Below is a letter concerning health care that AVA Berlin is sending to selected members of the U.S. Congress who are engaged in the health care debate. But because letters from constituents seem to matter more to Congress than letters from those who do not vote in a given state or district, and because some in Congress only accept mail from their own constituents, we urge each of you to send this letter along PERSONALLY to your representative and senators.
You can use the following URLs to find the appropriate addresses:
http://www.senate.gov/Use the pull-down menu in the top right hand corner to select your state (the state to which you send your absentee vote) and go from there.
http://www.house.gov/Welcome.shtmlClick on Find Your Representative (by zip code) or Write Your Representative in the top left hand corner.Feel free as well to send the letter to friends or other parties involved in the discussion of health care reform.Don't forget to personalize the greeting, and remember to copy the interesting notes when you forward!
Hoping for wide distribution,
Carolyn Prescott and Ann Wertheimer
To our Senators and Representatives:
As a non-partisan group of Americans living abroad who remain engaged and active as U.S. citizens, we of American Voices Abroad Berlin* are following the debate about health care in the States with particular interest. We hope that Congress will examine various foreign plans - Germany, Britain, Scandinavia, Canada - in order to eliminate some of their weaknesses and focus on their strengths. Having experienced the health care system here in Germany, we feel we can contribute to the discussion by sharing some information about a system that achieves near universal coverage and high-quality health care at a significantly lower cost than the American system.**
The German system*** has the following features: 1) Health care coverage is mandatory. About 88% of the population is covered by one of over 200 nonprofit public insurance funds, but some people do purchase private insurance based on their circumstances or because of the extended coverage (such as private hospital rooms) offered by some private insurance companies. 2) Premiums for the public option are levied based on income, or, in the case of children and the unemployed, are covered by government funds. 3) A government health fund manages the distribution of collected premiums to the public option insurers based on assessment of actuarial risks of the individuals covered. 4) No one in the public system can be excluded or charged excessively based on pre-existing conditions or their current state of health. Private insurance companies are also subject to certain requirements related to coverage of persons with ill health. 5) Insurance is largely portable and considered by most to be affordable. In addition, as patients/consumers, we note the following: 6) We choose our own doctors. 7) We do not have long waiting times for consultations, diagnostic procedures, or surgeries and treatments. 8) We seem to have access to the same advanced medical technologies and medications that are available in the U.S. 9) We have very limited co-payments; we do pay a fee of 10 euros for each first doctor and dentist visit per quarter as well as 5 to 10 euros per pack of medications and 10 euros per inpatient day up to 28 days.The German system is not perfect and continues to undergo changes in order to cover and contain costs. However, the underlying principle of the German system, that health care should be financed by individuals on the basis of their ability to pay but should be available to all who need it on roughly equal terms, has been maintained. There is a sense here that it is in everyone's practical and humanitarian interests to promote health and to care for the sick and injured in the society as a whole. We would encourage Americans to consider features of the German system on their merits rather than dismissing them with scare words like 'socialist' or presenting them as too clumsily or expensively bureaucratic, as we know first-hand that they generally are not.We strongly urge lawmakers to bring American health care up to the standard enjoyed by others in the developed world.
Sincerely,Carolyn Prescott (
CarolynPrescott@web.de) for American Voices Abroad Berlin
* American Voices Abroad Berlin (AVA Berlin) is politically progressive and independent of all political parties. AVA Berlin is opposed to preventive war and the Patriot Act. It is dedicated to fair elections, civil liberties and social and economic justice at home as well as to a foreign policy rooted in respect for international institutions and the rule of law.
** Comparing Costs: A Patient's StoryOn March 17, 2008, while visiting friends in Berlin, Germany, Karen Hillmer fell down a steep flight of stairs at a subway station and broke many bones. Karen required five operations in a span of a few weeks, each operation involving surgeons from different specialties within orthopedic surgery. Karen spent a total of six weeks in the hospital. During that time, in addition to the surgery and round the clock skilled nursing care, she received physical therapy every day. On April 25, 2008, Karen was moved to a clinic in Berlin specializing in rehab medicine for geriatric patients. During the five weeks in this clinic, Karen received skilled nursing care, extensive physical therapy and occupational therapy each day. On May 29, 2008, Karen was able to fly back to the U.S.The total bill from the hospital for all the care she received during her six-week stay was just over $28,000. The bill from the rehab clinic was about $11,000. (The dollar amounts given here are based on an exchange rate of about $1.60 for 1 euro, the worst exchange rate ever for the dollar.) Thus, the final bill totaled $39,000.Karen required two follow-up operations after returning to the U.S. The most recent one was performed on her left elbow. It was done as an outpatient procedure with several x-rays and radiological therapy before the operation and extensive occupational therapy for about 18 days after the operation. The combined costs of this care, which took place over a period of about 3 weeks and did not include any inpatient care, was $19,600. The operation only involved one surgeon working on one specific problem while each operation in Germany required several surgeons working together on different problems at the same time. To summarize, 11 weeks of in-patient care and 5 complicated orthopedic operations in Germany came to $39,000, while 3 weeks of out-patient care and one orthopedic operation in the U.S. came to $19,600.
