Lecture Notes on U.S. Healthcare System Comparison with Germany

Introduction

Current Sentiment: 70% of Americans believe the U.S. healthcare system is in crisis or has major problems.
Medicare for All Discussion: Proposals include banning private insurance, affecting 149 million Americans within four years.

Personal Freedom: The speaker argues that the proposal does not trust American citizens to choose their own healthcare options.

Universal Coverage: Germany provides universal health coverage while maintaining a competitive insurance market.
Healthcare Spending:
- U.S. healthcare spending: $10,200 per capita (2017).
- Germany's spending: < $6,000 per capita.
- U.S. spends 17.1% of GDP on healthcare; Germany spends 11.2%.

Uninsured Population: 8.8% of Americans are uninsured (~28 million people).
Preventable Deaths:
- Germany: 83 avoidable deaths per 100,000 people.
- U.S.: 112 avoidable deaths per 100,000 people.
Life Expectancy: Germans live 2.5 years longer on average.
Infant Mortality Rates: Germany: 3.3 deaths/1,000 live births; U.S.: 5.8 deaths/1,000 live births.
Maternal Mortality: U.S. rates more than twice that of Germany.

Insurance Coverage:
- Mandatory health insurance for all citizens and permanent residents.
- Two types: Statutory Health Insurance (SHI) and Private Health Insurance (PHI).
Statutory Health Insurance (SHI):
- Covers those earning < $60,000/year and dependents free of charge.
- Monthly costs capped around 840 euros.
- SHI sickness funds are heavily regulated, acting like quasi-public organizations.
- Funded through compulsory contributions based on salary percentage.

Choice of Funds: Citizens can choose and switch between sickness funds annually.
Marketing and Perks: Funds compete by offering specific coverage and bonuses, e.g., gym memberships.

Eligibility: Available for those earning > $60,000/year or self-employed.
Risk-Related Premiums: Costs increase with age; regulated by government to avoid excessive burden.

Bureaucracy: Administered by over 100 organizations, which can contribute to inefficiencies.
Wait Times: 37% of Germans cite wait times as a significant issue; problematic in large cities.

Balancing Costs and Coverage: Germany achieves both universal coverage and cost control while maintaining competition.
Public Sentiment: German citizens appreciate predictable costs and universal access.
Commitment to Universal Coverage: The speaker emphasizes the need for the U.S. to commit to providing healthcare for everyone, irrespective of the model chosen.