How Germany’s Universal Health-Care System Works

Seventy percent of Americans
say the U.S. health-care system is in a state of
crisis or that it has major problems. That’s why we’re hearing a
lot about Medicare for all, including some plans going as far
as banning private health insurance companies altogether. On page eight of the bill, it
says that we will no longer have private insurance as we know it. And that means that one hundred
and forty nine million Americans will no longer be able to
have their current insurance. That’s in four years. I don’t think that’s a bold idea. I think it’s a bad idea. Problem. Senator Sanders, with that damn
bill that you wrote and that Senator Warren backs, is that it
doesn’t trust the American people. I trust you to choose what
makes the most sense for you. Not my way or the highway. One country found a way to
provide universal health care coverage while maintaining a competitive insurance
market that offers citizens more choices: Germany. Here’s
how they did it. In 2017, U.S. health care spending came
to around $10,200 U.S. dollars per capita in Germany. It was a little under $6,000. Overall, Germany spent about 11.2 percent of its GDP on
health care, while the U.S. spent 17.1 percent. Germany manages to cover
100 percent of its population. In the United States, about 8.8 percent of the
population remains uninsured. That comes to about 28 million
people with even more people underinsured. Despite spending less, Germany
has better or comparable health outcomes to
the United States. Studies show that in Germany, there
were fewer deaths that could have been prevented with proper
access to care. In 2013, there were 83 avoidable
deaths out of every 100,000 people in Germany, while the
United States had 112. Life expectancy in Germany is 2.5 years higher than the United States,
and the infant mortality rate is lower in Germany, with 3.3 deaths per 1,000 live births
as opposed to 5.8 deaths in the United States. Additionally, the maternal mortality rate
in the United States is more than 2 times
higher than in Germany. So how does Germany manage to
have better health outcomes while spending nearly half as much
as the United States? Germany is a system that would
look familiar to Americans in that everybody buys health insurance from a
private company and then the doctors and the hospitals and the
labs are almost all private. That’s T.R. Reid, author of the
book “The Healing of America.” He traveled the world exploring different
health care systems and how well they worked. But it works better in
Germany for a couple reasons. One is everybody is covered. Everybody is required
to have insurance. Everybody’s in the system. The insurance companies can’t turn you
down because you had cancer last year or something, they
have to take you. They have to cover you. Everybody has access to the same
treatment and all the doctors. You can go to any doctor without
any limits set by the insurance company. In Germany, health insurance is
mandatory for all citizens and permanent residents. There are two different systems that
residents can turn to for insurance. SHI, which stands for
statutory health insurance and PHI or private health insurance. German citizens are eligible for PHI if
they make more than a roughly 60,000 U.S. dollars per year or if
they are self-employed . Citizens making under that threshold
must pay into S.H.I. S.H.I is made up of a network
of competing, not for profit private health insurance funds known
as sickness funds. In S.H.I., dependents are covered free
of charge and monthly costs are capped around 840
euro per month. Even though S.H.I sickness funds
are not government agencies, many Germans think of them as part of
a public system because of heavy regulation. Keith Tanner helps expats
navigate the German health care system and he considers SHI
sickness funds quasi -public organizations. Basically, they have to
do what they’re told. They they are told by the government
in what range they can charge. They they’re told what health procedures
they can fund and they are told by the government who they
can accept as clients so they’re really just carrying out orders. They’re basically charities. They don’t exist to make a
profit for investors like American health insurance companies. They’re there
to keep people healthy. That’s what they’re there for. They follow all sorts of
rules that American insurance companies wouldn’t dream of. This system is funded through
compulsory contributions based on a percentage of citizens’ salaries with
employers sharing the costs. There are also built
in safety nets. The government will pay into S.H.I. on behalf of the
long term unemployed. Despite being non-profit organizations,
sickness funds compete for customers by offering specific
coverage and perks. This competition has changed over the
years as the system has allowed citizens more choice. As of 2019, there are about
100 statutory health insurance companies, but there used to be many more. When Germany’s system was first
established in the late 1800s, sickness funds were linked
to a person’s profession. It used to be that people were
assigned to a specific sickness fund based on their
occupation or region. Now Germans can choose where they enroll
and they can change funds on a yearly basis. As a result, sickness funds begin
marketing themselves in order to retain customers and
