Healthcare. As the world tackles the Coronavirus crisis, the healthcare systems of many countries are under higher scrutiny than ever before.
Fortunately, I can’t tell you what it’s like being treated for COVID-19 in Germany. I can, however, tell you what the healthcare system in Germany is like in general; in particular, in comparison to the USA.
Disclaimer: this goes without saying, but I am sharing my personal experience. Other American expats in Germany may have a different experience with the German healthcare system, especially if they have private insurance. I also have no idea what it’s like to have “good” health insurance in America.
With that out of the way, here’s my comparison of healthcare in Germany and in the United States.
Monthly Cost of Health Insurance in America
The cost of health insurance in America varies by state and plan type. In my home state of Michigan, for example, the cheapest plan (aptly named “Catastrophic”) will cost you about $200 per month. “Silver” coverage, which is about mid-tier, is around $300 per month.
The better your plan, the lower your deductible, which is the amount you have to pay every year before your insurance pays for anything besides certain prescriptions.
Here are two of the cheapest individual plans I found available in Michigan:
If you have insurance through your employer, they are supposed to cover part of the cost of your monthly health insurance.
Monthly Cost of Healthcare in Germany
Public health insurance will cost you and your employer 14.6% of your monthly gross income. If you earn more than 4,688€ per month, the cost will not continue to increase. Since your employer must cover half the cost of your insurance, the most you will pay for public health insurance in Germany (as of data for the year 2020) is 439€ per month, after you add the additional 3.05% for your Pflegepflichtversicherung (long term nursing care).
Private insurance is only available to freelancers, students, doctors, civil servants, and employees who earn more than 62,550€ per year. You must have public health insurance in Germany if you do not fit into one of those categories. The cost and quality of private insurance varies depending on the insurance provider.
Visiting the Doctor
As you have probably already guessed, the biggest difference is the cost. The most I’ve paid to visit the doctor in America was $80, when I had awful health insurance with an insurmountable deductible. The least I’ve ever paid was $20, way back when I had “decent” insurance.
I’ve never paid for a doctor’s appointment in Germany.
Appointments are Different, Too
In America, I was weighed and had my blood pressure and temperature taken at every appointment. I was then taken to an examination room and, regardless of why I was there, the doctor would do a quick examination. Then, he would listen to my symptoms and either write a prescription or give me a referral.
In my experience, doctor’s appointments in Germany take place in the doctor’s office rather than an examination room. It’s like attending a business meeting about your health. I’ve never visited my family doctor for a cold or flu, but rather long-term symptoms that I could no longer ignore. So, she’s never so much as taken my temperature. Instead, she either listens to my symptoms and sends me off to a specialist with an Überweisung (referral) or she explains any results we’ve received.
Visiting a Specialist
As an adult, I’ve seen one specialist in America and four in Germany. Once again, cost is the biggest difference. The specialist in America cost a little over $200. They recommended further testing, but because my insurance wasn’t great and I couldn’t afford more $200+ exams, I declined.
Every specialist I’ve seen in Germany was covered entirely by my health insurance, including any procedures they performed.
It’s true, you technically have to wait longer to see a specialist in Germany than in the USA. When you take into account the years some people wait to get treatment in America, just because they can’t afford to see a specialist to begin with, though, what do a few months really matter?
The longest I’ve waited for an appointment for a specialist in Germany is three months. I might have gotten a quicker appointment if I’d chosen a different radiologist, but I wanted to go to the one near where I live.
My only gripe with the German healthcare system isn’t so much about the system as it is with providers. Anecdotally speaking, absolutely no one I’ve made an appointment with seems to have call waiting or a way to make an appointment online, and their phone lines are always busy. I will readily admit that it is very frustrating to sometimes spend hours trying to get through to make an appointment.
Eventually, though, you do get through.
My Stay in an American Hospital
One day in 2012 I got really sick. My abdomen felt so stiff and painful that I could barely move. Then, my lower back started to hurt and, a few hours later, my right arm. I was working a low-paying hospitality job at the time and, even though I had health insurance, it wasn’t the best. I think I had subconsciously decided I couldn’t afford for anything to be wrong, so therefore nothing was wrong.
By the time I went to bed, the pain was overwhelming. I finally gave in around midnight and went to the hospital. They ran some tests and initially told me that, not only was there something wrong with my gallbladder, but that my appendix and liver were also enlarged.
