What better argument for universal health care can you make than that of Germany? By far one of the most successful systems, it has had some form of universal health care for almost 130 years, and is currently one of the most successful health care systems in the world. It is again, a mixture of public and private funding, with employers providing most of the funding for health care by paying into one of several hundred “sickness funds” that provide health care funding to their employees. Germany is widely regarded as having excellent access, short wait times, care with the best technology and pharmaceuticals available, and this again while spending 10.7% of GDP (US 16%) with per capita spending of ~3.3k USD (approximately half of that in the US).
The German health care wikipedia entry is a good starting point, and it’s always fun to try to translate German web pages and try to make sense of Google translations. But I’ve found several good articles describing the system including several articles in the MSM like this NYT piece which refers to Americans as having an “… immature, asocial mentality [that] is rare in the rest of the world,” one for travelers, and one for those looking for German jobs. The consensus seems to be that Germany rocks when it comes to health care.
Let’s talk about how it performs and how it works.
I know I’m starting to sound like a broken record, but as usual, the universal system blows the US out of the water in terms of cost and performance. A survey of health satisfaction comparing the US and several other countries, including Germany, showed that they are superior in many measures of patient satisfaction and provision of care.
Germans enjoy the shortest wait times for elective procedures, short ER wait times rivaled only by the Netherlands, and are the most likely to get a doctor’s appointment within one day’s notice. Depsite this the Germans seem to be the hardest on their system, with many thinking it could be better and needing significant reforms. In performance and outcomes data it’s better than the US in almost every regard but about middle-of-the-road compared to most other universal systems studied.
Their system works almost entirely through funding of “sickness funds” through employers, with a small contingent of private funding (about 10% of people) from those who are self-employed or make enough money to opt out of the system. The system is still one-tiered, despite the option of buying insurance that provides more amenities, all Germans have access to the same health care from mostly public hospitals, and public and private clinics. From the age of 18 to 65 all Germans are required to have insurance and employers match funds provided by employees. Private insurance can be bought, one can self-refer to specialists (unusual in most universal systems), and fee-for-service does exist though rare. The sickness funds are non-profit, and independent of the government, but highly-regulated funds that are incentivised to pay for chronically ill and sick patients. The large number of funds allow a great amount of choice for individual subscribers.
Germany to me doesn’t sound like they have a perfect system, but it is an enduring one, and one that outperforms the US. Again, the key we’re seeing among these successful systems based on private insurance is a high degree of regulation designed to prevent the sick from being screwed out of the system and better sharing of risk.