attract new ones. This also led to the funds
merging so they could become more competitive. Some of the sickness funds
offer perks that might seem similar to credit card rewards. You still can get a bonus for going
to the gym and a bonus having a checkup. This is in
the public system. And if you get a certain number
of bonus points, then you get a voucher. But kind of trivial stuff like
200 euros a year or something like that. 200 euros a year. Nothing which is particularly relevant
to the person who’s paying their 840 a month. As of 2017, roughly 87 percent
of Germans receive their primary coverage through S.H.I. and 11 percent of
the population through P.H.I. The remaining population, such as
soldiers, police officers and refugees receive health insurance
through specific government programs. All individuals
insured through P.H.I. pay a risk related premium with
separate premiums for each dependent. These risk based premiums mean that
costs will increase as the insured gets older. As a
result, the government regulates P.H.I. so people don’t become overburdened
by premiums as they age. The biggest issue with private health insurance
if you opt out of a public system is affordability
in old age. If you don’t impose these financial
constraints on insurers, then the government will be lumbered about a whole
lot of old people who reach 85, 90, 95. It’s gonna be totally able to
pay for their health insurance, so it’ll all fall back
on the government. Once someone switches to P.H.I., they can not switch back to S.H.I. in the future. But Tanner says
there are ways around that. If you’re a freelancer in the private
system, you just can’t get a job paying less than the threshold. Any employee earning under about 5000
euro a month is required to have public. If they own more than
that, they can opt out. So if you are a freelancer, you
want to go back into the public system for some reason. Then you’ll get a part time job with
a friend, pays you 500 a month for a few months, and then
you react in the public system. So there are ways to do it. The
only reason you probably want to do that, though, is if you have
lots of children, because children can be covered free in the public system,
in the private system, have to pay separately for each child. Germans can also buy supplemental
private insurance while staying in S.H.I.. For example, many Germans
buy supplemental dental insurance. The public system pays like for
major dental work, about half the cost and then you get supplementary to
take it up to 80, 90 percent of the cost. Germany’s system is not perfect. With so many different insurance
companies, there’s a lot of bureaucracy that contributes
to costs. One of the financial things thinking
it’s a big system administered by more than 100 organizations is
called krankenkassen, each of those has a head office and a president
and vice president and a financial officer, a whole lot
of unnecessary bureaucracy. This may be one of the reasons that
the German system is not as cost effective as other
European countries. More than 30 percent of both
Germans and Americans felt bureaucracy was a major issue
in their country’s system. Wait times can also be an
issue for people in S.H.I. Thirty seven percent of Germans cite wait
times as one of the biggest problems within their system, while 22
percent of Americans feel the same. Generally I think people are quite
happy with the public system. It works reasonably well. The major issue in big cities
— I’m in Berlin, Munich, Düsseldorf, Hamburg. It can take quite a while
to get an appointment with a specialist. It is the case that
the doctors prefer private patients because they own up to three times
more if they see a private patient. So what can the United States
learn from the German system? Germany has managed to balance
cost controls and universal coverage while also maintaining competition. And Germans generally
like their system. In one survey, not a single German
said they had to wait more than four months for an elective surgery,
while four percent of Americans said that they had to wait that
long for the same kinds of procedures. And only 7 percent of
Germans said they experienced a barrier to care because of cost in
the past year compared to 33 percent of Americans. Those citizens really like it. They like the fact
that everybody is covered. They like the fact that
the costs are totally predictable. You know what it’s going to cost
you and how much your insurance company is going to pay you before
you walk in, unlike the United States. They think it’s normal that
the insurance company pays every claim. They can’t believe that insurance
company might deny a claim. And they think it’s normal that
they get to choose the doctor. They don’t understand America, where
the insurance company says we won’t cover a doctor Jones. You have to go
to Dr. Smith instead. So the main thing I learned in going
around the world is you have to make the commitment to provide
health care for everybody. That’s the destination. It turns out there are many
different routes to that destination. I found, you know, the Canadian
model, the French model, the British model, the German model. They all get to this goal
in different ways and different models. So I don’t care what the model is. I think it’s important that you
make the commitment to cover everybody. And this is something
the world’s richest country has never done.