So, I had to stay over night. They ran more tests and determined the other tests were wrong. My gallbladder was actually clear and some people “just have large livers and appendixes.” Then they ran a few more tests, including an ultrasound to see if there was fluid in my abdominal cavity. Sure enough, there was; but, they couldn’t determine where it was coming from and said it appeared to already be “going away.” I was discharged with more questions than answers.
Oh, and one other thing. A $10,000 bill.
Thanks to my insurance I “only” had to pay $2,000.
My Stay in a German Hospital
I have no experience staying in a German hospital for an emergency; my stay was planned.
My dermatologist suspected my lip swelling was due to cheilitis granulomatosa and that the underlying cause was Crohn’s Disease. Instead of taking a sample of my lip himself, he gave me a referral for a hospital skin clinic.
They took a sample of my lip and performed a few other tests and procedures. In total, I ended up staying two nights.
The total cost? 30€. The only thing I paid for was the room at 15€ per night.
Which Hospital Experience was Better?
There were aspects of my stay in an American hospital that were much more pleasant than in the German hospital.
For one, shared rooms have privacy curtains. The hospital I stayed at in Germany had no such thing and (from what I’ve been told) they usually don’t. That lead several uncomfortable situations, including being purposely flashed by my roommate, an elderly woman who seemed to be of the, “it’s OK because we’re both women!” mindset as she tried to get me to look at the rash on her chest.
I also wasn’t happy with the way mealtimes were handled. One of the procedures I had was a gastroscopy. They looked around my stomach with a small camera and took samples. They told me not to eat for an hour after the procedure, but I was still given my food at the same time as everyone else. It was a heavily-spiced chickpea curry. I tried to eat it (after waiting an hour), because I hadn’t eaten in nearly 20 hours by then, but I just couldn’t keep it down.
In the American hospital, they were much more careful about meals. They avoided giving me peanut butter for breakfast, for example, because they still weren’t absolutely sure I didn’t have gallstones; the nurse even took the time to explain why I couldn’t have peanut butter, even though I hadn’t asked.
Was the food and privacy curtain worth $10,000? Absolutely not.
The German hospital is the clear winner.
How much you have to pay for your prescriptions in the US depends on how many generic versions are available and (of course) your insurance plan. There is, unfortunately, a lot of price gouging on prescription drugs in America. The two most well-known examples are insulin and epipens.
None of my prescriptions in Germany have been free, but they aren’t expensive, either. On average, I pay about 8€ – 10€ for prescriptions in Germany. I’ve never paid more than 15€.
In comparison, I’ve paid as much as $45 for my inhaler in America when my insurance didn’t cover any of the cost. The average American pays $1,200 for prescriptions every year.
Filling prescriptions in Germany is easier than in America. You can go to any pharmacy and, since your prescription cost isn’t tied to your insurance, you don’t need to have a “customer account” like in the US. There’s no waiting for them to confirm how much of the cost (if anything) is covered by your insurance. They just fill your prescription and you leave.
I never had the “luxury” of having paid sick days in America. If I missed work for being sick, I either wasn’t paid (crappy customer service jobs) or I had to cover it with a vacation day. Yes, even if I had a doctor’s note. In America, a doctor’s note often only serves the purpose of keeping your employer from being able to fire you for missing work.
Workers in Germany have more rights in general, and one of those rights is still being paid when you’re sick. All you need is a doctor’s note. There’s an upper limit to the amount of days you can be sick, but even then your pay just goes down to a certain percentage.
There’s No Going Back
I can’t help but wonder how long I would have put off going to the doctor for the symptoms that led me to eventually being diagnosed with Crohn’s and an enlarged thyroid, if I still lived in America. And if I had given in and saw the doctor, would I have said no to further testing after the first, less invasive tests made it seem like everything was OK?
If your deductible is $10,000 and you’re only bringing home $2,000 per month, non-emergency medical costs are to be avoided at all costs; even, potentially, at the risk of your own health.
When I hear about how much some of my friends pay for their medicine, examinations, etc. for their chronic illnesses, I wince. $800 for a colonoscopy! With insurance! Simple skin biopsies that cost over $1,000. Monthly supplies of insulin for just under $400. A quick ultrasound of the thyroid for over $400!
The American healthcare system is broken.
Insurance companies, pharmaceutical companies, and hospital CEOs/administrators don’t care about your wellbeing. They care about profits. You cannot trust a capitalist system to take care of people. You have to force your government to create laws and put protections in place. Healthcare is not a luxury, it’s a human right.
Americans need to start demanding more from their government and, honestly, affordable healthcare should only be the beginning.