Tuesday, October 1, 2013

Healthsanity

As an expat living in Germany where everyone has healthcare, I feel like I'm in a somewhat unique position to comment on what's going on in the states right now over the Affordable Care Act and give my fellow Americans some perspective on the differences between the two systems. Chris and I had a "rough" healthcare year the year before we moved overseas, and we were lucky even then, so we have at least some inkling of what the differences are and how much these costs can impact your average citizen. There are some stark differences people should be aware of.

Please note: I’m not, nor am I claiming to be, an expert on healthcare systems of any kind. I’m just relaying my personal experiences with both the US and German systems as an average person. A typical healthcare year for us is a checkup and maybe one other visit if there’s a serious illness like the flu or something.


1.     1. On the tax thing: yeah, we pay slightly higher taxes. Sort of. When you look at the cost of healthcare in the states + taxes and the fact that our taxes DON'T offer us anything in regards to healthcare, we actually pay more and get nothing for it. If you get health insurance through your employer you’re STILL paying for your healthcare in that system, plus usually getting limited coverage, or dealing with deductibles and all kinds of other stuff.  Plus lots of insurance companies will up and decide not to pay for things whenever they feel like it.

So really we're paying less here in Germany and getting a lot more. As in full coverage for healthcare. Check out John Green’s breakdown vid for a look at what I’m talking about. This isn’t up for debate, this is reality. We pay more in the states and get nothing for it. It’s broken and messed up and needs to be fixed.



2.     2. What we got in the US with (good) insurance: in network doctors for a co-pay fee that could range from $10-$20, likewise any specialists which often cost much more, co-pays on prescriptions anywhere from $10-lots depending on the prescription and it’s generic status, and some kind of deductible. Out of network doctors cost much more out of pocket. You could also have to travel fairly long distances to get a doctor in network. We also had dental, but the coverage was much lower on everything but checkups. Took us a year to pay off a tooth cap out of pocket. No eye care. We were generally paying about $200+ a month for insurance, at least, for the base HMO (read: cheapest) option. And that’s if we even had an option.

Average wait time for an appointment was at least 3 weeks, usually more. When Chris had an allergic reaction to something and his fingers swelled up (but no breathing problem) we were told we had to go to Urgent Care and it took several hours to find one that was in our area and we had to go out of network. He was given a shot for it and told to go to a dermatologist, which we had to wait so long for we had to take pictures of the initial reaction so they could see what the problem was. Chris also lost quite a bit of work time over it since he couldn’t use his hands. That Urgent Care visit cost several hundred dollars out of pocket.

3.     3. What we get here with just coverage, nothing special (and everyone in Germany is required to have insurance that your taxes pay for): no co-pays for doctors visits. Period. We’ve both had checkups with full blood work, I’ve had a gynecologist visit WITH the use of an ultrasound, and no cost to us at all. I have a few prescriptions that cost me about $10 euros, total, every 3 or 4 months. You don’t have to show your insurance card, that’s jut the flat cost of the prescriptions. You can go to any Apotheke and get them filled and it will be the same at each one.  They have no idea what you mean by “generic” vs not, so far as I can tell. Also: the taxes thing is the ONLY thing you pay into. There's no additional insurance costs from your paycheck on top of it, no deductible nonsense, no stress over pre-existing conditions etc.

Some people like to say that one of the big “problems” with universal healthcare is long wait periods. I have no idea how it works elsewhere, but every time we’ve needed any doctor’s appointment we’ve scheduled it within days, or the same day if we needed to. That’s normal here, and 3-4 is the longest wait we’ve had so far. I’ve called a doc on a Monday and had an appointment by Wed, without having to come in at ass-early o’clock or be squeezed in at some weird, inconvenient hour, and even then in the states it was usually at least a week’s delay. In terms of actually in the office wait times in the US it was, on average, at least an hour no matter when I showed up. Longest wait I’ve had in an office waiting room here is maybe 10min.

So, that’s the care we’ve had so far here. Very qualified doctors, good treatment, no muss no fuss. The cultural attitudes about healthcare are also dramatically different. Here, if you feel even mildly unwell, people are like “Go to the doctor, right now!”. That’s normal here.  Even those who are politically/socially conservative are like, yeah, everyone should have healthcare. It’s not even a discussion. So the states current uproar about it makes absolutely no sense to Germans at all. They think it’s barbaric and, you know, they’re pretty much right.

