There is no one in Germany without health insurance.
This isn’t because, as many people falsely assume, Germany has some sort of magical “universal” health insurance system that automatically covers everyone. It is because the system has been designed assuming that everyone will get in line. Which means that if you’re not in line, you’re not on the map. Which in turn means that there are almost no resources for people with low (or no) incomes without insurance. So it’s not that everyone in Germany is insured, it is that it is simply inconceivable, within the system, that you could not be.
The myth that everyone in Germany is insured probably stems from two facts. The first is that if you become unemployed, you can (read: are expected to) sign up at the Arbeitsamt (I suppose the equivalent of the Welfare Office in America). After you’ve jumped through a series of flaming hoops (and the reason some people choose not to deal with them is because they make you do the paperwork equivalent of getting stripped down and hosed off as well as requiring mind-numbing resume-writing seminars and one-euro job participation), they’ll pay you money each month and sign you up for their insurance. Even if you fuck up, and they cut your money down to nothing, they are supposed to continue to insure you. Because, haha, it’s illegal not to be insured in Germany. Which is the second fact that contributes to the myth that everyone has health insurance in this country.
So, imagine you are in Germany and you aren’t insured, for whatever reason. If you are ever caught (which might happen if you simply defaulted on a German insurance policy—be warned, they will eventually come looking for you) or attempt to sign up for a new insurance policy, you will be required to pay the premiums for every month that you were not insured. The logic is highly social—the system can only work if everybody is paying into it all the time—but the application is incredibly fucked up, particularly for the extremely poor. You don’t have enough money to pay for insurance? Take some time to get back on your feet financially, and then find out that you have gotten yourself into crippling debt with the insurance company because of it. Have qualms with the entire insurance system and want to opt out of it completely? Sorry, but no. The strange bit of logic here is that you are also supposed to pay back these premiums because you were insured the entire time. Even though you weren’t, had no insurance card, and had to pay for all of your doctor’s bills yourself. It’s sort of an enforced insurance illusion. Just thinking about it makes my head smoke.
Of course, there are a lot of positive sides to the insurance system here. Because it is illegal to be uninsured, it it also illegal for an insurance company to turn down your request for them to insure you (though I have the impression that this only applies to state insurance—the system is currently a mixture of private and state insurances which is a whole other can of worms that I’ll get into some other time) or to kick you out because it turns out you are really sick or have what they call a “pre-existing condition.” They even pay for a lot of neat things that I never would have dreamed of having covered on my American insurance policies.
But I would still rather live in a world without health insurance. I would still rather cut out all those middle men and middle women and pay my doctors directly. My current daydream is that instead of an insurance premium, everyone could pay a monthly chunk directly into the salary pool of a hospital or clinic and then be allowed to go there for free whenever the need arose.
Huge corporations have risen out of a universal fear of sickness, pain, and death and the only reason they sometimes seem to care about our health is because the healthier we are, the less money we cost them (though they like to thwart this logic as well—for example a midwife’s 250 euro fee for doing a home birth is not covered despite the fact that a home birth costs thousands of euros less than a hospital birth), and we all know what happens when you end up needing an expensive non-traditional operation to stay healthy—then you get denied coverage and are left to rot, at least in the United States. And it’s because of just such issues and cases, as well as the fact that I used to work for a publishing company whose clients were all insurance companies, that I’ve never felt like health insurance offered me all that much, well, insurance. And it is because of just such issues that I can tell you first hand that, yes, there are people in Germany without health insurance.
When people here hear that you are uninsured, their reactions tend to range from shocked to angry. People get rude. They say things like “you’d have to be stupid to not be insured these days.” The receptionists at doctor’s offices—who ask you which insurance company you are with when scheduling an appointment as part of their standard script—generally need to pause and take a deep breath before they are capable of continuing the conversation without comment. The only people, I’ve discovered, who don’t react adversely to the uninsured are doctors because the doctors know that people who don’t have insurance are people who pay their bills themselves, which at the end of the day often means more money in their pockets (there being different levels they are allowed to charge depending on state insurance or private or selbstbezahler, ie “self-payer”). Smart bunch.
Do you have a love/hate relationship with health insurance? Have a better idea? Couldn’t imagine life without it?
Tomorrow check back for more ramblings about the German health insurance system and my experiences within it.