The German flag
This article is the tenth in a series examining health care reform in the U.S. and abroad. So far, this series has explored the history of health care in the U.S., distortions in the debate over reforms, plans proposed by republicans and democrats, the public option, and the single-payer, national health care systems in Canada, Britain, and Taiwan.
Read: A history of health care in the U.S.
Read: Distortions in the public debate on health care
Read: The Patients’ Choice Act
Read: The Affordable Health Choices Act
Read: The Public Option
Read: The Canadian health care system
Read: The British health care system
Read: The health care system of Taiwan
Due to the inherent problems with any large, governmental bureaucracy, Americans are uneasy about putting too much control over health care into the hands of the public sector. In the same vein, many are not nearly as concerned as they should be about the inherent market failures of the for-profit sector, and the problems that are created through the fragmentation and lack of uniformity in our current system.
The next several articles will focus on the mix of public/private systems utilized successfully by countries including Germany, Japan, France, and the Netherlands. The Bismarck model, named for the Prussian Chancellor Otto von Bismarck, has enjoyed positive health outcomes on a variety of measures, while providing universal coverage for citizens at a measurably lower cost than the U.S. Due to the origin of the Bismarck model we will look at the health care system in Germany first.
Germany
In 2008, health care consumption in Germany was 10.7 percent of GDP – slightly higher than in Canada. According to the CIA World Factbook, the German’s have a higher life expectancy than the U.S., as well as the U.K. and Taiwan – though they rank lower than Canada, France, Japan, and the Netherlands. However, Germany outperforms each on infant mortality – with the exception of Japan and France.
According to the Commonwealth Fund, the state health insurance (SHI) benefits package covers preventive services; inpatient and outpatient hospital care; physician services; mental health care; dental care; prescription drugs; medical aids; rehabilitation; sick leave compensation; and since 1995, long-term care.
A rather dated poll from 1999 indicated that roughly half of those polled n Germany were either very or fairly satisfied with their health care – which means about half were not. In 2003, the German health ministry concluded that their system suffered from “lack of competition; superfluous, insufficient or inappropriate care; shrinking revenue and an aging population.” Germany suffered from waiting lines, just like Canada and the U.K.
Recommended solutions to tackle these problems included “providing incentives to promote cost-effective care; perform a therapeutic benefits/cost analysis of prescription drugs by the Centre for Quality in Medicine; and finance benefits not covered by health insurance by increasing cigarette taxes.” Germany is in the process of addressing weaknesses in its health care system, but because many reforms have just gone into effect this year, it is difficult to measure their success.
As of July 2002, the average premium rate was about 14% of an employees’ non-exempt income – split roughly in half with the employer, making the combined maximum contribution about $750 per month. Those making between 400 and 800 Euros per month pay less – about 4 percent. Those earning less than £48000 per year are automatically enrolled, and their contributions cover family members – this applies to roughly 75 percent of the population.
Nearly 90 percent of the population is covered by the compulsory state health insurance program. Of the 20 percent of the population eligible to purchase private insurance, 75 percent continue to enroll voluntarily in the state health insurance plan. Even though only less than 1 percent of the population has no coverage, beginning this year health insurance will be mandatory.
There are over 200 competing insurance funds; independent, private, nonprofit, government-regulated entities.Although the sickness funds (SF’s) had traditionally been allowed to set their own premium rates, beginning in 2009, they will be required to charge a uniform contribution, or “community rate,” as the earlier Committee on the Costs of Medical Care had recommended to the U.S. in 1932. In 2002, legislation created disease management programs (DMP’s) for chronic illnesses in order to give the SF’s an incentive to care for chronically ill patients.
Although the SF’s will continue to collect contributions, they will be pooled into a new national health insurance fund – similar to that discussed under the Taiwanese model – based on a risk-adjusted, weighted capitation formula similar to that in Britain. The government will provide considerably more to funds that take on consumers with cancer, AIDS, or any other one of 80 cost-intensive conditions.
Also, starting this year, private insurers offering coverage will be required to take part in a risk-adjustment scheme to be able to offer insurance for persons with ill health who could otherwise not afford a risk-related premium. Unlike the U.K., in which private coverage is often duplicative, the private health care industry in Germany is more supplemental, and offers coverage unavailable through the SHI, such as better amenities, and some co-payments.
