Es Gibt Kein Kostenlos Mittagsessen
Germany has one of the best health care delivery systems in the world. It normally ranks number 1 or 2. Germany’s system covers all residents, regardless of age or a history of pre-existing conditions. Their medical expertise is leading edge and the care is compassionate. And, lest we forget. The German health care delivery system cost about one half the per capita cost found in the US.
Germany has a national health care system. The Germans recognized that “es gibt kein kostenlos Mittagsessen” (there is no free lunch). Health care must be paid for, but health care should not be a place whose objectives are profits.
In their national system, doctors, hospitals, and drug companies remain private. They have both private and national insurance but the role of both is to administer and pay claims. Everyone participates through taxes they pay. All Germans (and their health conditions) are “pooled”. Rates are set on the entire pool reflecting no difference between sex, age, or marital status.
Wait, you mean that all Germans must have health care coverage?
Well, here in America, that would be taking away my rights to choose. Suppose I don’t want to buy insurance? Suppose I don’t want to pay higher rates when I am in great shape and hardly ever visit a doctor? Suppose I don’t want to pay for others who can’t pay for themselves? Suppose I want to go to the doctor (or hospital) when I want to and not have to wait? Suppose, suppose, suppose.
The deficit debate that is raging now is coming awful close to making Americans wake up and realize their health care delivery system is not as good as they think it is.
The spotlight has been on raising taxes on the top 2%. Neither party has proposed how to address the largest single component of the deficit, Medicare and Medicaid. The GOP’s “Ryan Plan” has proposed block grants to States as a method of slowing the rise in Medicaid costs. In essence, the GOP plan just passes the problem on to States who may solve their problem by changing qualification requirements. This could be done at the Federal level just as easily. Block grants also misses the point on whether citizens are entitled to health care coverage (access) and how that care should be covered (costs).
This week, a few GOP members have offered ideas aimed at lowering Medicare costs. Their solution would be to change the onset age from the current 65 to maybe 67 or so gradually over the next few years. The math guys confirm that over a 10 year window, the amount of government spending on Medicare would shrink. Is that the “kostenlos Mittagsessen” solution?
Critics are quick to point out that there would be many problems. First, as the age where Medicare began increased, those people not covered would still need coverage. Where would they get it and how much would it cost? Ironically the rest of the Medicare pool, say those older than 67 would generate even higher per capita health care costs (since it was an older group).
So, if the goal is to lower what the government spends (in excess of what is collected in wage taxes), the solution of raising the beginning age for Medicare might make sense.
It is tempting to say that there is another approach. For example, tax working citizens more. The concept behind Medicare is in fact that workers pay in and when they retire and are on fixed incomes, their health care costs are covered at a rate they can afford. So why not just increase Medicare taxes?
Back to “kostenlos Mittagsessen”. Asking everyone to pay more in taxes might be fairer to those suddenly without Medicare (ages 65-67) but that approach is not without problems. If increasing Medicare taxes was the only tool used, the medical industry would be delighted knowing that what ever they charged, Medicare would pay. Even worse, the US would be missing world class cost information.
US Health care costs, regardless of whether one compares per capita costs or costs are a percent of GDP are off the charts. The deficit is the canary in the mine. Our politicians need to stop fighting over tax levels and look for permanent solutions to the underlying problems. Transitioning from the US health care delivery system to one like Germany’s will be complicated and take some time.
Wasting time now looking for the expensive “free lunch” is time poorly spent.