American Views Abroad

Friday, July 03, 2009
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: 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. 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 ( 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 <> 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.

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