US Health Care Is like Rotten Eggs! It stinks!

Compare it to Germany's Heath Care system.

I just arrived back in USA on Friday. This week I am going to be spending time trying to straighten out problems related to my 90-year-old mother’s medicare and long term disability coverage among other things. Her dementia makes this hard for her to manage, while that is to be expected, it is also wrong that the long term disability insurance has ignored me from abroad, and makes it so difficult to access care. My 79-year-old, legally blind aunt was late to my house yesterday because she was filling out forms to start getting payouts of her long-term disability care. She feels that she needs so much support from her husband that he should get paid for his time. I agree. She hopes she can get this coverage that she has spent many decades paying into, but is uncertain that she will get it. That is just wrong. She should be able to count on it. This past summer we lost my cousin, my aunt’s 57-year-old daughter to complications from Multiple Sclerosis. This marked the end of my aunt spending weeks each year filling out forms to get her daughter disability payments until her pension would kick in. Her family needed that income to live off of. The forms they filled out had to be timed just right regardless of whether they could get the doctor appointment on time for him to sign off that she still had MS, or they would not continue to cover her disability. This was crazy for someone who has deteriorating mental capacities to have to manage on her own. Also, health insurances should know that unless there is a cure, MS is a chronic disease. All of these nuisances are to cut people off that should be covered, and to avoid paying them monies owed.

My 23-year old newly graduated nephew, only has health insurance because his father still has him covered under family insurance. He also has over a hundred thousand dollars of loans to pay off from his undergraduate degree, which is currently only getting him jobs that don’t provide health insurance or other benefits. He cannot consider living on his own and being a fully independent adult when he is saddled with debt and does not earn benefits as he starts off his career as a chef.

My husband who has no chronic illnesses and is working for a university, is the only one in my family who has a good health care situation in the US. That would change when he retires, if he were to stay here. The rest of my family cannot count on their insurance to continue, or to cover what they need it to cover, or that it will remain affordable. We have recently found out that both my mom and my aunt have Medicare Advantage plans too. That will be another thing to look into while I am here. I should call these “Medicare Take Advantage plans.” I think it was one of these that threw my mom out of their plan 5 days before the last day to sign up for another one. She has just been diagnosed with dementia this summer, so I assume the insurance company waited until after Trump won to do this, believing there would be no legal or financial repercussions for them, and that my mom’s care costs would go up. I know our family is not alone in having these problems with health care. My friend could not get her manic and bulimic stepdaughter into the best program to treat her disorder because it does not accept insurance. The out of pocket cost for anyone except the extremely wealthy to pay. All of my friends in the US at least have employer pooled health insurance costs, with copayments to see physicians, and other specialists. Some have large deductibles before they get services paid. Their insurance is tied to jobs which ties them to the jobs. This is not how it is in many other countries.

When I moved to Germany two years ago, health care was an important aspect of my decision to move there. In retirement one wants to believe one can get access to health care when one needs it. In Germany people who are in the public (Statutory) health insurance, which is what I have, can expect to pay from 125 € a month as a student to around 755€ a month at the maximum. They count your income up to around 5,100€ a month, or 61,000€ a year, and one pays 14% of that, but not beyond the maximum even if one has a higher income. For that money, one gets medical care, dental care and long term disability insurance. Most Germans pay into it from birth until death, so it is a good system in that it has a wide range of incomes paying into it, and the wealthier subsidize the less well off, but everyone has to be covered. It is like what medicare could be if it covered everyone from birth to death as a family. If you are living on social welfare, there may be additional subsidies to your health care costs, just as there are subsidies for other things in your life like energy costs, or food here in Germany. The conventional wisdom is to get into the statutory health insurance, not the private, because if you choose the private, they won’t let you into the statutory one. It is not as clear cut as that, but it seems to be difficult to get into the public insurance if you have used private insurance. So, people get into a public insurance and it follows them regardless of what job they have or what health issues occur. That gives people freedom that one does not have in the USA to go from one job to another without worrying about changes in health insurance.

