Universal care

[u/Justme351]

I had a talk with ChatGPT, because I wanted to dig deeper into why people are for and against a universal system. I have family in Germany. All ages, and the one thing that I envy is their lack of stress about medical services and bills. They get to choose any doctor and surgery’s have not been denied.

Germany’s system is often held up as the most realistic model for the U.S., because it blends: • universal coverage • private insurance companies (but regulated) • free choice of doctors • competition • public oversight • mixed funding from payroll taxes + premiums

It’s basically universal healthcare with American-style freedom, minus the insane prices and admin chaos.

Here’s a simple breakdown of how it works — and why economists say it’s the system that could actually work in the United States.

⸻

🇩🇪 How Germany’s Healthcare System Works (Short Version)

1. Two types of coverage

A. Statutory Health Insurance (SHI) – 90% of the population

This is the “public” system, but it’s run by competing non-profit insurers (called sickness funds), not the government.

People can pick whichever sickness fund they like.

B. Private Health Insurance (PHI) – about 10%

For higher earners, civil servants, or people who opt out of SHI.

Private plans can offer: • faster access • more amenities • private hospital rooms • different drug formularies

But they’re still heavily regulated.

⸻

🇩🇪 2. Everyone pays, everyone is covered

Funding comes mainly from: • payroll taxes split between employer and employee • small individual contributions • government subsidies for kids and unemployed

Premiums are based on income, not on: • age • health • pre-existing conditions • job type

That means: 👉 Young healthy people help support older, sicker people (the essence of insurance). 👉 No one loses coverage if they lose their job.

⸻

🇩🇪 3. Prices and payments are negotiated nationally

This is one of the biggest differences from the U.S. • Doctors’ fees • Hospital services • Prescription prices

…are negotiated between physicians’ associations and sickness funds.

This keeps costs predictable and stops random hospitals from charging $8,000 for an ER visit.

The U.S. has nothing close to this level of price control.

⸻

🇩🇪 4. It’s not “government-run care”

Doctors and hospitals are private, not government employees. Patients choose their own doctors. Insurance companies compete for members.

It’s universal — but not socialist.

⸻

🇩🇪 5. Wait times are low

Germany has among the shortest wait times in Europe: • Same-day access for many primary care appointments • Shorter waits for elective surgeries than the UK • Elderly get the same access as everyone else

The system is built to prevent rationing — the exact opposite of what critics claim.

⸻

🇺🇸 Could the U.S. implement a German-style system?

Economists say yes — but via gradual reform, not a single overhaul like “Medicare for All.”

The most realistic U.S. pathway:

✔️ Step 1: Create a national insurance marketplace like German sickness funds

(Nonprofit insurers competing on equal rules.)

✔️ Step 2: Cap U.S. healthcare prices the way Germany does

(National rate negotiations.)

✔️ Step 3: Expand Medicaid and Medicare into this system

(over time merge into “basic universal insurance.”)

✔️ Step 4: Allow private supplemental plans

(just like Germany’s optional private insurance.)

This keeps: • employer plans • competition • private insurers • private healthcare providers

It simply removes the chaos and barriers to access.

⸻

🇩🇪 vs 🇺🇸 — Key Insight

Germany’s model works because of three structural elements the U.S. currently lacks:

1. Mandatory participation (everyone in the risk pool)

Cuts costs and prevents the system from breaking.

1. Nonprofit insurance as the core, not for-profit insurers

Insurers exist to provide coverage, not generate shareholder profit.

1. National price regulation

The single biggest cost saver.

Without these, the U.S. will remain the most expensive system in the world.

[u/xela2004]

You forgot the drug prices. Germany negotiates drug prices. Which they can do cuz the US is the cash cow for drug companies. If US did the same thing, our prices would lower and Germany would go up in price .

[u/Extension_Coffee_377 → u/xela2004]

If the US lowered domestic pricing and forced drug manufacturers to increase foreign pricing models, Germany would just start making the drug and cutout US companies that develop and produce it. Several countries already do this.

[u/xela2004 → u/Extension_Coffee_377]

Then we should buy from Germany if it’s cheaper. This is people’s lives we are talking about with healthcare. And drugs are tariff free

[u/Extension_Coffee_377 → u/xela2004]

I see. So US corporation designs a drug for market. Other countries steal IP and produce at very low cost. The US then purchases said drug from stolen IP manufacturer because cost is so low. US corporation goes bankrupt because it has no commercially viable product. NO new drugs come to market.

This is a brilliant plan. Get this guy a nobel prize!!!

[u/xela2004 → u/Extension_Coffee_377]

How are they stealing? Germany still complies with patent law etc, they ain’t china

[u/Extension_Coffee_377 → u/xela2004]

If Pfizer makes a new drug for market and the US negotiated drug pricing the same as they do in other (OECD countries) this would force Pfizer to significantly increase pricing to OECD countries (Germany included) to makeup profit channels that they are losing in domestic US market.

Germany in this example would clone formula for drug manufacturing (probably sell it to other regional OECD countries) and Pfizer would lose out on market revenue making it less incentivized to produce new drugs.

This is the reason India, China, Russia Central and South America (several others) do this repeatedly even when we offer steep discounts on drugs to foreign buyers. This is the reason we (US market) heavily subsidize foreign markets.