Is Germany's health care a good model for the US?

BERLIN, Germany — With all the outlandish, scurrilous and otherworldly aspects of the health care reform melee in the United States, it is strange that the German model is almost never invoked — neither by the Obama administration nor its foes on the right. This is particularly odd since its mix of public and private insurance plans is much more like the Democrats’ vision than those of the health care systems of France or Great Britain, which are so often cited. Also, it works pretty well and might be something Americans could profit from examining. 

Allow me to use myself as an example: As an American living in Germany and working as a freelance writer, I have health insurance through a multi-payer, non-profit insurance company. I can walk into any doctor's office in all of Germany, show my provider's plastic card and receive treatment without ever seeing a bill. I can go to another doctor the next day and do the same — and the day after that. I pay a $15 cash-fee on the first visit of every quarter, and a modest percentage of the cost of most prescriptions.

There are more than a few glitches in Germany's health care system, which dates back to the 1880s. Nevertheless, I find it a basically sound, effective model, if one in growing need of adjustment. One thing is certain: It is cheaper by half than the American system, and everyone here is insured.

The first thing to clarify about Germany's system is that it is not a public, state-run scheme like those in France and Great Britain — or the U.S., in the case of Medicare. Rather, it is financed by its users, individuals like myself, and German employers. So health care isn't "free" in Germany by any means. Rather, the law compels everyone to be insured.

This is how it works: Just about every full-time employed person in Germany has about 10 percent of his wages deducted from his paycheck, which is paid into a government-supervised central fund. The individual's premium is then matched by his employer. This central fund distributes these revenues to over 200 non-profit health insurance companies. As I said, these companies aren’t state-run, but they're tightly regulated and monitored by government agencies.

The percentage of payroll tax that (just about) every breadwinner pays, however, is determined by the state. Here's where the rationale of Germany’s social welfare state kicks in: If every earner forks over 10 percent of his paycheck, those who earn less, pay less, and those who earn more, pay more — for the same health care. A young, healthy man pays the same as someone 60 years old and chronically ill. This is the social solidarity principle, which was introduced under Kaiser Wilhelm I and his chancellor, Otto von Bismarck, in 1883, although it has come a long way and changed dramatically since then.

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