*** Two Sources of Information on the German System: Reinhard Busse, M.D. M.P.H., Professor of Health Care Management, Berlin University of Technology and Charité—University Medicine Berlin
http://www.commonwealthfund.org/~/media/Files/Resources/2008/Health%20Care%20System%20Profiles/Germany_Country_Profile_2008_2%20pdf.pdf <
http://www.commonwealthfund.org/~/media/Files/Resources/2008/Health%20Care%20System%20Profiles/Germany_Country_Profile_2008_2%20pdf.pdf> Uwe E. Reinhardt, James Madison Professor of Political Economy, Princeton University, “Health Reform Without a Public Plan: The German Model,” /Today’s Economist/, April 17, 2009.
http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/
One of the most realistic comments on rationing health care appeared in today's IHT. New York Times business columnist David Leonhardt takes on the R word:
'Today, I want to try to explain why the case against rationing is not really a substantive argument. It is a clever set of buzzwords that tries to hide the fact that societies must make choices. In truth, rationing is an inescapable part of economic life. It is a process of allocating scarce resources. Even the United States, the richest society in human history, is constantly rationing. It rations spots in good public schools. It rations lakefront homes. It rations the best cuts of steaks and wild-caught salmon. .....Milton Friedman's beloved line is a good way to frame the issue: there is no such thing as a free lunch. The choice is not between rationing and not rationing. It is between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries and gets worse results by many measures, it is hard to argue that is is now rationing very rationally.'
www.nytimes.com/2009/06/17/business/economy/17leonhardt.htmlThis struck a cord this morning because in yesterday's LA Times there were a series of articles on how health insurers refuse to limit rescission of coverage. Rescission, of course, is a nasty move to drop customers and cancel medical coverage for some sick policy holders even though they have been paying into their policies for years:
'It also found that policy holders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.'
www.latimes.com/business/la-fi-rescind17-2009jun17,0,5870586.storyIs it any wonder that whenever anyone asks if a return to the home country is planned now that the time has come to consider selling our home, the only honest answer is no because of lack of good quality health insurance? With all the illnesses the two of us have been up against these last few years (Parkinson, strokes, heart attack, a major OP correcting a scoliosis, a new hip), one thing we do not have to worry about is paying medical bills, getting good quality care, not having to worry about being thrown to the wolves financially because of medical expenses for care or medicine.
There has been a lot of discussion in Germany about how quality and care for non-private patients has fallen a notch or two recently. Yet this has not been our experience. Whether as a private patient in the hospital (where an extra insurance pays the difference) or as a non-private patient outside, the quality has been excellent, the wait for appointments rather short, all tests have been done that were needed. Of course, it does depend on whether one has a serious illness or is just trying to calm one's nerves if something might be wrong. There have been attempts to put off CAT scans for weeks, but a simple explanation of what's behind it all has always led to an immediate appointment.
Society has to make choices. One extremely important one is to see that every citizen and resident has health insurance, in particular for serious illnesses. It is hard enough dealing with a range of health problems, but having to be brought to financial ruin because of medical expenses seems uncivilized. Nor is there anything wrong with allowing the government to provide a health insurance plan along side of private ones. The main thing is a peace of mind knowing that coverage is there and it works when everything else in life seems to be falling apart.
The word of the day is
stereotype. President Obama: I consider it part of my responsibility as president of the United States to fight against negative stereotypes of Islam wherever they appear. But that same principle must apply to Muslim perceptions of Americans. Just as Muslims do not fit a crude stereotype, America is not the crude stereotype of a self-interested empire.
Der Spiegel is doing a three part essay on Trans-Atlantic Comparisons: Sophisticated Europeans, Obese Americans? at
www.spiegel.de/international/europe/0,1518,628381,00.html. Interesting to look at its photos and charts comparing poverty and wealth between the US and various western European countries. It leaves little place for normal stereotype thoughts.
