What has social medicine ever done for me?

I moved to Germany about 27 years ago from Canada to work as an engineer in a large international engineering company (think Seamens spelt different). Moving to Germany meant that I received immediate social medical insurance. Having spent nearly 20 of those 27 years working in the medical equipment field, in quality control and service, I’ve had the opportunity to view various medical systems all over the globe from the sidelines, as it were. Some systems work relatively well, others not at all.

Much of what I read these days in the US newspapers makes it seem as if adopting a universal health system is going to lower standards medical services. It is as if Mr. Obama is trying to flog off something inferior. It doesn’t have to be so. Having friends and family scattered all over, we’ve shared many stories about in ins-and-outs of our countries medical systems. What these discussions made me realise is that, even though many Germans complain about their social medical system (national favourite pastime), and there are many things that could be improved, and many indications that services will get worse, overall, we have it good.

I can say this because the system here tries to keep some things that traditionally were good (e.g. having the same family doctor for 20 years), as well as implement some things that are new (e.g. alternative medicines). All the while, they offer everything from preventative medicine to emergency care for everyone living in Germany.

The title of this post “What has social medicine ever done for me?” comes from a conversation I had recently with an acquaintance, who was complaining about having to pay for a selective preventative procedure at her gynaecologist. As a response to her, and hopefully of interest to you, here is a list of a handful of situations that highlight what the social medical system has done for me or my family over the years:

• We have had the same family doctor since we moved into our present apartment for the last 15 years. If, as has occasionally been the case, one of us is too ill to come to her office, she makes house calls.

• At all births, even in hospitals, a midwife as well as a doctor is present. Midwives are there to assist you through the labour and birth in a way that doctors can not.

• During my second pregnancy, I experienced early labour pains as of six months. I had to say at home in bed the last trimester. The medical insurance paid my salary after the initial six weeks of being on sick leave.

• After my children were born and after we went home, my medical insurance paid a midwife to come for a daily visit for ten days. They also paid for a friend to clean my house daily for two weeks since I had to (unfortunately) have caesareans both times.

• They paid for both my children’s orthodontist costs when they needed braces and my son's dental surgery.

• They paid for taxi costs when I had to come into physio therapy after some surgery.

• When my daughter became lacto-intolerant as a young child, they paid for homeopathic therapy.

• I’m not sure who pays for what (i.e. employer, medical insurance, and social services), but for 6 weeks before estimate date of birth, during your stay in hospital, and 3 months after your baby is born, you get 100% of your salary, (You also get partial payment for up to 1 ½ years and job security for up to 3 years maternity leave, but that has nothing to do with the medical insurance).

• For the last 12 years, I have been a part of a preventive breast cancer program receiving mammogram and ultrasound examinations for free since my mother had breast cancer.

• The insurance company pays for part of my glasses and hearing aids costs. There are glasses and hearing aids available at the prices they pay me, but they look somewhat gorky, so I choose to buy more modish expensive ones.

• They pay for annual and semi-anual check ups to the gynaecologist, ERN, cardiologist, internal medicine, dermatologist, and dentist.

Well, I was hoping to come up with ten examples and I came up with eleven, so I guess I’ll stop while I am ahead.

German Medical System 101

Ronni asked her non-US readers to write about how our universal (social/national) medical insurance systems work. One aspect that I find interesting about the debate in the US is how little differentiation is made between the existing universal medical insurance systems. Instead, the discussions seem to be stuck with the “Yea or Nay for Health Care Reform”. So much of what I am reading these days has to with the analysis of the poor behaviour of the nayists. Their tactics and arguments rob me of words. I do hope that Ronni’s idea of each of us writing posts the next two days has a positive effect in some way or manner to the debate.

In Seth Godin’s recent blog post, “Willfully Ignorant vs. Aggressively Sceptical”, he presents a short astute argument to those people who openly oppose health reform. He writes, “If you want to challenge the conventional wisdom of health care reform, please do! It'll make the final outcome better. But if you choose to do that, it's essential that you know more about it than everyone else, not less.”

Even if the differences in the various systems are not highlighted or discussed, it would be advisable for people on both sides of the argument to take a look of these systems and try to decide which components they like best. There are a slew of articles available out there that point out the differences. Admittedly, many of them are not written from the patient’s point-of-view, which is why I thought I’d write about how the German social medical insurance system works from a user’s perspective.

It is actually a very easy system to understand; it is a two-tier system where you can decide yourself if you want to be state insured or privately insured. Most people opt for the state system.

The principal reason some people go private is out of costs reasons. If you earn a relatively high income, it can be less expensive to be privately insured. All people, whether privately insured or state insured, go to the same doctors’ offices and hospitals. You chose whom you want to go to and where you want to be treated. You can choose general practitioners or specialists according to your will.

There is a selection of state run insurance agencies to choose from. Each agency has to compete against each other in services offered and costs. They all offer the following:

Children (under age 18)

Children and students are insured under one of their parent’s insurance policies at no extra cost. This insures that 100% of your children’s health costs (medical and dental) are covered for all short term or long term diagnostics or therapies. All prescription drugs are paid by the insurance company. You go to a pharmacy with a prescription slip and they hand you over the drugs; the pharmacies deal directly with the insurance companies for recompenses. With certain chronic illnesses (e.g. neurotmesis, asthma, allergies), recognised alternative medicine therapies (e.g. homeopathy, acupuncture) are also paid for.

If your child is sick, each parent is able to take up to 10 days of “child sick leave” per child per year. The insurance company compensates 75% of your salary for these sick days you’ve taken because of your child’s illness. If your salary is below a certain income, 100% is compensated.

