America's Unenviable Health Care Record

September 29, 2009, 5:00 pm

Health Care Abroad: Germany

NY Times

By Anne Underwood

Uwe E. Reinhardt is a professor of health economics at Princeton University and a former president of the Association of Health Services Research. He is also a member of the Institute of Medicine of the National Academy of Sciences, a board member of the Journal of the American Medical Association. His research has compared health care in the United States to that in other countries, including his native Germany. He spoke with freelance writer Anne Underwood.

Q.Is it true that the concept of health insurance originated in Germany in the 1880s?

BY THE NUMBERS Germany

• Life expectancy: 80 USA: 77.85 well behind Japan( 81.25), France (80.98) Switzerland, Sweden, Australia, Canada (all above 80), USA ranks 42nd in the world
• Infant mortality: 4 per 1,000 live births USA: 7
• Health spending as a percentage of GDP: 10 USA: 16% ( Difference: $882 Billion, more than the $80 billion needed for universal U.S. health care)
• Percentage of health spending that is private: 23
• Doctors per 10,000 people: 34 USA: 23 and 52nd in the world way behind Cuba#1 and N.Korea #28 with 33 doctors

Source: World Health Organization. U.S. statistics.

A.During the Industrial Revolution, workers who got sick didn’t earn money, so they formed what they called “friendly societies.” These were cooperatives into which workers paid monthly premiums, pooling their resources so they could continue the cash wages of workers who got sick. Those cooperatives became what are now called “sickness funds” in Germany.
Around the same time, Karl Marx and Friedrich Engels were stirring up the masses with their tracts, including “The Communist Manifesto.” To Otto von Bismarck, the so-called Iron Chancellor of Germany, it seemed that the only way to stop the growth of communism was to take the wind out of its sails by giving low-income people the things they craved — health care, education and a social safety net in general. So in 1883, he passed the Imperial Insurance Order — in German, the Reichsversicherungsverordnung, or R.V.O. — which made it mandatory that all workers up to a certain income threshold pay premiums to such sickness funds. The R.V.O. still governs German health care, although it’s had a thousand amendments in the meantime