Free, Public Healthcare

Then please update me: What is the current revenue loss from the Bush tax cuts to the federal government?


What is the extent of these effects in dollars? As observed in the data I mean, not as postulated by Republican think tanks as an article of faith?


So? How does that affect the cost of the healthcare reform plans currently on the table?

Medicare and medicade provide health care to about one third of our population. The other two thirds will likely cost far more.

You know very well there is a relationship between taxation and economic activity. While we could argue endlessly about the degree of such effects in a given situation, that they exist is beyond doubt. Perhaps you see this as a useful rhetorical point, however, it is not one that merits a response.

I don't find that "likely" at all, given that Medicare insures old people, Medicaid insures poor people, and both demographics are more likely than the rest of the population to get sick. But more importantly, your argument would fall apart even if that weren't the case, because "the other two thirds" of the American population isn't the relevant group of people.

To see why it isn't, consider that most of those two thirds already have some form of health insurance, and are already paying for it. Now, if Obama gets to execute his reforms, some members of this already-insured majority will stay in their current insurance plans, which changes nothing for the federal government. Others will opt out of their current policies and into the US government's "Medicare for all" plan, paying premiums to the government instead of their current private insurer. On the reasonable assumption that the "Medicare for all" plan's premiums will on average equal its benefits, this also changes nothing for the federal government's bottom line. Either way, then, the choices of the already-insured majority will make no difference to the federal deficit.

That leaves the uninsured -- about 50 million people, or one sixth of the American population rather than the two thirds you're so worried about. By your analogy with Medicare and Medicaid, paying the "Medicare for all" plan for them should cost about $100 billion a year, which is at the low end of the range I gave earlier. (The rest of the range comes from insuring the under-insured.)

Summing up, you are overestimating the costs of reform because you overestimate the number of new insurance holders who will get, but not pay for, the newly introduced government service.


With all due respect, George, you're the one using rhetoric to cover up holes in his substantive argument. Your original claim, to which I responded, was that the expiration of the Bush tax cuts wouldn't even make a dent in financing Obama's health care reforms. My response was that the volume of the Bush tax cuts is actually higher than the costs of the reform.

To cover the difference between your claim and my response to it, it isn't enough to state that in principle there is some qualitative effect of tax cuts on economic activity. You also have to demonstrate a rather dramatic quantitative effect -- dramatic enough to get you from "the tax cuts is costing 1.5-3 times more than health care reform will" to "the expiration of the tax cuts won't make a dent in financing health care reform."

You have not demonstrated such a dramatic quantitative effect. Indeed, you have demonstrated no quantitative effect at all, dismissing my request for a demonstration as "rhetoric" instead.

Herr Hinteler is obviously not telling the truth.

If he thinks I would go to a country which is losing its doctors by the score because the German Health System does not pay them enough, he is daft!

He won't read this because he thinks he is the Ubermensch. He thinks Germany should have won World War I and World War II and that Germany has the best thinkers and scholars in the world as well as the best economy.
|
Herr Hinteler won't tell you that the German Universities compared to US Universitie SUCK. The German GDP is falling faar behind the US, Chinese and Japanese GDP.

Again, Herr Hinteler wont read the evidence below. I do hope that Thomas will. I would never want to have to have any medical care in a country whichc cannot keep its doctors. In such cases, the best ones leave and the slugs remain behind:

Note:

InternationalNACHRICHTEN VIDEO ENGLISH EINESTAGES FORUM SPIEGEL WISSEN ABO SHOP Front Page| World| Europe| Germany| Business| Zeitgeist| International Forum| Newsletter English Site > SPIEGEL Magazine
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BYE BYE DEUTSCHLAND
More and More Leave Germany Behind
By Julia Bonstein, Alexander Jung, Sebastian Matthes and Irina Repke

Faced with poor job prospects, high taxes and an intrusive bureaucracy, more and more Germans are choosing to emigrate. Most of those who leave, though, are highly qualified -- which could mean devastating economic consequences.


