Health Care in the US and Germany: My Personal Experiences

by Christina Geyer on August 19, 2009 · 10 comments

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This post is the second one of my series on universal health care. The first was a description of the health care system in Germany, the third was reader submitted experienced with universal health care in Germany, the fourth gave experiences with universal health care around the world, and the fifth takes on myths surrounding the universal health care debate.  This post is about my own and my family’s experiences.

Health Care in the US versus Germany

All my life, I had good health care coverage in the US.  I grew up in northern Virginia and my dad was a government employee.  As a child, I was covered under BlueCross BlueShield.  I have no idea about the billing, as I wasn’t involved in money matters at that age.  When I was a teenager, my family switched to Kaiser Permanente, an HMO, which I stuck with through my undergraduate years.  I don’t care much about seeing the same doctor every visit, so that part of being in an HMO was fine, but there were pretty long waits for appointments.  I remember having to make gynecologist appointments at least a month in advance, and for urgent care, sometimes I still couldn’t get an appointment for several days.  I was usually advised that if it was that urgent, I should drive the 45 minutes (in non-rush hour traffic) to the Kaiser Permanente hospital that was about 25 miles from us.  There were fairly long waits in the waiting room before getting in to see the doctor as well.

In grad school, I was covered under the Duke University Student BlueCross BlueShield plan, which was good compared to the plans most Americans have (they’re covering students only during their schooling, a time in which most people are relatively healthy and require little medical care, so their risk is low).  It cost $750 a year and covered 80% of medical costs (I had to pay 20%), with no deductible (so their coverage began immediately, I didn’t have an amount I had to pay out-of-pocket before coverage started).  I know there was an upper limit to how much I’d have to pay out-of-pocket, I believe it was somewhere around $10-12,000.

I had access to top doctors at the Duke Medical Center, and when I slipped a disc in my back, I was treated by the Duke Basketball team’s sports medicine doctor.  I was given physical therapy three times a week.  I don’t have the paperwork anymore to know what the full charge to insurance was, but I remember I had to pay $10 per visit, so working it out, it must have been $50 a visit total. In the end, it was about $300 out of pocket for me, which was a lot for a grad student to cover.  I still have back problems, and get physical therapy here in Germany.  It is covered 100% by insurance, and the cost to the insurance company is €19.50 a visit.

I remember still having to make gynecologist appointments weeks in advance, and that once I was in the office, the wait could be considerable.  I always had a paperback or a textbook with me for doctor’s office visits.  I had an MRI done on my knee once when I tore my meniscus, and I had to make the appointment a week in advance.

I was looking through my medical records, trying to find old bills from the US that I could compare with bills from Germany.  Back in 2001, I had an ingrown toenail operated on in the US.  The total cost for the operation was $339, of which I had to pay $116.40.  In 2007, in Germany, I had the same problem on the same toe on my other foot.  It was operated on and the cost was €197.81, fully covered by insurance.

During my last visit to the US, I got a sinus infection and went to Urgent Care for treatment, where the doctor gave me sample antibiotics so I wouldn’t have to pay out-of-pocket for medication.  The cost to me was $100.  Treatment of the same ailment, including the cost of antibiotics, here in Germany, was €45.58 (covered entirely by insurance) .

Those are real examples of the difference in cost between treatment in the US and in Germany.  Additionally, while I don’t know how much a birth in the US costs (I’ve heard it’s quite a lot), Oliver’s birth, which was not easy and required a lot of medical monitoring, and my hospital stay cost €2,779.22.  Everything was covered by insurance except that Rainer “rented” the second bed in my hospital room for two nights (giving us a private room and him a place to lie down), at €40 a night, including meals.  Much cheaper than getting a hotel room near the hospital!

My Time with Public Insurance in Germany

I started out in Germany with one of the public statutory funds.  It was quite a shock, the first time I got my paycheck here and saw how much money was being taken out for health insurance.  I remember making a big fuss about it to Rainer, saying that I could have paid the full health care costs for my back problems in the US and not even reached half the amount I paid for insurance over the course of a year here (I was counting the full 14% contributed by employer and employee).  I even talked to our financial adviser about switching to private insurance, but with my preexisting back problems, he assured me that I wouldn’t even be considered.

Over the years, I’ve come to really appreciate the idea of everyone paying in what they can to ensure that everyone has health care.  Before, I was thinking about all the things I could do with that money, all the things I could buy, the vacations we could take, but isn’t making sure everyone gets health treatment worth putting off the purchase of a designer bag, or a new car, or a new big screen TV for a couple years (or even indefinitely)?  Not to mention the piece of mind in knowing that if you became seriously ill, your treatment will be paid for and there’s no chance of it bankrupting you.

