Mar 05 2012
I've been in Germany about six months now and I thought I would take a moment or two to write about my experiences with the German Medical system.
In my previous employments I was either under American insurance and being seen by American doctors or I was under military care and being seen and having my medical information used against me-against my will. In only selected cases was I personally seen and treated by foreign doctors-in Japan, Singapore, and Australia. I was able to witness the S.O.'s dealings with the Japanese system as well as the frustrations of her transition to American doctors and their different standards of courtesy towards patients ( something I heard about from her repeatedly-and not in a good way).
However, here-my ability to see American doctors is quite limited. Its not impossible-just not practical. As a military retiree I have some access to American military clinics. However it is such a low priority ( and it probably should be IMHO-given the budget cuts the services are taking), it is simply not practical. I do use them to fill my prescriptions though. As a result, I see German doctors. So far the experience has been exceedingly positive and it only serves to reinforce my belief that the American health care system is really fucked up-and needs massive changes.
Actually I should correct that a bit. America medical care itself is quite fine. Our system of paying for it though is completely and totally fucked up. The malfeasance of insurance companies is simply criminal.
As an "Auslander" I am not a full participant in the German Health Care system. A system, by the way, that is not " socialized medicine"-but does make kliniks and insurance companies adhere to a standardized set of rules and fee structure.
I have a German primary care physician. He is superb-and has done diagnostics for a particular issue relating to cholesterol-that I never got in the states. Its helped-and its actually cost a lot less than I thought it was going to. Same is true for the S.O. and her back issues. An MRI cost half what it cost state side-and the same is true of the ten sessions of physical therapy that were prescribed. The procedure where I had a sonogram of my neck and other locations was fairly reasonable given the amount of time the doctor took to perform it and explain what he was doing and the results he saw as he went.
In all cases the doctors were patient-spoke English well-and the technicians were patient with my less than perfect German. So far I have never had to wait longer than 10 minutes to get seen after my arrival at the doctor's office. In Shopping Mall the wait was usually about 25 minutes or more.
The primary difference between Germany and the US-as far as I can concerned- is that in the US, I could rely on the doctors office to do all the billing of my insurance company. Here I have to serve as my own billing agent-meaning that I had to establish a "war chest" of money to pay doctor's bills and then replenish it through my payments from the two different health insurance plans I belong to. (TRICARE and my employer provided program). If I had German "Versicherung" they would bill for me-but I don't and can't join because I am not a German citizen. So I am learning more than I ever cared to about filing and following up on insurance claims.
And I'm not liking it very much. With my employer provided insurance-I actually can upload claims fairly quickly, and thanks to the type of plan it is -one aimed at American Expatriates- I don't have to do medical translations of German bills. They are able to do it for me. TRICARE on the other hand is much more time consuming proposition. Not because it has to be-but because they have not taken advantage of several time saving things.
(I, like most veterans, am completely opposed to the upcoming TRICARE fee increases, but that is a topic for another time).
So because of the requirement to deal with claims stateside I average 3-4 weeks, " in the hole" money wise. The German system of payment requires electronic bank drafts-checks are not used very often. ( For anything-I pay my rent and electricity via bank drafts too). So I have to have the cash on hand. Fortunately thanks to the advice of the S.O. and a savings effort that started the day I got rid of a substantial amount of American female baggage-it is not so big a deal. And certain Kliniks are getting up on line and direct billing my insurance company in the future. ( E.G., in Garmisch the ER was able to bill TRICARE directly).
So what are my conclusions after admittedly-a short amount of observation? Well I have several, actually:
1) I think Doctors are pretty much the same. They got in the profession because they wanted to help people. What they morph into after being their a while though-varies from country to country. The US has probably the biggest transformation-because in the US doctors make HUGE amounts of money. ( Some of them). In Germany and Japan, doctors are still well compensated-and in Japan doctors enjoy a status in society-but not nearly as well as their American counterparts. Being human, there is some resentment of that.
2)T.R. Reid is right: " No other country would dream of doing things the way we do. So it’s clear that we can’t fix the basic problems by tinkering at the margins of our existing system. Any proposal for “reform” that continues to rely on our fragmented structure of overlapping and often conflicting payment systems for different subsets of the population will not reduce the cost or complexity of American health care. Any proposal that sticks with our current dependence on for-profit private insurers – corporations that pick and choose the people they want to cover and the claims they want to pay – will not be sustainable."
In particular I am now more convinced than ever that insurance companies should be not for profit vehicles-and no employer or employee should be able to "opt out" of paying for health insurance. The mandate is essential-unless you wish to follow a model of Medicare for all Americans. Which would be also fine with me-but I think the private insurance model, provided employers were held down and forced to fulfill their moral obligations as employers would probably be more suitable for American society.
3) The process of paying a claim should be a lot easier and a lot more automated. If I can pay my credit card on line-insurance companies should be able to pay me electronically with 10 days from claim submission.
4) The people screaming about Obamacare "socializing medicine" and how it is making government run peoples lives-don't have a fucking clue what they are talking about. Private, for profit, insurance companies are doing that now-and with no consistency. Free markets do not solve everything. In particular, with respect to health care, the blatantly encourage a criminal and immoral mindset among insurance companies.
5) Cost controls don't seem to be stifling patient care or innovation here in Germany.
6) American exceptionalism sucks! It is stopping us from capitalizing on the best experiences of other nations and as T.R. Reid pointed out is mostly founded on collective ignorance of how other nations really are.
Another reason Americans tend to ignore the valuable lessons we could take from the rest of the world is that we have been in thrall to conventional wisdom about health care overseas. Thus we conclude that the foreign approaches would never work here. In fact, as I found on my global quest, much of this conventional wisdom is wrong. A lot of what we “know” about other nations’ approach to health care is simply myth.