A healthcare system is a combination of social, cultural and political factors relating to

health and illness is addressed within a society. In the United States, the elements of the
healthcare system that fit into the traditional Western establishment tend to be emphasised but in
reality healthcare systems are made up of more than just hospitals, insurance and pharmaceutical
companies and patients. They also include the perceptions, traditions, and social norms related to
health and illness. Healthcare systems are cultural systems as much as political or economic ones
and they include both formal and informal medicine.
Some of the most important aspects of a healthcare system are the public perceptions and
cultural norms relating to the way in which health is perceived. Cultural conventions determine
the framework through which different illnesses are viewed and this has a significant impact on
even the more formal elements of the healthcare process. For example the treatment of mental
illness in the United States is not emphasised in the same way that treatment of physical illness is
because of social perceptions and a culture of stigmatization. The types of treatments that are
considered valid and are therefore more likely to be covered by the health system are also
culturally variable. Practices like herbal remedies, acupuncture, astrology are seen as valid in
some cultures but not in others. The way the formal healthcare system is paid for and structured
relies on the social values of the country in question. In many countries national ideals like
equality and solidarity promote systems with more equal access to care.
The most fundamental difference between the German healthcare system and our own is
the assumption in German society that healthcare is a universal right and should be provided to
people whether or not they are capable of affording it. While 50 million Americans had no health
insurance in 2010, residents of Germany are fully covered regardless of their employers or their

ability to pay (p.75, p.245). The German system provides a much wider range of services
including dental and mental health services, chiropractic medicine and health club memberships.
The quality of medical care in Germany is comparable to if not better than that in United States
but with shorter waiting times (p.67).
The current healthcare system in Germany is the Bismarck model which was originally
developed by Chancellor Otto von Bismarck in 1883 . Under the Bismarck model a number of
different insurance companies (referred to in Germany as krankenkassen or sickness funds)
compete with each other to provide services. The sickness funds are nonprofit and paid into by
both employees and their employers (p.66). In addition this deduction, Germans now pay a
copay of roughly 13 dollars each quarter (p.77). Americans who receive health insurance through
their employers rely on the Bismarck system too but unlike in the United States, Germans never
lose access to their health insurance if they are unemployed because the government covers the
difference. Insured Americans also pay significantly more for healthcare with both much higher
copays and health insurance premiums (p.75).
German sickness funds operate very differently from their American counterparts in a
number of ways. Built into the German Bismarck system is guaranteed issue, which requires
the sickness funds to cover everybody (p.38). The policy of guaranteed issue prevents many of
the problems that are an inherent part of the healthcare system in the United States. For a
developed country the United States in ranked very poorly in regard to equal access to care and
there is a huge discrepancy in the availability of care between the wealthy and young people,
people of color, the unemployed and the poor (p.21,p.23). Until recently American insurance
companies could deny coverage based on pre-existing conditions or could accept a customer's

insurance payments over a period of time only to cancel coverage when that person actually got
sick. Although the 2010 Obamacare law made these practices illegal it still did not make
healthcare equitable or universally accessible (p.247-249).
One of the primary differences between the healthcare system in the United States and
most wealthy industrial nations is the individual mandate. In order for guaranteed issue to
really be feasible the individual mandate, which requires everybody to participate in the
insurance pool, must be in place. This enables the healthy to pay for the sick and makes the
entire system sustainable (p.38, p.39). In Germany the majority of the population is required to
buy health insurance and while the wealthiest segment of the population is exempt, over 90
percent pay into the sickness funds (p.77).
Although the healthcare system in Germany is moderately expensive by European
standards, costing 11 percent of the GDP, it is still fairly reasonable when compared to the 17
percent that the United States spends for much more limited services (p. 68). Healthcare in the
United States is so expensive for a number of reasons, but it is primarily because of the multitude
of different systems that we rely on and the immense administrative costs of private insurance.
Most Americans rely on private insurance companies, but others are covered by Medicare or
Medicaid, or have no access to health insurance and pay out-of-pocket (p. 20). The fact that
different Americans rely on different systems complicates the billing process, as private
insurance and government run institutions all operate and pay differently (p.42-44).
Within health insurance companies themselves the administrative cost is very high.
Health insurance companies are for profit they require a budget for marketing and for
administrative costs which makes them much less efficient than the non profit companies in

Germany. The administrative costs acceptable for health insurance companies in the United
States was just limited to 20 percent by the 2010 healthcare reform law, but compared to public
programs like Medicare with an administrative cost of only 3 percent, insurance companies are
still very inefficient (p. 37,p.38).
One of the ways in which Germany saves money on healthcare spending is through the
use of several record keeping technologies including the Gebhrenordnung fr rzte (GO) and
the digital health card. The GO is a national online directory which lists the acceptable
treatments for various ailments and the established price of every procedure and transaction. The
prices listed in the GO are a result of negotiations between the sickness funds and the hospitals
and clinics. In 2008 Germany introduce their digital health card, similar to Frances carte vitale
which has a record of each patient's medical history eliminating much of the paperwork inherent
to the healthcare process (p.68, p.69).
Although the German healthcare system presents many advantages, it still has its
shortcomings. Doctors are especially dissatisfied with certain aspects of the German model.
German doctors do not have as much freedom to decide which treatments are appropriate and
they are paid considerably less than American doctors. While those in healthcare professions
typically support more hospital funding and higher salaries, many Germans believe that their
health care system is already too expensive. Healthcare reform is a frequent topic of discussion
in German politics and adjustments have been made in recent years (p.78-80).
Despite its flaws the German healthcare system seems preferable in most ways to the
American system. Although American doctors are paid considerably more and the quality of care
can be as good as anywhere in the world for those who can afford it, the inefficiency and

inequality present in the American model prevents it from being truly effective on a national
level. Even though American healthcare is the most expensive in the world many Americans pay
out-of-pocket or lack access to basic care altogether.