According to the Commonwealth Fund:
The German government delegates regulation to the self-governing corporatist bodies of both the SFs and the medical providers’ associations. The most important body is the Federal Joint Committee, created in 2004 to increase efficacy and compliance; it replaced several sectoral committees. However, more purchasing powers are also given directly to the individual SFs, e.g. to contract providers directly, to negotiate rebates with pharmaceutical companies or to procure medical aids.
Germany also took action in 2004 to improve its quality of care by requiring continuing education, and health technology assessment for drugs and procedures; though hospital accreditation remains voluntary. “Minimum volume requirements were introduced for a number of complex procedures (e.g. transplantations), thereby requiring hospitals to provide this number in order to be reimbursed.” Furthermore, transparency and accountability are encouraged through the mandatory quality reporting system for all acute care hospitals. More than 150 indicators are measured and hospitals receive feedback on their performance. Since 2007, around 30 indicators are made public annually.
While there are no gatekeepers blocking patient’s access to physicians, there are plans that incentivize consumers to be more conscientious of the care they receive by offering bonuses for restraint. Physicians in the outpatient sector are paid by a mixture of fees per time period and per medical procedure, which is different than the fee-for-service reimbursements used in the single-payers models and encourages providers to offer more care to more people. SF’s annually negotiate with the regional associations of physicians to determine aggregate payments – a mechanism used to contain costs.
According to one source, “most of the negotiating power lies with the sickness funds. Thus, the purchasing power of German physician’s wages is about 20 percent of that of physicians in the U.S. In 2005, there were physician strikes over low wage compensation. Further, physicians have to deal with significant reimbursement caps and budget restrictions.” As a result, physicians only attempt to provide the minimum care necessary.
However, another source notes that health care professionals in other OECD countries pay significantly less, if anything for their medical education.
Inpatient care is paid through a system of diagnosis-related groups (DRG) per admission, currently based on around 1,100 DRG categories. Introduced in 2004, it is revised annually to take new technologies, changes in treatment patterns, and costs into account. DRG’s ensure that hospitals are paid the same amount for the same type of patient – because they are based on average costs, hospitals are pressured to perform.
With respect to prescription drugs, SF’s are free to negotiate with pharmaceutical manufacturers and incentives are used as a means to achieve prices below the reference prices. Hospital budgets were phased out between 2005 and 2008; and beginning in 2009, the fixed budgets for ambulatory care will be replaced by more flexible budgets that take population morbidity into account.
Reform efforts in 2004 have been unpopular; patients are now required to pay a co-pay of £10 each quarter, £5-10 for prescriptions, and £10 per inpatient day. As mentioned above, it is still too early to tell if the new policies will have the desired effect of addressing problems with the German health care system. However, they are clearly taking a proactive approach to targeting and correcting problems that do not consider the possibility of dismantling their universal model.
The next article will examine how Japan mixes the private and public sectors to achieve some of the highest health care rankings in the world.
Read: The Japanese health care system
To receive notification when the next article of the series on health care reform is published, click on the “Subscribe” link below.
*If you would like to submit a health care story, with the possibility of seeing it published here, please send me an email message at jennyk1981@gmail.com.
Copyright ©2009 Jenny Kakasuleff
For more info:
Descriptions of Health Care Systems: Germany and the Netherlands
Health Care Around the World: Germany
Five Capitalist Democracies & How They Do It
Health Care Systems: The Four Basic Models
Comments
Do you understand the proposed health program? I do not, let me know what you think.
Frank: I have not analyzed the House version, but have written on the senate's, called "The Affordable Health Choices Act." There is also a separate article on the public option. Each are linked toward the top of this article.
Here is the HR3200 House bill.
thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:
Jenny, when you put in your text that some of these countries have longer life spans it is important to realize they have not had 16 million people illegally cross their borders from third world nations in addition to the million of legal immigrants from these nations which tax our health care system. Another important point to make is that we pay for Germany's defence which would cost them billions of dollars each year which they could use to not prop up their experiments. This hold true for most of Europe except maybe the British and French who have not faired to well with their entitlement experiments.
It is a lot more complicated than just trying to look at an issue through by itself as there are unique social factors facing every nation. If someone was paying for our defence we could probably have a second rate system that covers their masses just like they do-but we have to live in the real world now don't we? Ironically many of these nations are turning to the right-
Mark, there you go bringing up truth and facts and things like that. We can't have that here now can we?
"...it is important to realize they have not had 16 million people illegally cross their borders from third world nations."
Please name a source for this fact. You are again trying to argue that the U.S. is the only country where third world immigrants migrate to. That defies common sense and logic, so please provide your source.
