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by thomascarney 1199 days ago
In Germany, my wife and I pay together about ~2,000 USD per month for public health insurance. It's not cheap!
3 comments

Nor is it universal: I can count at least one extended family member who is not insured and is one accident away from bankruptcy - not unlike some people in the US - except that personal bankruptcy is exceedingly difficult process in their EU country, and it would be quite doable (if not straightforward) to go to prison for the debt.
Which is about what a good family plan on the exchanges would be in the US.
Not good. Basically bankruptcy insurance, you pay for all your typical health expenses outside disaster. I don't know what Germany offers for that price, but given the overall lower cost of healthcare, presumably it actually covers your healthcare.
It's fairly good coverage without frills (i.e. you get a shared room in the hospital). Doctors tend to de-prioritize public insurance when giving appointments, because they earn less from them, particularly for elective or non-urgent issues, so you usually have to wait a bit longer than privately insured patients.

On the other hand, the insurance costs ~15% of income with a cap, so it has an element of solidarity to it - if you earn less, you pay less, and children and non-working spouse get covered without extra cost.

It's not public insurance though. It's private insurance companies on a given state's exchange which may be pretty similar to what you have through an employer. The big thing with Obamacare is that you can now get private insurance even with pre-conditions. I'm not going to especially defend health insurance in the US but the idea that you can only get it through an employer is just not true.

There's also Medicaid if you're poor of course.

If you pay $2000 per month combined (which btw includes all children up to the age of 18 and all children not in full employment up to the age of 25) you're paying the maximum rate.

Your public health insurance rate in Germany is based on your annual income up to €59,850 (i.e. you pay the same whether you make €59,850 per year or €200,000 per year). At the maximum rate, you usually pay €807.99 per month for health insurance (including the average extra fee of 1.6%, which varies slightly by insurer) if you're a salaried employee.

In addition to the public health insurance you also pay for public nursing care insurance, the rate of which depends on whether you have children or not and are older than 23. Assuming both of you are self-employed, have no children, are older than 23 and have not opted out of public sick pay (which for employed people giving birth includes a combined 14 weeks of pre and post-natal leave known as "maternity protection", or a combined 18 weeks for early births or twins) and assuming the same average of 1.6% for the extra fee, you indeed pay €977.50 or just above $1000 per month each.

For the record, if you're self-employed, the absolute minimum you have to pay for public health insurance is €158.43 (without sick pay) plus public nursing care insurance plus the variable extra fee. This basically assumes your income is at least €1131.67 in any given month even if you make less than that: you can't pay less than that as long as you're self-employed unless you switch to a private insurer instead.

Another issue for self-employed people is that because your insurance rate is paid by you in full (unlike salaried employees where 50% of it is paid by your employer and your rate is adjusted automatically if your salary changes in either direction) your rate is much less dynamic and will often have to be adjusted retroactively. Public health insurers are legally only allowed to adjust your insurance rate based on your tax returns which means even if you magically manage to file your taxes in January of the following year and the tax agency immediately processes it, you may end up having to backpay (or be refunded) the difference for an entire year if your rate changes. If you are self-employed and not incorporated, you can file quarterly tax advances and the insurers are allowed to use these to temporarily adjust your rate until the final tax return is available but once you incorporate you're stuck in the worst of both worlds.

As this hopefully illustrates, there are many problems with how the public health insurance system works, especially for self-employed people and founders (and especially people who can get pregnant as it's not common knowledge that "sick pay" includes "maternity protection" and self-employed people often opt out of sick pay because it's an easy way to cut costs), but pretending our public health insurance is "not cheap" is a bit dishonest.

To reiterate for emphasis: if you pay a combined 2000 USD together per month that means the two of you each make at least 60k USD per year and you will not pay a single cent more for health insurance no matter how much more money you make. Arguably this ceiling is the main problem and if it were abolished, the rates could be considerably lowered for everyone else. The insurance rate is very painful if you're self-employed and make less than 60k EUR per year. It becomes increasingly less painful the more you make beyond that and that doesn't seem very fair.

I'm not sure what is dishonest about what I said.

My point is that the German system is not a magical system of free healthcare. Rather, it's financially backed by charging a considerable chunk of earnings.

As a side note, the idea that the employer pays 50% of the contribution is a political slight of hand - an employee's labor covers 100% of the health insurance payment.