70% of Americans say the US healthcare
system is in a state of crisis or that
it has major problems that's why we're
hearing a lot about Medicare for all
including some plans going as far as
banning private health insurance
companies altogether it says that we
will no longer have private insurance as
we know it and that means that 149
million Americans will no longer be able
to have their current insurance that's
in four years I don't think that's a
bold idea I think it's a bad idea
problem senator Sanders with that damned
bill that you wrote and that Senator
Warren backs is that it doesn't trust
the American people I trust you to
choose what makes the most sense for you
not my way or the highway
one country found a way to provide
universal health care coverage while
maintaining a competitive insurance
market that offers citizens more choices
Germany here's how they did it in 2017
US health care spending came to around
ten thousand two hundred US dollars per
capita in Germany it was a little under
six thousand dollars overall Germany
spent about eleven point two percent of
its GDP on health care while the u.s.
spent seventeen point one percent
Germany manages to cover one hundred
percent of its population in the United
States about eight point eight percent
of the population remains uninsured that
comes to about twenty eight million
people with even more people
underinsured despite spending less
Germany has better or comparable health
outcomes to the United States studies
show that in Germany there were fewer
deaths that could have been prevented
with proper access to care in 2013 there
were 83 avoidable deaths out of every
100,000 people in Germany while the
United States had 112 life expectancy in
Germany is 2.5 years higher than the
United States and the infant mortality
rate is lower in Germany with 3.3 deaths
per 1000 live births as opposed to 5.8
deaths in the United States
additionally the maternal mortality rate
in the United States is more than two
times higher than in Germany so how does
Germany manage to have better health
while spending nearly half as much as
the United States Germany is a system
that would look familiar to Americans in
that everybody buys health insurance
from a private company and then the
doctors and the hospitals and the labs
are almost all private
that's TR Reid author of the book the
healing of America he traveled the world
exploring different health care systems
and how well they worked but it works
better in Germany for a couple of
reasons one is everybody is covered
everybody is required to have insurance
everybody's in the system the insurance
companies can turn you down because you
had cancer last year or something they
have to take you they have to cover you
everybody has access to the same
treatment and this all the doctors you
can go to any doctor without without any
limit set by the insurance company in
Germany health insurance is mandatory
for all citizens and permanent residents
there are two different systems that
residents can turn to for insurance Shi
which stands for statutory health
insurance and pH I or private health
insurance German citizens are eligible
for pH I if they make more than roughly
sixty thousand US dollars per year or if
they are self-employed citizens making
under that threshold must pay into shi
shi is made up of a network of competing
not-for-profit private health insurance
funds known as sickness funds in Shi
dependents are covered free of charge
and monthly costs are capped around 840
euro per month
even though Shi sickness funds are not
government agencies many Germans think
of them as part of a public system
because of heavy regulation keith Tanner
helps expats navigate the German
healthcare system and he considers Shi
sickness funds quasi public
organisations to do what they're told
they are told by the government what in
what range they can charge they they're
told what health procedures they can
fund
and they are talking about gum who they
can accept as climbs so they're really
just coming out orders
they're basically charities they don't
exist to make a profit for investors
like American health insurance companies
they're there to keep people healthy
that's what they're there for they
follow all sorts of rules that American
insurance companies wouldn't dream of
the system is funded through compulsory
contributions based on a percentage of
citizens salaries with employers sharing
the costs there are also built-in safety
nets the government will pay into Shi on
behalf of the long-term unemployed
despite being nonprofit organizations
sickness funds compete for customers by
offering specific coverage and perks
this competition has changed over the
years as the system has allowed citizens
more choice as of 2019 there are about a
hundred statutory health insurance
companies but there used to be many more
when Germany system was first
established in the late 1800s sickness
funds were linked to a person's
profession it used to be that people
were assigned to a specific sickness
fund based on their occupation or region
now Germans can choose where they enroll
and they can change funds on a yearly
basis as a result sickness funds begin
marketing themselves in order to retain
customers and attract new ones this also
