Monday, February 1, 2010

An American returns to US to confront US healthcare

A colleague of mine who has spent much of the past 10 years in Germany moved back to the US recently and says he misses German healthcare. Apparently, he cannot pick the doctor he wants; he has to make sure first that the doctor is certified (or whatever) with his insurance company.

I left the US when I was 24, so my contact with healthcare in the US is both scant (those were my healthy years) and a long time ago. Honestly, I have no idea what healthcare in the US is like, aside from recollections about what my father, a pharmacist, said. But I have been hearing in US media that Americans don't want "socialized medicine" of the kind we have over here because they fear not being able to choose doctors. So it surprises me that you already can't choose your doctor in the US.

I am not sure what the situation is in every European country, but certainly you can choose your doctor in France and Germany. I would be surprised if the situation were different in Spain, the Netherlands, Switzerland, etc., but you have the comments box below if I am wrong.

My understanding is that the US was considering a public option alongside all of the private healthcare, which would have made the US system look a lot like the German system (and a lot unlike the French system). I do not completely agree with my colleague, however, that German healthcare is all that great. Your average German would tell you that we have two types of medicine over here: one for first-class citizens and one for second-class citizens. If you are in the public system, which tries to keep costs down by not paying too much, then the doctors tend to make you wait longer than if you have private healthcare, which tends to pay better, so doctors like it more.

Nonetheless, Americans apparently seem to completely misunderstand both their own healthcare system and what they call "socialized medicine," at least when it comes to the freedom to choose your doctor.

1 comment:

  1. Most Americans who have health care choose either an HMO or a PPO. In an HMO, you must use in-network doctors, but most of your costs are covered after a copay. For example, my HMO makes me pay $15 every time I go to the doctor for routine care, but they pick up the rest of the tab. I was able to choose among about 6 General Practitioners. In order to see a specialist, those in HMOs need referrals. Your GP refers you to a specific specialist who is in your network. I learned after I asked that if I wanted to see a different rheum, there was one other in my network in my area.

    The other choice is a PPO. With that, you can *technically* choose which ever doctor you want. However, there is a network of doctors, determined by the insurance company, who they will foot more of the bill for. For example, if you choose a doctor in the network, the insurance might cover 85% of the bill; however, if you choose someone out of the network, they might only cover 60%. The other benefit of a PPO is that you don't need a referral to see a specialist, you just choose one and go.

    I've never actually seen the benefit of choosing my own specialist, though. I don't want that kind of responsibility, and frankly, I wouldn't always know what type of specialist to see. I like the comfort of a GP overseeing things.

    A PPO is also generally more expensive each month than an HMO, so an HMO is cheaper all around, with less choice from the patient.

    Not all employers offer both HMOs and PPOs. Some might only offer one or the other.

    Many many many Americans do completely misunderstand their own healthcare system, and have bought the propaganda. The most frustrating point for me is that a public option would "let the government decide what care you get, rather than your doctor." I'm sorry, your doctor doesn't get full control over what care you get right now. The insurance company tells him what will and will not be covered, which has the effect of what care you will or will not recieve.

    I think the big problem was that the government tried to work *with* the insurance companies to get them on board, when it should have vilified them. Every complaint people imagine would happen with "government-run healthcare" is ALREADY happening with the insurance companies, whose main goal is to deny care in order to boost profits. Someone should have painted the devil's horns on them where they belong.