I'm sure we're not propping up Germany's defense using 6% of our gdp - that's the diff between what the two spend on health care. Same goes for all the other countries we supply aid to.
I have thus far posted ten articles discussing the complexity of health care - so please don't antagonize the hours of research I've put into this one topic as futile. I still have yet to see you discredit any one of the multitude of sources I've linked throughout this series.
Que: I'm glad that you need nothing more than a bloggers first name to determine whether they are a legitimate source of "fact and truth," or can you provide the source for Mark's fact?
Jenny, there was a study by one of the universities out here that put that number between 12 million and 20 million- I can't recall the specific time of the study-but since you have plenty of time I would suggest you start looking into this as even if it were 5 million (that number would be a joke) this is a huge factor when it comes to healthcare.
Jenny, you don't think these nations are taking advantage of being under our defensive umbrella? Huh? If we did not exist a country like Germany would be spending 100's of billions of dollars more than they do now to keep Russia in line which is a current and historical threat-Do you think they would have to shelve some entitlements?
When it comes to immigration most of the European nations are not bordering a third world nation like Mexico (which is our buffer from the even poorer countries like Guatemala) so they can vet the people that immigrate to their countries (in Germany's case immigration from India) a little better than us.
Mark: I was not referring to a study on how many illegals we have in the country, but rather, the proof that other countries aren't dealing with the same issues.
Germany has one of the strictest immigration policies in the world, and they wouldn't if it wasn't a problem for them.
Jenny, did you actually watch the Messiah's laughable press conference on health care? If this was is best attempt then forgive me for being a little concerned.
This “vague” press conference with his putting his foot in his mouth regarding the "so called race" issue was a disaster. I do not believe Obama knows what is in the health plan.
I tried to warn everybody that Obama was in way over his head and with both Biden (with asinine statements regarding Russia which will further damage relations) and Obama further widening the racial divide by having a knee jerk reaction to a stupid question (without knowing the facts) are proving me right-so much for "Change".
At least a couple of my liberal friends out here are starting to come around and see this man for who and what he is-an unaccomplished blow hard Chicago politician and nothing more.
We are suppose to trust people who can’t fill pot holes to fix our health care?
No one can justify the fact that America spends nearly double on healthcare per person compared to other industrialized nations while having outcomes that are average or worse compared to other industrialized nations. That is one reason why the American Medical Association and the American Nurses Association supported President Obama's general principles behind reform and the House legislative effort.
Mark: Then you obviously ignored the content of his remarks, and are instead resorting to bringing up the race issue - like all conservatives have been. He spoke for over an hour, but "acted stupidly" is all the MSM is talking about.
If Obama is in over his head, who would you recommend? Yourself?
It doesn't take a genius to realize that competition isn't working in the present system to contain costs and widen access.
Informative interview of a former CIGNA executive:
"WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so."
From an interview on Bill Moyers Journal
"This hold true for most of Europe except maybe the British and French who have not faired to well with their entitlement experiments."
Measured by what and whom? Economic growth? It may shock you to know that some people don't believe that cutting off others at the knees in order to achieve a financial advantage is moral, ethical, or right.
Their finances aren't perfect - but you're sure one to point a finger at them as an American. Have you checked our financials lately?
France is faring a hell of a lot better in this recession than we are.
Your statements are frankly, kind of ignorant. People leave America to live abroad, just like people from abroad come to America.
Personally, I wouldn't mind seeing a more communitarian society that didn't believe the means always justify the ends, and that shared a little more mutual respect for each other.
Yes, Jenny there are probalby a several million people who could do a better job than what we had to choose from- Jenny is there something special about a politician that sell themselves out to special interest and reads from a teleprompter? The smartest and brightest people steer clear of politics or government work and end up producing for society and not being a parasite.
No matter if you want to define it as greed or not-The profit motive is what has propelled our quality of life and is the reason why a poor person win another country would kill to be a "poor person" here which might mean you have an apartement with a/c and a big screen.
Just remember is is the productive and innovative private citizen that has caried all of us and not some gov. lacky- I've always said 1% of the population carries the other 99% on their backs.
I believe that life should offer you an opportunity, but not a gaurantee-Cuba will give you certain basics if you have that mindset.
Mark: Can you say with a straight face that California's liberal public education system is providing an equal opportunity to their students, respective to other systems?