Now, for more “emergency” care. I can only compare my personal experience in the states with one of our friends here, to contrast what it’s like. Neither Chris nor I have needed emergency/serious care in the year we’ve lived here.

About six months before we moved overseas, while still living in the US and having “good” coverage, I woke up one Saturday at like 3am in a lot of pain. I had no idea what was going on but it was bad. I waited at least an hour before waking Chris up and telling him I thought I needed to go to the hospital because it was getting worse. We drove over at about 6am and they admitted me to the ER. I was diagnosed with a kidney stone. I waited about 2 hours before getting painkillers, morphine, and then anti-nausea meds because I started throwing up not long after the morphine kicked in. It was another few hours until I had a scan to see what size the kidney stone was, if there was more than one, and whether it would pass on its own or need help. Turned out to be passable on its own, and only one, but I was admitted to the hospital for monitoring and pain management overnight. They were concerned I might get an infection and I was still throwing up constantly. They also gradually moved me off morphine and onto vicodin. I took it because it was the only way to go home, but I hated it. They wanted me to stay another night for pain management but I was worried about the cost and went home, where I proceeded to vomit every hour, violently, for the next 5 days before the stone passed. Even with the meds I was unable to do much besides sleep and throw up. And strain my pee in what looked like a coffee filter.

When we got the hospital bill, it was for over 25k. For one night in the hospital. The biggest costs were the tests and pain meds, without which I would not have been able to function/stay sane. We were lucky and “only” ended up having to pay 3k. Which is still a lot of money, in case you were wondering. I can’t even imagine what we would have done without insurance.

I would like to point out that prior to the kidney stone episode, I had never had to be in a hospital other than visiting people in my life. I was and am in extremely good health. Low blood pressure and cholesterol, apparently fantastic blood work on things like all the essential nutrients and vitamins for  living, etc. I currently have great kidney, liver, and thyroid function. Other than regular checkups I had never had to use the healthcare system in any major way. Hopefully the kidney stone was an anomaly that NEVER occurs again, but that’s the thing: no matter how healthy you are, you WILL need healthcare in a meaningful way at some point in your life. Whether it’s now or later, it’ll happen. I did not “deserve” better care just because I was lucky enough not to need it until then.

Now, compare that to a friend of ours here who had to have major spinal surgery a few years back after an injury. She was in the hospital for two weeks and then had physical therapy for at least 6 months after. Grand total cost for her? Nothing. I want you to think about that. I had a bill for 25k for which I paid 3k for ONE NIGHT in a hospital. She was in for 2 weeks WITH surgery and then physical therapy for months and did. Not. Pay. Anything. In the states that bill would likely be well over 100K and she’d be paying at least half. That’s the kind of debt some people can never dig out of.

I could tell you about other people I know having similar experiences. I could tell you about aging parents and the utter insanity of how Medicare and Anthem “work” in increasingly complicated and confusing ways that still doesn’t require insurance to pay for anything before high deductibles. I could tell you about the friend who had cancer 2 years back and whose treatment costs made them consider not bothering because of the debt it would incur. That’s not unusual for people in the states, to wonder if their LIVES are worth the debt and even bankruptcy their care will cost to themselves or loved ones. It’s also not unusual for people to avoid going to doctors sooner and potentially catching problems earlier because of that same fear. Which results in conditions being worse and more costly in the long run.

The US has a healthcare system that essentially punishes people for being alive and needing health related care. Which literally every single person will need at some point because our bodies are not designed to never break down. We have, in a lot of ways, delicate systems. One little thing goes off, like random deposits in a kidney, and you’re in the hospital. And that’s not even up there with the more serious things that can go wrong.


And yet we’re debating whether people “should” have care when they need it because…why? We think some people deserve care and others don’t? Because of how much money they make, or how lucky they are in circumstances, genetics, or whatever? To be honest, I don’t care how or why  a person is sick, I just care that they get treated if they are. And not have to worry about being in lifelong debt over it. This seems like something everyone should agree on…and yet we don’t. And from over here and it looks increasingly more inhumane and grotesque.

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