Healthcare Differences US vs Germany Part 1 | COVID-19 | Cultural Differences | American in Germany

With COVID-19 making it’s way across the world - I thought now would be a good time to talk about the differences between the US Healthcare System and the German Healthcare System.

I know the US Healthcare System is a major topic in this upcoming election - especially over the topic of Medicare for All. I know a lot of Americans are wary of socialized healthcare and today I plan on trying to tackle why Americans may feel that way!

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[Roger-npwi]

First of all...health insurance is not an option in Germany, it is compulsory.
I often deal with Americans who lump socialism and communism together. The minute they hear anything about social, they shut down. They just don't want to have to pay for others, people they don't even know.
The whole system in the United States is not going to change for the better. Two-thirds of the world's millionaires live in the United States. This incredible accumulation of capital in the hands of private individuals has an immense impact on politics in general, on true democracy and social policy.
At the same time, no other country in the world has more debt than the USA, funnily enough 15% in China.
Since 2001, the USA has always spent more than it earned. By the way, the USA has the most expensive health system in the world. Doctor and hospital bills are the main cause of private bankruptcy.
We in Germany have been living with statutory health insurance since 1884, and I don't see this in the USA in the future either.

[Pewtah]

I'm glad YT recommended this video on my start page. Because I want to understand that topic for a long time - especially why other health care systems than the US one were denigrated as "communism" - but nobody of the expats produced such an in-depth look at that. Now I'm switching to part 2 of your series ....

[kirstenolson]

As an American who has lived abroad, on the whole I find the German system better than the American system. Yes, there are going to be examples of people who have benefited more from the US system over the German, or people who have felt neglected by the German system. However, on the whole, Germans have more access to affordable, quality health care than Americans. According to a CNN article from last November, over a third of American households experienced financial hardship due to healthcare costs and is the top reason people consider filing for bankruptcy.

[wolfgang]

Hello La Mari. Sorry, but I do have a comment on @12:32 Not everybody pays 840€. You pay approx. 7.65% of your paycheck, and your employer pays 7.65% as well. 717€ is the maximum you and your employer have to pay together. The 840€ you are mentioning is probably the maximum that you and your employer pay together for the health ensurance and nursing care ensurance. E.g. if you earn €2500 a month, you pay 187€ for health care plus 38€ for nursing care ensurance. If you earn 4687€ or more a month, you pay 358€ for health care plus 71€ for nursing care ensurance.

[swanpride]

Ah...you have to understand that those people who set the criteria for those ranking lists like "who has the best healthcare system" or "who has the best Universities" are usually from the anglosphere. Hence they pick the criteria based on their own biases. For example German university rank lower than US or UK universities because "wages of the professors" are often considered a mark of quality (something which is more controlled in Germany's state-run universities), as is the level of research and development (in Germany universities are mostly for teaching, a lot of research and development happen in so called Instituten instead). In the case of the health care system "efficiency" apparently includes things like how much time a doctor spends on each patient. Yeah, I don't want an "efficient" doctor, I want one who listens to me. Sure, the paperwork aso is an issue, but it has a purpose, it's not there nilly-willy. And at the end of the day, numbers like survival rates for babies and infants, for cancer patients and overall health of the population are a better indicator for the worth of a system than "efficiency". The NHS, which is usually listed at the top of such lists, is certainly not better prepared for Corona than our system was.

But yeah, it would be even better if private insurance were a thing of the past. Doctors aren't really allowed to favour the private patients, but in practice, most of them do.

[mangalores-x_x]

Germany has a pretty unique concept of organizations of statutory bodies|public institutions (translations difficult). In essence the state delegates functions considered for the public good to organizations which act like companies but are regulated by law in exchange of getting monopol rights to handle a certain function, in case of healthcare a highly protected and regulated market only they can be in.


That is how the healthcare bodies work as well as the public broadcasters and a network of others. They are not actually state owned or directly controlled by the government (they are controlled via law), they are essentially given a mandate to do something in exchange for guarantees (state will pay their deficits so they cannot go bankrupt), privileges (they can levy fees) or monpoly status if they adhere to those state regulations enshrined in law.
Usually they are mandated to be non profit, banned from going to the stock market, no private shareholders etc.


E.g. germany is in stark contrast to the UK or France who organize more through their state budgets and tax money.

[thechadeuropeanfederalist]

It is possible to lose (or at least temporarily freeze) your health insurance in Germany, when you
a) become unemployed
and
b) don't register with the agency for work, which would then pay for your health insurance
and
c) don't pay for the health insurance yourself
This happned to me last year.
Then i had a problem with my knee, could barely walk anymore, and no doctor would treat me, because i had no health insurance card.
You only still get treatment for emergency cases, not being able to walk not counting as an emergency.
Anyway, i got it resolved pretty quickly within a week by registering at the agency for work which then paid the outstanding bill for the health insruance.
The agency for work also only pays for your health insurance for a few months. If you still have no job after that you need to apply for Hartz 4 and you only get it if you are "needy", which means for example you can't have any savings above a certain threshold, depending on your age. Otherwise you have to pay for your health insurance yourself, which is about € 190 a month at minimum, i.e. if you don't have any income, only savings.