100 thoughts on “How Germany’s Universal Health-Care System Works

  1. Unfortunate thing is universal care will require doctors to get paid less. Their resistance is one of the reasons the US can’t have affordable care.

  2. CNBC please make video on Which model is quite the best for America ….

    I want comparison of
    US, France , Canada and Germany Health care systems ..

  3. Americans don't want to universal healthcare or higher education because they believe it will cost them. Apparently, paying outrageous medical costs and being regulated to low-paying McJobs because you couldn't "afford" higher education doesn't cost them anything. Go figure.

  4. Healthcare's main goal should not be profit first, treatment and cure secondary. Why do I need a second Dr appointment and pay for said appointment to get test results? Simple so they can make more money. I've been with health insurance most of my adult life because I can't afford it. Even with insurance I can't afford to see the Dr. What's the point then?

  5. We keep changing what doesn't work and get something else that doesn't work, STOP changing and start fixing what we have, fix pharmaceutical the pharmaceutical companies need to desperately to be regulated and on top of that if go to Medicare for all taxes go up to trillions of dollars not millions not billions but trillions. Then we have infrastructure our roads bridges tunnels need to be either fix repaired or in most cases replaced another trillion (s) of dollars taxes go up the next thing we will see is that we become tax poor when will it stop. The ass we have promised to replace our broken bridges tunnel roads, he also promised to fix medical and he promised to reduce taxes for the middle class he didn't but he managed to reduce taxes for the wealthy will increasing the deficit by trillions. So all you Trump supporters take your heads out of the sand or keep them right there in the sand will it passes you by then you can ask wtf happened when it will be to late.

  6. If some of you did not get T-O-N coin from T-e-l-e-g-r-a-m yet, I advise take time by the forelock because this is the only reliable project this year which will give X – es!

  7. I still don't like the idea of being forced into paying for something. It's inherently a trash idea. Private healthcare CAN work well, it just needs people who put people before profit. Mutual Health Insurance is one effective example of this. They're non-profit and all decisions are made by the policyholders, not shareholders. Without any of the socialist garbage.

  8. Health isn't all about Healthcare. The other thing is Germans like being outdoors and will walk for miles in a day. So that is partially why all those health stats in the beginning are higher.

  9. Why is the solution always having the government step in and help subsidize health insurance? Why do we believe regulating the money we give to the middle-man will be the solution? The middle-man's entire business plan is to take your money and give less of it to the doctors… If we truly want the government to intervene wouldnt it make the more sense to take action on the actual payments going to doctors? Why do doctors charge my insurance a different rate than yours? Answer: because they can. Insurance companies are definitely scum but they arent the ones setting the price at the doctors office, hospital, pharmacy, ect… Let that sink in.

  10. all medicare for all does is give government control over what you get covered for, but somehow has to pay for healthcare for everyone having extremely permanent high taxes, even the low income earners, what that does in order to keep tax rates lower, is give everyone poverty level health coverage, medicare for all would either bankrupt americans or it would bankrupt government

  11. I think the next video should be.. why America let big evil mega corporations, (owned by the elites and the rich, mainly Jews mind you, e.g. Disney), run America?
    America is the only country where the rich.. not just don't care about the poor, but LOVE to exploit them and push them to the brink of death.. squeezing every penny and life out of them..

  12. This is a lot worse than I thought it was. I’ve known German friends to complain about a $10 payment for meds as being too expensive, so I assumed healthcare in Germany was free. Healthcare is a human right. It should not cost anyone a penny, nor should they have to “work” to be entitled to it.

  13. Yes, I want the choice to be ripped off by a mafia-like company and not get the doctors I want.
    That's the choice I want.

    EDIT: not talking about the German system. Talking about American centrist system.

  14. Some European Countries have even better functioning health care systems than Germany – I suppose Germany was taken as an example because it is the largest European country by population

  15. Fist to compare the US to Germany we need to compare economy and culture. Economically the US might be able to sustain the health system for all but would need to sacrifice many other options that depends on many life. Culturally is where the US is not ready and the government will harm the country if forcing a policy that looks like helps the many they don't mention how it will harm them at the end if the gov. don't have a plan for all the jobs created in the medical system. Or if keeping them in the same salaries taxes will increase because business is business and will always look for ways to charge more in a monopoly system.

  16. Oh stop it America you can NEVER have a functional health care like any successful country like Germany. Your values are self centered and segregation.

  17. americans have the most toxic and disgusting mentality. money is their god and profit is only way anything is possible. i have met ppl there who have been bankrupted due to health reasons but still defend their "freedom" based systems. same with education. the problem lies with republicans who are wholly bought by corporations and too pro business

  18. I live in Sweden and we have a pretty terrible Health-care system. The mass media in the U.S. that is glamorizing these socialized medicare are exaggerating and they are never speaking to the real people who live in these countries. Or cherry pick opinions. I've been to the hospital many times. The only way you'll get a proper health care is if you are bleeding out on the spot.