How often does one open up the business pages of the IHT these days and come upon a heart-warming report along these lines: Let them eat brioche! Town saves bakery by Sarah Schweitzer. Not just any bakery, but a real French one and the town is a small rural one in New Hampshire that is being hit hard by lay-offs and businesses closing. Citizens of an American town rising up and fighting to keep something that at first seemed so alien, but in the end proved a smashing success and something they simply didn't want to live without, even in hard times. Alas, a story worth smiling about.
www.boston.com/news/local/new_hampshire/articles/2009/05/21/town_rises_up_for_bakery
There was a full page of articles on why fewer foreigners in Germany are striving to obtain German citizenship in the Sueddeutsche Zeitung. The primary reason given is that Germany demands its new citizens to renounce their first citizenship when becoming German. Worth noting is that any new citizen who is from one of the European Union countries does not have to comply with this rule and is allowed to keep both passports. According to all reports there has never been any problem with those who do indeed have double citizenship. So why the double standard? Of course the only example constantly mentioned in the media is the case of Turkish citizens who often don't want to give up their Turkish passport because they might have difficulty inheriting property later on. What is almost never mentioned are all those citizens from, say, English speaking countries who refuse to renounce one citizenship for another. It is a drastic step, forcing one to officially cut a tie to one's birth nation, and for non-political reasons. What does one get in return, except for the right to vote in local and national elections? If you are a permanent resident you have to pay taxes here, have health insurance, pay into the social security system and follow all the laws of the land, which we all do. In my case I exchange voting in US federal elections instead of in German national ones. I am forced to give up my rights to vote in local elections both in New York City and here. There is no good reason for me after over 30 years to have any voice in local NY affairs, though I follow what happens there closely. After all, it's my hometown. I do follow closely what happens here, but from a unique distance. I'm part of it, but then I'm not.
Ultimately it comes down to the rather emotional factor of when returning home do I want to line up in the foreigner's line and present a German passport which lists my birth city as New York or do I want to pass through my birth country as one of its own? What harm would it do Germany to have citizens like me who have feelings for both countries? It is interesting to note that never once has any German official ever approached me about obtaining citizenship. On the other hand, since 9/11 the rules have changed here. Should I decide to leave Germany for a period over three months without informing the authorities, I would lose all my rights to permanent residency and would have to start the process all over again. Never mind that I am married to a German citizen and my children were born here. Did I mention that these children have double citizenship from birth on? They were lucky enough to have a German father and an American mother. For those children now born in Germany with non-German parents who have lived here for a number of years, the laws are different. These children are allowed to have both citizenships until age 23 when Germany demands they decide which one to hold onto and which one to abandon. It is going to be interesting to see what happens when this generation comes of age. What are the Germans going to do with those who have served in the German military, perhaps even abroad in these days, and then decide not to hold onto their German passport? Will they really count them as foreigners suddenly? Tell them that though they were born here, attended school here and speak the language, they are no longer a citizen simply because they have decided for another passport? Of course, most of them most likely won't opt for the other passport. It just seems harsh and petty to force them to have to make a decision that is a private, emotional one.
It's time to break out of the cocoon being ill creates and re-enter the political arena. One gets so involved with oneself when illness strikes and depleted energy leaves you unable to see the bigger picture. It is too easy to think at such moments politics doesn't matter, but politics is involved in all facets of life whether it's health care, jobs, war, torture, even mundane things like where to park your car, or as in the case in Berlin yesterday where they voted about whether religion should be taught equally next to ethics in the school plan. The majority voted no to organized religion and opted for having all students, independent of their religious background, being taught values in a secular way. Those students who want lessons in their religion can, of course, do so outside the mainstream plan.
On the other side of the pond there are two enormous themes burning brightly. What to do with torture, in particular to those who willingly agreed to it use and why. Should they be held accountable? Perhaps the better question should be: how could they not be held accountable? Frank Rich in The Banality of Bush White House Evil sums it up in perspective at
www.commondreams.org/view/2009/04/26-0.
'President Obama can talk all he wants about not looking back, but this grotesque past is bigger than even he is. It won't vanish into a memory hole..... Congress and politicians of both political parties should get out of the way. We don't need any Capitol Hill witch hunts. What we must have are fair trials that at long last uphold and reclaim our nation's commitment to the rule of law.'
The other theme is the economic crisis and how it is affecting the common person, the forgotten one in the huge sums of money being thrown around daily in the media. Tomgram: Nick Turse, Hungry and Without Options in New York at
www.tomdispatch.com/post/175064.
'Here, on a quiet, tree-lined section of 116th Street in Manhattan, it's possible to see the financial crisis that has the planet in its grip up close and personal. The new working poor, as well as more families with young children, are threatening to overwhelm New York City's last hunger safety net.'
