German Healthcare: Better Than Medicare for All?

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–There are many paths to universal health coverage, and the German healthcare system is one that might be better than alternatives that have been proposed so far

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Broadcast on February 26, 2019

 

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87 thoughts on “German Healthcare: Better Than Medicare for All?

  1. Dear deplorables look at your paycheck
    You pay federal income tax
    State tax
    Medicare
    Social security
    On top of that you have to have health insurance
    Once you have insurance you have to pay deductibles
    Before deductibles you have to pay copay
    And the insurance can only pay so much.
    Now imagine this, you work every day, and God forbids you get sick you are in the hospital for over two weeks, at this point there is no money flowing back to the insurance now the payments stops and eventually the coverage stops.
    The healthcare should never be a tool for profit, now all these idiots such as Sean Hannity and Rush Limbaugh and Laura ingraham talking all that crap but they are well set, Ingraham had cancer but she was set, now ask yourself if that happens to one of us, be real fellows healthcare system sucks we need changes

    • +Charles Farmer tbh this thread is gold. I love when dumb ignorant Americans try to tell me how poor my country is because it has social healthcare, meanwhile in their country people are dying because they cant afford those completely over the top medical bills.
      America is in my eyes a third world country in many cases. Sure, not military (be proud) but everything else. Your treatment of the poor, your crime rate, your prisons (goddamn your prisons… *facepalm*), your chosen ignorance of the rest of the world and your more and more advancing ability to ignore factual statements so it fits your world view. Look at all those crazy americans you have. Thats is completely unique to the US

    • +Yuion aro if our country is so 3rd world, then why are all these people trying to come here illegally. These people want to be caught and arrested.
      Prisoners here get much better treatment than in any other country. Hell,some have cable tv, cell phones, all the drugs they can get. Just awful treatment. Now, since Obama was president, we have a lot of racial problems and a lot of stupid young people that doesn’t think laws apply to them.
      Believe me when I say, “you ain’t seen crazy Americans yet”.
      Socialism doesn’t work.

  2. I am German and we have a good Healthcare system. it is normal. every developed country has it. to be honest, the USA are a third world country. just vote and get a proper health system for you. VOTE!

    • 1794, 3rd Congress 1st Session p170 LoC, James Madison refuted spending tax money on charity to help NEEDY REFUGEES:
      *_”I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress_*
      *_of expending, on objects of benevolence, the money of their constituents.”_*
      The constitution limits Federal powers to those ENUMERATED by the Constitution. Madison showed tax paid charity for needy is NOT a fed power

    • and pay 3x for gas and 3x in taxes your who life. Also, don’t forget the drugs come from the US companies that develop them. You are already subsidizing socialized medicine, so be happy. So, if we then send our Rx development outside the US, then you can add that price into your taxes too. Stupid comparison, but simple, so you like it.

  3. The irony of our Healthcare system is that it was originally implemented under Bismarck in the 1880s. He was against it, but saw universal Healthcare as an effective strategy to prevent the social democrats from becoming too strong. Basically, imagine the Republicans giving all dreamers citizenship and criminalizing political bribes.
    This system has survived both world wars and reunification, and enjoys support from all non-extreme parties.

    There is however the issue of possible preferential treatment for privately insured people at private doctors. There are aims of preventing this through legislation, but these issues do not extend to essential treatments.

    The insurance covered in part by the employer is called ‘Sozialversicherung’, and is in addition to any additional insurance you may have. This additional insurance can come from private or public providers, who compete. You pay exactly half, whilst the other half is paid by the employer. Deducted from your pay is also the “Rentenversicherung”, which is basically the public retirement plan. At 67, you have the right to retire, and will receive a monthly sum depending on your prior income, current wealth and years of work.

    • Bismarck also introduced accident insurance and pension insurance in order to bribe the workers to “battle socialism”. He was probably the most successful socialist in german history, while battling socialism. Thanks Otto! 🙂

    • He was not against public healthcare. He was against the social democrates and went for weakening them by realizing some of their demands. It was an “embrace your enemy” strategy that let him in hold of power for quite some time.

