PUTTLINGEN (Germany) — Near the large brownstone church, Dr. Eckart Rolshoven witnesses the long shadow of coal mines in his clinic in the small German town of Puttlingen.
Just a few miles from the Saarland’s final-operating coal shaft, the closure ended centuries of mining in this mostly rural state, which is located between the Rhine River, and the French border. The mines, like many others in America’s coal regions, left a hard legacy.
Rolshoven has many patients who suffer from chronic pain and lung disease as a result of years of underground work. Rolshoven, a charming primary care physician and 71-year-old doctor is approaching the end of his long career.
Saarland residents are more sick than anywhere else in Germany. The region is also facing economic difficulties, just like West Virginia. German politicians, business leaders, and unions have worked for decades to adapt to the slow decline of the mining industry.
This region is healthier than West Virginia in many ways. data indicates that residents of the region are less likely to be prematurely buried. They live on average four years longer than West Virginians.
Another important distinction exists between the former coal region and its Appalachian counterpart. West Virginia’s economic woes have been made worse by medical debt. This burden affects approximately 100 million Americans, but West Virginia is the most affected.
Medical debt is virtually non-existent in the Saarland. It is so rare that it is not even tracked by the Federal Government’s Statistic Office in Germany.
It is not government health care. Like the U.S., Germany has a private system of health care that relies heavily on private doctors and private insurance companies. Many Germans, like Americans, enroll in a health insurance plan through their work. They split the cost with their employers.
The U.S. has not done this for years. Germany has a strict limit on how much patients must pay out of their own pocket to go to the doctor, hospital or pharmacy.
Rolshoven is completely free for his patients when they visit him. He said that this not only boosts their health but also helps them to feel better. Rolshoven described it as maintaining social peace. He said, “It is really important not to worry about these issues.”
German business leaders, economists, and health officials say that the Saarland has been able to access affordable health care, which has helped it get back on its feet financially. This was also supported by the assurance workers could go to the doctor.
Beatrice Zeiger, managing Director of the Arbeitskammer der Saarlandes, a regional labor organization, stated that “without this, the Saarland wouldn’t be alive.” “It’s unthinkable.”
While the U.S. is experiencing rising health care costs, Germany has them.
Access to health insurance has been crucial in West Virginia as it battled the decline of its mines.
Ten years ago, leaders in the states moved to expand Medicaid through the Affordable Care Act. Last year, only 6% of state residents were without insurance, half of the rate prior to the 2010 law.
However, a growing number of West Virginians are enrolled in private health plans that have deductibles which require them to pay thousands of dollars from their own pockets before they can get coverage.
An average individual health plan that an American has to get through work comes with a more-than $1,500 deductible. This is a significant sum in West Virginia, where residents are often less well off than those from other states.
This is leading to medical debt. According to the data from the non-profit Urban Institute, 25% of West Virginians have medical bills in collections. This is almost double the national rate . The rate is almost a third in several counties.
These numbers are likely to underestimate the extent of the problem. More people have medical bills on credit cards, borrowed from their families or enrolled in installment plans with hospitals or other providers to pay their bills.
Jessica Ice, executive director at West Virginians for Affordable Health Care said that “it’s a huge issue here.” “People with medical debt can’t apply for loans to buy a home or start a business. This is preventing people from moving up the economic ladder.
There are no deductibles in German health plans (also known as sickness funds).
Patients almost always get a free visit to the doctor. Most prescription drugs have a copay of 10 euros or less. This is about $10. Patients admitted to hospital pay just 10 euros per day.
Armin Beck, regional director for the Knappschaft Bahn See said that “access to medical care has been essential.” KBS is a health insurance plan whose roots go back to the 13th Century, when miners established a mutual aid society in order to help each other in the event of injury or accident. Beck stated that this has been the foundation of our community.
“So glad we don’t have to worry”
The region’s economic woes are evident along the Saar River in Germany. Rusted steelworks and closed coal-fired power stations can be seen. Puttlingen is one of many towns that continue to live in the shadows of Berghalde — the debris left behind when coal was extracted from the rocky earth and hauled up underground.
The region faces new challenges today. Ford, which has owned a local car factory for many decades, will close the plant within a few years to allow production to move to Spain.
Rolshoven’s clinic, a small group of offices nestled in a residential area, is where most patients are able to see the financial burden that American medical bills impose on them.
Andrea Fecht (63), a diabetic, came to Rolshoven after recent tests showed a worrying rise in her sugar levels. She estimates she pays 120 euros per year or approximately $125 to fill six of her prescriptions including daily insulin.
According to a recently released report by Rand Corp., a research organization, the U.S. average insulin price is nine times higher than in Germany.
