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News of the Day ... In Perspective


National health insurance in trouble in Europe; doctors fleeing Germany

Germany is the pioneer for state-funded medicine, dating back to the time of Bismarck. The damage to German medicine may be irreparable.

Once established, a national health-care bureaucracy may be impossible to dismantle. Reforms adopted in October, intended to fight exploding costs and red tape, simply added a complex new scheme with a new layer of bureaucracy and a 0.5% hike in the payroll tax.

“Free” medical care in Germany costs workers 14.2% of their paycheck. Since the 1970s, payroll taxes have doubled. Unemployment stands at 10.2%.

The sickness funds, which cover 9 in 10 Germans (the other 10% earns enough to be permitted to opt out and buy private insurance) are quasi-state-run bureaucracies. They are free from competitive pressures and €4 billion in debt.

German doctors work grueling hours and earn less than one-fourth as much as American doctors. The $56,000 salary for a 60-hour work week translates into wages that a cleaning woman wouldn’t accept (“Bismarck’s Baby,” Wall Street Journal 12/5/06).

About 2,600 German doctors are working in Britain to escape bad pay, all-encroaching bureaucracy, and rigid organization. About 2,700 have emigrated to the United States (“Sick of Bad Pay, Doctors Flee Germany,” by Udo Ludwig, Spiegel Online 2/7/06).

Germany is not the only EU country with health-care difficulties. Waiting times are common throughout the EU. In three of four countries, cancer patients face waits of more than three weeks to begin treatment. In two of three, government delays reimbursement of new medications. Half of the systems deny patients access to their medical records or to a second opinion. At least four of five Europeans are denied knowledge of medical conditions, available only to an informed elite or to those with a reading knowledge of English and good internet skills.

EU Health commissioner Markos Kyprianou is working to create an internal market that would allow patients and medical professionals to move freely within Europe (“Market Medicine,” by Johan Hjertqvist, Wall Street Journal 12/6/06).

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