But when you become unemployed and don't register with the agency of work, you will get letters from your health insurance provider every month. If you don't reply after 1 month, you get a totally overpriced bill every month. After 6 months of not replying you will literally get the police banging for 15 minutes on your door. This actually happened to me. I didn't open the door, because i was scared af.
Don't ask me why i didn't reply, i had mental health problems back then and completely isolated myself from the outside world.
But at that point i noticed that i am not really free. I went to the furthest extreme possible to test the limits of my freedom from the state, not violating any laws, but just passively not replying to letters. You can't just cancel your health insurance. You are forced to pay for it or go to state institutions to ask them to pay for it. This is a differnce to the USA.
Of course for the vast majority of people this is no real infringement on their freedom and they don't care.

[peterfischer]

Regarding waiting times for appointments. You´re entitled to be seen within 4 weeks. If you fail to get an appointment within 4 weeks you can call the "Terminservicestelle" (appointment service) and they will arrange one for you. If they also can´t get one you can go as a privately insured patient and they´ll pay the higher fees you mentioned. I must say though that I used to live in Germany for more than 40 years and never experienced waiting times of more than 2 weeks.

[henrikrod]

I’m a little late to the game, but I found abs subscribed to your channel some weeks ago. I debated making this comment but your video has really had me thinking. I am proud to be an American, who has also had a fascination with German culture since high school. I am a firm believer in our constitution and that the government should be for the people and by the people. Im a supporter of free speech and the freedom of religion and all other rights and privileges that are embodied in our constitution. I’m not a believer in repealing the second second amendment or redistribution of wealth. But as I watch the current situation with people I personally know with health issues combined with the COVID pandemic, I can safely say that the America I live in is not any longer the one I recognize or agree with. As high lighted in your videos, America has become an all for profits country. As I’ve witnessed in recent years, The rights of the people mean nothing anymore, the healthcare benefits that you spent years paying for aren’t available to you when you need them, and we’ve relegated ourselves to being without a sense of compassion to our fellow man along with being materialistic and sex oriented. Our education system is horrible, the government views our constitution as being subject to arbitration, and hypocrisy and lack of self accountability are rampant. Though I’m repeating myself, this isn’t the America I once believed in. Having seen your videos, I can safely say. If this is the healthcare system that Germany uses, I would be happy to see this take place in the USA because Germany seems to have their priorities in order. It’s sad to know that you live in a country where the government Robs you left and right through taxes yet you have to fight to get decent healthcare and benefits. And again I can speak from first hand experience because my mother is terminally ill and Medicare and doctors are a constant wolf you have to fight. America has sadly lost its sense of self and we no longer have culture or tradition. Germany seems to be where it should be and I think we can learn from that. I enjoy your videos and thank you for sharing a point of view I can agree with. Keep putting out the good content.

[wolfgang]

Thank you for that comprehensive explanation! I am learning a lot about the US health care system from your video. Here is a little comment on your video at timestamp 12:12. Even when your spouse is unemployed your children and spouse are covered by your health ensurance without paying extra fee. Best Regards, Wolfgang

[christophstahl]

Actually, in germany we had different health insurance providers for certain groups, like guilds. So if you were employed at a mining company, you would be insured by their healthcare provider. Free choice of your provider only exists since 1996 - and one rate for all only since 2008. You always had free choice of doctor or hospital and coverage was very similar between providers. As an author you can chose the Künstlersozialversicherung, the artists social insurance and only have to pay the employee half of the rate and the other 50% is subsidized by the government.

[hjstackofbooks]

This is interesting, I am keen to hear your thoughts in part two because it's mind-boggling to me why people want to keep it. For profit makes sense but like. Argh. Here in Aus we have Medicare and then people can choose their own private insurance.

[geddinixan]

They just cant say no if you arent already insured. They only have to take you if for some reason you are not insured.

[swanpride]

Health insurance in Germany isn't really a choice. Every employer has to make sure that their workers are insured by law, if they aren't he can't hire them.

People who fall through the system are usually self-employed who can't think ahead and the homeless....and those could get some coverage if they went to the state for help (the reasons why they don't is complicated).

