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Analysis: One freelancer in Germany thinks the health care system there could work in America.
Germany's model is quite similar to that of other European states, such as the Netherlands and Switzerland. They are the opposite of single-payer systems, in which one price fits all. Also important, the premiums are not contingent on the individual's health condition, something that President Obama wants in the U.S. The insurance sector is compelled by law to insure anyone who qualifies for insurance — and who pays into the central fund — as well as their spouse and family.
Although this model is the rule in Germany, there are also privately insured people. High-income earners and those who demand better health care than the standard service can opt for more expensive, private health plans. Generally, these profit-driven, private insurers offer better, more extensive coverage than the regulated, non-profit companies. Many freelancers, too, use the private option because they have no formal employer to match their payroll contributions. This, of course, begs the question of how I am covered since I am a freelancer. The closest Germany comes to a state-financed public option is the Kunstlersozialkasse, or Artists' Social Fund. It acts as a full-time employer for independent writers, translators and broadly defined “artists” of all kinds. Thus I have the mandatory payroll tax deducted from my bank account every month, based on my previous year’s income, and the Artists' Social Fund matches that amount. I know dozens of independent “artist-types” like myself who could never afford private insurance, but are fully covered through the artists’ fund. The state benefits because freelancers pay at least something into the system and don't show up at hospital doors with health problems and not a penny to pay for care. Incidentally, Germany’s version of social security works the same way.
Now, for all of the perks of the German model, there are distinct drawbacks and flaws. One is that the discrepancy between the privately insured and everyone else has grown ever larger over the years, creating a de facto two-class system. Thus, the better off do in fact receive better care — exactly what is not supposed to happen in Germany’s great social welfare state. Also, many freelancers (that is, if you do not qualify as an “artist”) fall through the cracks. This pool of people, which has been steadily growing, is forced to buy private insurance, which is extremely expensive.
But the greatest problem facing the German system today is its exploding costs. Technological advances and new drugs have made health care costs skyrocket. Moreover, Germany's rapidly aging society is straining the system to its breaking point. Ultimately, in the German model, today's workforce (and its employers) pay for the health costs of those now retired, who are using the system the most. With an ever older population and sagging birth rates across Europe, it leaves fewer people paying for the health care costs of ever more people. Closing this gap is the dilemma that Germany's political class faces, and to which it has so far found no answer at all.
Perhaps it isn’t so curious that America’s Obama-bashers don’t pick up on the German plan for fodder. For one, it works, and two, it’s not strictly “government-run” (i.e. socialist). Should the right manage to kill the public option in the U.S., the White House might want to take a closer look at the pros and cons of Germany’s system.