{"id":494,"date":"2022-12-14T10:32:36","date_gmt":"2022-12-14T10:32:36","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=494"},"modified":"2022-12-14T10:32:40","modified_gmt":"2022-12-14T10:32:40","slug":"what-germanys-coal-miners-can-teach-america-about-medical-debt","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=494","title":{"rendered":"What Germany\u2019s Coal Miners Can Teach America About Medical Debt"},"content":{"rendered":"

\n\tNoam N. Levey<\/span><\/p>\n

P\u00dcTTLINGEN, Germany \u2014 Almost every day, Dr. Eckart Rolshoven sees the long shadow of coal mining in his clinic near the big brownstone church that dominates this small town in Germany\u2019s Saarland.<\/p>\n

The region\u2019s last-operating coal shaft, just a few miles away, closed a decade ago, ending centuries of mining in the Saarland, a mostly rural state tucked between the Rhine River and the French border. But the mines left a difficult legacy, as they have in coal regions in the United States, including West Virginia.<\/p>\n

Many of Rolshoven\u2019s patients battle lung diseases and chronic pain from years of work underground. \u201cWe had an industry with a lot of illnesses,\u201d said Rolshoven, a genial primary care physician who at 71 is nearing the end of a long career.<\/p>\n

The Saarland\u2019s residents are sicker than elsewhere in Germany. And like West Virginia, the region faces economic hurdles. For decades, German politicians, business leaders, and unions have labored to adjust to the mining industry\u2019s slow demise.<\/p>\n

But this is a healthier place than West Virginia in many respects. The region\u2019s residents are less likely to die prematurely, data shows<\/a>. And on average, they live four years longer than West Virginians.<\/p>\n

There is another important difference between this former coal territory and its Appalachian counterpart: West Virginia\u2019s economic struggles have been compounded by medical debt, a burden that affects about 100 million people in the U.S. \u2014 in no state more than West Virginia.<\/p>\n

In the Saarland, medical debt is practically nonexistent. It\u2019s so rare in Germany that the federal government\u2019s statistical office doesn\u2019t even track it.<\/p>\n

The reason isn\u2019t government health care. Germany, like the U.S., has a largely private health care system that relies on private doctors and private insurers. Like Americans, many Germans enroll in a health plan through work, splitting the cost with their employer.<\/p>\n

But Germany has long done something the U.S. does not: It strictly limits how much patients have to pay out of their own pockets for a trip to the doctor, the hospital or the pharmacy.<\/p>\n

Rolshoven\u2019s patients pay nothing when they see him. That not only bolsters their health, he said. It helps maintain what Rolshoven called social peace. \u201cIt\u2019s really important not to have to worry about these problems,\u201d he said.<\/p>\n

German health officials, business leaders and economists say the access to affordable health care has also helped the Saarland get back on its feet economically, bolstered by the assurance that workers could get to the doctor.<\/p>\n

\u201cWithout this, the Saarland would be dead,\u201d said Beatrice Zeiger, managing director of the Arbeitskammer des Saarlandes, a regional labor group. \u201cIt\u2019s unthinkable.\u201d<\/p>\n

Exploding Out-of-Pocket Costs<\/strong><\/p>\n

In West Virginia, whose wooded valleys and decaying industrial plants could be mistaken for the Saarland\u2019s, access to health coverage has been important as the state weathered the decline of its mines.<\/p>\n

A decade ago, state leaders moved to expand the Medicaid insurance program through the Affordable Care Act. And as of last year, just 6% of state residents were uninsured, less than half the rate<\/a> before the 2010 law.<\/p>\n

But growing numbers of West Virginians without government insurance are in private health plans with deductibles that require they pay thousands of dollars out of their own pockets before coverage kicks in.<\/p>\n

The typical individual health plan<\/a> an American gets through work now comes with a more than $1,500 deductible, a particularly big sum in a state like West Virginia where residents often earn less than residents of other states.<\/p>\n

That, in turn, is driving medical debt. A quarter of West Virginians with a credit report have medical bills in collections, almost twice the national rate, according to data<\/a> compiled by the nonprofit Urban Institute. In several counties in the state, the rate is about a third.<\/p>\n

And those figures likely understate the problem. Many more people<\/a> put medical bills on their credit cards, borrow from family or enroll in installment plans with a hospital or other providers to pay off their bills.<\/p>\n