Knut Gärtner
Frank Pigorsch was unemployed in Germany. Until he found a job in Calgary that is. He now lives there with his family.
They are fed up, truly fed up. Fed up with the constant bickering over the costs of wage benefits, social reforms, elimination of subsidies, store closing hours and all the other symbols of a country stuck in bureaucratic and legislative gridlock.

They are tired of living in country where landing a job is like playing the lottery, a country where not even half of citizens live from gainful employment and a country in which even academics in their mid-40s are already considered problem cases when it comes to job placement. In other words, they are fed up with living in a country where all opportunities already seem to be taken: opportunities to succeed in one's career, to own property and to achieve prosperity.

That is why they want to leave -- as fast as they can, in fact -- and move to places where they believe there is hope for a better future. One of those places is the Third World -- India, to be more precise. René Seifert, 35, still raves about Bangalore, India's booming metropolis, where young computer programmers spend their nights crowding into the city's dance clubs and where, during the days, cars share the streets with rickshaws and cows. And where, despite the seeming chaos, every thing has its place. "I'm fascinated by the pulse of Asia, the upbeat prevailing mood and the wealth of opportunities," he raves.

With a few thousand euros in starting capital Seifert, a businessman and former head of entertainment at Internet portal Lycos Europe, founded a company in Bangalore that provides accounting services for mid-sized German companies. He is so enamored of India that he can hardly imagine ever wanting to return to Munich. "Things are really starting to move here," he says.

"Why stay in Cottbus?"

Frank Naumann, a 38-year-old doctor, fled to Austria with his wife because of "miserable working conditions at home." German doctors, he says, "are in demand from North Cape" -- in northern Norway -- "to the Emirates, so why should I have stayed in Cottbus?"

Naumann worked at a hospital in the eastern German city of Cottbus for six years without ever being offered a permanent contract. Because his chances of being promoted to senior physician were so uncertain, Naumann and his wife decided to move to the Salzburg region, where he now has permanent contract as a senior physician at a hospital in the Austrian town of Schwarzach. Back in Cottbus, doctors are working multiple shifts because the hospital suffers from a shortage of qualified personnel.

Almost everyone in Germany these days knows people like Seifert or Naumann -- people who have decided to make a fresh start in the middle of their lives. Saying goodbye is difficult for almost anyone, but at some point the frustrations and the yearning for a new future become too overwhelming to ignore. Rarely have so many Germans decided to leave it all behind -- their houses and properties, parents and aunts, friends and co-workers. According to the German Federal Office of Statistics, 144,815 Germans left the country last year, a jump of almost 25 percent over 2002. At the same time, fewer and fewer Germans are returning from abroad. The most recent figure is 128,052. For the first time in a generation, more Germans are emigrating than returning. And these are only the official figures.


AP
"Overseas is calling!" More and more doctors are leaving Germany out of disgust with the job conditions here. This image is from a doctors strike this spring.
There are probably just as many who move away without bothering to notify officials in their local municipalities. And those who go are no longer only social dropouts, those seeking a tax haven or celebrities. Nowadays doctors are moving to Norway, engineers to the United States and agricultural experts to New Zealand. Germany is becoming a net exporter of people.

The typical emigrant is in his prime, between the ages of 25 and 45, has had a decent education and is already well into his career. "Those who go are often highly motivated and well-educated," says Stefanie Wahl of the Institute of the Economy and Society in Bonn. But immigrants are a different story altogether. "The people who come here are usually poor, unskilled and have little education."

A paucity of immigrants

This is precisely the problem. Not only are more people turning their backs on Germany, but those who go are typically the country's best and brightest. According to a study by the Organization of Economic Cooperation and Development (OECD), hardly any other industrialized nation is losing so many academics to other countries. The percentage of emigrants with doctorates is 10 times as high as it is in the general population. And half of emigrants are younger than 35. "This is a warning sign," Ludwig Georg Braun, the president of the German Association of Chambers of Commerce and Industry, said recently.

Meanwhile, the number of new immigrants is on the decline, and those who do choose to make Germany their home are often not exactly the kinds of workers companies actively seek out. While countries like Australia and Canada restrict immigration mainly to the kinds of people they can truly use, all it takes for someone to immigrate into Germany is proof that they already have family there or are Eastern Europeans of German descent.