    • But also like how would you live of off 900€ a month? I mean now as a student it’s alright but as an elderly you probably don’t want to live in a shared apartment and honestly I don’t want to only be able to shop at Aldi lidl etc. and not be able to go out and do nice stuff. 
      Being in the younger generation it make me angry that I have to pay for something now that will decrease in value once I am older. I’d rather save up privately. +Facepalm

  4. Im from austria and like david says, we have the same system as the germans. here and also in germany, if you not happy with what the general healthcare offers, you can get an additional private insurance, which, of course, you have to pay yourself. with this additional private insurance then you can have a single bed room in hospital, a bigger menue you can choose from etc.

    • +Daniel Love All relate back to poor salary’s. And bad education generally speaking. If u can afford it i would say people in general properly would eat healthier. of cause there would always be the ones who cannot get enough gooo down their neck

    • I am from Wien, and I can say that the Austrian healthcare system is extremely spotty. Private care is generally great, everyone with the money or an employer that provides private care tries to get it as often as possible, but the public care is generally extremely impersonal, rude and not efficient, and is generally unpleasant. It is great that it is there of course for those in poverty or unable to access private care, but most people try to avoid it if they are able to (and the Austrian system usually performs better than Germany’s according to many metrics). I think that the answer is an outright nationalised system which elimates private healthcare altogether, and focuses on bringing the quality from private systems avaliable to everyone, avoiding the utilitarianism that comes with most public systems in Europe, especially in light of constant attempts to cut them from the neoliberals across party lines.

    • +Jerrad Williams really seems you had bad experiences….I never had any problem with our austrian general healthcare system….and I know both sides, means with and without additional private insurance.

    • +Karina Schmidi Natürlich können sich Superreiche noch mehr Extras leisten, wie z.B. nicht-approbierte Ärzte und nicht approbierte Therapeuten, ganz ohne Umweg über eine Kasse – aber wen stört’s?

    • +cweed Actually the rich Germans do pay less than the average German if they use the normal Healthcare companies instead of a private insurer. The reason is that there is a maximum monthly income to do the math how much you have to pay – everyone who earns 6000 Euro or more per month pays the same amount of money, regardless if he earns 6000 per month os 60.000 per month. That’s part of our version of the rich not paying their fair share.

      Germans pay 15 % of their income for their health insurence; half of this is covered by the employer, the other half by the employee. But because of this maximum income thing people above 6000 Euro income actually pay less, which is unfair and should be changed. In Switzerland, who also pay a share based on their income, there is no such exception which means the rich actually pay their fair share. This allows for a lower % for everyone (8.5 % of income if I remember correctly).

  5. Removing the profit incentive is mandatory. Profit poisons everything and you cannot have a healthy society when fundamental human needs are essentially held hostage for ransom by private companies. Things like healthcare, education, infrastructure, utilities, prisons, etc. none of these should be allowed to fall into the hands of the private sector. All of them should operate purely as non-profits and be publicly funded.

    • It’s dangerous to think of the “profit motive” as some sort of “evil spirit” that’s omnipresent in private enterprises and nonexistent in the government. At a more literal sense one can say that the state has not a “profit motive”, but its agents are still people and they can still have the same fundamental conflict of interest between themselves and the public at large, having more personal gains/profit by doing stuff that doesn’t optimally serve the public, or even that’s detrimental.

      On the other direction, the profit motive on private businesses (just like that of personal gains of politicians, NGO and non-profit individuals) can be often aligned with incentives to better serve people/consumers, even if we only take into account self-interest, assuming that every business owner is fundamentally evil, immoral, always putting their own gain above anyone else’s welfare. But one shouldn’t make this latter assumption any more than that all politicians are evil and just conspiring against the people all the time.

      Or at least be consistent and adopt this hobbesian dog-eat-dog view in either case. On which case one should be some sort of individualist anarchist, I suppose.

    • +philip thomey in some cases private and for-profit prisons have better outcomes than state ones. Profit itself is not the problem; the problem is always an alignment of profit (or private gain not strictly labeled as profit) and policies or actions that are detrimental to the general welfare.

