Gesundheit! Here's to America's health?

Would the German model of healthcare work for America?

Under German law, every citizen must be insured and has a choice of public and private options, including more than 250 gestzliche Krankenkassen (state sickness funds) that are heavily regulated. The government determines healthcare standards and sets premiums based on risk, such as age and health status. Although the government collects premiums through taxes and pays each citizen's chosen health care provider, it stays out of the business of managing the day-to-day delivery of health care services.

Monthly costs in the German system amount to about 15 percent of the citizen's income, split by employee and employer. Spouses and children earn automatic coverage as soon as a wage-earner pays into the system. German children are never without health care because its covered by general tax revenue. The public option is for Germans earning up to $66,000 a year. Those who earn more can buy private insurance, but only 20 percent of the choose to do so.

How does it work? It depends whom you ask. No one is turned down for care. And the quality is considered world-class in major cities.

German citizens grumble about rising copayments and the quality of non-medical services and a reduction of preventive care.

Physicians grumble about being underpaid and overworked. In 2006, they took to the streets in protest. Until recent reforms that repealed the required prescribing of generics, they also felt over-regulated.

Citizens and physicians alike sometimes feel like they pawns in an epic battle about cost between the government and insurance companies.

No health system is perfect. But a competitive system with some centralized regulation and a public option that covers everyone could be a step forward, if Americans can agree on it.

The best thing, I believe, about the German system is full coverage for all children. This is a source of shame for America. Upcoming generations need a good start. Their future and the future of our country depend on it.

— Tom DeSanto

Image:clker.com