It is failed policy with far-reaching consequences. Hamburg economist Thomas Straubhaar warns of what he calls a "DDR effect" if the country loses those who are the most flexible and open to innovation as happened to former East Germany. "Unless we do something about it," he says, "this country's problems will become more severe than almost anyone can imagine today."

The country's pension system is losing contributors just as vast numbers of baby-boomers are gradually entering retirement. The demographic crisis is getting worse, especially when one considers that deaths outnumbered births by 144,000 in 2005, and that this gap is continuing to widen.

Beyond the social system, the emigration of the country's elites represents a loss to the German economy as well. The government spends untold thousands of euros for the education and training of every biologist, computer scientist or engineer. And then these specialists become frustrated and leave the country.

Of the just under 12,000 students who enter medical school in Germany each year, fewer than 7,000 end up working in hospitals or private practice. Of those who find employment, about half of them find it outside of Germany, according to the Marburg Bund, the trade association of German hospital doctors. Training these 3,000 or so doctors who end up emigrating costs the government about €600 million -- an expense that ultimately benefits patients in Great Britain, Norway and Switzerland.

Fifty-seven thousand Germans in Austria

Ultimately, such an export of intellectual wealth weakens Germany as a site for investment. Many companies already lack specialized workers today, and 16 percent of German companies are unable to fill all their positions because of a lack of qualified candidates. There are about 7,000 unfilled engineering jobs in the machine building industry alone.

"We cannot simply look on as precisely those people emigrate who are valuable, well educated and motivated," says DaimlerChrysler CEO Dieter Zetsche, referring to what human resource experts call the "brain drain." Zetsche believes that the solution lies in the government changing its approach to immigration policy. "We should encourage people to immigrate who can help us solve our problems."


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Some are motivated by a yen for adventure in faraway places. Others are simply fed up with German idiosyncrasies, such as the propensity to constantly come up with new rules where none were necessary in the first place. But the most important motivation is often economic, as Germans facing a lack of career opportunities at home seek to build new lives in places where their skills are still in demand. And that is the case in a surprisingly large number of places in the world.

The "costs of reform" are not yet known, despite your inferences that they are. Moreover yours is an entirely static analysis that completely ignores both the Congressional Budget Offices recently published projections of the cost of the proposed legislation, and several subordinate issues that are likely to prove central to what the real cost will be.

The fact is the current Mediare and Medicaid systems have already seriously distorted costs of all forms of medical treatmend for those not "benefitting" from those programs. Legislators and brueaucrats set caps on prices for services and accept or reject their 'admissability" by fiat, without regard to either market forces or the individual circumstances at hand - often creating truly absurd situations. The result is that doctors, labs and hospitals retaliate by raising their prices for those same services to other patients. Insurance companies, in turn retaliate, by negotiating discounts from the doctors and hospitals, however they are a good deal less than the discounts the government arbitrarily imposes. One result is the here, most doctors will no longer accept patients whose sole coverage is Medicare - even if they express a willingness to pay the difference themselves.

The central debate today about the Administration's health care proposal - apart from the projected total cost - lies precisely in their insistence that a government-managed and operated "option" is needed to ensure "competition" in a marketplace currently operated by hundreds of insurance companies, HMOs and cooperatives. Critics charge - with very good reason - that the already known dynamics of the government program will deive most private insurers out of business (and like its medicare & Medicaid forebears drive up government deficits through excess hidden spending). The result is we will end up with near universal coverage in a government system that will operate with all the well-known efficiency and wise encouragement of investment for which Medicare is so infamous.

I'm over 65 and still employed. I pay about $2,900/year in Medicare Taxes and another $2,500/year for my share of the full coverage insurance provided by my company. Apart from a knee surgery a couple of years ago our total medical bills have never exceeded (and rarely come close to) the annual premiums & taxes. Indeed a quick calculation over the past decade revals that I have been a substantial donor by a large margin. Worse, because medicare pays only after my private insurer pays, and disallows nearly everything, I doubt that my family costs Medicare more that a couple of hundred /year. I also earned "lifetime medical care" as a career Naval Officer, however that coverage has been diluted into non-existence, since it stands behind both private coverage and Medicare and has much higher decuctablkes - I can't recall ever getting anything out of it.

