Tuesday, September 15, 2009
Health care here and there
One thing is for sure: Nowhere in the industrialized world would people put up with a system like the one in the US, and if they had one, they wouldn't resist change to that degree. A reader raised the issue, so let's see...
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15 comments:
Hi Ulrich, I am knee deep in trying to understand Baucus's health care plan, which so far does seem to be, as Wendell Potter pointed out, a "gift" to the insurance companies and I was wondering how the Germans organize their health care system. Is it single payer or a mix?
I also saw the author of a new book on health care around the world being interviewed and he said that people in other countries think Americans
are crazy to put up with our health care system. Is that what the Germans think? When did your health care system come into being? Who promoted it, the Social Democrats? To bad our Democrats weren't more social than corporate. Love the words of the month and the drawings are too darling.
@Heika: I have to research this a bit, but let me say this up front: Everywhere except in the US do people understand that you cannot rely on a service provided by a for-profit industry if that industry's profit depends on the degree to which this very service is denied. It makes no sense to me or the rest of the world.
Furthermore, the fact that nobody here even dares to raise the issue shows me how much Reagan's idiotic dictum that the private sector always does things better than the public one still holds sway over a large portion of Americans, in the face of all the evidence to the contrary that we have.
As I said, I have to research the situation in Germany a bit, but in continuation of what I just said, I think the insurance companies in Germany generally are private, but not for profit!
I followed the debate in the US with interest and from a friends experience I understand, that it's important to have a change in your health system. Years ago his little baby boy was born with hyaline membrane disease, and he was left with a $ 20.000 bill and this was in the eighties.This is inconceivable even in todays Germany, when our so far solidary system is at stake.
Until now we have a duality of systems : a statutory health insurance up to a certain income. If you are in regularly employment the fee is shared between you and your employer. The social security package contains health insurance, unemployment insurance and pension insurance. If your income is higher you can have your individual private insurance designed according to your individual healthrisk, the fee is higher but the benefits as well. In this case the employers share is limited to the statutory ceiling and the difference is taken by the taxpayer. If someone is unemployed, his fee is payed by the social security system.
Some politicians in Germany want to reduce the employers share, to lower the costs of labour. They promise to create more Jobs, but to be honest , I dont believe them because their main driving force is greed.
Until now our system seems to be quite fair and affected by solidarity but we have state elections next weekend and then it depends on who will be in power for the next four years.
I strongly believe that certain basic functions in society have to remain under control by the public hand, like the financial system, public transportation, drinkingwater supply and most important, the Health System.
By the way, our election campaign is dull, the main protagonists are lame ducks and what I'm really missing is a boost like that one, when you guys were backing Obama.
@mick: Thank you for your very instructive post, and I couldn't agree with you more about the role the public sector has to play in a civilized society. The question is how to do this best so that the system remains sustainable while benefiting those whom it is supposed to benefit and not supporting those who abuse it. And it's here that different countries differ in their approach, and I would be really interested in an unbiased review of what the differences and similarities are across countries. But of course, humble KrautBlog cannot do this...
A remark on the German system, based on discussions I had with one my brothers, a successful entrepreneur who started his own company from scratch and now employs about 300 people--it's what's called in German a mittelständiges Unternehmen--a mid-sized, privately owned company. Let me also state upfront that he by no means a greedy capitalist of the Gekko type--when I talked to him half a year ago, he told me he would vote for the Social Democrats in the upcoming election, but I haven't talked to him about this lately. Anyway, he firmly believes that the German system must be reformed b/c it has a basic flaw:
Since, as you say, the funding of social services is derived from taxes on wages and employer contributions, the system works best when it is least stressed, i.e. in times of full employment and with a relatively young work force; it works at its worst when it is needed most, i.e. in times of high unemployment and an aging populations that puts ever-increasing demands on the pension fund and health care. My brother believes that the tight coupling between wages and funding the system has to be given up--otherwise, the system will collapse if present trends continue.
That's why I am interested in systems where public health care is funded out of general tax revenue, like infrastructure, the army, the police, firefighters, schools and the like--I understand that in a country like New Zealand, that's considered the duty of the government, and most people are fine with seeing their taxes used for this purpose.
