On some occasions, Americans in Germany will be caught in the open....having some German want to challenge or interpret what they heard on German public TV. So the topic of US health insurance is on my mind.
It's a difficult topic to explain to a German because you have to lead off and say that 50 different levels exist because of fifty different states....then you add the bronze, silver, and gold levels of insurance.
Then you come to the deductible situation. For an individual (single gal), the national average (2016 numbers, from E-Health Insurance.com is $4,358. For a family, the national average deductible is $7,983.
Most Germans start to shake their head because that's only the deductible.
So you explain the subsidized business, then you get to the beef of the whole topic. For individual, the average costs around $320 a month. For the Family unit....it's near $830 a month. Again, 2016 numbers.
This means that a single guy will be paying $8,300 roughly a year. For a family, it's around $17,000.
Naturally, Germans will then ask why? This usually goes to five basic reasons (some people have a list of twenty-five reasons....but why complicate the mess).
1. Drug costs. Nothing that congress has done over the past twenty-five years....has made drug costs any cheaper.....most of the time, they've rigged the cost to escalate. Maybe lobbyists were involved....maybe it was pure stupidity.
2. Defensive postures by doctors. Because of legal insurance required for doctors....they ask for more tests, and you could be taking eight tests for a situation....where only three really make sense in the first round of things.
3. Doctors versus specialists. There is a general rate for doctors, and there is a general rate for specialists. One will drive a BMW 300-series car.....the other will drive a BMW 700-series car. The German will typically grin at this comparison.
4. Hospital staffs are made up of doctors, specialists, nurses, security guards, support personnel, and administrators. Toss in the same situation with health insurance companies. You have to pay for each in the system. This explains why a 40-cent aspirin will be $7 when you sit in the hospital.
5. Now, you come to brand-medicine. X-brand is better than Y-brand. If you got cancer.....you want X-brand. X-brand costs more. Sometimes, there's no substantial difference between X-brand and Y-brand.
The German is likely shaking his head at this point because it's the wrong way of looking at this. Then you inject the last part of this discussion. Every single year....the rate goes up. Sometimes three or four percent. Sometimes, six to ten percent. Sometimes, twenty percent. This $17,000 number for 2016 that you gave? It'll be $20,000 in less than three years. If you go to a spreadsheet and figure 2025? It'll probably hit $27,000 by that point. You could buy an awful nice car for that amount of money, or send two kids off to Auburn University for a year.
Finally you come to two integral pieces which make things difficult to project. There's the problem over accepting everyone into the same bucket regardless of past health issues. For decades, the insurance companies made this a difficult barrier....now with Obamacare....you have no choice, you must accept all applicants. But this has to inflate the previous level of cost to another plateau. The second piece is that you can opt out,, and the next year....opt in. Pay the $1,000 and just skip this situation with health insurance. Even with the subsidy business....you can't get around the deductible side, and most low-wage earners will tell you that they can't find $5,000 a year for possible doctor visits on top of the monthly premium. So company X will say this year they have 3-million people in their program....next year they find that it's 2.85-million, and the year after that it'll be 3.1-million....all because of the opt-in or opt-out situation.
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