Not surprisingly I am not very hopeful about the "benefits" of any government-operated scheme. It simply promises higher taxes, more bureaucracy and government-imposed rationing. It shouldn't surprise anyone that most doctors in Britain are immigrants and that there is a serious shortage of people entering the field. As you well know price controls and rationing are a proven formula for the lack of investment and innovation and mediocre service.

GeorgeOb1- Itis becoming exceeedingly obvious that Obama's Health Plan will not fly--Read anyone of today's Newspapers-New York Times-Washington Post.

I find it exceedingly curious that no hard facts about how these programs will be paid for have emerged.

If you recall, the same problem occurred with HillaryCare.

The left wing can moan and groan but they cannot hide the fact that when Europeans and Canadians need the BEST MEDICAL CARE in the world they go to the Mayo Clinic.

The left wing can moan and groan but they cannot hide the fact that millions of Americans would not put up with a plan that did not allow them to CHOOSE their primary physician and any specialists they may select.

The left wing can moan and groan but they cannot REMOVE the benefits that accrue to the "fine" Union health plans( See GM) without incurring the wrath of one of their trusted allies.

As Senator Graham said today--The Obama health plan is dead!!!

Well, at first I must admit that you pay a lot less than you would pay here.
(My mother, as a pensioner, pays about $800 per month - though that's the highest possible sum.)
Secondly, health insurance is here an insurance - you might not need - or you do. (Even during the last couple of yeasr, my mother's insurance had to pay more than she and my father paid in it during all their life.)

Insurance is the same here. The point is I (and many others) get very little from the government programs we are paying for. Our company plan is fully funded in that, between company contributions and those of the employees, it pays all costs incurred every year. The government programs, as a result, pay me virtually nothing and, if I were dependent on them, cover far less - even though I am required to pay for them.

BTW - I just tallied up all the taxes (Federal income, payroll (social security), Medicare, and State income-based taxes I pay -- they amount to 49.5% of my total income. This, of course does not include sales taxes (like VAT), property and capital gains taxes., which together add about 13% more.

Free public healthcare isn't free. It isn't very good either.

Any healthcare must be paid. (Interestingly, what generally in German is know as ' "free" public healthcare' is that what is offered by the public health departments. - Besides that, it was a term used in the armed forces for their health service ["freie Heilfürsorge"] for conscripts as opposed to the mandatory insurance.)

I'm not sure if it isn't good - I just can compare our European systems (of a couple of countries) only with that in the USA.

Bollocks. Pure unadulterated rubbish. You utterly ignorant stupid prick.

Now there's a fact-filled, perfectly rational and persuasive argument !! Uplifting too to see the respect for another point of view and the reasoned, clearly stated support for the author own perspective.

The CBO projection didn't include the Public Option; it doesn't account for the savings such a large, non-profit group will create.

Cycloptichorn

Obama Allies Worried Health Care Plan Lacks Necessary Votes

Much of the concern came after the nonpartisan Congressional Budget Office estimated that the plan
would cost $1 trillion over 10 years but cover only about one-third of those now lacking health insurance.

I knew Herr Hintler wouldn't answer this post. He thinks that German Health Care is the best in the world. He is obviously mistaken. When thousands of German doctors desert the BEST HEALTH CARE THAT HINTELER THINKS IS BEING OFFERED IN GERMANY, it clearly shows that the health care is sadly lacking.

I, for one, would never consent to be treated, unless it was an unavoidable emergency, by the obviously second rate doctors that are left in Germany after there has been a rush by the best to leave the German service. But Herr Hinteler wont be deterred by his Deutschland, Deutschland Uber Alles stand.

NOTE:

Herr Hinteler is obviously not telling the truth.



Again, Herr Hinteler wont read the evidence below. I do hope that Thomas will.