@ulrich, in no way I was criticising companies like the one, owned by your brother. They create jobs, their gains are taxed within our country and contribute a valuable share to our national economy.They are the Saints of our society. With the end of full employment the social system has to be financed more and more by taxes but there is , because of a lack of tax equity , not enough money in the system. Many holding companies have their headquarters in low tax, or no-tax-at-all places like the Cayman Islands, Panama or the Channel Islands. They produce with all the benefits of a highly developped industrial country without contributing their share to the national economy by paying taxes.These are the ones to be blamed together with our politicians, who failed to enact the appropriate laws.That's why our next weeks elections are so important for the social peace in our country.
Peeking in on your discussion while watching early episodes of the new Ken Burns series on National Parks, I was struck with the struggle of dedicated conservationists against the nearly overpowering advocates of rampant exploitation with the perennial right-wing mantra: Free Private Markets! Never mind that those can be greedy and heartless monopolies, destroying peoples and places in their wake.
The tide turned when the argument switched from noble spirituality and purity of the irreplaceable natural assets to passionate preservation in the name of Patriotism and Posterity... It strikes me that the health care reform is losing because Obama hasn't gone the outright passion route in the name of all Americans, as Teddy Kennedy did.
Obama tends to speak of the "middle class" too often and too calmly, rather than the rights and need for protection of ALL the people... If he can't see mounting a positive attack on the comfy elite himself, even after bailing out the banks, etc., he should find another single-minded advocate who can rally public pressure in the cause of equality, a legitimate democratic legacy! The majority are now ready, and highly frustrated at this point, don't you think?
@artlvr: This article, together with the article by Jane Hamsher linked to at the end of it, opened my eyes and provided an explanation for a mystery that has vexed me for years: Why can't Democrats bring themselves to advocate policies favored by the majority of people on rational, principled grounds? Why don't they spell out what they really stand for?
Take health care as an example: Why don't they hammer away at points like these:
1. Medicare is a single-payer system and very popular.
2. The Veterans' Administartion runs a truly nationalized service. Combining 1 and 2 would make any knee-jerk accusations of "socialism" moot
3. Private insurance companies cannot allowed to write legislation b/c they produced the current insurance mess--there are thousands of cases that could be used effectively to illustrate this.
4. A public option is essential to keep them honest--it restricts nobody's choice and puts no insurance co. out of business that truly has the well-being of its customers in mind.
Why doesn't the White House and the Dem. leadership say this in a coordinated, focused effort? Greenberg in the article above and Jane Hamsher give the first convincing explanation I have seen. It's not b/c of incompetence (my first assumption); it's not for the goal of "bi-partisanship"; it's b/c the White House led by blue-dog democrat Emanuel and the Dem. Leadership Coucil have one over-riding goal: To get re-elected, and they have concluded that money is more important than solid policies--and the sources of that money have to be wooed so that they contribute to Democrats and pleased enough so that they do not contribute, or contribute less, to Republicans--everything Emanuel does can be explained based on these premises.
In other words, Democrats do stand for something: to get elected and re-elected. Principled policies would only get in the way b/c some big donators would inevitably be unhappy. I see a real revolt brewing over this in the progressive base, and I'm not sure the White House understands what's coming.
Admittedly, there are more facets to this (like the Clinton disaster with health care that the Obama White House tries to avoid at literally all costs), but I'll stop here to allow others to chime in...
Keith Olbermann also pointed out tonight that Federal insurance programs were heavily patronized in states ostensibly against such policies, and topping the list was Louisiana in number of people wanting reimbursement after Katrina, etc.
I don't agree that Dems are as bound by "the next election" considerations -- they just are not up to pursuing the strongest ways to combat GOP lies. They already have the mandate...
Correction -- it is Texas most utilizing nationally subsidized property insurance, with LA second. Reimbursements go through private insurance companies but are 100% paid for by us the taxpayers, not the insuarnce companies.
@artlvr: I didn't mean to imply that all democrats are like that. I was referring to the powerful blue dogs and the DLC, who really call he shots right now...
...that's the reason, for example, why Howard Dean, who really works from principles, has been sidelined.
Maybe Obama's tactics will bear fruit, after seeing the Senate vote today with Sen. Snow voting with the Dems... We can still hope!
@ArtLvr: Yes, but it will require Senators and House Members with real spine, i.e. not shilling for the insurance companies. I'm not sure how much support they will get from the White House...
Seems like we got over one hurdle!
I stayed up to watch it, almost too nervous to watch.
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