturally homogeneous. Singapore is a multicultural society. Anyone who has actually been to Singapore will not say that it is culturally homogeneous.Report

  6. Avatar Murali says:

    And saying that Singaporeans eat healthily (like the japanese do) doesnt seem that accurate either. Singaporean favourites like Char Kway Teow and Laksa are heart attacks waiting to happen. They probably contain more saturated fats, and more calories than hamburgers. (depending on the burger ad the serving size of said dish) Moreover, singaporeans eat home cooked meals (which are often healthier) far less often than americans do.Report

  7. Avatar ilona says:

    Being that i was born and raised in germay …and experianced both systems ..if i for any reason would get a sickness like cancer or diabetis…i would not hesitate go back to germany until treatment is done….there is nothing social or decent about american health care it only serves one group the gangsters that go home with the golden parachutes …for denying treatments …..american mothers should stop giving this country children….period until the contribution to society by american woman is recognized ….some jobs dont even offer paid maternity leave …many american woman are forced of jobs unto government doles to carry a pregnancy to term….and all of this mess is created by white man that govern or have governed this nation ….your disregard in this country for mothers ..and expectant mothers …is all anyone needs to see for what this society is!!!!!children in day cares staffed with former mcdonalds watch over new borns …so the cost is capped ….what mother in her right mind would go back to work after 6 weeks and leave her new born with semi retards to be cared for …..american woman should stop gestating unless …th government honors their contribution ……best regardsReport