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In 1993,
when the Clintons where in the White House, Germany’s health care
system was hailed as a model for how to remake the American way of
providing insurance coverage. It consisted then, and still consists
of, everyone paying into a publicly funded health system through
payroll taxes.
Health care
is delivered through what are known as Krankenkassens, or ‘regional
health plans,’ which are non profit and heavily regulated in terms
of what hey charge and the care they deliver. If someone changes
his job or is fired or, more often the case in Germany, they remain
unemployed, they have health insurance that is portable.
Since then,
the German health system has careened toward bankruptcy and worse as
a result of three factors:
1. An
aging and eroding population base cannot support a generous package
of benefits that includes a six-week spa vacation.
2. The
government’s efforts to control cost have initiated a death spiral
of more serious financial problems triggered by penny-wise and
pound-foolish measures. By limiting access to new drugs, Germany
regulators drvoe up the use and total cost of hospital stays and
nursing-home use.
3.
Government regulation of health plans hinders innovation. Efforts
to improve outcomes, reduce hospital stays, increase efficiency or
consumer choice with electronic patient records and health savings
accounts are almost non-existent.
German
Chancellor Angela Merkel has seized the health reform portfolio from
Social Democrat health minister Ulla Schmidt, whose policies have
depended the crisis. That’s a good first step. The next step would
be to import some health care innovations from America and let
Germans, if they want, pay for them with tax-free dollars.
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