Note:

InternationalNACHRICHTEN VIDEO ENGLISH EINESTAGES FORUM SPIEGEL WISSEN ABO SHOP Front Page| World| Europe| Germany| Business| Zeitgeist| International Forum| Newsletter English Site > SPIEGEL Magazine
Print | E-Mail | Share | Feedback 11/10/2006 Digg Stumble Upon Reddit Facebook Del.icio.us Fark Yahoo Newsvine Google MySpace Font:
BYE BYE DEUTSCHLAND
More and More Leave Germany Behind
By Julia Bonstein, Alexander Jung, Sebastian Matthes and Irina Repke

Faced with poor job prospects, high taxes and an intrusive bureaucracy, more and more Germans are choosing to emigrate. Most of those who leave, though, are highly qualified -- which could mean devastating economic consequences.


Knut Gärtner
Frank Pigorsch was unemployed in Germany. Until he found a job in Calgary that is. He now lives there with his family.
They are fed up, truly fed up. Fed up with the constant bickering over the costs of wage benefits, social reforms, elimination of subsidies, store closing hours and all the other symbols of a country stuck in bureaucratic and legislative gridlock.

They are tired of living in country where landing a job is like playing the lottery, a country where not even half of citizens live from gainful employment and a country in which even academics in their mid-40s are already considered problem cases when it comes to job placement. In other words, they are fed up with living in a country where all opportunities already seem to be taken: opportunities to succeed in one's career, to own property and to achieve prosperity.

That is why they want to leave -- as fast as they can, in fact -- and move to places where they believe there is hope for a better future. One of those places is the Third World -- India, to be more precise. René Seifert, 35, still raves about Bangalore, India's booming metropolis, where young computer programmers spend their nights crowding into the city's dance clubs and where, during the days, cars share the streets with rickshaws and cows. And where, despite the seeming chaos, every thing has its place. "I'm fascinated by the pulse of Asia, the upbeat prevailing mood and the wealth of opportunities," he raves.

With a few thousand euros in starting capital Seifert, a businessman and former head of entertainment at Internet portal Lycos Europe, founded a company in Bangalore that provides accounting services for mid-sized German companies. He is so enamored of India that he can hardly imagine ever wanting to return to Munich. "Things are really starting to move here," he says.

"Why stay in Cottbus?"

Frank Naumann, a 38-year-old doctor, fled to Austria with his wife because of "miserable working conditions at home." German doctors, he says, "are in demand from North Cape" -- in northern Norway -- "to the Emirates, so why should I have stayed in Cottbus?"

Naumann worked at a hospital in the eastern German city of Cottbus for six years without ever being offered a permanent contract. Because his chances of being promoted to senior physician were so uncertain, Naumann and his wife decided to move to the Salzburg region, where he now has permanent contract as a senior physician at a hospital in the Austrian town of Schwarzach. Back in Cottbus, doctors are working multiple shifts because the hospital suffers from a shortage of qualified personnel.

Almost everyone in Germany these days knows people like Seifert or Naumann -- people who have decided to make a fresh start in the middle of their lives. Saying goodbye is difficult for almost anyone, but at some point the frustrations and the yearning for a new future become too overwhelming to ignore. Rarely have so many Germans decided to leave it all behind -- their houses and properties, parents and aunts, friends and co-workers. According to the German Federal Office of Statistics, 144,815 Germans left the country last year, a jump of almost 25 percent over 2002. At the same time, fewer and fewer Germans are returning from abroad. The most recent figure is 128,052. For the first time in a generation, more Germans are emigrating than returning. And these are only the official figures.


AP
"Overseas is calling!" More and more doctors are leaving Germany out of disgust with the job conditions here. This image is from a doctors strike this spring.
There are probably just as many who move away without bothering to notify officials in their local municipalities. And those who go are no longer only social dropouts, those seeking a tax haven or celebrities. Nowadays doctors are moving to Norway, engineers to the United States and agricultural experts to New Zealand. Germany is becoming a net exporter of people.

