Hometown Wayfarer

No Death Panel, No Deductible: A Glimpse Into the German Healthcare System

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Before moving back to Germany, I would never go to a doctor in the U.S. just to get my blood work done or to talk about minor medical issues. I do not know a lot of U.S. Americans that would. Simply because after paying your health insurance premium each month, you would still have to pay $35.00 at check-in and then later on get surprised by a hefty bill for any additional procedures (e.g. x-rays). I always felt like you do not see a doctor in the United States until it is literally too late. You do not go if you have an iffy feeling about a health situation, you go when this feeling has proved to be true.

It is no secret that I absolutely love the United States. I lived in the States for seven years (in Kentucky and Texas). I was an au pair (live-in nanny) for a year and a college student for an additional three years. During that time I was covered under German travel insurance. One trip to the emergency room one night which might have lasted just a few hours and included tests like EKG, blood work, and a chest x-ray would have cost me around $10,000 if I would not have had that German travel insurance.

After I graduated from college and started working in Kentucky, I no longer had German insurance and instead was covered under insurance provided by my employer. While being employed in the United States I did not call sick into work once nor did I ever go to an actual doctor’s office- I only went to the Urgent Care nurse. But I did not go to get my legs checked out when they started to hurt and worry me. I did not even think about going, ever. There are people who still pay off the little bit of glue the nurse used in the ER to seal their wound, or others who wish they would have died instead of having to pay a fortune for that ambulance ride three blocks down to the next hospital.

People in Germany take their healthcare system for granted because for them it is a basic right. After moving back to Germany last summer I realized I used to take it for granted as well, but am now amazed by it. Here are a few points that made me appreciate the universal health care system after I had the first surgery on my leg this year:

1. I was off work for three weeks after the surgery

And while I recovered, my salary was paid in full and those 15 days I was not at work did not count towards my vacation days.

My work was legally prohibited from firing me due to sickness because once you receive a sick note from your doctor, your work cannot make you come in.

2. The total bill was just under 20 Euros (TWENTY EUROS!!!!)

That bill covered the 10% out of pocket I had to pay for the tailor-made thrombosis stockings as well as some lotion for my scars that I decided to buy. I did not receive a bill after the surgery nor did I pay a co-pay at the doctors I visited prior.

The bill was paid at the pharmacy when I picked those two things up and they threw in some goodies (free vitamins and trial size lotions). To be honest, before moving to the U.S. I would have internally complained about paying ‘so much’.

3. There was no long waiting period for appointments

A big misconception is that due to universal health care, people die here before they get the necessary procedures done. It is true that sometimes you have to wait longer for an appointment due to the lack of specialized doctors. You might have to wait a month for a routine dentist appointment, but if it is an emergency or you are in pain, you most likely will be squeezed in the same day. After talking to my family doctor, he made sure I got an appointment at a specialist the very next morning. After talking to that doctor I made an appointment at the local hospital who had a surgeon specializing in vascular surgery. I opted for a later appointment to fit my schedule, but I could have had this surgery within three months. So you can imagine, how fast you will get an appointment if it is life-threatening.

A few other things I’d like to mention while I’m at it:

4. Health care in Germany is not completely ‘socialized’ – you pick from more than 200 different insurance companies. Some people even opt for privatized health care. If you do not like your plan for whatever reason, you can change your plan at your own discretion. The state has no say as to what insurance company you have to use.

2. THERE IS NO DEATH PANEL (screaming it especially loud for them people in the back… and Sarah Palin). The fact that people actually believe this nonsense had me shocked. The elderly and sick are being taken care of very well in Germany and most other countries in Europe. There are a lot of different establishments – socialized and privatized- as well as other programs to include everyone in society.

And since there is no death panel: health insurance providers have to accept everyone in their program, they cannot reject you due to a ‘pre-existing condition’ like migraines.

4. The taxes in Germany are high – no doubt about that, but honestly that’s a sad excuse for not wanting universal health care. I pay a monthly 8.4% of my salary for health insurance. I might have paid a bit less in Kentucky, but with these 8.4% I am 100% covered. No deductible, no copay, no additional bill. I wouldn’t mind paying double if it meant that I can go to the doctor and receive treatment without worrying about any future healthcare debt. And I am not paying it all by myself: the employer pays half and also matches your payment for any other social tax deductibles.

Health insurance is of course not the only deduction from your paycheck in Germany. In my case I also pay the below percentages for other social programs:

1.525% for longterm care or nursing care insurance (you are taken care off once you can no longer take care of yourself due to illness)

1.5% unemployment insurance (you receive unemployment money as well as access to multiple programs and classes to help you get back into work)

9.3% pension insurance (something you do not think off in your 20s, but it doesn’t hurt me nonetheless)

I’d rather keep paying a higher percentage and know what I get out of it than paying a lesser percentage, but then also having to worry about the financial consequences when going to see a doctor. In Germany, you do not necessarily need savings in case of a medical emergency. People here save for vacations (your employer is legally required to give you at least 20 vacation days a year if you work fulltime, most employers give you up to 30 days), they save for a home, or a new car. I have never heard someone mention their medical bills here.

5. Fun fact: you cannot purchase over-the-counter medicine at a drug store or grocery store (only vitamins and supplements). You always have to go to the Apotheke (engl. pharmacy), even for Aspirin. This prevents people from taking too much OTC medicine than they actually really need. Aspirin comes in a bubble pack with 20 pills which last exceptionally long in a German household. After my surgery I received an IV with pain killers while in the hospital and was released with three 800mg paracetamol pills. Yes, the pain was outrageous, but something you just got to go through. I have heard international friends complain about the lack of administered pain killers in Germany. In the US you receive Vicodin after a small procedure. Such a strong substance would not be prescribed to take home ‘just in case the pain gets worse’. There is a horrible heroin epidemic going on in Kentucky and so many other U.S. states which all falls back onto this excessive need to prescribe highly dosed medicine. Sometimes the doctors in Germany won’t prescribe you anything and instead will talk to you about how you can get healthier by changing your current lifestyle. While deemed expensive by Germans, buying medication in Germany is so much cheaper than in the U.S., where I know people who have to depend on their GoFundMe-pages to pay for their life-saving medical expenses.

6. Preventive care is huge in Germany. Whether it is pre- or post-partum care (another topic…), the programs at school and work, or any other preventive care your doctor think you could benefit from: most of it is covered by your insurance (depending on the situation you might have to pay a small fraction yourself). If you have burnout syndrome e.g., your doctor can ‘send you away’ to a Kur (treatment at a health resort) for up to six weeks. At Kur, you learn how to manage your illness or how to live a healthier lifestyle. Furthermore (and actually, a lot of Germans don’t even know about this option), every employee has a right to Bildungsurlaub (engl. educational vacation) which is also partially if not fully covered by your insurance and it does not count towards your vacation days. Usually you take a three day trip somewhere (maybe the German seaside…) and take part of a course which can range from Yoga to business administration.

Preventive care is an active part in German schools: kids bring their own lunch from home or are provided with a healthy lunch (not fast food), there are many excursions year-round for kids to understand what being healthy means, but also to make them a well-rounded citizen. In addition, as a student you go on several 5-day-long trips that are part educational and part recreational (best childhood memories came from those Klassenfahrten). At work, you can often times utilize the employee services (for physical and mental health issues) or join a sports team.

I understand that the United States are much bigger than any other country in Europe and with that size come a lot of different opinions. I understand you cannot make everyone happy, but you can at least give everyone the right to affordable health care and stop denying the success these programs have in other countries.


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