« Not keeping promises | Main | Grand Rounds »

March 06, 2006


Felix Kasza

I grew up in Austria and worked all over Europe, including nearly six years (1992-1998) in Germany and a few more (1998-2004) in Luxembourg, right next door.

Germany does not really have an employer-based system. The employer and employee both pay an equal share of a mandatory premium; the split was made to make the numbers look better to the employee. In short, it works more like Medicare tax, only at unprecedented levels of taxation. Non-employees get the amount torn out of their unemplyment cheques.

Even this still leaves huge holes in the budgets of health insurance and social security, deficits which are covered with yet more taxes.

And you know what? The quality of care is _still_ abysmal. "Too little to live, too much to die" is what Germans say about the care provided as standard.

If you want to find arguments for a single-payer system like Germany has, you may want to look elsewhere; the German system is on the verge of breaking down because it can no longer be financed.


Martha Grant

Theoretically, your argument is sound. After all, if we get more people covered under an employer-based framework that means there's less of an incentive to change. Makes sense.

But what does this mean practically?

You talk about which is 'better': single-payer or an incremental approach. That's fine, and certainly has its place. But even as we sit here and post, thousands upon thousands of Americans are desperately ill and without insurance. In the end, this argument should be about who can save lives best. Frankly, that means we need – indeed, it is a necessity – to take an incremental approach.

A better proposal than MA’s, more feasible and cost-effective, is currently making its way through the NY legislature. It needs support . While you can read more details here, it essentially requires corporations over a hundred workers (rather than ten) to provide health insurance. Practically, this makes sense.

The facts are that we can’t get single-payer now, and I, personally, cannot justify sacrificing individuals for a theoretical cause. I'm not saying we should abandon universal healthcare; but in the meantime we should help who we can.

The comments to this entry are closed.