\u201cIt\u2019s a huge problem here,\u201d said Jessica Ice, executive director of West Virginians for Affordable Health Care. \u201cFolks with medical debt aren\u2019t able to apply for loans to start a business or buy a starter home for their family. It\u2019s really preventing people from climbing up the economic ladder.\u201d<\/p>\n

In German health plans, known as sickness funds, there aren\u2019t typically deductibles.<\/p>\n

Physician visits are almost always free for patients. Copays for most prescription drugs are capped at 10 euros or less, about $10. And people admitted to the hospital pay only 10 euros a day.<\/p>\n

\u201cAccess to medical care with minimal costs for patients has been essential,\u201d said Armin Beck, regional director of the Knappschaft Bahn See, of KBS, a health insurance plan whose roots stretch back to the 13th century, when miners set up a mutual aid society to protect one another in case of injuries or accidents. \u201cThis has been a foundation of our community,\u201d Beck said.<\/p>\n

\u2018So Glad We Don\u2019t Have to Worry\u2019<\/strong><\/p>\n

Along the Saar River in Germany, rusting steelworks and shuttered coal-fired power plants bear testament to the region\u2019s economic struggles. Many towns like P\u00fcttlingen carry on in the shadow of hulking mounds of debris \u2014 Berghalde, as they are called \u2014 the detritus left behind as coal was separated from the rocky earth hauled up from underground.<\/p>\n

Today, new challenges confront the region. Ford, which has operated a car factory here for decades, plans to shutter the plant in a few years and move production to Spain.<\/p>\n

But at Rolshoven\u2019s clinic \u2014 a small set of offices tucked into a residential neighborhood \u2014 few patients can conceive of the burdens that medical bills put on Americans.<\/p>\n

Andrea Fecht, 63, who has diabetes and came to see Rolshoven because recent tests revealed a concerning rise in her blood sugar, estimated she pays 120 euros a year, or about $125, to fill all six of her prescriptions, including her daily insulin.<\/p>\n

In the U.S., the average price for insulin alone is nine times that in Germany, according to a recent report<\/a> from Rand Corp., a research group.<\/p>\n

Andreas Mang, a former miner who left the industry 20 years ago after a series of accidents, would likely pay even more out-of-pocket for his family\u2019s drugs. Mang\u2019s wife recently underwent a course of chemotherapy that would cost thousands of dollars if not for Germany\u2019s limits on medical bills, Rolshoven said.<\/p>\n

\u201cI can\u2019t imagine what it would be like not to have this support,\u201d Mang said.<\/p>\n

Christine Wagner said she\u2019s had a glimpse of what Americans face. Wagner\u2019s 18-year-old son, Jonas, has Down syndrome and has required more than 20 surgeries.<\/p>\n

In global Facebook groups with other parents who have children with disabilities, Wagner said she\u2019s amazed to see how much fundraising American parents do to pay family medical bills. \u201cI\u2019m so glad we don\u2019t have to worry about that,\u201d she said. \u201cWe have enough to do looking after Jonas.\u201d<\/p>\n

American Exceptionalism<\/strong><\/p>\n

International surveys underscore the difference Wagner observed between her experiences and those of American families.<\/p>\n

In one recent study<\/a> of health care in 11 high-income countries, the nonprofit Commonwealth Fund found that 44% of Americans had out-of-pocket medical expenses that topped $1,000 in the previous year. Just 16% of Germans reported paying that much. The rates were even lower in France, at 10%, and Great Britain, where only 7% reported similar medical expenses.<\/p>\n

U.S. patients were also more than twice as likely as patients in any of the 10 other countries studied to say they had serious problems paying medical bills.<\/p>\n

\n\tLoading\u2026\n<\/p>\n

\u201cMany Americans may not understand how affordable health care is for patients in other countries,\u201d said Reginald D. Williams II, who oversees international research at the Commonwealth Fund. \u201cMedical debt is a largely U.S. phenomenon. It just doesn\u2019t happen in other countries.\u201d<\/p>\n

Most wealthy countries in Western Europe, East Asia and elsewhere limit patients\u2019 out-of-pocket costs.<\/p>\n

In the Netherlands, where patients enroll in private health plans as they do in Germany, insurers typically cover all medical expenses after patients pay a standard deductible of 385 euros, or about $400. Physician visits are fully covered.<\/p>\n

In Great Britain, where medical care that is \u201cfree at the point of service\u201d has been a foundation of that country\u2019s government-run National Health Service for almost 75 years, there are rarely any doctor or hospital bills.\u00a0<\/p>\n

