Enlightening information in the Health Care Reform debate...

This is a long piece, but worth the read. It is written by the Area Medical Advisor of the Mormon Church Missionaries in Central Europe. Received by computer mail:

Report From Germany
From RK Maddock Jr., MD FACP, Area Medical Advisor Europe Central, LDS Church.

For the past year I have been serving the LDS Missionaries in Central Europe and Scandinavia. The scope of my direct responsibility includes: Central Europe up to the Ukrainian and Russian borders. My supervisory responsibilities include the rest of Western Europe and Cape Verde. In this region are 4000 young LDS missionaries, about 300 senior missionaries and other support staff. My medical background in the U.S. began in 1962 and has included advanced training, academic medicine, private practice and about 25 years of experience in the insurance review industry. In Frankfurt, Germany where we are located I can see CNN and BBC news on TV and hear WABC New York City on my computers. I have listened with morbid fascination as various politicians have spouted off about reforms needed in the U.S. for “health care”, newspeak for medical care.

Even with its flaws – mostly government imposed – our medical care system has been the best in the world, but under the onslaught of Government interference and regulation, a complex insurance system (mostly Government mandated) and assaults by our legal system it is losing much of its luster. This may surprise you, but the German private system is superior. Notice, I did not say “public system.” I can get anything here for 1/3 the price or less and I can get it on a moment’s notice. Yes, I have to pay for it at the time of service, but the fee is equivalent to what most of us would recognize as” co-pay.”

I have had a chance to see European government medical planning first hand. Germany probably has the best of all the social systems, but that is because 50% of the care is done in the private system. There are two basic differences between the German private system and the U.S. On the private side it is against the law for a physician or institutions to accept “insurance assignment of benefits.” That means no direct third party or insurance company payment to “providers.” It also means no HMOs. The second that affects both private and public system is a legal tort system of “loser pays.” combination of these two plus the high degree of private practice allows for a “free market” in medical pricing. How do the doctors do? Very well – they don’t have 60+% overhead expenses, most of which in the U.S. is caused by the complexities of our payment systems and the horrific medical mal-practice expenses. I am finding out that what we pay for in the U.S. as “medical care” is in fact “insurance care” and “legal care.”

It is one of the biggest rip-offs that have ever been devised. takes a lot of big buildings, CEOs, and armies of paper pushers just to manage your money and when you look at the government side, you have a Ponzi scheme.

In the U.S, prices in medicine have been under government control since the early 1970s. In insurance terms it is called “usual, customary and reasonable.” As a result, the prices are as much as 10 times lower here in Germany and physicians make a good living because they do not have to contend with 60%+ overhead that we do in the States. In the States you find a bunch of “patrician” specialties such as “cardiology” next to a bunch of “helot” specialties such as “pediatrics.” It is amazing what happens when the “market” is permitted to operate in medicine.

Several examples should show the difference. I had a senior missionary from the U.S. come into my office one morning about 6 months ago complaining of chest pain. I sent him immediately to the Johan Wolfgang Goethe University Hospital 60528 Niederrad, Frankfurt am Main, Germany. This is a huge teaching hospital and clinic complex occupying 1.5 k x 0.5 k of space and includes over 95 buildings, many which house specialty surgical and medical units. He was seen in the ER, admitted to the cardiology service, a heart attack was ruled out that day. The next day he had a number of tests that determined he was having myocardial ischemic attacks. That afternoon he went to the cath-lab where they discovered a blocked stent. The cardiologists fixed it by first removing the clot, dilating the old stent and placing a new one inside it. He was discharged the following day and has been well ever since. I shudder to think of what that would have cost in the U.S. The total bill – hospital, physicians, various lab technologies – the “whole boat” - 1800€ ($2600). I know, we pay and approve the bills.

A missionary was admitted to the University Medical Center with viral meningitis, he was hospitalized in the neurology unit for 7 days and in bacterial isolation for 5. He was seen by various specialists, had two spinal taps, an MRI of the brain, numerous lab studies. The entire bill, physicians, tests, imaging studies, hospitalization - 2600€ ($3700).

A missionary is admitted following a hit and run auto pedestrian accident. He had been flipped on the hood of the car traveling about 40k/hr, smacked his head against the windshield and was carried 30 m before he dropped onto the roadway. He was found to have a depressed skull fracture, fractured zygomatic arches, two maxillary fractures,
fractures of the bases of both orbits and a broken nose and a defect in his IV cranial nerve on the left. In Romania where the accident had occurred, they missed everything but the broken nose. He was hospitalized in the Goethe University Medical Center in the orthopedic plastic surgery section for 10 days. He had a complex 6-hour surgical repair of his facial and orbital fractures. He was seen by a number of specialties including ophthalmology, he received a thorough ophthalmoscopic evaluation, two CT scans, IV antibiotics, a trip back to surgery to stop some nasal bleeding – total bill, the whole 9
yards - 7800€ ($11, 143). Try to get this in the States for under $50,000.