  19. Is free for some people if you are not working but if you are working you will pay part of it and your employee will pay part of it and if you are a self employee you will pay for private insurance yourself like I make €2,370 last month and I paid €190 for my health insurance, my insurance covered me my wife and my two kids if I made less than this I will still pay less every month and pay more if I made more

  20. I DON’T TRUST THE AMERICAN GOVERNMENT WITH ANYTHING! If you’re smart, you won’t, too.

    Obama and Democrats created this mess by pricing many people out of private insurance plans with all the crazy mandates.

    We need LESS government, not more. Government is not your friend!

  21. As long as any form of private insurance is allowed, there is going to be a lot of bureaucratic waste in the system. Germany's implementation is imperfect. I want an American NHS instead

  22. This is one of the worst propaganda videos I have ever seen. If Germany had a great system, then why are they not producing the greatest innovation? Why are they not producing doctors in excess that live in other countries. Good Lord, Leftists are stupid.

  23. Let the President have it as he has planned, i.e, open market and companies and doctors who compete… and everything will be all right. But – no, you prefer to envy European countries that are taxed for 60% of their salary.

  24. I had insurance once and the urgent care center didn't accept my insurance and I have to pay $4k out of pocket for a minor surgery

  25. She doesn't mention that if you pay out of pocket for even emergency room care in Germany it will cost you less than your monthly premium in USA. They control costs.

  26. Why include mayor Pete and that Amy lady at the beginning of the video… So misleading and deceptive trying to suggest they have any intention of improving the healthcare system or that they would provide anything close the thd quality of care found in Germany. They both come across as total lapdogs of big business.

  27. Truth about private health insurance – The TRUTH will NEVER be told by our government or corporate America, because they hide it. When private health ins. pays a claim, they write it off as a business loss and the tax payer is flipping the bill. This type of system is bound to fail at some point. It's a total sham!!

  28. Admit it Americans, you love being screwed by insurance companies, because is better to go bankrupt than considering a "commie" health plan right?

  29. As a German I have to say the German healthcare system is not nearly as good as orchestrated here. In fact, there is a huge brain drain of professionals. Doctors and nurses are leaving the country to go to Switzerland or the Nordics because payment and working conditions are much more favorable there. This leads to more and more regions being chronically underserved. Patients oftentimes have to wait several months to get access to critical treatment and sometimes have to travel huge distances.
    I’m pretty sure the American healthcare system is not in great shape, but please don’t take Germany as a role model.
    You should rather take look at countries like Switzerland, where access, quality of healthcare and outcomes are much better compared to Germany and the US, basically everyone has insurance and it is cheaper, at least compared to the US.

  30. In Germany, people see the doctors for a physical more than once a year. In USA, people file for bankruptcy for medical debt which has never been done in all of Europe.

  31. insurance companies ought be non profit. like they were meant to be when started by the churches to take care of the clergyman and their families.

  32. The opening statement by Klobuchar is very misleading. The bill states that private firms can't insure the things that medicare would already cover. But private insurance will still be able to cover any procedures not provided under medicare.

  33. The US literally has caravans of people going OUT of the country in order to get medicine.
    Healthcare, prisons… Something things should absolutely not be privatized.

  34. Snowflakes I’m too lazy and i want expensive toys so we need socialism so y’all can pay for me to stay healthy and housed! Also in Germany there is a huge margin of people who hate socialism there because of all the refugees that swarm there that don’t pay taxes but take advantage of all the benefits of a citizen. Socialism will fail there in 10 years or maybe lower

  35. Germans pay into the insurance so it's not a free service. In the US, Immigrants come in and get free service which is messing up our system. Even the American German elderly can't just go back to Germany get health insurance if they didn't put the monies into the system.

  36. Of course I grew up in the Canadian model and would be nervous about changing it, but those German numbers look great. In terms of health outcomes they do much better than us.

  37. Thanks to Der eiserner Kanzler (Iron Chancellor) OTTO VON BISMARCK ! Yes, not through long, painful, and useless debate in a crowded parliament full of primordialists but with Iron and Blood an impactful decision can be made. What Germany's social security has now is nonetheless a brainchild of Bismarck among his other brilliant ideas and strategies.

  38. It's not just the American healthcare system that is "behind" the rest of the world it's education too, and for no good reason at all.
    About the history:
    "The first move towards a national health insurance system was launched in Germany in 1883, with the Sickness Insurance Law. Industrial employers were mandated to provide injury and illness insurance for their low-wage workers, and the system was funded and administered by employees and employers through "sick funds", which were drawn from deductions in workers' wages and from employers' contributions. Other countries soon began to follow suit."

