Germany: Medical

One of the goals of my comparative politics class is an attempt to understand how a society actually functions.  To get to that understanding requires a two-part examination. Of course, it is important to know what they do - but I think it is equally important to understand why they do it the way they do.

I don't think it is just the centrality of the “health care debate” to American politics that makes me think healthcare is an important element in understanding any given society. Rather, the centrality of issues of one's personal health to a person's general quality of life makes it perhaps the central element of politics almost everywhere. Without your health, what matters?

Insurance Ad - They'll take anyone - no extra fee

In the US. We are debating whether healthcare is the government’s business. In Germany, that debate ended more than a century ago. Germany has the oldest Universal Health system in Europe (I suppose that means in the world but I'm not sure). It was the product of Bismarck crafting the German state. He was looking for a way to tie the public to the regime and win their support for what were monumental changes to German life and politics. It also made sense to the conservative, paternalistic, business-friendly, autocrat that healthy workers were a boon to an industrial society. He imposed an “individual mandate”.

Today, the overwhelming majority of Germans have government-subsidized “basic” insurance provided by private insurers. The services to be provided and the costs of these policies are stipulated by law. The cost structure is progressive in that low-wage workers pay little and premiums increase with income (not age or health status). You can opt out of the public system and acquire a private policy (government regulated) if what you want (and can afford) is not part of the public package.

The system seems to work pretty well. I visited a hospital in a working-class/immigrant neighborhood of Berlin (Kreutzberg). The people visiting the hospital are not wealthy but their economic status could not be discerned by the medical facility they enjoyed. The building was modern, comfortable and not terribly crowded. The services available were what you would expect at a first-class hospital. The facility was taking care of its community, it seemed. It really looked like the system works.

I can't help but compare that to hospitals in low income neighborhoods in the Bay Area. Couldn't we adopt their system? Do we have to reinvent the wheel?

Well, there are trade-offs. You have to be comfortable with government involvement in the system, something German Conservatives will accept. Isn't it ruining their lives? Their economy? Check their balance of trade against ours. They are doing OK. I did not hear Germans complaining about government oppression.  In fact, they have trouble understanding why a society would not do what they do.

WiT? Clue: Love him or hate him?  Which would he prefer?