According to the German Federal governmental website most employees in Germany have Statutory health insurance. Each insurance has a list of doctors and dentists that accept its insurance, like an HMO in the USA. Doctors visits and medication are usually paid for directly by the insurance, so you will not receive a bill. Your family also benefits from your insurance. If your spouse does not work, they will be included in your insurance for no extra cost, as will all your children until they are 18, or 26 if they are in school, university or a paid internship program up until that age. The Statutory health insurance covers all urgently needed medical treatments, outpatient medical treatment, dental care, medication, health remedies, medical aids, inpatient medical treatment such as in a hospital, necessary medication, pregnancy and child birth services. Other services might be charged to you, but the costs for these are much lower than in the USA. Dental cleaning is not covered, but costs 95€ in my German city. The city is also doing free yearly screenings of women over a certain age for breast cancer. The screening is centralized but then one gets the results sent to your doctor. I assume they have identified that this screening pays off in timely identification. People who are self employed or not working but have other funds can also be in the statutory insurance but they are considered to be voluntarily not mandatorily in this statutory health insurance.

Another advantage to German public insurance is that the electronic health card one gets is good in all European Union Countries, as well as in Great Britain, Iceland, Liechtenstein, Norway and Switzerland. One of the men working on our house in Germany is from Poland. He cut himself and while we have building insurance, his Polish health insurance paid for the care he received at the hospital in Germany. He was also put on a waiting list in his country for a spa retreat, which is a part of many people’s health care here in Germany as well. There are some exclusive private practices, and there are some things covered only by private practices. If you have statutory insurance you are responsible for paying for any private health care services on your own. In Germany privately insured people must pay for their bills themselves, and then they have to submit them to their insurance for repayment.

I happen to wear glasses. When I broke the glasses that I need to see well, I went to a eyecare chain that sells glasses called Fielmann. I am not recommending them, just everyone I know says that is where they got their glasses. They offer free eye exams and then one buys glasses from them. The glasses I bought cost me 40 € with glare protection, and I paid an extra 20€ and could come back in 2 hours to get them instead of waiting 10 days. A family friend told me she got her glasses for 23 € at a different branch of Fielmann and says they are cheaper in her part of town. She might also have gotten a special deal because she is 90. My daughter, who lives in a more expensive city in Germany also went to a Fielmann store for her eye exam and glasses. She picked designer frames and paid 80€ for her glasses and an additional 10€ on insurance to replace her glasses for the next 5 years I think she told me. In the US, my mother balked at the price she had to pay for glasses, which was several hundred dollars, even though it affected her ability to read which she really enjoys. I had to point out that she can afford them. Now she has lost these glasses, and I am going to spend my day looking for them. They are not covered by insurance.

The USA is the wealthiest country in the world. Germany is the wealthiest country in Europe, but come in at number 4 behind the USA as measured by Gross Domestic Product. I don’t need to list all of the problems people run into with American health insurance. Just do a survey of heath care articles from ProPublica and you will find plenty of stories of things not working for the people. Or, you can read Matt Stoller’s Big Substack who covers anti-monopoly laws on cases of monopolies in the American health care system that harm us. Why does the much wealthier USA not cover everyone with health insurance and long term disability insurance? One reason is our politicians do not manage to get a bill passed that mandates that everyone have health insurance. Another reason is that the US has developed a system where everything in health care costs more than elsewhere. In Germany medical school is tuition free as is all university education. This is covered by the tax payers, and ensures a well educated population. As such, no doctor is coming from medical school with exorbitant debt that we then pay for in higher insurance cost and much more expensive medical care. That makes a difference.

Doctors cost a lot in the US. Still that does not prevent the US from having a Statutory health insurance. I think US politicians should be studying the health care systems of other countries who manage to cover all of their citizen and applying that to the “concepts of health care” that Donald Trump has not figured out. Those of us in Americans Abroad would be glad to share what we know about the health care systems in the countries in which we live in. In fact, most Americans who move abroad have lower health care costs, even though Medicare is not available to people who have paid into it and choose to retire abroad. This should not be. Americans should be able to collect Medicare wherever they live, they have paid for it, and the system would be cheaper if more Americans retired elsewhere and had only the costs of much cheaper health care to pay. Right now the US health care system stinks like rotton eggs for those living in the USA and those living abroad. We need to have this fixed.