Friday, February 05, 2010

My experience with the "public option"

I am an American who has for the past year been a legal resident of Germany. As a legal resident, I am required to have health insurance in order to receive and maintain my residency visa. My husband and I have the so-called "public option," which here inGermany is often regarded as the best available. As the U.S. Congress and the White House struggle to agree on ways to improve what has been called the worst healthcare system in the industrialized world, I thought I might offer up my experience with private health insurance in the U.S. and the public-private insurance system here in Germany.

I begin with the brief story of an Australian classmate of mine in my German language class who was hospitalized for a week in a German hospital. After a week full of medical services, which included a battery of tests required to diagnose her and determine her course of treatment, she was released. She opened her wallet as she was leaving and asked nervously, "how much?" The hospital representative smiled and said to her, "You must be American." My classmate replied that no, she was in fact Australian. The hospital rep said, "Oh. We get this question all the time from Americans. You don't owe us anything. It was our pleasure to serve you."

My Australian friend had health insurance, and that insurance information was probably collected when she was admitted to the hospital. Her visit was not free, it was paid for entirely by her insurance. Nevertheless, she remarked how nice it was to have her insurance cover her entire visit and how nice it was for her to be able to return to her apartment to complete her recovery without having to worry about a bill coming in the mail.

When we landed here a year ago, in part as a more affordable place to ride out the global financial recession, our health insurance in the U.S. had lapsed. In Germany, it is illegal to not have health insurance. However, we were determined to get the public option because my husband who was born and raised here had it as a child (long before the privatization of healthcare), and my husband's family had advised us that it was the highest quality insurance available in Germany. The hitch was, as I understood it, if we were ever at any point covered by private health insurance, we would not be eligible for the public option. Our American health insurance didn't count against us, since only private insurance is offered in the U.S.

We played it fast and loose with no insurance in Germany for about a month while we negotiated with the public insurance company. There were questions about how my husband had been insured when he lived in the Netherlands and Switzerland. And, of course, there were income questions. The public option is based on a sliding scale of affordability. And if you can't afford it, the government will pay. We had no proof of income at the time, and that factor made things a bit of a challenge.

During this month, I ran out of a medication I take daily. In the U.S., a 30-day supply of this medication would cost $450 without health insurance. I knew from experience when a momentary glitch in my health insurance led me to believe that I would have to shell out that shocking price from my own pocket. Fortunately, the problem was resolved. But knowing the cost in America worried my husband and me that we would have to pay the same in Germany. We managed to get our health insurance coverage by phone, but we hadn't been issued our cards yet. My husband went to the pharmacy with the prescription that a doctor had been kind enough to give me without proof of insurance. The pharmacy apologized and told us we'd have to pay full price without proof of insurance and seek reimbursement from our health insurance. Without asking them the price, my husband came home asking me how much I thought he should take out of the ATM. €450? Really? He trudged back to the pharmacy. Again apologizing, they asked for the full price. "That'll be €25, but you can get that back from the insurance company." We were shocked. The retail price was about the same (notwithstanding the exchange rate between the U.S. dollar and the euro) as our co-pay in America.

When we finally got our insurance cards, we learned the system works like this:

  • Every calendar quarter, we are required to pay a co-pay of €10 to the first doctor we see. That doctor, in turn, is the doctor who writes our referrals for the that quarter -- no questions asked. We can see any doctor we'd like, and that quarterly €10 is our only co-pay throughout the course of the year.
  • Our prescriptions are for the most part free. I don't entirely understand the prescription part, but on rare occasions we have to pay, typically under €5.
  • Our monthly premium for two people is around €250, which employers are required by law to pay. Since my husband and I are freelancers, we pay this on our own. That's €3,000 per year, and it includes basic dental. By contrast, friends of mine in the U.S. who are also self-employed have received a quote of $2,000 per month for two people or $24,000 per year.

Hospitalization is covered entirely. Emergency rooms (which we've already used) are covered. Alternative treatments such as acupuncture and doctor-prescribed massage or physical therapy are covered.

I should also dispel the rumor that public health insurance creates long lines of people waiting hours for treatment. I have seen many doctors in the last year, and I have never had to wait. The system runs very efficiently. The one time I've had to see a doctor without an appointment, the receptionist told me I'd have to wait until the doctor had a break in his schedule. That ended up being about 15 minutes.

Admittedly, I have no experience with private health insurance in Germany. But with the strict limits on who is eligible for the public option, my sense is that the private health insurance market is thriving.

It saddens me to see the debate around healthcare in the U.S. People like my friends I mentioned earlier -- hard-working, educated people who own their own home, pay taxes and who want to pay for health insurance -- should be able to afford health insurance. The U.S. system is miserably broken.

I want to live in a country where I know I can afford to be sick should that happen, without my having to worry about losing a home or having to go without treatment. Unfortunately, right now my own country is failing to provide that basic comfort. Americans should not be forced to look beyond our own borders for reasonably priced healthcare, whether we resort to looking next door to Canada or across the Atlantic to Germany. Healthcare is a problem that can be fixed or at the very least greatly improved. Congress needs to stop the fear-mongering and help us achieve a healthcare system that is a successful model to which other countries aspire rather than seen globally as disaster to be avoided.