I’ve gotten used to it now, but I know I used to complain a lot about German doctors’ bedside manner.  They’re very blunt.  If you’re overweight, they will come right out and say you’re fat and need to lose weight.  Some are also not used to being questioned or involving the patient in health care decisions.  But it doesn’t cost you anything but time here to visit doctors until you find one you like.  I can’t count how many doctors I went to in Berlin before I found ones I was happy with, but my care didn’t cost me anything except €5 for prescriptions (this was before they started charging a €10 copay per quarter).

It was so easy to just hand over an insurance card and not worry about what it was going to cost.

By the time I lived in Rostock, it did bother me that I was limited to 8 physical therapy sessions a quarter by my insurance plan.  I was getting spoiled, the thought of paying for them myself, out of pocket, even at less than €20 per visit, was absurd!  I had also gone back to being a student and was no longer paying in to the system anymore.  I was covered by my husband’s contributions, so looking back, my complaining seems a little ridiculous.

My orthopedist wanted an MRI done on my back at the time, and wrote me a prescription to give to a radiologist.  His secretary gave me the addresses and numbers of 2 or 3 places in Rostock where I could go.  I called one of those places, the hospital radiology department, to get an appointment, and they told me to just come in the next day.  After the MRI, the radiologist went over his findings with me there in the office, I didn’t even need to wait till the following day, when I saw the orthopedist again, to hear my diagnosis.

I slipped and fell down some ice stairs while in Rostock too and twisted my ankle along with re-injuring my back.  The surgeon (they handle accidents in Germany), who was in a private practice, wanted to have a CAT scan done on my back (the x-rays were done in the surgeon’s office), so she sent me over to the radiologist’s office in the same building and I got in for the CT scan that day, just after lunch.

Observations on Private Insurance in Germany

Now that my husband is a professor, he’s one of those government workers who gets reimbursed for health costs (he’s reimbursed 50%, while my costs are reimbursed 70% and Oliver’s are reimbursed 80%).  We have basic private insurance (nothing fancy, no single rooms in hospitals or handling by department heads, etc) for the non-reimbursed percentage of costs, which is pretty expensive because of our pre-existing conditions, but not as much as paying the full 14% for public insurance (the government doesn’t contribute half, so we’d need to pay the full amount, something that I think is completely wrong and should be changed).

I haven’t noticed much difference in treatment from when I was in the public system.  We still wait at the doctor’s, our record is put at the bottom of the pile below all the patients who arrived before us.  Maybe I get appointments a little quicker, but honestly, I haven’t really noticed, because the waits weren’t bad at all under public insurance.  Maybe we get a few extra tests done than we would as public patients.  At the hospital, I can get slightly better food, like the choice of a whole wheat roll with breakfast instead of just a white bread roll.  There are only two doctors that I’ve visited that had separate waiting rooms for private patients: our pediatrician, and I don’t see a big difference between the private and the public waiting rooms, they’re just different rooms; and the surgeon who worked on my toe.  His office didn’t have a separate waiting room, but just a pair of comfy leather chairs at the end of a hallway for private patients.  The one big difference is now I get unlimited physical therapy, so that’s awesome, but honestly, if the government gave us a choice between being reimbursed and having private insurance, or being in the public system with the government contributing half, we’d be back in the public system in a nanosecond.

Hospital care in Germany versus the US

My hospital experiences varied a lot in the US.  I have migraines and sometimes my medication doesn’t work and if it’s the middle of the night, I need to go to the emergency room for an injection (in Germany, I can just call the doctor to come for a home visit, which is so much more comfortable, but I went to the ER a couple times too, in Berlin, because we were only a few blocks from a hospital).  In Richmond, at the MCV hospital, my wait times were usually minimal, although it was occasionally a long time.  One time the doctor tried to release me before I felt ready.  Just as I was about to sign my release papers, I turned and said that I really didn’t feel ready to leave.  The doctor said “You’ll be fine, the medicine will kick in any minute now, and we need the bed.”  I turned back to the papers, then paused, and threw up all over the floor.  As a nurse patted me on the back and walked me back to a room, where I now had to receive IV fluids, I heard another nurse tell the young doctor, “I told you so.”

Once, I had to go for an injection to the Duke University Emergency Room, it took me six hours to be seen.  The hospital is located in the middle of a low income area and the waiting room was full, every seat taken, by people with colds and flus, and screaming, ill babies.  A professor’s wife later told me that I should never go to the ER there, I should go to the hospital in the rich suburbs, where the wait isn’t as bad.

In Germany, I’ve never had more than a 30 minute wait in an ER.  Often it has been 5 minutes or less.  I’ve never felt rushed out before I want to go. In fact, I’ve wanted to leave and they’ve made me stay.