[dl]

Health care being efficient is the actual problem of countries like the UK, Italy, Spain and France. They cut so much costs in the last years that they lack capacities for their population. The reason why Germany´s health care is that strong because we have enough ICU beds, ventilators etc. unlike the aforementioned countries which have really low numbers. Germany does not have a real problem with bureaucracy in health care. The real problems are the amount of skilled nurses and doctors and better wages for these jobs. Furthermore, spezialized doctors in cities or towns need to be increased but there is an institution which helps with finding appointments across the country in short time. But in case of emergency, you can always go to a hospital and get treatment within short time. As I know from nurses and doctors, they need to write everything down they do. This is good for the patient as it creates transparency and history but requires work. As Germany did not have a digital system for the ICU beds capacities in the beginning, they quickly build one. There are digital patient records, too. So I don´t see that there is a big issue regarding the digitalization. If you get really ill, I hope that you are in a German hospital because the health care system is definitively on top of the world. We have several university hospitals which have many experts and a high level of expertise (Charite Berlin (among the best worldwide), Hamburg Eppendorf, Aachen, Tübingen, Munich). Private health insurance needs to be viewed separately. But except civil servants, nobody is forced into it. I am very curious about the second video since this is rarely covered on YouTube. :)

[Luflandebrigade]

Things that Americans always come up with when getting compared with a System like Germany: „The waiting times are worse!(without ever having been treated in Germany)“ „The quality of treatment must be worse!“ (looking at the casualties in the US right now... 👀) „It is more expensive than what you have to pay in the US“ (yes if you have a shitty insurance in the US with a lot of Co-Pay your insurance is cheaper. Enjoy calling an Uber in case of an accident!)

[Dahrenhorst]

A statement saying, that our health insurance are private companies, is mostly wrong. 90% of Germans are members of health insurance organisations (what you call statutory) which are indirectly owned and co-funded (besides the health insurance premiums paid by their members) by the government. They are public service organisations created by the government for the benefit of the people.
Regarding problems to get an appointment at specialists, there is now a law, that the regional health organisation must find a specialist for you within 4 weeks and all specialists must reserve a significant amount of hours per week for those calls. The remaining disadvantage is, that you cannot really select the doctor you want to go to, you will be send to someone, and that this someone can be - in rural areas - up to 50km or so away, in very exclusive areas of expertise even more.
This appointment problem is - besides more spacey und luxurious rooms in hospitals - virtually the only difference in medical treatment between PHI and SHI patients.

[RustyDust]

Still very acurate today.

All SHI funds from both employees and employers are payed out to one central pot, which is then distributed among ALL SHI companies by a very complicated key. But this complicated key does not affect you as a patient, only as one of the bureaucrats who have to calculate who gets how much. This key includes some aspects such as number of insured people in an SHI company, their reported disease status, etc.
As such insurance company recieve funds depending on (mostly) the number of insured. So insurance companies actively seek out possible patients, even with preexisting conditions.
Sure, all of this contributes to the bureaucracy costs. Another aspect of the high amount of bureaucracy occurs due to the large number of smaller hospitals. All of them need to be part of a centralized register which is available to emergency services. This centralized register gives info about the number of available beds in each specific speciality, assumed days patients will remain in these beds, etc. All of this info has to be signed off by doctors. This forces doctors into the role of bureaucrats rather than medical practitioners. This is probably THE one problem most medical practitioners see with the current system in Germany.
Next, a large panel made up of insurance companies delegates (each company again receieves delegates depending on their quotas of customers) negotitates with pharmacy companies with how much they are willing to pay for specific medications. This panel is very powerful, so it has quite a chance to actually reduce the costs a LOT. Pharmacy companies can't just dictate their prices because they know someone will definitely attempt to underbid them to recieve the coveted preferred customer choice by the insurers. The insurers then attempt to get their customers on the medication with the lowest cost. Only if this "aut idem" medication fails to achieve the same results as higher priced medication will the insurance companies cover the higher cost for higher price medications.
PHI insured people do get some special treatments earlier or easier depending on their PHI company's statutory limits. But in most cases SHI recieves exactly the same treatments and medication that PHI customers recieve.
Waiting times (for specialists) do vary depending on the number of available specialists in your area. But usually there are no wait times beyond four weeks, max. Only elective surgery or non-dangerous diseases might take a bit longer to be treated.

[connectingthedots]

Okay, that's a super fair assessment. But the reality is the differences is like night and day.

[helfgott]

Bismarcks Krankenversicherungsgesetz von 1883/84 was the first step to german health system.Sure it developed and dear americans social does NOT mean socialistic get educated. sorry but this is true, i do know ure education system sucks but there is wikipedia and such, and believe it or not i am not at all anti american.I met american soldiers who did not even know on what continent ther are stationed, sorry to hurt ure feelings but this is true.
The task of a government is to take care of their people, germany does.Not perfect but for example if i wanna see a pysician i can always no pay at all.