When the government asked Britons<\/a> who\u2019d gone into debt about the causes, just 2% cited paying for medical treatment. A similar share attributed their debt to gambling or another habit.<\/p>\n

In the U.S., 41% of adults currently have debt from medical or dental bills, according to a KFF poll<\/a>.<\/p>\n

An Economic Backstop<\/strong><\/p>\n

Germany\u2019s strict limits on medical bills have periodically stoked concerns about patients overusing the health system.<\/p>\n

But when health plans tried implementing a copay of 10 euros for physician visits, it was quickly rolled back amid criticism from patients and frustration among doctors, who didn\u2019t like chasing after their patients for bills.<\/p>\n

At the hospital in P\u00fcttlingen, which is operated by the Knappschaft, Dr. Marion Bolte said asking patients to pay more isn\u2019t worth the risk, even if it might bring in more money.<\/p>\n

\u201cIt\u2019s better to have 20 unnecessary visits than to have one patient get harmed because they didn\u2019t come to the hospital because they were worried about how much it would cost,\u201d said Bolte, the chief medical officer. \u201cWe don\u2019t want patients to worry about money. We want them to worry about getting better.\u201d<\/p>\n

Nationally, German patients are less likely than Americans to die from conditions that can be treated with good access to medical care, such as heart attacks, diabetes, pneumonia and some cancers, according to regional data<\/a> compiled by the Paris-based Organization for Economic Cooperation and Development.<\/p>\n

Germans are also less likely than Americans to say they had to wait to see a doctor, surveys show<\/a>.<\/p>\n

Lower-cost health care that protects workers from going into debt has meant fewer concerns for the Saarland\u2019s policymakers, as well. \u201cAll that our predecessors had to worry about was creating jobs,\u201d said Oliver Groll, a senior official at IHK Saarland, the regional chamber of commerce. \u201cHealth care took care of itself.\u201d<\/p>\n

As mining jobs disappeared, the Saarland shifted toward other industries, such as auto manufacturing, which has been a major employer since Ford opened its factory in 1970, sparking the development of a robust auto parts sector. The chamber and other business leaders are now working to lure technology and pharmaceutical jobs to the region.<\/p>\n

For Mang, the former miner whose wife had cancer, knowing that medical bills wouldn\u2019t drive him into debt helped give him the peace of mind to switch careers. \u201cI never had to think about how much health care would cost me,\u201d said Mang, who is now a nurse.<\/p>\n

Maintaining this system has required that Germany do something else that U.S. policymakers have historically eschewed. Germany, like most wealthy nations, regulates the prices that hospitals, doctors and drugmakers can charge. This regulation occurs through a highly structured system in which insurers negotiate collectively with physician and hospital groups to set prices.<\/p>\n

American hospitals and other medical providers for decades have fiercely resisted limits on their prices, spending millions to fight government regulation.<\/p>\n

Price regulation can put more financial pressure on providers, who, unlike their American counterparts, can\u2019t just demand higher prices from insurers to bolster their bottom lines.<\/p>\n

Mario Sch\u00fcller, the hospital administrator who runs the Knappschaft hospital in P\u00fcttlingen, said hospitals must instead compete to attract patients with better care and better customer service. Those that can\u2019t compete may close, he said.<\/p>\n

But Sch\u00fcller said he wouldn\u2019t want to charge patients more, even if he could.<\/p>\n

\u201cIf I had to bill patients and then try to collect from them, I\u2019d have to pay for all that,\u201d he said. \u201cWe\u2019d need new staff, who would have to get paid. And if we used collections companies, they\u2019d have to be paid, too. It becomes a devil\u2019s bargain.\u201d<\/p>\n

About This Project<\/h4>\n
\u201cDiagnosis: Debt\u201d is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.<\/p>\n
The series draws on the \u201c KFF Health Care Debt Survey<\/a>,\u201d a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.<\/p>\n
Additional research was conducted by the Urban Institute<\/a>, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.<\/p>\n
The JPMorgan Chase Institute analyzed records<\/a> from a sampling of Chase credit card holders to look at how customers\u2019 balances may be affected by major medical expenses.<\/p>\n
Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.<\/p>\n
KHN<\/a> (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF<\/a> (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.<\/p>\n
USE OUR CONTENT<\/h3>\n
This story can be republished for free (details<\/a>).<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
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