led to the funds merging so they could
become more competitive some of the
sickness funds offer perks that might
seem similar to credit card rewards you
still can get a bonus for going to the
gym the bonus of having a checkup
this is in the public system and if you
get a number of bonus points then you
get the voucher but the kind of trivial
stuff like two hundred a year or
something like that
Turin euros a year nothing we did
relevant to the person was paying but
there are eight hundred forty a month as
of 2017 roughly eighty seven percent of
Germans received their primary coverage
through Shi and 11% of the population
through PA chai the remaining
populations such as soldiers police
officers and refugees receive health
insurance through specific government
programs all individuals insured through
pH I pay a risk related premium with
separate premiums for each dependent
these risk-based premiums mean that
costs will increase
the insured gets older as a result the
government regulates pH I so people
don't become overburdened by premiums as
they age the biggest issue in private
health insurance if you opt out of of a
public system is affordability in old
age
if you don't impose these financial
constraints on the insurance and the
government will be lumbered with a whole
lot of old people per each 85 90 95 as
the gonna be totally unable to pay for
the health insurance so it'll all fall
back on the government once someone
switches to pH I they cannot switch back
to Shi in the future but Tanner says
there are ways around that if you're a
freelancer in the private system just
going to get a job paying less there's a
threshold any employee earning under
about five thousand a month is required
to have public if they are more than
that they can opt out so if you are a
freelancer you want to go back into the
public system for some reason then you
get a part-time job with a friend they
usually 500 a month for a few a few
months and then you reckon the public
system so don't waste our doing the only
reason you probably want to do that
though is if you have lots of children
because children can be covered free in
the public system and the privacy's you
have to pay separately for each child
Germans can also buy supplemental
private insurance while staying in Shi
for example many Germans buy
supplemental dental insurance the public
system pays like for major dental but
about half the cost of supplementary to
take it up to eighteen ninety percent of
the cost
Germany system is not perfect
with so many different insurance
companies there's a lot of bureaucracy
that contributes to costs one of the
financial things thinking it's public
system administered by more than 100
organizations called trenton castle each
of those has a head office and the
president and vice-president
financial officer a whole lot of
unnecessary bureaucracy this may be one
of the reasons that the German system is
not as cost-effective as other European
countries more than 30 percent of both
Germans and Americans felt bureaucracy
was a major issue in their country's
system
wait times can also be an issue for
people and Shi 37% of Germans say wait
times as one of the biggest problems
within their system while 22% of
Americans feel the same Emily I think
people are quite happy with the public
system it works reasonably well the
major issue in big cities I'm in Berlin
Munich dusseldorf hamburg it can take
quite a while to get an appointment with
our specialist it is the case that the
doctors prefer the private patients
because they earn up to 3 times more if
they see a private patient so what can
the United States learn from the German
system Germany has managed to balance
cost controls and universal coverage
while also maintaining competition and
Germans generally like their system in
one survey not a single German said they
had to wait more than four months for an
elective surgery while four percent of
Americans said that they had to wait
that long for the same kinds of
procedures and only 7 percent of Germans
said the experience to barrier to care
because of cost in the past year
compared to 33 percent of Americans
citizens really like it they like the
fact that everybody is covered they like
the fact that the costs are totally
predictable you know what it's going to
cost you and how much your insurance
company is gonna pay you before you walk
in unlike the United States they think
it's normal that the insurance company
pays every claim they they can't believe
that insurance company might deny a
claim and they think it's normal that
they get to choose the doctor they
understand America where the insurance
company says we won't cover dr. john
jeff spoder dr. smith instead so the
main thing I learned in going around the
world is you have to make the commitment
to provide health care for everybody
that's the destination it turns out
there are many different routes to that
destination I found you know the
Canadian model the French model the
British model the German model they all
get
get to this goal in different ways and
different models so I don't care what
the model is I think it's important that
you make the commitment to cover
everybody and this is something the
world's richest country has never done