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.

Introducing...

Maggie Ruth

May 21, 2009 8:11am

3450 g (7 lbs 10 oz)

53 cm (21 inches)

First Impressions; Flashback to Munich Part I

WARNING: This is a really long post about pre-natal health care.

When I was pregnant with Max, I was considerably more ambitious about recording my pregnancy experience than I am this time; I kept a journal as well as sent various emails to all of my family about our experience. Here is an edited snippet from an email about my first impression of pre-natal and labor and delivery care in Munich.

"We finally found an Obstetrician. In Germany, they (the proverbial they) recommend that you pick where you want to give birth, and then find the doctor. We went to an orientation at the Frauenklinik Roten Kreuz (the women’s Red Cross hospital). It was amazing. It was a beautiful hospital, very clean and all the latest technology. They have an on-site NICU. The doctors are all highly regarded, and they are one of the few hospitals that have been able to maintain a highly qualified and full nursing staff despite the nursing shortages. The hospital is number three in the country for obstetrics.

Hindsight: Reading between the lines, many of our friends and family were concerned that the "socialized" health care in Germany would be a detriment to the quality of care I and my new baby received. I went a bit overboard in reassuring everyone that I was getting care on par with the care in the States.

They use the latest technology in Cesareans which has the shortest recovery time. And they have all the pain medicine available should you choose to use them. However, pain medication is not encouraged.

Hindsight: Again, I had to reassure everyone that I was getting the best care. While it's true that they try to encourage you to have the baby naturally, my midwife was the first to suggest the epidural to me. I was only half way through the labor, and she could tell that I wasn't dealing with the pain well. I have a very low threshold for pain, and a high intolerance for discomfort. She read me very well, and I don't regret the epidural at all. I received the epidural six hours into the labor at two cm dilated. I fell asleep immediately after the epidural, and when I woke up I was fully dilated, and ready to go.

Every birth is assisted by a doctor and a Nurse Midwife.

Hindsight: While this was true, it was really the Nurse Midwife who did all the work. The only reason the OB ever came in to the room was to make the episiotomy. They have doctors on hand for complications, but they don't do the brunt of the work for the majority of the births.

They have eight birthing rooms with all kinds of birthing assistance. Over the bed is a rope/towel thing hanging from the ceiling to help you situate yourself. There was a birthing ball, a birthing stool, and they recommend all kinds of different ways to help ease the pain. They also have three birthing tubs, which they highly recommend using to deal with the pain of labor. They offer aroma therapy, homeotherapy and an extensive library of music for you to play during the birth. They encourage you to bring anything from home that will make you comfortable from candles and scents to music.

Hindsight: The only thing I really took advantage of was the birthing tub, and the minute I got out of the tub, the pain got 10xs worse. This time around, I'm hoping to stay in the tub longer, because I really do believe that it is much better for pain management.

Standard of care is to stay in the klinik for three to four days afterwards. They have lactation consultants to help you learn to breast-feed, and a special nursing room with the gliding rocking chairs and nursing pillows. They also have a room with a glass ceiling so you can see the stars, where they encourage you to use the time to bond as a new family. If they have the space, they’ll let you have your own room and the father can stay overnight.

Hindsight: This paragraph highlights the best parts about my hospital stay. Max and I spent four days in the hospital afterwards. I only had a roommate for half the time I was there, and Paul, Max and I spent a lot of time in the atrium once my roommate moved in. The nurses were so fabulous too. I would have given up breastfeeding if it wasn't for the encouragement and support I had received from them. Afterwards I sent all the nurses chocolate as a Thank You.

Oh and they have classes before and after the pregnancy that are free of charge. They have everything from your “crash course” on birthing to back building exercises and gymnastics. They also have a class after the birth to help you get back in shape.

Hindsight: The classes aren't really free of charge; your health insurance pays for them. However, it was still really fabulous to have them available. We went to a different pre-natal class, which was lead by an English speaking midwife. I didn't take advantage of the post-natal get back in shape class, but I've gotten mixed reviews on its quality. For health insurance to pay for it, you have to enroll three months after giving birth, and the quality of the class depends on the midwife leading it. My friends who attended the classes, all said that it was pretty low-impact, which I guess is good if you just recently had a baby. However, I'm generally only into high impact exercise classes like spin and kickboxing.

And, if you’re really alternative you can get acupuncture for 15 Euros to help you with the discomforts of late pregnancy. I’m not that adventurous, though if I get desperate, we’ll see.

