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.


The Roaming Southerner said...

thanks for writing this post. We are moving to Austria soon (my husband before our baby is born and me after). I think the idea of giving birth in German or in a totally new healthcare system just was a bit too much...(it doesn't help that we found out officially about the move at 30 weeks preg.).

Great blog!

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