In the land of unlimited possibilities, some things are handled differently than in this country. In addition to miles and feet, the health care system in the USA also works with different standards.
You can find out what parallels there are to the German health care system and where the respective countries can learn from each other in this article. Read on and be well prepared when it comes to the USA!
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How does the health care system work in the U.S.?
There is no uniformly regulated health care system in the US. There are a large number of private and public providers of health insurance and the regulations regarding insurance are subject to constant change.
As in other aspects, freedom is a great asset and everyone can decide for themselves whether they want to insure themselves or not. This was the case at least until 2010. After that, a law was passed, which provided new food for thought and heralded a different era.
In 2019, around 92% of the population had health insurance. Two-thirds of these were private health insurance companies and one-third state-owned. The most common was health insurance through the employer.
Obamacare – Does it still exist?
Under Obama, the Patient Protection and Affordable Care Act (PPACA) was created, often referred to as Obamacare. The declared goal was to make preventive health care accessible to a broader spectrum of the population.
This resulted, for example, in the obligation for insurance companies to use 80% of the contributions for the health
of the insured.² The other 20% may be used for administration, marketing, etc. ³ In addition, the “Individual Mandate” was introduced. This ensured that most of America’s residents were required to provide their own health insurance. Likewise, companies were encouraged to provide insurance for their employees.
This broad participation was the cornerstone of Obamacare because it ensured that sufficient financial resources were available for medical care.⁴ If there was no insurance, a penalty had to be paid.
The “Individual Mandate” has been overturned at the federal level and since 2019 almost every citizen can again decide independently whether he wants to insure himself or not.⁵ However, there are currently some states that have introduced the “Individual Mandate” at the state level. This is:
- New Jersey
- The District of Columbia
- Rhode Island
So it can be said that some aspects of Obamacare are no longer preserved, but others continue to apply or are being realized to a different extent.
There are two government insurance programs in the U.S. health care system, but they can only be used by a small portion of the population. They’re called Medicare and Medicaid. If you want to know more about private health insurance, then have a look at our other article.
Medicare is an insurance program for people over 65 or young disabled people as well as dialysis patients. It is available throughout Germany. Insured persons pay low monthly contributions for treatments outside of hospitals and have a deductible for treatments in the hospital.⁷
The deductible for hospital treatment is 1484 USD per benefit period. A benefit period begins when you are hospitalized and ends when you have not received any benefits in a hospital for 60 days.⁸
Medicaid, in turn, is organized at the state and regional level under the guidance of federal regulations and is a support program. It is available to low-income people of all ages. The exact design varies from state to state, but usually, patients pay nothing for treatments.⁹
It’s no secret that medical care in the U.S. is expensive. In fact, it is so expensive that Americans spend the most on health care in any developed world. In 2016, it was 9982 USD, which was about 25% more than second place, the Swiss, with 7979 USD.¹⁰
Why is that? The high-cost apparatus is multifaceted. One reason is the profit-oriented insurance market, in which there is no basic insurance cover at the public level. Health care is seen as a privilege, not a right.
The famous scenes from films in which the insured person is told that treatment does not fall under the insurance rate are unfortunately true. A 2017 study showed that 34.2% of all costs to the health care system are caused
by administrative costs.¹¹ In comparison, it is only 1.1 to 7% in-state Medicare.¹² Less search for “gaps” and a more efficient system is the reason. While at Medicare everything is managed from a single source, in the private system there are several service providers, from invoicing to hospital operators to doctors, who all act as a cog in the health apparatus.
Here is a table with average treatment costs in the USA¹³⁺¹⁴⁺¹⁵⁺¹⁶⁺¹⁷. In the USA, only pure surgery is meant and any hospital costs and other things are added together, in Germany, they are included:
|United States||Germany (Berlin)|
|Knee surgery with prosthesis||$35,000||14,338 USD|
|Bypass surgery||$123,000||25,335 USD|
|Eye surgery (cornea)||$17,500||6396 USD|
|3-day hospitalization||$30,000||no data|
|Leukemia treatment||$156,000||50,524 USD|
Another aspect is the lack of competition and regulation. In terms of competition, in many states there are usually only one or two companies that offer insurance or medical services. Due to the lack of competition, there is also no price war and prices are set by themselves.
On the other hand, the U.S. government does not regulate prices for insurance, medical services, or drugs. As a result, providers can charge private companies high costs. And if it doesn’t pay one company, it pays another.
If, on the other hand, there is no large number of negotiating partners, the costs do not rise immeasurably. For example, a study showed that private insurance companies paid two and a half times as much for the same benefit
in the same institution as Medicare would have.¹⁸ The US system could thus benefit from government regulation with a basic service.
Some figures are very meaningful when you compare one health care system with another. These include not only average treatment costs but also life expectancy or infant mortality. Below is a comparison of the figures for the German and American health care system.¹⁹⁺²⁰⁺²¹⁺²²⁺²³
|The average cost of health care per person||10.586 USD||5986 USD|
|Infant mortality rate under 5-year-olds, deaths per 1000 live births||7||4|
|Life expectancy (newborns)||78.8 years||81.1 years|
|Preventable deaths according to WHO||0,0175 %||0,012 %|
|The death rate, deaths per 1000 inhabitants||9||12|
The US is a large economy. Almost four times as many inhabitants as Germany and that in an area more than 25 times as large. These things must be borne in mind when reading the figures for such statistics.
It is, of course, important to have an efficient and effective system. The number of preventable deaths is a good indication of how effectively a system works. These deaths include many cancer deaths, heart attacks, but also suicides and car accidents.
Another option is to look at treatable deaths. Germany then stands at 66 per 100,000, the USA at 88 per 100,000 people. The OECD average of 36 countries is in the middle at 75 per 100,000. Switzerland shows that it can be done quite differently with a very effective system, in that the treatable deaths are only 40 per 100,000.
In short, the US health care system lags behind European standards in many respects. In particular, which corresponds to the efficient use of financial resources, but also to the effectiveness of the treatments.
The U.S. is known for offering treatments to a standard that is not available in other countries. Special medical devices or medicines ensure active medical tourism. But what is the truth of this image?
If you take a look at studies, they reflect what also corresponds to the previous consensus of the article: The costs in the health care system are high, but the benefits are rather mediocre.²⁴ Problem is that there is no uniform (treatment) standard.
While in Germany, when visiting a family doctor, it may only be bugged and a conversation is conducted, in the USA a CT is prescribed more quickly. Of course, more can be seen, but is it always
appropriate?²⁵ Nevertheless, the USA is the country in which medical knowledge, machines, etc. are state-of-the-art in many areas. In an international comparison, they are in 4th place in the index of innovations in the health sector. Even far behind in first place in terms of science and technology.
In the overall rating, they are beaten only by the Netherlands, Germany, and Switzerland.²⁶
As with all things in life, there are always two sides to the coin. The health care system in the USA is not uniform like the German one and suffers from high costs. At the same time, however, it also offers technology and treatment methods like no other country. A brief overview should shed light on the most important advantages and disadvantages.
Benefits of the U.S. Health Care System
- high technological and scientific progress in treatments
- free decision on health insurance
- good access to new treatment methods
- diverse selection of tariffs
Disadvantages of the American health care system
- high costs, for insurance companies and insured persons
- no uniform standards for prices
- no universal state health insurance
- very fragmented system with long processing times
Many clichés about the American health care system, such as technological progress or high costs, are true, willy-nilly. The fact is, health insurance in the USA can save financial worries like no other country.