I live in Germany & it's important to understand just how many immigrants live here. When a person walks around Berlin, one feels as if he/she is on the streets of NYC. Part of Berlin is called "Little Istanbul" for a reason. The number of Romanians, Polish, Russians, Arabs from all over, Turkish, etc. & so forth is unbelievable... all over Germany. One also must take into account that, Germany is part of the EU, so when someone from, for instance, the UK wants to live in Germany they can. If that person cannot get a job, for whatever reason, they can very easily go on the public welfare system, including full coverage for health care. I've asked Germans from all over the nation what they think of that. They don't mind. They aren't angry. They feel like people should get enough to eat, a place to live & health care as their basic, human needs. They do not mind paying high taxes to cover it either.
The people simply have a different way of thinking than Americans.
I might also add: I think the fact that doctors have a strict ceiling on what insurance will pay plays a key role on keeping costs down, & I think this has been left out of the reporting on Germany's health system. The insurance companies will pay up to a certain amount, the private a bit more than the public, but they will not exceed the pre-set industry-wide amount. This is a two sided-coin, of course: a) costs are kept down & everyone gets healthcare; b) doctors do not have as much incentive to provide more than "the basics."
But, do not, for one minute, think that the US is the only nation in the world with legal & illegal immigration issues, language barriers in the health industry, etc. I am a US expat & I cannot afford the German insurance because I am self-employed & all people in that category pay the same regardless of their income. It's time Americans stop believing all the propaganda. We're not "the greatest." We're one of many. A truly great nation will learn from others
By the way, Mark, your condescending attitude, trying to "teach" Jenny a thing or two, is so trite since she has quite obviously read far more on the topic(s) than you have.
You're making your self look/sound like a real pompous jerk. It's one thing to have a differing opinion, but it's quite another to attempt to educate one who has researched & studied the subject(s) far deeper & more thoroughly.
It is true that Germans have a longer life-span than Americans. It could be that Germans do not have nearly the amount of stress that Americans have because they receive so much holiday time per year... & they use it! It could be that Germans do not have as much stress as we do because they do not worry that they will be out in the cold (literally) if they are unemployed.
Hrmmmm...
Better?
Worse?
How about just "different?"
Germans are getting fatter, just like we are, so who knows how long the trend will last. But what we've been doing isn't working, so WHY NOT study others' way
@ Mark you're spot on with your comments, but Jenny's pretty out there with LIEberal brainwashing, she might need a specialist.
Jenny,
HERE'S YOUR SIGN
Yes Jethro, I believe you're right dear boy. I'm making an educated guess by Ms. Jenny's email address that she was born in 1981, which would make her prime-age for LIEberal indoctrination. I mean she came along after MTV dropped real music for that Gangsta cRAP.
Yes Dr.Fraud, it's like Ballerina Commie Boy Rahm Emanuel wanting his Civil Defense Core or some commie name like that for 18-25 year olds. I would love to continue with our conversation but Granny has got vittles ready. We're having neck bones and collard greens, corn bread and sweet tea, and I haven't ate since my breakfast of a whole box of corn-flakes and a gallon of milk.
Yeah Obamao certainly seems to have an agenda there boys, I mean with his Harvard friend, and his ARIBA!! Latina woman, the commie mentor in Hawaii, Wright, Ayers, Rezko, Emanuel-Frank-Axlerod the Kosher Nostra etc. It's obvious to all that aren't hopeless libtards.
You forgot ACORN Mean Gene. A Criminal Organization OF Registered Nitwits.
Jenny, I can say with a straight face that the "liberal educators" and politicians have ruined California's education system which for most part delivers an equally bad education to all (even in the upper middle income areas people are using private schools) as the school unions and mis-management have sunk the ship despite huge spending of over 10,000.00 per child.
Betsy Ross, I agree with you if you are wanting to work 30 hrs a week and have the good life then this is not the country for you as you get for the most part what you put in. That is why an immigrant from vietnam can become a millioniare in 10 years by hard work and a person looks at his country like its paradise. Of coarse we have some people who want others to do it for them and resent people people who have more. The Paris Hilton types are the exception not the rule and most upper middle income and upper income people put in a lot of hard work and effort into getting what they have and do not want to part with it because somebody is jealous becuase they took the easy way in life.