As for operations, I’d say my experiences have been comparable.  The waiting times to get the operations were similar, as was the care in the hospital.  Sure, there aren’t curtains around the beds in German hospitals, but that’s a cultural thing, German’s don’t care as much about privacy.  My last long stay in a hospital in the US was in 1990, so I don’t know about how things are now.  I’ve heard there are DVD players and stuff in the rooms, but there weren’t back then, and there aren’t in Germany.  [Update: when I stayed in the hospital for hyperemesis in December of 2009, my room had a DVD player].

I hope my experiences have helped give you a little more insight into the German system.  Tomorrow I’ll be posting the experiences that people have sent in to me.

Read more of my health care series:

What are your thoughts?

  • Quickroute

    I was lucky that my company covered 50% of my medical insurance costs in New York but even then it was expensive. The quality of service was pretty bad – long waits for my GP even though an appointment had been made and the support staff were rude beyond belief.

    When I lived in UK the healthcare was free but long waiting times were frequent and you were shifted out the door in 5 minutes for a GP visit.

    I remember the healthcare in Australia was pretty good but you had to pay as you go although not too expensive.

    There is free healthcare in Argentina but most expats avail of private care which is as expensive as USA but better.

    Still figuring out how it all works in Hong Kong!
    .-= Quickroute´s last blog ..Macau, China =-.

  • rositta

    When I was last in Germany my aunt complained that she was not getting enough physio for her shoulder. Germans should thank their lucky stars for the kind of health care they have. I personally envy you all. Getting and MRI in days, a cat scan in hours, wow. We can’t even pay for it here, we’d have to drive to to the U.S. to do that. Good writing…ciao
    .-= rositta´s last blog ..Were We’ve Been =-.

  • Harvey

    Thanks for these posts!
    My mom suffered a heart attack when was visiting her sister in Germany back in 2003. The ambulance, an operation to place 3 stents, several days stay in intensive care and then a couple days in the normal care cost a grand total of $ 5200, 3/4 of which got picked up by her US insurance (Tricare). I doubt she’d have gotten off so cheap here in the U.S.
    I had a similar experience when I had a kidney stone removed in the Klinikum Rechts der Isar back in ’87 during the one month I was no longer covered by my U.S. insurance and before I’d started my German job and signed up for their health insurance. The amount of money I ended up paying was amazingly low by U.S. standards.
    .-= Harvey´s last blog ..Now for something really cool =-.

  • Amanda

    I am so glad you are posting this! I think I might even send a link to my parents in the US—-even though my mom doesn’t have any insurance (she isn’t yet old enough for Medicare), they are both terrified of a “socialized” system.

    As a grad student in the US, I spent 6 hours in the hospital with a very bad case of the flu. Nothing drastic—-but the grand total was $10,000. (Including an outrageous charge of $400 for a saline IV). My insurance left me to pay about $2,000 (and as a grad student that was my entire savings). In comparison, this year in Germany I spent 6 DAYS in the hospital for getting my tonsils out. Total that I was charged: 60 Euros.

    I am grateful every single day for the German health care system.

  • Isabella

    Another great post about this topic! Thanks very much for taking the time to go so in-depth! Well done :-)

  • Jessica

    This is a very interesting and thorough blog post. I might be inspired to do the same for the Swiss, although my experience is not as extensive as yours. Looking forward to the other personal experiences….

  • silvia

    I have lived in the US for 11 years now, and I am outraged by the stupidity of the Americans when it comes to universal healthcare. They just don’t get it. There not much for change, and townhall meetings are full with elderly’s, screeming hell what they don’t want in the future, don’t need and so on, even tho they are on Medicare anyways, but I rarely see middle aged folks standing up with their opinion.
    The republicans scare the living hell out of the people with lies and stupid, rediculous reasons why national healthcare is bad, it makes my toe nails curl up!

    I am a native of Germany and enjoyed the healthcare system while I lived over there. I never had to worry about my life or had to spent a penny out of pocket except for a prescription fee and some dental work. I never expedted to be seen by a doctor this instant, and I really did’t think any wait was a major dissaster, nor did I ever receive bad treatment anywhere.

    Now to the US. I came here debt free, got a job, so did my husband. We both had seperate health insurance plans offered by our employers. No need to go out and choose one of the non competetive creedy crooks on the private market.
    We had a 200$ deductible, a 25$ copay when seeing a doctor, and full prescription coverage. Emergency room cost was at 100$ a visit, short and long term disability in case of an accident or illness available and coverd, plus disability payments for a time period when wages are lost. We felt fortunate and blessed that we got plans that good and felt all around secure.