Andreas Mang is a former miner, who quit the industry twenty years ago following a series of unfortunate accidents. He would likely have to pay more for the drugs his family needs. Rolshoven stated that Mang’s wife, Mang, recently had chemotherapy that would have cost him thousands of dollars without Germany’s restrictions on medical bills.
Mang stated, “I cannot imagine what it would feel like to not have this support.”
Christine Wagner stated that she has seen the American reality. Wagner’s 18 year-old son Jonas has Down syndrome, and has had to have more than 20 operations.
Wagner shared her amazement at the amount of fundraising American parents have done to help pay their family’s medical bills in global Facebook groups. She said, “I’m so glad that we don’t need to worry about this.” “We have enough to look after Jonas.”
Affordable health care in countries where it is affordable
International surveys highlight the differences Wagner noticed between American families’ experiences and Wagner’s.
The nonprofit Commonwealth Fund conducted a recent study on health care in 11 high income countries. It found that 44% of Americans had medical bills that exceeded $1,000 in the preceding year. Only 16% of Germans reported that they had paid this much. France had rates of 10% and Great Britain had rates at 10%. Only 7% reported similar medical expenses.
Patients in the United States were twice as likely to report serious financial problems than patients from any of the other 10 countries.
Reginald D. Williams II oversees international research at The Commonwealth Fund. “Many Americans might not understand how affordable healthcare is for patients in foreign countries,” he said. “Medical Debt is a U.S. phenomenon. It doesn’t happen elsewhere.
Patients’ out-of pocket costs are limited in most wealthy countries of East Asia, West Europe and other parts of the world.
Patients in the Netherlands can enroll in private health plans like in Germany. In this country, insurance companies typically cover all medical expenses, provided that patients pay a standard, 385 euro, or approximately $400, deductible. All physician visits are covered.
There are very few hospital or doctor bills in Great Britain, which has had medical care “free at the point-of-service” for nearly 75 years.
Only 2% of Britons who had gone into debt cited medical treatment when the government asked them. Similar percentages attributed their debt to gambling and other habits.
According to , a KFF poll, 41% of Americans have medical or dental debt.
How Germany regulates doctor, hospital and drug prices
Germany’s strict restrictions on medical bills have occasionally sparked concerns about patients using the health system in excess.
However, when health plans attempted to implement a copay for doctor visits of 10 euro, it was quickly pulled back by patients and frustrated doctors who did not like having to chase after patients for their bills.
Dr. Marion Bolte, who runs the Puttlingen hospital, said that asking patients to pay more for their care is not worth it, even though it may bring in more.
Bolte, chief medical officer, stated that it is better to have 20 unnecessary visits rather than one patient being hurt because they didn’t go to the hospital because of concerns about the cost. “We don’t want patients to worry too much about money. We want them to be concerned about their health and getting better.
According to regional, Americans are less likely to die from conditions that can easily be treated by good access to medical care. This is according to the Paris-based Organization for Economic Cooperation and Development.
Germans are less likely than Americans that they needed to wait for a doctor to see them, surveys reveal.
The Saarland’s policymakers have less to worry about because of lower-cost health care, which protects workers from falling into debt. Oliver Groll, a senior representative at IHK Saarland (the regional chamber of commerce), stated that “all our predecessors had was to worry about creating jobs.” “Healthcare took care of itself.”
The Saarland began to shift away from mining jobs and shifted towards other industries like auto manufacturing. This industry has been a major employer in the region since Ford’s factory opened in 1970. It also sparked the growth of an auto parts sector. The chamber and other business leaders are working together to attract technology and pharmaceutical jobs to the region.
Mang, a former miner who lost his wife to cancer, felt that knowing that his medical bills would not drive him into debt gave him the confidence to change careers. Mang, now a nurse, said that he never had to worry about the cost of health care.
To maintain this system, Germany must do something that the U.S. has historically avoided. Like most wealthy countries, Germany regulates the prices doctors, hospitals and drugmakers are allowed to charge. In order to regulate prices, insurers work together with hospital and physician groups in a well-structured system.
American hospitals and other medical providers have for decades fought price limits, spending millions to resist government regulation.
Providers can feel more pressure from price regulation. They can’t ask for higher prices from insurance companies to boost their bottom lines like their American counterparts.
Mario Schuller, who is the administrator of the Knappschaft Hospital in Puttlingen said that hospitals should not compete for patients. He suggested that they must offer better care and customer service. He said that those who can’t compete might close.
Schuller stated that he would not charge more to patients even if he could.
He said, “If I had patients to bill and then try to collect from them, I’d have a to pay for all of that.” “We would need new staff and they would have to be paid. We would also need to pay collections companies if they were used. It’s a bargain for the devil.
Copyright 2022 Kaiser Health News. For more information, visit Kaiser Health News.
KHN (Kaiser Health News), a national newsroom, produces in-depth journalism on health issues. KHN, along with Policy Analysis and Polling are the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information to the nation on health issues.
