The Wonderful World of Health Insurance

Ah yes! The wonderful world of Health Insurance and the entire field of Medicine. What a glorious thing it is!

It is 2025 and so I will be 65 this year and with that comes the issue of Medicare. Up till now I've been playing the Health Insurance game as it is for normal folks. So, here is a little bit of 'thinking' about this very complex subject.

First, let me just say that during my years in Germany I was insured through my employer, theaters, when I was a full time employee. There are 2 systems in Germany. The Public (Öffentlice or better known as the "Kasse") and the Private Insurance for those who make enough money to get out of the Public, which offers more services at a lower price provided you don't get a 'pre-existing' condition...then all bets are off. The employer paid 1/2 and I paid 1/2 of my Public insurance policy which was automatically deducted from my paycheck each month. The going rate for public insurance is between 13% and 15% give or take. So at a salary of 4,000 a month that comes to about EU 560/month with  EU 280 taken from that 4000 each month. Now, preface that by saying if you paid 100% for public insurance at the maximum you were facing a monthly cost of about EU 800+ or EU 9,600 per year. In essence, while I was employed, I was paying EU 280 for an EU 800 policy out of my own pocket. EU 280 was picked up by the theater and the rest was by default a government subsidy of EU 2,800 per year! Now, the thing is, that all government expenses are paid for from Tax revenue, so I also paid Taxes on everything from Income to Gasoline and all of the other things that get taxed at a 19% sales tax rate. So, essentially, actually, I was paying more than face value for my health insurance...

....BUT! 

...and this is a huge BUT, this insurance actually paid for mostly everything you had in terms of medical expenses. Yes, that program IS expensive for the consumer BUT it actually pays 99% of the bills! You can depend on it. You aren't faced with a million statements or complicated billing like you are here in the states no matter what insurance you have. So, when people in the USA talk about "Free" this is what they actually mean. It means that when you get medical care you aren't then presented a massive bill that you don't understand anyway. It seems like it is "Free" because you aren't billed for each service, but it definitely isn't "FREE".

So, anyone who says "Free Insurance for ALL" is lying to you. There is no such thing. It gets paid for by somebody and everyone pays one way or the other.

The German Private insurance system is just as confusing as the American, but it also pays for stuff, you just have to pay for it first and then they 'reimburse' you...provided it gets approved, and you don't know that until after the fact....usually.

The Question about Health Insurance is "How do you make it affordable, fair, dependable, most of all 'Who pays for it?" 

So, lets look at all of the moving parts here and really looking into Medicare is a good way to sort it all out!

  • Insurance Companies
    • They are responsible for collecting money and paying out money for the entire business of healthcare. It is a huge job.
      • They are huge companies on the stock exchanges with investors who take part in their profits and losses.
      • Accounting, Legal, Management, Customer Service, employees and some I have no idea about.
  • The US Government
    • The Government pays for the insurance of all military personal, employees, elected officials, teachers, administrators, janitors, not only while they are working but also after they are done working. This includes US, State, and Local governments. All of this is paid for by Tax Revenue...or YOU!
  • Medical Providers
    • Facilities, Doctors, Nurses, Therapists, Pharmacists, etc.
    • Lab techs and costs of research for a patient.
    • etc.
  • Pharmaceutical
    • Production of Medications
    • Research for Medicine
    • The supply chain for delivery from production to wholesale to retail. Everyone takes a cut along the way, creating businesses and jobs.
  • Patients
    • Healthy People
    • Sick People
    • Old People
    • Young People
    • People who smoke, drink, abuse drugs, and take risks
    • People who don't smoke, don't drink, don't abuse drugs, and don't take risks.
    • Employed and Unemployed
    • Rich people and Poor people and everyone in between.
    • Living people.

What you see above makes it clear. The Medical Industry is an immense undertaking. I doubt there is any way to pull it altogether in such a way where everyone is happy. It just isn't going to happen.

So, how do you create a way for each individual person to be able to afford and have access to medical care that is fair to everyone else?

The truth is that everyone wants and need what they need but they want someone else to pay for it or they have so much money it doesn't matter and they can pay for their medical care 100% out of pocket. But, those are very few people.

In America, we have the freedom to choose! But, choosing requires work and this work can be very confusing. There is a lot of number crunching to be done and that is what I am doing.

For me personally, right now, I want to have an insurance which served me as well as my German insurance. I am fine with paying a reasonable price for health insurance as long as I am not asked to pay for copays, coinsurance, out of pockets galore every time I need something done. My experience with US health care is that sure, you can get an inexpensive policy, but you pay a huge deductable, towards 10K a year, plus all of the copays along the way. Right now I don't have many prescriptions so that is not yet such a big deal. But, it may be later or sooner, heaven forbid.

Having said all of that I can understand people wanting the cheapest insurance possible if they are healthy. But, it only takes one incident and you are in trouble and it doesn't even have to be your fault. I think it is wrong to expect someone else to pay for our health insurance. We should take responsibility for it and I do.

People aren't equal. Everyone has a different set of needs and these needs change over time. Everyone must have health insurance. That much is clear. It is part of the price for living.

 

Timothy Simpson