The typical emigrant is in his prime, between the ages of 25 and 45, has had a decent education and is already well into his career. "Those who go are often highly motivated and well-educated," says Stefanie Wahl of the Institute of the Economy and Society in Bonn. But immigrants are a different story altogether. "The people who come here are usually poor, unskilled and have little education."

A paucity of immigrants

This is precisely the problem. Not only are more people turning their backs on Germany, but those who go are typically the country's best and brightest. According to a study by the Organization of Economic Cooperation and Development (OECD), hardly any other industrialized nation is losing so many academics to other countries. The percentage of emigrants with doctorates is 10 times as high as it is in the general population. And half of emigrants are younger than 35. "This is a warning sign," Ludwig Georg Braun, the president of the German Association of Chambers of Commerce and Industry, said recently.

Meanwhile, the number of new immigrants is on the decline, and those who do choose to make Germany their home are often not exactly the kinds of workers companies actively seek out. While countries like Australia and Canada restrict immigration mainly to the kinds of people they can truly use, all it takes for someone to immigrate into Germany is proof that they already have family there or are Eastern Europeans of German descent.

It is failed policy with far-reaching consequences. Hamburg economist Thomas Straubhaar warns of what he calls a "DDR effect" if the country loses those who are the most flexible and open to innovation as happened to former East Germany. "Unless we do something about it," he says, "this country's problems will become more severe than almost anyone can imagine today."

The country's pension system is losing contributors just as vast numbers of baby-boomers are gradually entering retirement. The demographic crisis is getting worse, especially when one considers that deaths outnumbered births by 144,000 in 2005, and that this gap is continuing to widen.

Beyond the social system, the emigration of the country's elites represents a loss to the German economy as well. The government spends untold thousands of euros for the education and training of every biologist, computer scientist or engineer. And then these specialists become frustrated and leave the country.

Of the just under 12,000 students who enter medical school in Germany each year, fewer than 7,000 end up working in hospitals or private practice. Of those who find employment, about half of them find it outside of Germany, according to the Marburg Bund, the trade association of German hospital doctors. Training these 3,000 or so doctors who end up emigrating costs the government about €600 million -- an expense that ultimately benefits patients in Great Britain, Norway and Switzerland.

Fifty-seven thousand Germans in Austria

Ultimately, such an export of intellectual wealth weakens Germany as a site for investment. Many companies already lack specialized workers today, and 16 percent of German companies are unable to fill all their positions because of a lack of qualified candidates. There are about 7,000 unfilled engineering jobs in the machine building industry alone.

"We cannot simply look on as precisely those people emigrate who are valuable, well educated and motivated," says DaimlerChrysler CEO Dieter Zetsche, referring to what human resource experts call the "brain drain." Zetsche believes that the solution lies in the government changing its approach to immigration policy. "We should encourage people to immigrate who can help us solve our problems."


NEWSLETTER
Sign up for Spiegel Online's daily newsletter and get the best of Der Spiegel's and Spiegel Online's international coverage in your In- Box everyday.


Some are motivated by a yen for adventure in faraway places. Others are simply fed up with German idiosyncrasies, such as the propensity to constantly come up with new rules where none were necessary in the first place. But the most important motivation is often economic, as Germans facing a lack of career opportunities at home seek to build new lives in places where their skills are still in demand. And that is the case in a surprisingly large number of places in the world.

If that's true, that cuts both ways, and you really had no basis for saying that the expiration of the Bush tax cuts won't make a dent in it. (Not that I agree it actually is true.) Anyway, I have made my case as good as I can, and have no interest in going in circles. So I'll drop this particular point.

Let's take a look at a study by the Cato Institute--

http://www.google.com/search?q=%22The+Grass+is+not+always+greener%22+Cato+Institute&rlz=1I7DKUS_en&ie=UTF-8&oe=UTF-8&sourceid=ie7

On the link above you will find some very interesting items about German Health Care:

l. It may reach 30% of GDP by 2020 if not reformed radically

2. German Health Care has begun to cut back now excluding eyeglasses, lifestyle medications and over the counter drugs

3. Overall, Germans pay about for about 13% of Medical Care out of pocket

4. Rationing is occuring for the elderly and those with terminal illnesses.

5. Surveys of German Hospitals reported that waiting times were prolonged due to both lack of capacity and hospital target budgets that make the treatment of sickness fund patients with serious conditions FINANCIALLY UNATTRACTIVE.