Hindsight: I didn't take advantage of this, but I have friends who did and really thought it helped them.

The hospital is amazing, and the doctor that gave the orientation is going to be my doctor He told us that most of the doctors and Nurses speak English, and they will make sure that we have English speakers in the birthing room with us. If a shift ends in the middle of your labor, they actually take an hour with the next staff person to get them up to speed."

Hindsight: This wasn't true at all. All of the doctors spoke very good English, but only a few of the nurses knew more than a few words. However, it wasn't difficult to communicate with my Midwife at all. She was one of the most experienced midwives in the hospital, and though she didn't speak a lick of English, and we spoke very little German, we had no problem communicating with her. She was really awesome, and came to visit me after the birth of the baby in my hospital room. We also had no problem communicating with the nurses despite the language barrier.

Baby Boom?

I don't know much about population studies, and it might be my age, but seems like there are an extraordinary number of women who are having babies in 2009, or are trying to get pregnant. Off the top of my head, I can think of 20 women I know who are pregnant, between friends from the States, family members, friends in Europe and classmates from high school and at least two friends who are openly trying to get pregnant. And everyone I know who is pregnant, seems to have the same feeling, that there are a lot of pregnant women right now.

When I was pregnant with Max, I had a few friends who were pregnant, and I made a few new friends through the pregnancy, but it was nothing like the babies coming out of the woodwork this year. People seemed more conservative, not sure if they wanted to reproduce, and if they did, they only wanted one, maybe two offspring. In the last year or so, people seem to be less conservative about breeding, and there seems to be a sense of optimism about the future. Perhaps, it's in the air, or perhaps it's just my age, but it seems like we're starting a baby boom.

In honor of the 44th President of the United States of America, Barack Obama, I'm dubbing this generation the "Baby 'Bama Generation." We'll see if I'm right, and historically this and the next years prove to be a contemporary baby boom.

Beginnings

Back in 2005, while my husband, Paul, was in the midst of his third year of law school at good ol' University of Baltimore, we started to contemplate our future. We could take the traditional route; an aspiring Patent Attorney, Paul could apply for positions at local B'more law firms, or the USPTO in DC. However, Paul and I weren't ready to throw in the towel and settle down. We started to look for a new adventure.

Ready to try out a new city, state and possibly even a new country, we started to look at Intellectual Property LL.M. programs, Masters in Law. In the United States, many legal professionals don't see the point in an LL.M., however, this was a great opportunity for Paul to further his expertise in Intellectual Property and specifically patent law. He applied to programs all over the United States, including San Francisco, St. Louis, Seattle, Chicago and Washington, DC. He also applied to a program in London, and low and behold there was an English speaking program in Munich. Ultimately he was accepted into all of the programs, but the one in Munich had the most appeal.

The Munich Intellectual Property Law Center was still fairly new, only a couple years old since it's inception. MIPLC was a partnership between Max Planck Institute for Intellectual Property, Competition and Tax Law, the University of Augsburg, the Technische Universität München, and the George Washington University Law School (some of the biggest names in Intellectual Property academia). But what impressed Paul, was that there was no permanent faculty, the classes were taught by the elite of the World's IP academia and professionals. Another deciding factor, was that Munich's location, pretty close to the center of Europe. What a great jumping point to visit other countries and cities in Europe. It was dual package, it would sooth our wanderlust and it would further Paul's career.

We moved to Munich in September of '06. Since I couldn't work, while we were in Munich, we decided it was the perfect time to get pregnant. I could fill a whole blog on being pregnant and giving birth in Munich, so I'm not going to say much right now, other than it was ultimately a great experience. I'll try to fill in other posts with reflections on being pregnant and giving birth here. In April '07, our son, Maximilian was born.

Four months later, albeit reluctantly, we returned to the USA. Paul finished his thesis in the States and started to look for a job. In January '08, he started his career at a law firm, as one of their first Patent Attorneys, we bought a home in Western Virginia, and we started to settle down. We made friends, joined clubs, and classes. We planned to live out our lives here, we thought our adventuring days were over.

However, not quite six months into our new "settled lives" Paul received an offer from the biotech company in Munich he had interned at during his LL.M. We were not looking for this, nor were we expecting it. It surprised us as much as we surprised our families, friend and colleagues when we accepted the position. We decided we weren't ready to throw in the towels on our adventure, and we didn't see any reason why our son Maximilian couldn't join the adventure with us. That brings us to today, here we are starting our lives in Munich once again. This time we have a different perspective on our lives here, as we are now Raising an American in Europe.