21 August 2009

The Great Health Care Divide

Since the health care debate is the main topic of conversation in the United States right now, many people have asked me about my experience with socialized health care. Germany is a mix of private and public health care. Everyone that works here pays into the public health system, and they and their dependents automatically qualify for public insurance. However some people choose to upgrade to private insurance so they can go to specific clinics or doctors and get more services like the gestational diabetes test covered.

Back, when Paul and I lived in VA, we paid out-of-pocket for private health insurance, because Paul’s employer’s health plan was super expensive, and they didn’t contribute towards it. The premium amounted to 9,6% of our gross salary. This did not include maternity coverage. To get maternity coverage we would have to pay an additional lump sum which would have amounted to 12,3% of our gross salary. Furthermore we would have had to pay for the maternity rider for six months before I could even get pregnant to qualify for the coverage. If I got pregnant five months and twenty nine days after we started the maternity rider, I wouldn’t have been covered. And, we could only add this coverage in six month intervals from when we first enrolled. When I got pregnant with Maggie, it wasn’t planned, and if we had been in the USA, we would have had to pay for the whole thing out of pocket.

When we asked our friend, a health insurance sales representative, he told us we wouldn’t be able to find any less expensive coverage. Furthermore, this coverage would not cover any pre-existing conditions, so it was a good thing that we were all healthy. We also maxed out our health savings plan in six months with co-pays and uncovered services, like visiting the optometrist and the dentist. This doesn’t include what we paid for prescription drugs.

In Germany, there also is no such thing as pre-existing condition or maternity riders. For this we pay 7,45% of our gross salary, Paul’s employer pays the same amount as required by law. For each doctor we visit in a yearly quarter, we pay 10€. It was a good thing I got pregnant in Germany where the public health insurance has no such thing as a maternity riders or rules on how to qualify for coverage.

Total out of pocket expenses from my first check-up all the way to post-birth care for two pregnancies: 125€. This included the 3 standard ultrasounds, all the regular maternity visits to my OB, all the standard tests, a gestational diabetes test, a strep-b test, giving birth twice, staying four days in the hospital after Max’s birth and three days after Maggie’s, and getting an epidural once. I paid 0€ when I went into the hospital for a uterine infection staying another four days, and they let me bring Max with me. Though, we did have to pay for Paul and my Mom to stay in the hospital room overnight to help me with Max. My health insurance covered the rental of a Medela Symphony breast pump, a pre-natal class, and a midwife who visited me at home after the birth as long as I needed her. If I choose to, I could have paid 0€ to take an ante-natal get back into shape class. Additionally, I’ve paid 40€ for 3 months of birth control, and I will pay 175€ for an IUD which is good for 3 years.

Regarding pediatrics, we’ve had equivalent care as we had in the States. For sick visits, we’ve get in to see the doctor the same day, for well-visits, we schedule about two weeks in advance. With Max, our pediatrician actually visited us at home after he was born. We only pay 10€ a quarter to the pediatrician including all the World Health Organization recommended vaccinations. We paid 10€ to the pediatric optometrist for a check-up and scheduled within two weeks. We paid 10€ for the pediatric dentist and scheduled the same week.

After three ER visits, we’ve had to pay 0€. When we take the children to the ER, we take them to a children’s hospital, of which there are at least three in Munich. When we took Max for what we thought might be bronchitis, we waited about two hours on a Friday night. When we took Max after he swallowed hand sanitizer, we waited about five minutes. I’m pretty sure every time I’ve ever been to the ER in the States; I’ve never waited less than two hours. When I was in the car accident in Ann Arbor, brought to the hospital in an ambulance and had my neck in a brace, I waited four hours before I saw a doctor. I thought they had forgotten about me. I don’t know how much, but I know my parents got an enormous bill for that, and now ten years later, they are still owed money from the University of Michigan hospital for being over billed.

When Paul went to the ER for his broken clavicle in Germany , he waited three hours on a Thursday night, paid 0€. He scheduled his follow-up with an orthopedic surgeon one day in advance, and paid 10€. His physical therapy to rebuild his muscles will cost 10€ a quarter. In the USA, Paul went to the ER for his appendix, we waited about four hours the first time. When he went to the ER for his appendix the second time for his appendix we waited another four hours. We walked out of the ER the first time because his tests came back negative, but the surgeon still wanted to cut him open, even though he couldn’t even look at us because he was too tired. Out of pocket, we paid $2000 in hospital bills for what the health insurance wouldn’t cover.
Of course the ERs aren’t full of uninsured people seeking basic medical care in Germany, because there are no uninsured here.

For sick visits to general MD, we’ve gotten in on the same day (even if we have never been to the doctor before.) I’ve been denied by doctors in the States because my health insurance was from a different State. When I had the ovarian cyst in DC, I had to call six doctors before anyone would see me, and the one who did see me only did because I was crying when I called. For Paul’s root canal, we paid 0€. For my cleaning, we paid 0€, and Paul had a special cleaning which he paid 80€ for out of pocket.

All this government running of health care hasn’t ruined it. Saudi Arabians and other nationalities from around the world come here to pay out of pocket when they get really sick. They could certainly afford to go to the USA if they felt the health care was better there. In fact, Munich airport has a medical center for people who fly here for health care. Even the plastic surgery industry is highly desired.