    • I find this argument to be an emotional one not a logical one. Why is it intrinsically bad that there’s a profit motive in healthcare, but not in food production, something else that’s required to live? How can you reconcile the fact the market works so well for consumer goods and most sectors with saying it’s immoral to have profit in some sectors? I see no consistency here. I think most of us are some form of utilitarian, or at least consequentialist, so really the only concern should be the outcome, not some emotional principle of profit being evil. Inequality is an outcome thats fair to criticize, though I think it should be on a basis more logical than “it feels unfair”. There are legitimate logical reasons why inequality is undesirable beyond that. Improvement at large is more important than fairness in general it’s safe to say.

      I think the better argument is that in some sectors it’s difficult or impossible to align the profit motive with the desired outcomes to an acceptable degree. So information asymmetry combined with the coercive aspect of facing harm or death leading people not to negotiate prices down, and the fact that there aren’t many options for treatment often. In food, if wheat prices go up, you can buy tons of other alternatives to bread. That’s not the case if you need a hip replacement or have cancer or something. That’s why it makes sense to have the government intervene to push prices down. But on the other hand, most of the dynamics of the market still contribute positively to healthcare at large: the profit motive is still aligned with creating a new drug to heal people, with creating a superior and cheaper medical device or prosthetic, with treating your patients well and serving them efficiently. As much as there are tons of problems with pharma companies and our total lack of price control in the US, it’s an objective fact that the profit motive has led them to creating tons of new drugs that tons of people want or need.

      In private prisons and private military the problem is that the profit motive is aligned with having more people incarcerated or more wars, and more spending on those. In a system of legalized political bribery that brings into play all sorts of corruption. That being said, private prisons are an absolutely tiny percentage of overall prisons in the US. It’s often used as a way to make it seem like politicians are opposing mass incarceration when they’re really not.

      And as others have pointed out, ultimately profit is just the legal/business term for gain in a certain context. There are non profit hospitals that have insanely overpaid board members overseeing them. Non profits that are really just tax dodges aren’t rare, and even if it’s not that extreme it’s not clearly better than outright profit necessarily. It’s also profit to get paid a wage. So you could have a nonprofit system where surgeons and board members continue to be wildly overpaid, that doesn’t fundamentally change the dynamics. States too have incentives pretty similar to profits, particularly when there’s budget constraints. Just look at Iran contra – elements of the state had a goal, they were barred from using regular tax funding, so they created a criminal racket to fund their plans. Similar profit seeking happens with police departments trying to get federal grants etc.

      In every single system devised by humans so far, and I think intrinsically, there will always be a motive to hoard resources and gain at the expense of others. That doesn’t mean that I think it’s inevitable that it’ll be as widespread and culturally approved of as it is in the US today, but people seem to think of profit as this alien concept when it’s really just a formalized term for something at least some humans have done under every economic system. And it clearly leads to preferable outcomes in most sectors of the market. This is why social democracies are so successful – they recognize and preserve the importance of profitable competitive markets with a strong public sector, addressing market failures, redistributing much of the wealth that the market creates (which is the source of most social programs resources), and effective regulation – not a view that the most regulation and highest corporate taxes will bring the best results. I think most American soc Dems are missing that fact. Most or all of the Scandinavian countries had a lower top nominal corp tax rate than the US until the trump tax cut. Almost all of these superior universal healthcare systems maintain significant private sectors and profit motives.

  6. I grew up and lived in Germany until moved to Ireland in my early 20s and can confirm that the German healthcare system is fantastic and I benefitted a lot from it

  7. God damn Germany, you have to do everything better and more efficient. Meine Mutter hat mir das seit Jahren erzählt. 🙂 I love you guys.

    • Well Germany is currently run by Idiots. Idiots that try to literally destroy the internet. The guy who pushes all this even said the politicians should forbid People to watch YouTube, becuase all the people against his will are Fake News.

      It’s very embarrassing.

      The GErman…no the European People are currently fighting against what is most commonly known as article 13, but as a whole is known as the new Copyright reform. Urheberrechts Reform.

    • +YourMajesty You’re talking about psychologist? What’s about health insurance in the US for accidently shot children?

  8. Very accurate and fair description of the German healthcare system. Being part of the system as a doctor I have to say, even though the principles are quite right, the effectiveness of the system is still a mixed bag.