Here are some comparisons of x-ray studies: plain x-ray 35-75€ ($50-107), CT scan 300-400€ ($428-572), MRI scan 400-700€ ($572-1000). However this includes the x-ray, a sit down consultation with the radiologist reviewing the x-rays with you, a copy of the x-rays plus DVD when necessary, a typed signed report as you walk out the door and pay your bill and consultation with your physician with report to him. The physicians speak English. An MRI of the brain will take about 1-½ hours and can be set up in less than 24 hours on the private side. [These prices and practices are those found at Gemeinschaftspraxis Radiologie & Nuklearmedizin‎ 191 Mainzer Landstrasse, 60327 Frankfurt.] Their equipment is all digital and state of the art. The place is busy, clean, and complete with fish tank in the central waiting room, and works well into the evening hours. Parking is free.

Medicines here include almost everything you can get in the U.S. My Januvia that costs $5.50 per tablet when purchased in lots of 100 in the US (Costco) is $1.55 each here. This is typical of many prescription drugs. But all is not sweetness and light. If I
purchase over-the-counter medicine in the U.S. like aspirin it is pennies to a few cents per pill, but here I paid 15€ for 40 aspirin tablets. Physician credentialing that we take for granted in the U.S. is non-existent in Europe. Consequently there are lots of quacks. The best way to avoid them is to go to a university medical center where only western style physicians are trained or have personal professional knowledge about them otherwise the system is “caveat emptor” – let the buyer beware.

If you want reform that works in the U.S., get the government completely out of medicine. Yes, there can be a safety net for those who truly cannot afford care. There is one here in Germany. All Germans have a Euro medical card. It is good in all EU countries. This allows complete freedom of choice wherever there is a private system. If you’ve got the card, you can get medical care anywhere within the EU – free of charge. However, there are problems –“queue-up and wait” and a “preferred provider” who may not be the best or even competent. However, you can get the “RED CARPET” treatment in the private system and pay cash. In Germany 50% elect the private system. In the government system, the government sets the price based on the private system prices. The physicians will go out on strike – “legally” – if the government does not keep the technology up to snuff for the public patients. If you see a government patient, you submit the bill electronically and the government bank transfers the money within seconds to your bank account. There is no wait and no hassle at the point of service. However, if they catch you up-coding or otherwise cheating the system such as giving a patient a paid bill when it has not been paid – and they do check – you lose your license FOREVER and you GO TO JAIL. There is no appeal, no lawyers, no courts no bribes. Consequently the physicians are very careful about this. Medical malpractice suits exist here, but it is relatively rare. If you bring a frivolous suit, you pay if you lose and that includes all the defendant’s expenses. Here are some mal-practice premium costs – orthopedic resident in training - 1000€/yr; orthopedic surgeon - 3000€/yr; OBGYN - 5000€/yr.

If you go to the private system, you are expected to pay CASH NOW. This can be in Euros or a German bank debit card. No foreign cards, especially credit cards or personal checks are accepted. If you have personal medical insurance, you submit the paid bill to your insurance company and they reimburse you on a scheduled basis. Insurance companies compete for your business by rapidity of reimbursement. This same payment attitude is true of most transactions except in the purchase of large items like houses, property or automobiles. People pay cash for large appliances and consequently there is little personal indebtedness when compared to the U.S.

There are other countries that have social systems. Most of them are either severely degraded or substandard, like the Italian, Spanish and Portuguese Systems. However, within these, you can find a few clinics and hospitals that meet U.S. standards. The UK – don’t even go there – the system is in chaos. It is running out of money and horribly
flawed, the wait to see specialists and get imaging studies is measured in half years. You can get fairly rapid “Mommie care,” but not complex diagnostics. Recently the public outcry was so great about getting an appointment to see your designated general physician that National Health Service put out a decree requiring the general
practitioners to see all cases within 48 hours of the phone call. The GPs responded by switching off their telephones.

In Sweden, Denmark, Finland etc there is a long “queue-up and wait” in the public system and the taxes have pauperized the citizens to the point that many cannot afford the smaller private systems where they exist. In the eastern areas, the systems are coming out of complete devastation and are so substandard as to be dangerous. Much as Canadians come to the U.S. for their care, we see people from England going to France and people from Scandinavia coming to Germany.

My advice to all physicians and those likely to use our medical care system in the U.S. is that you jump into this fray with all your might and make sure you know what is at stake. Do not let the Government take over medicine with any fixes other than stopping all 3rd party payments to physicians, hospitals and clinics, making medical insurance only for individuals – not businesses, unions or large groups, and creating a loser pays legal system. Your children will curse you with their last breath if you do not resist what is going on with all your might.