    Fast forward, two years later. I have fallen ill, needed a hospital stay, blood transfusions, lab testing and expensive medications. My illness is permanent, which puts a pre-existing condition stamp on my forehead. I lost my job, my insurance due to lack of hourly labor contribution, was left with a copay in the thousands, and the hospital collection agency calling on a daily basis. Care was excellent, no extra charges on the single room, no waiting for the doctor to show up to answer questions. To this day, I am beeing cared for in a superb manner. However, we have struggled to be covered again due to my pre-existing condition and job changes. Times have changed, private plans are so expensive, no family of three or four can afford them without taking on second and third jobs on the side. People are looking forward to employer sponsored health care plans. The downside unfortunately is, that people are stuck with those plans and outrageous deductibles and copays. I went from 200$ 11 years ago, to 6000$ today. That means, if I see a doctor, no matter what specialty, it costs me what ever he is charging, no matter the network. There has never been a shortage of in-network hospitals or doctors in my area, but that doesn’t benfit me in any way since we pay,pay,pay til doomsday up until the deductible is satisfied. Lab work in connection with a office visit is no longer covered, DNA testing is out of pocket anyway, running a whopping 1200$ per test and prescription copays are running anywhere between 2500$ and 4500$ a month out of pocket…We don’t even make that much money. Our live consists of paying medical bills and medical credits.
    We have been forced to take out a medical credit for a oral surgery last year and will be making payments for another 4 years. The insurance covered amount was a joke, and we are hoping and praying that we don’t need another procedure done before the other amount is paid off. This beeing said, we worry everyday that nothing is happening to us or I get worse.

    To me it is outrageous, that this country’s health care system has so badly derailed, and politicans call this the best health care ever??? I guess they are never sick and never will be.

    I hope, that the US will get national healthcare in place, so that everybody will be covered, no matter child, adult, married or with a pre-ex, costs manageable, so people don’t have to choose between food on the table or drugs or beeing worried sick weather they will loose their house in case of an emergency. I would very much welcome a plan to take e certain percentage out of the paycheck to cover costs like in Europe. People will benefit from it in the long run instead of going bankrupt in a life time.

  • Sara

    I’m really glad you wrote this because it’s nice to have a different perspective. I’m an American living in the UK and when I visit the US people ask me how bad the NHS here is. I am always honest and say that it costs about half to a third less than the better US plans and the coverage is universal. Do I wait a bit longer for non-emergency proceedures, probably. But I don’t mind because when my husband needed Emergency services, they were quick and efficient and we waited no longer in the UK A&E waiting room than we would in hospital emergency rooms in the US. It sounds like Germany’s is even better than the UK’s. I would love to live in Germany for a while to compare the German and the British healthcare systems. Thank you again for your insight.

  • wxsunnydays

    I think your crazy! I pay more with the German health care system than I ever did with the American health care system. I have had to wait a considerable amount of time in a German ER. Appointments in the German system also have long wait times. Your passage is very contradictory. Yes, all people should have health care. Is rationed care better? You day you are only allotted 8 physical therapy sessions a quarter-what happens when you need more and the doctor does not agree? What about those who are not diagnosed properly because the doctor has met his quota for the quarter and will be charged out of pocket for the service. People forget that America is not like Germany, it is not like the UK. Just as Germany is not like the UK and America. What work for one country will not necessarily work for another. Our politicians will stick some other type of law or bill in with the health care reform bill that has nothing to do with health care. For instance, Caps law that is currently integrated in with Obama’s health care reform. Are you willing to give the American Government full control of you health and RETIREMENT! I am not ready to hand over close to 50% of my pay to support others.

  • Christina Geyer

    @wxsunnydays: I must commend your very skilled debating, LJ. You disagree with my personal experience, so that makes me crazy. Fair enough. You also state that my reporting of my personal experiences is contradictory. How so?

    I think you may want to go back and fully read this article. Yes, you pay more in the German system than in the American system. I stated this: ” I remember making a big fuss about it to Rainer, saying that I could have paid the full health care costs for my back problems in the US and not even reached half the amount I paid for insurance over the course of a year here.”

    Personally, I’m surprised you experienced such long wait times, especially in the Stuttgart area. What kind of sample size are we speaking about? If you mainly use the medical services on base, then I can see that you might have had a one off bad experience. It does happen. This article only speaks to my personal experiences. If you want statistics, you should read my article on German Healthcare.

    Again, reading comprehension: I was allotted 8 physical therapy session per quarter covered 100% by insurance. As I stated in the article, I could have as many as I wanted, without a prescription from the doctor, by paying for it myself, 20 Euro per session.

    If you don’t like your doctor or want a second opinion, you just go to another. There is private health insurance here for people who want extra coverage. There are private retirement fund accounts for people who want more money at retirement than the government fund would give.

    Just because there are public options, does not mean one cannot invest privately in ones own health care or retirement.

    I would suggest that you look at my other two articles, Health Care in Germany and Universal Healthcare: Taking on the Myths, for the facts about this subject. I do make clear in the German Healthcare article that the US is not Germany, or the UK and the system here is not perfect. The US can learn from other countries, however. And instead of whining about how corrupt and immoral US politicians are, why not do something about it with your vote. Or run for office yourself. Nothing is going to change if nobody is willing to do anything about it.

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