    For example:
    – Connecting the distribution of the funds to insurers to morbidity data creates an incentive to influence the diagnosis documentation to create “more” sick people in order to get a greater share. That doesn´t mean the insurers manipulate the data themselves, but they try to influence the process how these documentations are created.
    – On the side of the healthcare providers the system also gives incentives to offer more complex and invasive procedures – even when not really neccessary – to generate more profit, especially for hospitals and specialists.
    – The patients are not participating in the billing process, so they have no idea what their doctors bring to account with the insurers nor do they get an impression what kind of costs their care generates.
    – The public system inlcudes a budget element, so doctors don´t have an incentive to go beyond a certain threshold with the care they provide based on a quarter year division, the system is indifferent to the question if more care is needed or reasonable.
    – While insurers are legally non-profits, hospitals and nursing homes are not. Initially coming from public funding they are increasingly turned into corporations with negative impacts on working conditions especially for nurses due to economic measures.

    Overall I think the basic layout is right, but the way the system is regulated and fine-tuned requires constant adjustments and is always reason for dispute between insurers, healthcare providers and politicians.

    • KlausM54 so we can cut costs if we make some regulations and can raise cost so that the incentive for the doctors is still there. And we still have 21 Billion Euros in deposits to use.

    • +KlausM54 thanks for your insights KlausM54. Yes, in theory it should be a great system, but due to all the lobbyist corruption tainting it, I don’t trust the German medical system anymore! Every patient is manipulated into the most invasive tests and most invasive, expensive treatments for the most blatantly minor symptoms, just because otherwise the health insurers don’t leave any space for doctors to turn a profit.

    • Yes, unfortunately in many cases that it is how it works. Try to find a decent GP, whom you can trust, who doesn´t dig massively into the private additional care business (IGeL). The family doctors can´t keep up with all procedures, that may get presented to you, but often times they can help to find out what is really neccessary.

    • Another point is that every insurer is negotiating drug prices with the pharma industry on their own – instead of negotiating prices from a centralized position for all insurers. This often makes drugs in Germany much more expensive than in neighboring countries. None of the patients really cares because there’s only a 5 Euro copay for each prescription. But in total bets are it makes the system more costly.

    • Thank you for your input, all you people.
      As somebody who only interacts with the German health care system as a patient I’m lacking insight into the things going on behind the curtain.

      I only know we have far too few psychiatrists, psychotherapists and other kinds of specialists in many areas. In some areas there are even far too few general practitioners, and not only in the countryside! I live in a large city and my GP is still overrun with patients. I tried to change to another one, but they are also overrun.

  9. One point to add. German health insurances have a lot of purchasing power, every few months the set up new contracts with pharmaceutical companies or producers of medical devices in order to get the lowest possible price. Not to forget, prescriptions are in most cases for the active ingredient, not a specific medication, so the pharmacy checks which is the cheapest medication with that active substance. The aim is to provide the patient with the best medication at the lowest price, therefore there is no incentive for selling something to the patient.

  10. David, please stop perpetuating the myth that we Germans wait automatically longer for appointments than in the USA.
    I am chronically ill, disabled, unable to work. The government covers my health insurance costs – I have free choice of insurer, not like in the USA.
    If I am ill, someone from my GPs office will make a housecall the same day. If it’s urgent, within two hours. If it‘s not anything really urgent I’ll get an appointment within a week.
    I see lots of specialists in a university hospital. If I need them badly, I walk in and wait. I will get seen. Else, I can make an appointment within a week or three, and that’s for a specific doctor. If you don’t care who you see, as is the case with most people in these clinics, your wait times will be even shorter.

    • Well, I had to wait 3 months for a urologist appointment, and if you need to see an orthopaedist, chances are that you’ll have to wait for quite some time as well. Unless of course you have a private insurance, which usually grants you preferential treatment. Doctors earn more money with privately insured patients.
      Having said that, I never had to endure long waiting periods in case of emergency. I broke my shoulder last year, and I received preferential treatment because the doctors saw that I was in pain. So within a couple of days I had surgery. It couldn’t be sooner because a number of examinations like MRI and CT had to be done. Maybe I was just lucky, because I’ve heard numerous stories of people having to wait for ages even though it should have been an emergency.