  39. You get all the basics covered. GP, ER, etc. But there’s loads of things that aren’t covered. Most medication needs to be paid for by yourself (again, unless you’re in the ER or hospital in general)

  40. It's not all glittery over here though. Our health care is underfunded and we have a dire lack of doctors and nurses, especially in pediatrics.

  41. US has a lot of problem..they r nowhere near perfect…I am Indian and is going to chose Germany over USA anytime because it's a lot better

  42. 4:15 “they’re basically charities”
    No, absolutely not. They make profits. They want to make profits. Otherwise the bosses wouldn’t get their bonuses 😉

  43. I understand the u.s. needs better health care, but theres no way I'd trust any of those morons on the dem debate stage with implementing it.

  44. Don't you have to wait like 6 months to see a doctor because there aren't enough doctors in Germany? It's like Canada, the healthcare is cheaper, yet there are very long lines and not enough competent doctors.

  45. Life expectancy in the US is less because we have minorities , Germany is virtually 99% white, why don’t they talk about that?

  46. Forgot to mention that the US pays for their defence. Also, Germany has a population of 83 million and no immigration problem. The US has 330 million and a big immigration problem. Can we get some real journalist? If anything that's the real problem in America

  47. It does not matter, these big corporations and lobbyist will find a way to stop universal healthcare for all. Welcome to America, where nothing gets done we just complain about it.

  48. maybe someday we will get to sanity like these decent european countries putting us to shame on most healthcare metrics… at least the health metrics that MOST impact BROAD population / societal health / societal cohesion & the deleterious economic effects of substandard population healthcare. just obvious facts for anyone who objectively researches.

  49. Germany has a total of 3 fat people. Long term diet related chronic disease care doesn't make sense in the USA because everyone in the USA is sick. FIX THE FOOD, healthcare cost will crash

  50. awesome job, CNBC, you guys have been doing a bang-up job…high-quality productionss! i thumb-up almost all of your videos, very well-deserved!!

  51. The health care system is the only system I know of that charges you more for the same service if you don't have insurance. I.E. If I wreck my car and go get a repair estimate they will tell me $1000 for the repair and I tell the repair guy no I'm fixing my car out of pocket not thru insurance they will say ok $ 700 for you.
    Health care works the opposite, an xray costs $50 if you have insurance and $500 if you don't. I had a kidney stone and the surgery to remove that was $20,000 and when I got the final bill my insurance only paid $3000 because if their lower insurance rate price. Things cost what they cost this price gouging needs to be illegal!!!
    Germans also pay over 50% of their pay in taxes, you can't have one without the other!

  52. 1:35 second from the bottom
    In case you wanted to know:
    The swedish healthcare system sucks ****.
    It’s better than paying $3000 for an emergency room visit like I did in America, but good luck getting ANY sort of care in less than 1 year wait. It is literally a joke.

  53. Outrageous that this video does not emphasize the number of Americans who are under-insured. I have a $5,000 deductible and spend hundreds of dollars per month while receiving no medical

  54. In the US, private companies have substantial control over the government, they influence everything from college tuition, to insurance, to military conflict abroad.

  55. don't know why everyone in the medical environment in Germany is wearing a $2 stethoscope like it's a fashion accessory

  56. OMG I currently pay 110 dollars a month through my employer for health, dental and vision with no deductible and 20 bucks co pay. Germans pay an average of 600 USD(50% less if you are employed) for health insurance a month. How is this better? Plus specialists make 90k in German but in the US they make 300k. Please keep comparing. Health insurance is mandatory in Germany, what happens if you don't pay? You are not insured and can't receive medical care, unless for life threatening situations. How is that universal healthcare?

  57. I’m so glad I work in the hospital. But still I’m confused about this health care insurance. This issue is not perfect.

  58. Can you also do a research of Turkey's healthcare system? Even though it's not a first world country, as far as I know they're pretty good at healthcare and have Turkey is one of the top spots for healthcare tourism.

  59. I'm from Germany and I got a little bit annoyed that while at the dentist the premium tooth repair would cost me 70€ and I took the basic repair that was 100% covered.

    Meanwhile in the USA…

  60. Who has no Telegraam t o k e ns in their investment portfolio, will not earn a lot of money this year) I advise to buy them, while the geing is good

  61. Yet America #1 in leading for medicine innovation. But somehow these countries are better in health out comes, um yeah right.

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