All billing formalities are carried out directly between doctors’ offices, hospitals, and insurance agencies: you go to the hospital or doctor’s office, they swipe your insurance card through the computer, you receive medical advice and then you go home to get better. Basta!

Adults (> 18 years and employed)

Insurance pays 100% medical and dental costs. Up until recently, this really was 100%, but in the last few years some of the selective (e.g. dental crowns) and cosmetic (e.g. plastic surgery) procedures are only partially covered. If there is any indication that such a procedure (e.g. breast reduction) is not solely cosmetic (e.g. back aches), the insurance company will pay for 100% of the costs.

Most people have a general practitioner they go to. This doctor,

• cures you of most of your ills,
• writes you your prescriptions,
• writes you off on sick leave,
• and makes recommendations for you to various specialists for both preventive procedures (e.g. mammograms), as well as acute diagnostic or therapeutic procedures (e.g. at a cardiologists).

Any procedure that is needed to be done immediately, you usually can get an appointment at a specialist or hospital right away. For preventive procedures, you might have to wait a 2-3 weeks for an appointment at a specialist.

Your state insurance company compensates you your income if you are ill for longer than a six-week duration. Under six weeks, your employer continues to pay your salary.

The insurance costs are a fixed percentage of your monthly salary. At the moment, the costs are somewhere between 12-13% of your salary. Your employer matches and pays the same amount (i.e. 12-13% of your salary) to your state insurance company. Thus, there is no necessity for company health insurance policies. (Therefore, it doesn’t matter if you are a large corporation or a small business, you pay the according to the number of employees and their income.) The monthly payment is automatically transferred from your pay check.

Students (> 18 years and not yet graduated from university)

Insurance pays 100% medical and dental costs. Your insurance rates are approx. 100 USD per month.

Adults (> 18 years and unemployed)

Insurance pays 100% medical and dental costs. Your insurance rates are paid by the unemployment agency or social services.

Adults (retired)

Insurance pays 100% medical and dental costs. Your insurance rates are paid by the state pension plan.

What I am hoping to convey in this post is that when talking about Health Care Reform, we don’t talk about the quantity of care, this is what doctors provide, but about the services offered and prices paid. And, these things do vary. The medical system in Germany has evolved over the decades. It is always changing, and so will the US system once it gets set up.

My personal belief is that any medical system that doesn’t offer full coverage for all people at competitive prices is a system that is ill. By all accounts, full medical and dental coverage in the States is almost unpayable for the average family. Why not just say, “Yea to Health Reform”, it would be the beginning of a long journey for all and not the collapse of a system for the few.

Need Some Help Here

I’ve just been offered a contract to give some occupational therapy students a ten-week technical English course. The goal of the course is to optimise their reading comprehension. Rather than try to teach them to speak better English, they must try to use their school English to their best advantage.

When the students become occupational therapists they will occasionally have to treat non-German patients, read English literature, or communicate with other professionals in their field outside of Germany. The course focuses on these three learning scenarios. Up until now, the person giving the course relied strongly on photocopied texts and question sheets for encouraging and testing reading comprehension. This has not been successful. The students remain unmotivated, sullen, and unwilling to participate in class. The teacher was not able to get the students to do the weekly homework, let alone work collaboratively with the other students or communicate with the outside world.

I would like to get the students to use the Internet to explore and communicate with outside sources. I want to see if the students could learn more about the world of occupational therapy outside of Germany than me.

My question to all of you is,

Could you refer me to any blogs, wikis, or websites dealing with occupational therapy in particular, or health and health care as a whole?

I’ve been told that overall the occupational therapists work a lot with children or aging patients. So, if you know any blogs or websites concerning these target groups, please send along the links.

I’d very much appreciate some starting points. Thanks.

A Healthy And Happy Life

Today’s topic of meditation:

We all dream about living a healthy and happy life.

After being on this planet for fifty years, I know that the pursuit of health and balance is not rocket science. Nevertheless, I constantly flounder. I know about daily exercise, drinking lots of liquids, eating a balanced and diverse diet, the need for sleep, and how to avoid stress. In fact, I know a lot more of then that, yet, does this translate into concrete, consistent, irrefutable action? Alas, no, not really.

And when you think of it, the pursuit of happiness is, at best, a precarious goal. It could well be that, in our society we invest too much time and effort trying to obtain the unobtainable.

Even the definition of what happiness is, tends to be prickly. If you asked someone what is loyalty, respect, courage, perseverance… most likely, we’d all, more or less, agree to common-based meanings. Yet, happiness; it appears to mean something different to each and every individual.

Mornings like this morning, I wish I could find the wings to fly the course of this day as I believe it could be done. All’s I need is a bit of courage and perseverance, don’t you think?

Buddy System

A while ago, I wrote a short article on the law of give and take. Since then everywhere I turn I’m discovering blog articles written by people who are in situations where they could use some help, but they are unwilling to ask others to assist or accompany them. And nowhere does this occur more than when it comes to health and age-related difficulties. What I wonder, especially when it comes to the American culture, is why anyone would wish to assert their independence and right to individual choice above all else, when it comes to handling difficult situations.

I am not saying we shouldn’t strive to live as independent people, but we should reflect upon our motivations for asserting this viewpoint like a wet washcloth over all messy surfaces. For, if we are honest, independence often translates into:

• having to handle situations alone
• denying the existence of disturbing symptoms
• refusing advice or company of friends or family members
• postpone making necessary decisions
• ignoring the inevitable
• being just plain ornery
  

When I looked up the meaning of independence (self-reliance, autonomy, freedom, liberty) and autonomy (freedom from external control or influence), I realise that independence is a philosophical stance and not a practical strategy for overcoming life’s difficulties. Why would anyone wish to face their problems alone when the benefits of buddy system are vast?