A Friend Drops By

A friend living on the northern tip of Denmark was travelling today on a train through Germany. She decided spontaneously to get off the train in Luebeck and make a pit stop visit. We met for lunch. Had a lovely chat. She then got on the next train heading north. I went back to my office with a smile on my face and a warm feeling in my heart. A sunny day in more ways than one.

Saying Adieu

When I moved to Germany 27 years ago, the first people who befriended me were Bernd and Trude. They were much older (nearly 30 years older) than I was, but we had a wonderful close and lively friendship. One that was easy to nurture, yet caused other people, including their two grown sons, to wonder what the attraction was.

Bernd died a few weeks ago and so this trip down to southern Germany to visit old friends, is mixed with a bitter sweet experience of saying adieu to my old friend. Yesterday and today, Trude and I talked about old times. She told me about his last illness and we visited the chapel where his memorial service took place and the cemmentary where he is buried. It sounds as if this would be a sad things to do, but actually it was more touching and endearing and, yes, at times, tearful, but mainly a quiet prayer to send him on his way.

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.

Food for Thought

If found that the facts contained in this video race by too quickly to read at the speed the video is presented. Nevertheless it is worth pressing the pause button while watching the video and taking time to digest the information.



What do you think, fade or revolution?

Magical Night Journey

One of the many joyful experiences I had during this last trip Montreal happened during the last hours of the journey. When the plane hit Europe (Ireland) and all the way down to Munich we had a spectacular clear view of all the cities and highways illuminated in oranges, reds, and yellows.

It is impossible for me to describe the magical beauty of this aerial landscape. The hour or so I watched, I thought we were seeing veins of burning lava, a treasure chest of jewels, and brewing colony of insects all in one. We flew in a perpetual dawn that never became sunrise...

Why Social Media

If you have ever asked "What is all this crazy hype about social media?", here is someone who makes no apologies, is in your face, and yes, is blatantly up front about saying "enough with the stupid question" and urges you just to get going.

What the F**K is Social Media: One Year Later

View more documents from Marta Kagan.

I found it surprising the 2/3 of the global internet population uses social networks. It seems as if a large part of my own social circle belongs to the 1/3 that doesn't. Why is that?

The Big Picture

The Big Picture is a fantastic site. Every few days, The Boston Globe presents a series of photos, fantastic photos, that concern a current topic of interest.

Whether the photos are about water,



Or, about Greenland,



they are not to be missed. Sometimes the topics are about war and violence and I can not look at the images because they just hurt too much, but mostly they are just spectacular.

Contemplation and Definition of success

I first heard of Alain de Botton when reading his book, The Consolations of Philosophy. Since then, I’ve very much enjoyed reading his work and hearing interviews he’s given. So, you can imagine my delight discovering he held a Ted Talk.



Do take a look while he contemplates how our culture defines success and how we might look inside of our minds and hearts to find a more appropriate definition.

Back from our Trip

Can't talk, let alone write... feeling the jet lag. On the red-eye flight from Munich to Hamburg, the pilot said something like, "Thank you everyone for arriving on time this early morning. Most of you probably were up even earlier than those of us in the crew. So, why don't you all just rest your heads and try to sleep. I won't bother you with any annoying announcements until shortly before we land." And he didn't.

Back from the Country

We've just got back from five days in the Laurentines, a range of mountains north of Montreal. Our dear friends have this wonderful house there with 66 acres of wooded land. We did the full monty: hiking, swimming, kayaking, canoing, swatting mosquitoes the size of helicopters, eating good food, enjoying a good read, and generally just having a marvelous time.

I don't remember the last time I felt so relaxed. Bliss. Thinking of all of you.

Early Morning in Montreal

Jetlag has woken my daughter and I up to a very early morning sunrise. All the other people in the household are sleeping and will probably continue to do so for a few more hours yet. It is, after all, summer in Montreal in a household of teenagers and teachers. And, even though my friends work veryvery hard during the school semesters, it is a life of luxury in the summer months. Visiting teachers who have lots of time off, is the best way to wind down quickly.

Normally, it would take a day or two for me to get into the flow of being on vacation. This has something to do with the chaos we left behind in Luebeck after packing at the last moment and the guilt of knowing that the to-do list on the dinning room table still had all sorts of items not checked off.

On this trip, we instantly became easy with all plans or non-plans. It's been delightful. I love Montreal. Especially, on a morning like this one, when the sun is shining and the cafe down the street is beckonning.

Listen to the Attitude

This video interesting analogy between the punk rock movement of the 1970s and the current social media revolution. The video also challenges large corporations and mass media to,

"... listen to the attitude and respond with respect..."

The reason for doing this is expressed well in Clay Shirky's recent TED Talk.



He nails the reason large institutes should be listening and responding around 12 minutes into the talk.

Sultry Summer

What a strange summer it has been hear so far. No summer weather as such. So much work to do on various projects, so much that needs to be addressed, and, therefore, I don't have the sense of experiencing a summer lull. Yet, the gods willing, I'm off on vacation at the end of the week until mid-August. If you notice a blogging lull then you know why.

Eyes - Postcards VI

She sits in the small terrace garden at her favourite restaurant. Alone, yet content. At home at the table with the lone white rose in an olive coloured bottle. Jazz music from the upstairs apartment seeps down the walls, crawling through the vines and peppers her food with unpretentious savoury pleasure.

A Love for Stop Motion

It might be the child in me, the one that tried to make stop motion films by drawing on the corners of pages in my school exercise books, but I love the stop motion films. There are so many excellent ones out there that I couldn’t possibly name them all. Here are but two of my favourites.

“This is the PEN Story in stop motion. We shot 60.000 pictures, developed 9.600 prints and shot over 1.800 pictures again. No post production! Thanks to all the stop motion artists who inspired us.”



I like this because it is obviously a story that took place in Germany in the last 50 years and I can identify not only the scenery, but also the emotions and impulses that have driven the man through his life.

Players from Sam Javanrouh on Vimeo.

This film is wonderful because the background motion in most stop motion films is relatively static, which is not the case in this film.

Lastly, are there any parents out there looking for a summer activity for their children to do during rainy summer holidays?

Self-evident but Clever

Even though so much of what Michael Shermer says in this video is self-evident, the way he says it is clever.

It makes me think John Hodgman's recent speech at the 2009 Radio and TV Correspondents' Dinner.


Can't help but think these two might add much sparkle to any dinner table conversation.

The idea behind both presentations is the need for all of us to question popular theories and offer intelligent skepticism towards our beliefs of life's truths.

Eyes - Postcards V

I’m listening to an interview of an elder, a well-known public figure, talking of his family’s past. So carelessly, so sincerely, this man says, “I look back on my parents with such enormous affection”. This statement acts like a knife, stabbing through my protective shell of pretend equanimity towards marred parental disputes and disappointments. Hard to know how to balance realistic expectations of how relationships can be with truthful acceptance of life as it is.

Eyes - Postcards IV

He sits in the night train travelling northbound, passing through a dark countryside spotted with neon-lighted train stations, through places he has never heard of, in languages he doesn’t understand. Alone in the train carriage, he stares outward towards the people he has yet to meet, to a life he’s yearning to find.

Eyes - Postcards III

A New Idea

A tiny ripple of hope
Then inspiration tearing
Downwards. Unexpectedly,
A synaptic burst of light.
My child’s mind. So simple.
Right there. There, where nothing
Is complete except that one step,
Or, leap into the unknown.