    • Not to forget that the “3 Months waiting time” got battled by the Government. Specialised Doctors have to give you an appointment within i think 2 Weeks was it?
      Called my Dentist 3 Weeks ago, got an appointment next day. No teeth problems just the yearly visit.
      Optrician the same. HNO the same.
      And if i go to my Family Doctor its long waiting yes. I have to wait between 30 minutes and 3hours. Depending on which day of the Week and how many People are in the Waiting room.

    • +Patbwoy He explicitly mentioned a university hospital. Those are usually only found in relative big cities, where the general health care is much better provided. If you live in a more rural area, specialists can be pretty overrun.

  11. As an American disabled Veteran living inGermany I have thought for years how much the American health care system could learn and benefit from learning from the German health care system. It really is a model. Our founding fathers developed a government based on flaws in European governing. Governance is necessary as anarchy does not work. Every country can learn what works best for their people as the US learned from Europe and European countries learned from the US. This is called evolution.

    • +BouncingCookie du musst aber wirklich aufpassen in deiner Studie was du vergleichst. Klar in manchen Segmenten sind die USA vorreiter ‘(du weisst das besser), aber für wen sind diese produkte dann zugänglich … ? Andererseits werden viele Produkte in Österreich eben erst viel Später von den Krankenkassen in den Leistungskatalog aufgenommen. Ja es gibt ein paar nachteile, summa summarum bin ich – als absoluter gutverdiener trotzdem froh HIER zu leben und nicht in den USA.

    • +BouncingCookie There is a reason why the regulations in the EU are like they are. In the US, in genral if you have a new chemical substance, you can just sell it and if it will harm anyone he will get charged by the court. in europe there is the other way, you havbe to proof your product is not harming humans before you are allowed to sell it. you ever heared about the company Grünenthal and their product contergan? Or you know about asbestos and how much ppl died on that and still do?
      I preffer someone selling me stuff i can be sure of it wount harm me or my family than beeing able to get millions of dollars because i will die soon or my family got terrible harmed. in some cases it can be alloed to get experimental medicines. but you need to have the approval by a moral council.

    • chris per, als jemand der in der medizinischen Forschung arbeitet, muss ich noch ergänzen, dass nur weil etwas nicht zugelassen ist, heißt es nicht dass die Methode nicht zugänglich ist, natürlich gibt es dafür dann strikte Regeln wenn zb als Teil einer Studie, oder wie eben manchmal auch zulässig als off-Label use.

    • BouncingCookie Germany, Switzerland, France all have very innovative medical industries that can compete with the US. The biggest issue is safety regulation as someone else here said. But that’s not necessarily a bad thing. There are so many useless drugs developed every year, only so that the pharmaceutical companies can charge higher prices. Might as well force them to unambiguously demonstrate that their new drug really is an improvement.

  12. It’s so funny and strange to hear those right wing talking points against single payer healthcare. Especially when you’re from germany or another country that has a healthcare system that works. It’s just very strange that the right wing guys are defending the american healthcare industry for f*cking them over big time. “No ! I want to be able to go bankrupt in a medical emergency!” “No! I want private insurance companies to make lots of money! Why should i pay less for better care?” – It’s just insane 😀 . How can such a big part of america not understand how much their getting screwed ? It’s basically stockholm syndrome

    • True, but it’s very close. The medical services and treatments that patients may receive and most of the prices are determined by a central agency for the whole country. For example a standard examination by the family doctor will be paid with (fantasy number) 30€, that’s it for the whole country, no discussion. So while there is no single payer when you look at the cash flow, it’s also not something like a free market with free floating prices and services. So in my opinion hardly a difference to a single payer system.

    • +Matthias Hunstock
      The German health care system is anything else but simple. I am German, living in the US for many years. I have seen nothing here that even comes close to explaining the system as it is in Germany. The reason for the lack of explanation is very simple. It is very complicated . It is NOT single payer at all. Everybody MUST be insured, either by state run agencies, private insurance companies, insurance companies that only deal with government agencies, or unionized industries. There are rules about what income level you must have in order to qualify for s specific insurance arrangement. If you make above a certain threshold, for example, you will no longer qualify for government sponsored (and required) insurance, but you MUST buy private health insurance (which is a much better coverage than government insurance, but expensive). In actuality there is a multi layered and multi tiered system which is tied into your income level, what you do (blue color/white color………). The quality of the care is dependent on which insurance branch you are forced to buy in. Best is of course the top level private insurance with supplemental (that part is voluntary and very expensive) insurance policies. Supplements can only be purchased if you are privately insured, if you are in the government run programs (Krankenkasse), then you are NOT allowed to purchase supplements (that is the socialist part of the program).
      There is much more to this, and the information is readily available on German websites (in English as well for foreigners, since German government language is convoluted even for Germans).