I'm one of these people who has been making pretty good money for very hard work and when I see what I percieve to be lazy people or people who live recklessly who want me to bail them out whether it is to pay their insurance, subsidize their mortgage etc. I get a little defensive-sorry-
Betsy Ross- Just imagine if Germany were paying for their defence right now-Do you think they may have to reallocate some of their entitlment money?- I am a little familiar with this country as I have a few friends from there-even a few in my facebook- and I nearly took a job in Dortmund, Germany about two years ago so I did a little research- By the way Angela Merkel's (who has been lecturing our "Messiah" to her credit in the press about spending) election marked a turn to the right as they are very concerned with out of control spending on entitlements that they can't sustain. Whether you love entitlements or not the reality always goes back to money. Just like the liberals in California found out the hard way-You have to pay for this stuff which is administred by least productive members of society as a whole and they have finally woke up it appears.
Betsy, Don't compare the German controlled immigration with our chaotic immigration where hordes come across the border without vetting-For sure two different systems.
Sigmund: I'm too young to remember music on MTV.
Mark: So, students in California do not have an equal opportunity to an education respective to other states...by your own admission.
Looks like Ariba-Ariba Latina is in the SCOTUS, wow what a shocker there huh.
That is correct Jenny- Unfortunately the public educations system was destroyed by the left and concerned parents (even lower middle class parents) are sacrificing to put their kids in Private schools-If you are going down the road of tax credits for private schooling-Jenny you may have an friend here (since you been arguing about competition and public option in healthcare you should be on this bandwagon I would assume right?- This is the way to give a lot of children equal opportunity to attend a better school- It is safe to assume Jenny would be a fan of vouchers? or are we a little hypocritical?
The left's expensive intervention into the California educations system has driven from #1 in the late 60's to #49 last I read just above Mississippi. It will take a lot of reverse social engineering to fix the problem with education. The first step would to strongly dissuade ill educated people or under-employed people from having children in the first place (dooms them out of the wound
Trying to create opposition out of straw by labeling others as "LIEberal" only eliminates any appearance of good faith rational argumentation.
The fact is, like I've said before, nobody can justify the fact that the United States spends nearly twice as much as other industrialized nations on healthcare while having outcomes that are average or worse than them. That's not a liberal interpretation. It's a fact shown in statistics by the World Health Organization and other international health organizations such as OECD.
Competition does not work the same in education versus healthcare. People die from lack of access to healthcare and there is no such thing as education insurance.
Paul Krugman explains why free enterprise alone can't fix access to healthcare.
July 25, 2009, 5:07 pm
Why markets can’t cure healthcare
Or you can also read Kenneth Arrow's paper which is linked in his essay. Game theory economics explains pretty well why competitive interests in healthcare and health insurance do not translate to better access and cost containment.
Kenneth Arrow was awarded a National Medal of Science in 2004 by President Bush "for his contributions to research on the problem of making decisions using imperfect information and his research on bearing risk."
The Atlantic Magazine published "An Interview with Kenneth Arrow" yesterday and today on their website.
It is quite telling that the American Medical Student Association supports single payer. The American Medical Association and the American Nurses Association support HR 3200 with the public option included. They know how to practice medicine and they know what shouldn't come between them and the patients.
The status quo is rationing based on ability to pay, the unChristian way to dole out healthcare. The alternatives at the very least provide health insurance so that basic care and preventative care are covered.
One purpose of health insurance is to cover catastrophic cases: "One point was that health is a random event. It's not like buying automobiles. Whether you're sick or not is hard to predict. Some get sick and some don't." - Kenneth Arrow. Cancer incidences fall in a range of probabilities from a variety of risk factors that do not always fall within the awareness of the patients. Studies say that people who live in some rural areas might be at risk for higher incidences of cancer because of pesticide runoff but does that mean that people in rural farming areas deserve unaffordable insurance premiums? I don't think so. Everyone benefits from American farming so I think the cost of that productivity should be paid by citizens collectively while researching ways to avoid runoff.
Mark: When the system was #1, who was running it?
I know The Man, The Myth, The Legend, Ronald Reagan was leading the way for Cali. from '66-'75!! DO IT.
If you want to know what liberal/progressives have done to our public school system, or in this particular case the California school system, look no further than Jenny's previous article.
Yet again, when opposition can't win a rational argument regarding healthcare and healthcare insurance they have to throw poorly substantiated red herrings about the education system.
The American Medical Association, the American Nurses Association, and the American Medical Students Association support reform of the healthcare insurance system. Red herrings don't change that fact.
The differences between the US & Germany are clear. To name just a few:
1) Culture. The people simply think & believe differently than we do.