6. Germans had far less access to modern medical technology than Americans.US had four times as many MRI units per million people than Germans and twice as many CT scanners.

7.The system would undoubtedly be worse without the EXISTENCE OF THE SMALL PRIVATE INSURANCE SECTOR.

8. and most important of all---------------------

PHYSICANS TRYING TO WORK WITHIN THE MAZE OF REIMBURSEMENT CAPS AND BUDGET RESTRICTIONS HAVE NO FINANCIAL INCENTIVE TO PROVIDE MORE THAN THE

MINIMALLY NECESSARY CARE.

*****************************************************************

Is that what Obama Care would bring us? NO THANKS!!!!

Note:


German Health Service Sick, Doctors Say

Großansicht des Bildes mit der Bildunterschrift: German doctors are working longer for less payGerman doctors have voiced concern about the health of their own profession during a four-day national congress in Berlin, responding to widespread protests over low pay and untenable working conditions.



Even before this year's German Medical Association congress got underway, more than 5,000 doctors demonstrated in several German cities to protest pay cuts of up to 17 percent and longer working hours. And on Tuesday, the opening day of the congress, desperate doctors took their protest to the streets of German capital. Among them was Ravindra Gujullah, an Indian-born general practitioner in the town of Landsberg.



"When you become a doctor, you have such zeal to be a good doctor and to serve people," Gujullah said. "But these things are not so important today. Now, you have to fight just to survive."



Medical brain drain



German hospitals are coming under increasing pressure to cut costs, and are seeking concessions from their medical staff. Doctors working in hospitals are paid roughly the same salary as an elementary school teacher, despite having to endure work weeks that often amount to more than 60 hours.



In recent years, hospitals have cut staff numbers, holiday pay and Christmas bonuses in an attempt to meet government demands for more efficiency. The president of the German Medical Association, Jörg Dietrich Hoppe, has predicted that more and more well-trained doctors will seek better-paid jobs in the pharmaceutical industry, or even leave Germany for better opportunities abroad.



"Our young doctors don't see any prospects for advancement and better pay in German clinics," Hoppe said. "Headhunters, especially from Britain, are currently looking for German doctors -- specialists in particular -- and offering them wages that are three times as high, plus working hours that don't go beyond 50 hours a week."



Patients bearing the brunt



Bildunterschrift: Großansicht des Bildes mit der Bildunterschrift: Federal Health Minister Ulla Schmidt is overseeing Germany's health services reform.Experts are warning of a severe crisis in health services as the brain drain is already leaving rural regions in economically depressed eastern Germany without enough doctors. Consumer advocate Thomas Isenburg accused the government of making savings on the back of patients.



"Patients fall by the wayside in a health machinery subject to cost-cutting and maximizing efficiency," Isenburg said. "More than 15,000 people die in Germany every year due to medical mistakes and faulty treatment, which is why it's important for German doctors to find ways at this congress to avoid such mistakes and reduce the cost pressure. A good health service cannot be had for nothing."



In a speech on Tuesday to open the annual congress, Health Minister Ulla Schmidt vowed that affordable treatment for all would remain the German government's ultimate goal. But in view of an ageing population on the one hand and the rapid advancement of medical science on the other, more efficiency was inevitable, Schmidt said.

The way I see it...

The cost of any given health care rises by about 35% as soon as the government gets involved.
Socialized medicine, a.k.a. ObamaCare will cost everyone about 35% more than what it costs today.
Also, the only way to reduce cost under ObamaCare is to restrict services.
All procedures will be prioritized and subject to approval by another Obama appointed ObamaCare czar.
Many people will be turned away and the rest will wait and wait for treatment...
the entire situation will be far worse under ObamaCare than the rare, worst case situation that you can dig up today.

An interesting perspective..................................................................

"By SALLY PIPES
Day: Warns of Canada's deadly waits.