    • +Ernst Fihn Sorry I’m german too, and the system is SO complicated that I cannot even agree to all the things you mentioned 😉 For example you are not forced to get private insurance when having high income. It’s actually that you are allowed to opt-out of the gov’t run system and get private insurance. But yeah, it’s too complicated to explain in detail in a short video, I guess we can agree on that.
      BWT sometimes I get the impression that in the comment section of every YT video with “German” in the title, there are like 95% germans hanging around… 😀

    • Artificial Gravitas
      I can’t speak for Canada but I lived in Germany for 13 years and there is no wait time and their health care is better.

    • Breaking Bad was not realistic. Everyone with catastrophic care gets treated in America. You just have to jump through the right hoops.

    • +Niles ButlerNicht wirklich, meine Krankenkasse macht sowas und es ist eine Gesetzliche Krankenkasse eine der größten. Falls es dir nicht bewusst ist vor paar Jahren wurde dir dieses möglich gemacht damit man bei Fachärzten schneller oder überhaupt an einen Termin ran kommt und danke für die netten Worte. (btw daß?) Ich wünsche dir trzd alles gute. MfG der Lügner

    • and pay 3x for gas and 3x in taxes your who life. Also, don’t forget the drugs come from the US companies that develop them. You are already subsidizing socialized medicine, so be happy. So, if we then send our Rx development outside the US, then you can add that price into your taxes too. Stupid comparison, but simple, so you like it.

  13. I love how my idiot coworker is constantly telling me now “ok maybe universal healthcare works in other countries but that’s because they are smaller than us.” Apparently does not understand math. The system scales with the amount of people in the country paying taxes to support it.

  14. The reason why the NHS is full of inefficiencies is in large part because *American ideas* about healthcare management have infected it.

  15. America is a total embaresment in the eyes of good non greedy civil country’s. STOP BRAGGING ABOUT THE BIGGEST GREATEST NATION OF THE WORLD.!!!!!
    The netherlands has a great healthcare system to . Your tax money in america is not used for the people!!!!!!!

  16. *Something important missing here: “Krankengeld” (sick pay)*

    Krankengeld is the money health insurance needs to pay an employee when he/she has been sick for more than 6 weeks (until this moment the employer is mandated to pay full salary). After the sixths week, the health insurance company needs to reimburse you 70% of your gross salary. You can receive “Krankengeld” for about 78 weeks / 19.5 months

    • +Mysterios1989 Not in some Companys. In all. German Healthcare is not “one single System” its 3 systems working toegether.
      Every Worker is an “Berufsgenossenschaft”. That gets paid 100% by the Employer. Because those only cover Work related Injuries/diseases.
      Then you have the “Pflegeversicherung” the “Care Insurance” which as the name suggests is for care like for example getting into an wheelchair after an accident. You need what? Yes someone who cares for you for a while till you learn to get on with that new life.
      And then theres the Health Care.

    • +T. Neulaender You should also be telling the Americans about the “Beitragsbemessungsgrenze” if you mention the Price.

    • +Toffi Kai No kidding! the Health Insurance Company’s makes a + in money anyway with this system. It is easy because a Heath-Insurance CEO dindN#t earn 60 Million $$$$$$ each year! the 1% gives a ****** off to the population of America! That wyh you pay so much for you drugs and doctors!

  17. I am from Germany and I can only say I am really proud on our healthcare system. We get what we need. I’m born here and have a handicap which might would have cost a couple of millions so far in all my life. It would be impossible for my parents if I would be born in the USA. And I never had any problem getting the best wheelchairs there are or anything else that I would need. My electronic wheelchair right now cost around 20k Euros and I did not had any problem ordering it without any additional payment.. The system we have here is fair you get what you need not what you can afford.

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