Obviously, I can only speak from our personal experiences with both systems, but in the States, I had many complaints about my health insurance. Here, I’ve not yet had one. And maybe giving birth, uterine infections and broken clavicles aren’t serious enough to be worthy of comparison, but I think they are. They didn’t bankrupt us like medical bills for similar services have done to so many Americans.

Finally, yes Germany has the fourth largest economy in the world, and yes its population is only 82 million, but the United States’ Gross Domestic Product is three times larger than Germany's.

17 August 2009


Last week, Paul and I went to the U.S. Consulate to report Maggie’s birth and apply for her passport. With Max, we applied for his straight away when he was two weeks old because we had no idea how long it would take for him to receive it, and we needed it to return home to the United States.

Since I know you are wondering if she has dual citizenship, no, she doesn’t. Neither of our children have dual citizenship. In Germany, you only qualify for citizenship by blood. Or, if you have lived here for seven years, you can apply for citizenship. A funny little quirk on that rule is that a friend of mine who lived here for seven years was able to get dual citizenship for her child when he was born, though neither she nor her husband have German citizenship. Once our children are here for seven years, we can apply for citizenship for them, but I believe they would have to choose between the two countries as adults.

I’m getting off point however, so back to passports. We had to get the kid’s photos for their passports, which are good for five years. Because everyone knows that an infant is very representative of what they are going to look like a year later, much less five. The photos couldn’t be just any old photo of their face; oh no they have to be biometric photos with mouth closed, no smile, eyes wide open, and no obstructions.

A two week old baby only keeps their eyes open for a few minutes a day, so I originally tried to take the photos myself. Here are examples of my first attempt at photographing Max for his passport photo.
I thought I did a pretty good job at meeting the biometric requirements, and I even had them sized right for the biometric requirements, but we couldn’t get them to print out to the right size on the do-it-yourself photo printer at the photo studio. So we finally took him into a photo studio to have them done.

Max adamantly slept the entire time we were trying to get his photo taken. He slept through fire truck sirens on the street; he slept through my mother and I undressing him. We tried turning him upside down, everything. Nothing woke this kid up. Of course the whole time I was wondering why wouldn’t he sleep like this at home?

Finally, we had to leave the studio and come back when he was awake. Of course a two week old baby is usually only awake when they are hungry and want to eat. And, if you don’t feed them right away, screaming usually follows, which doesn’t work out so well for the biometric photo either. Finally I was able to feed Max back to calm, and we got the photo which will represent him for five years.

And just for kicks, this is what Max looks like now, two years later.

With Maggie, I wasn’t going to mess around. I took her straight to the photo studio, and got her photos taken and printed out. Only I forgot they needed to be a different size than the standard German passport photo, so I spent 16€ on photos that are too small, which of course I didn’t realize until the night before our consulate interview. However, now we have six perfectly darling biometric photos of Maggie.
So in desperation, since there are no 24-hour photo studios here, I did the only thing available to me, I tried to do the photos myself. This time I had a photo printer, granted it is a cheap photo printer, not commercial quality, but I would be able to get the photos the right size this time. Anyone, who has tried to photograph a two month old, knows how difficult it is to get them to smile for the camera. Of course, when you are trying to photograph them not smiling, they seem to do nothing else but ham it up for the camera.
We weren’t sure if the consulate would take a home-printed photo, but they were quite happy with them, so, this photo is going to her passport photo for the next five years.

On a side note, the passport application also asks for their weight, height, eye color and hair color…hmmmm.

14 August 2009

Quick Update

On Paul: He went to see an orthopedic about his broken clavicle, and found out he has to wear the figure eight sling another 3-5 weeks. He was also very sternly lectured about not using that arm at all. It's very hard for him not to be able to hold his children. Once the bone has healed, he'll have to rehabilitate the muscles in his left arm. Then he'll be able resume holding Maggie and Max with both arms, and I'll be able to walk Asia again.

On Max: Potty training has pretty much fallen to the wayside, as Max has lost interest. He still uses the toilet about once a day in efforts to procure M&Ms. The process has added a whole new array of amusing vocabulary combinations to Max's repertoire, like "a big poop coming," which of course he never tells me in time to get him to the potty. When Max is perfecting a new word he practices combining it with all the important people in his life. His latest, "Maxi's butt, Da-Da's butt, Maggie's butt, Oma's butt, Opa's butt, Asia's butt, Ma-Ma's BIG butt." Thanks kid.

On Maggie: She's eating, pooping, drooling, crying, cooing and smiling. She's also getting Ma-Ma's BIG butt back in to shape, by forcing her to dance her to sleep twenty times a day. Since we never invested in a rocking chair, this has been both of our children's preferred methods of going to sleep in infancy. I consider it my exercise routine, and I recently added squats to my impressive dance routine. It's a good thing we live on the top floor.

On Asia: Poor dog hasn't gotten much exercise lately, since I can't take her for hour long evening walks anymore. She's been a champ about it though, and is pretty much doing the same as Maggie, eating, pooping and drooling.

On Me: Read above, as my life revolves around these three people and our crazy pooch.