US expat here living in Germany. Two days ago I was riding my bike to the bank when a car pulled out right in front of me and I hit the brakes, flying over my handle bars and landing with my face right into the front side of the car. Since I was riding my bike in a lane only for bikes, it was immediately clear that I wasn't at fault. I distinctly remember what I was thinking in those first few tenths of a second, perhaps even before I'd hit the ground... it was: "Please, neck, please don't break". It didn't... and for that reason I was really lucky. On the other hand, of all the many thousands of people that driver could have hit that day she hit me so I guess luck is a matter of perspective.
People gathered around very quickly to help but there was one man in particular who called the ambulance and rubbed my scalp the entire time, asking me questions and stuff to keep me awake. I never passed out but I do remember getting sleepy and thinking to myself for a moment "Well, this wouldn't be such a bad place to take a nap"- which is funny when you consider I was lying flat on my back in the driveway of an ALDI grocery store :)
It was the first time ever I'd ridden in an ambulance and the first time since I had my tonsils removed when I was three that I was in the hospital for something myself. Funny- after I had the X-rays done I was waiting on the result in a strecher with a neck brace on and thus forced to look at the ceiling for about half an hour. That's when some old memories came back of me in the hospital as a kid- and maybe a little part of me wouldn't have been too surprised if my mom had suddenly come around the corner with a bowl of jello :) ...!
I received good treatment- 4 X-Rays, an ambulance ride to the hospital, and several consulations with two specialist ENT (ear, nose, throat) doctors cost me 15€ or around $22. Actually, my public health insurance card (or "socialist" health insurance, as a lot of people like to call it in the US) was scanned while I riding to the hospital in the ambulance and I will never see a bill in the mail.
I'm hardly an expert on health care, but I do know a bit about how the system works here and how it is feared in the US, presumably because politicians are bought by the health insurance industry to lobby against reform.
Here are some of the main points I've gathered about how the industry works here.
- All health insurers, whether public (state) or private, must be non-profit.
- Anyone who is not self-employed and makes less than 35,000€/year must be enrolled with one of several public health insurers (such as Barmer, AOK or the Techniker Krankenkasse). This includes large portions of the German workforce. Anyone who is self-employed and/or makes more than 35,000€/year has the option to be privately insured if they wish.
- You cannot be denied coverage because of pre-existing conditions and the questions an insurer can ask you when you join are very limited.
"Benefits" of private health insurance are:
they may pay for you to go to a health spa; they may cover some forms of "lifestyle" cosmetic surgery such as breast enlargement to a greater degree than those publically ensured; there are generally slightly shorter waiting times to get an appointment with a family doctor in non-emergency situations; head doctor treatment when staying in a hospital (each hospital has a head doctor and if you're privately insured, you have the right to be examined and/or consulted by the head doctor). Note the head doctor is not necessarily the "best" doctor, as in many cases it may simply be a matter of seniority.
As far as not being able to choose your family doctor: totally untrue. As I understand, those publically insured get access to the same pool of doctors as those privately insured (with the one exception of head doctor consultations for hospital stays). The actual rule pertains to how many times you can change your designated family doctor (the one you choose on your own) within a calendar year or quarterly period, etc. For privately insured, continuously changing your doctor several times in one quarter of the year may either be not allowed or you may end up paying fines. For public/state insured, it may simply not be allowed.
As mentioned above, there may be differences in how much you have to pay out of your own pocket for a given treatment. For example, some people may have health insurance plans set up so that they have as little as possible out of pocket expenses for dental treatment (say, gold fillings). That said, my boss makes a lot more money than me yet still chooses public/state health insurance. Why?
- The amount you pay to a public insurer depends on how much you earn (but is not more than a certain limit as I understand), while the amount you pay as someone privately insured depends on your age. As you get older, if you are privately insured, the amount you pay will definitely increase.