2) Size/population. Germany is just a bit larger than NM & its population is dropping, just around 82mil now.
3) Education. Germany has far better education. Most Germans know more about US history, government, geography, etc. than most Americans. They know far more about world history & geography, economics, philosophy, science, mathematics, etc. than most Americans. Their universities cost between 250Euro -500Euro per semester... yes, even their top uni's that put out their top engineers, doctors, scholars, etc.
4) Health insurance. It's mandatory in Germany. If a foreigner can't afford it, you can't live in Germany. Germany isn't willing to pay for some foreigner's catastrophic illness or accident. The citizens are all covered one way or another; privately or on a government plan (which also costs the insured).
5) Crime is incredibly low.
Failures: I suppose it's the same education you got, since the liberal elite run all of the university's today, eh?
I might add that the tax structure is not so very different from ours. Americans tend to think that it's far higher, but I really do not see such a huge difference. They just tend to get more for their money in most cases.
I do not understand why the comment about Germany not paying for their own defense. They have a military.. it's mandatory to either do military or civil service for young men. The US has very few military personnel left in Germany. Because it is a free & sovereign nation, I don't believe anyone gives money to Germany for its defense budget.
The point is, that there are a hell of a lot of health care systems out there to study, some work better than others. But ours simply does not work. We have excellent medicine, but it's not affordable to many of us. Germans live longer, don't wait to see doctors, don't worry about losing their homes due to medical payments & are, in general, more healthy (their coverages all stress preventative care first).
Why are Americans so loathe to learn from anyone else? Perhaps because we're slapped on the ass at birth & told "Congratulations for being born into the greatest country in the world!" and it's enforced throughout our entire lives? Most Americans have never been anywhere outside the US to compare.. nor to view their nation from the outside. What do we gain by believing we are the "greatest?" Isn't that what caused Germany's downfall in the 40's?
And what's with all the racist name-calling? Is it to prove the point that American education has truly failed? Our thinking is no further along than in 1909?
Being powerful means having the ability to embolden others. Shouldn't we be emboldening our own? Why can't we take care of our children, elderly, poor? Why can't we learn from those that've been nations longer than we have? This is not to say we mimic, but we might consider taking the best & leaving the rest.. create our own system from the best of what's already out there.
Why not?
There are a lot of selfish people who cheat others out of their wealth then act like all the wealth was theirs legitimately.
Take the tobacco industry for example which for years said nicotine wasn't addictive while they were studying how to use nicotine to make cigarettes more addictive. The tobacco industry didn't have enough money to pay for the collective wrongs they had created by their lies.
There are a lot of selfish people who are not willing to pay for improving the collective health of the nation which benefits all communities because it allows everyone to have better access to preventative medicine which increases productivity in the long term.
President Abraham Lincoln introduced the Income Tax in order to pay for the Civil War because that was an additional price that most people in the Union were willing pay for the war and abolition.
The Constitution says "We the People in order to form a more Perfect Union..." not a Confederation of selfish, xenophobic pri
I watched a few parts of Frontline sick around the world (which is viewable online on the PBS website). Should Americans be surprised by that such a diverse group of countries decided saving money by going with national health insurance or healthcare was better than a purely free enterprise system where the most needed procedures are sacrificed for the least necessary but lucrative? In 2007, the United States spent $13.2 billion on cosmetic plastic surgery. 20,000 people died from the flu a year. How many thousands of people could have been saved if they had access to flu shots? It's just basic compassion that is missing from a lot of selfish Americans.
Betsy Ross, Bravo for Germany not paying for non citizens health care-that makes sense-if we just would do that over here we would save billions.
I know Germany has a military, but if they had to produce 1000's of nuclear weapons to keep the former Soviets and now Russia in check they would have a different perspective.
Jenny, California for the most part has been a moderate state up until the last 20 years when the legislature started bending to the left and the special interest took over. Now the left through horrible governing both at the ballot box with wild eyed propositions and leftist politicians have turned it into a third world disaster.
Jenny, regarding liberal education-I was educated by people who were mostly liberal as the more conservative productive people head into the business world. I did not fall under their spell and could think for myself.
There is some people who think the "brains" are the liberal left-no its is business and industry (ran by mostly fiscally conservative people) that funds your liberal institutions. It is private indutry that creates and invents and is the engine that drives America.
Mark continues a red herring regarding California instead of rationally examining what has worked and doesn't work in foreign healthcare systems.
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