THE rush to remake the 17 percent of America's econ omy known as its health- care system is matched only by the muddle of the motivations driving it. Above all else, consider the confusion of health insurance with access to actual health care.

The reality is that having insurance is not the equivalent of having access to care. In America and abroad, people with coverage (government or private) can lack access to timely care -- while those without insurance in the United States may in fact receive timely care while paying little for it.

Official counts place uninsured Americans at roughly 46 million, an alarming 15 percent of the population. Yet a closer look paints a less scary picture. Of the 46 million, one in three, or 17 million, live in a household with an income greater than $50,000. Four in 10 are 18 to 34 years old -- an age range where health spending averages less than $1,000 a year out of pocket.

As many as 14 million -- including many children -- are already eligible for taxpayer-funded health insurance via Medicaid or SCHIP, but simply haven't signed up. One in five, or 9.7 million are noncitizen immigrants, a portion of whom are here illegally. Seven in 10 people are uninsured for a year or less.

Then, too, health insurance often doesn't make financial sense for people with few assets, good health and limited income. They can pay out of pocket for routine care -- and rely on the social safety net for large, unexpected and unlikely events.

In the United States, that safety net includes: federally funded health centers, open-door policies at hospital emergency rooms, extra payments to hospitals that treat large numbers of uninsured, and charity care. Together, these work to insulate Americans from catastrophic medical bills.

In 2008, uninsured Americans consumed an estimated $86 billion in health care, or $1,686 per person. This was (predictably) less than Americans with insurance, yet evidence suggests the system functions as an informal insurer.

The uninsured reached into their pockets for only $536 of the care, less than the $681 that privately insured patients paid out of pocket. The other 65 percent of that care was paid for by either existing government transfers or absorbed by the institutions providing care. In short, anyone living in America -- citizen, immigrant, documented or undocumented -- has access to health care on multiple levels. The same is not always true under "universal coverage."

In Canada, the country of my birth, a person needing non- urgent care faces long waits -- last year, it averaged 17.3 weeks -- between seeing a general practitioner and getting treatment by a specialist, according to the Fraser Institute.

And diagnostic technology is severely controlled. Dr. Brian Day, the immediate past president of the Canadian Medical Association, notes that Canada is a country in which a dog can get a hip replaced in under a week but a human waits two to three years.

In Great Britain, everyone enjoys free health care -- in theory. But the rationing is explicit and out in the open. The National Institute for Health and Clinical Excellence denies the latest drugs and biologics to patients if the agency deems them not cost effective -- even though they may be medically effective. So while Americans have access to Orencia for rheumatoid arthritis, NICE has denied the care to Britons.

Massachusetts' ongoing reform experience illustrates that insurance doesn't equal access. The Bay State's bipartisan reform imposed an individual mandate, built a quasi-public insurance regulator and greatly expanded taxpayer-subsidized health care -- and the result has been a warning on the quest to achieve universal coverage.

After three years, it has succeeded in cutting the percent of uninsured in half to 2.5 percent, the lowest in the nation. But the taxpayers have paid most of the price: The majority of the formerly uninsured were either added to Medicaid or to heavily subsidized plans. A mere 41,000 -- less than 10 percent of the once uninsured -- have purchased individual plans. And, 60,000 have been exempted by the government from having to purchase insurance.

Costs are rising and many promised savings aren't materializing. Bay State residents use emergency rooms at the pre- reform rate of 23 percent. Today, 20 percent of residents are having trouble securing a doctor. The Health Safety Net fund, which pays hospitals to care for the uninsured, still spent $410 million in 2008.

Most startlingly, to control costs, the state is considering "payment reform" that resembles a giant HMO. Price controls and explicit rationing will surely follow.

Americans need to think through Washington's rush to reform. The last thing we want is what we'll likely get. Trade a system that provides excellent, responsive care to the fully insured, uses taxpayer money to cover seniors and low-income families and children, and highly subsidized care to those without insurance, for one where everyone pays more for less.

Sally Pipes is president and CEO of the Pacific Research In stitute. Her latest book is "The Top Ten Myths of American Health Care."

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