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Obamacare through European eyes

It’s been about a year since the United States fully implemented the Affordable Care Act – called by friends and foes “Obamacare.” It’s been about a year since curiosity rose in Europe about the highly contested milestone reform, and since my editors got hungrier by the day for stories about healthcare in America.

Katja Ridderbusch

Katja Ridderbusch

And it’s been about a year since people started calling me a socialist – neighbors, interviewees, even friends who are working in the health care arena. Sometimes with a wink, sometimes dead serious.  For one, because I think that Obamacare, overall, is a step in the right direction. But mostly because I happen to be from Europe — Germany to be precise–and that’s where, in the minds of many Americans, the somewhat subversive ideas that inspired the ACA are harbored.

At first glance, there’s some truth in this. It seems like the Affordable Care Act has pushed America a tad closer to Europe, a baby step. Mostly because there is an insurance mandate in place in the U.S. now, which is also the case in most European countries. Also, because insurance companies can no longer deny coverage based on pre-existing conditions, and parents are allowed to insure their kids under their plan until age 26.

And that’s where the similarities end. The most obvious difference, no doubt, is that for the American population between the ages of 18 and 65, which makes up the majority of the workforce, health insurance still is, by and large, based on private, for-profit coverage. In most European countries, health care is largely a not-for-profit endeavor, and is therefore regulated, organized and subsidized by the government.

Also, there is no such thing as a uniform European health care system, as each country has its own, and most of them vary considerably.  It’s somewhat ironic that Britain – which of all European nations is considered politically, economically and culturally closest to the United States – has the only “socialized” health care system in the Old World that truly deserves the name: the National Health Service.  In my native Germany, health care is more market oriented, and patients for the most part have the choice of insurance, doctors, hospitals, and treatments.

Spreading the risk is one of the principles that German health care was established upon 131 years ago. Federal law requires all Germans to have health insurance, but does not provide coverage directly. About 85 percent of the population purchase non-profit insurance called statutory health insurance. Premiums are based on the individual’s income. A person pays roughly 8 percent of their gross income into the insurance, while the employer contributes about the same amount.

Private insurance is bought by 10 percent of the population, mostly civil servants and self-employed. The private insurance market is also regulated, but is more flexible, more expensive and offers better elective services, like a single hospital room, or faster treatment by a leading physician. The remaining 5 percent fall under specialty insurance programs.

All insurance in Germany covers comprehensive medical care. Health care spending in Germany accounts for 11 percent of the GDP. In the U.S., it’s 17 percent. Less than 1 percent  of the German population has no health insurance at all; compared with 13.4 percent in the U.S., almost a year after the ACA went into effect – which is the lowest the uninsured rate has been since 2008.


Insurance and job are separated


Another difference: in Germany, health insurance and employment are, for the most part, de-coupled. While the ACA tries to fill that gap now, the majority of Americans still receive health insurance through their employer. When they leave or lose their job, they often lose insurance. In Germany, individuals can keep their insurance when they switch jobs, take it to the next employer, who will then continue to pay the mandated share, or pay the full premiums themselves. In case of unemployment, a government agency will jump in and subsidize the payments.

Munich, Germany

Munich, Germany

While certainly not socialized, the German health care system is heavily regulated, especially when it comes to doctors’ and hospital fees, as well as drug prices. Also, there are caps on the number of physicians who are licensed to practice in a certain geographical area. A doctor in Miami once explained to me that in America, you may have a hundred plastic surgeons and no family physician within a 30 mile or so radius – just as long as the market supports it. No chance for that to happen in Germany.

Here lies, I’m convinced, the deepest ideological divide between the European and American approach to health care: How freedom is defined. While Americans often feel that government intervention restrains their freedom, Europeans, by contrast, expect governments to secure freedom for their citizens. Many Americans therefore perceive a health insurance mandate as a constraint on their personal freedom, even though accidents and illness make up the largest share of personal bankruptcies in the U.S. Most Europeans, on the other hand, view mandatory insurance as peace of mind, providing the freedom of not having to worry about exploding medical costs and instead, being able to focus on whatever they consider important in their lives.

Finally, it’s not only that the U.S. has come a tiny bit closer to Europe in the field of health care, but also that Germany’s health care system has become more “Americanized”, albeit involuntarily.  While the United States has the best-trained doctors and most advanced medical technology on the globe, the problem is that access to this world-class medical care is limited to those who can afford it. It’s interestingly enough that Germany, of all places, having been described a role model for “equal access” quality medical care, has come under growing scrutiny for developing exactly what “Obamacare” is trying to fix: a two-class health care system.

In recent years, more and more Germans with statutory health insurance have been seeking treatment in the country’s emergency rooms for problems that don’t require emergency care. They have health insurance, but doctors’ offices are swamped, and it takes those patients up to three months to get an appointment, with a specialist in particular. For patients with private insurance, it’s a different story, because they have proven to be more profitable for doctors. All this happens as health care costs in Germany are on the rise, and out-of-pocket payments for all patients have doubled in the past 20 years.

Maybe neither socialism nor capitalism is to blame. And maybe organizing health care and making it widely accessible is just an extremely complex and, at times, incredibly messy business, that requires continuing review, tinkering and sometimes, substantial change.


Katja Ridderbusch is an Atlanta-based senior foreign correspondent for German news media, including daily nationals Die Welt and Der Tagesspiegel, as well as Spiegel online. She frequently reports about health care in the U.S.


An important time for people on Medicare

Fall is a wonderful time of year. Changing leaves. Cooler weather. It’s also the season for people with Medicare to review their current Medicare coverage, as Medicare Open Enrollment begins.

Marilyn Tavenner

Marilyn Tavenner

As we prepare for Medicare Open Enrollment, which began on Oct. 15 and ends on Dec. 7, Medicare wants everyone to know that quality continues to improve both in Medicare Advantage and in the Part D Prescription Drug Program.

Each year, plan costs and coverage can change.

During open enrollment, seniors and people with disabilities across the country have the opportunity to review their current Medicare coverage and see if they want to make any changes for the next year. It’s important for people with Medicare to take the time to make sure their current situation still meets their health care needs best.

To help people choose a plan, Medicare calculates “star ratings” for Medicare health and prescription drug plans. Each plan gets a number of stars on a scale of 1 to 5 — with 5 being the best — based on quality and performance. These ratings are designed to help people with Medicare, their families, and caregivers compare plans, in addition to information on their premiums and benefits.

This year, people with Medicare who choose to enroll in a Medicare health or prescription drug plan will have access to more high-rated, four- and five-star plans than ever before. Approximately 60 percent of Medicare Advantage enrollees are in a Medicare Advantage Plan earning four or more stars in 2015, compared to an estimated 17 percent back in 2009. Likewise, about 53 percent of Part D enrollees are currently enrolled in stand-alone prescription drug plans with four or more stars for 2015, compared to just 16 percent in 2009.

Since the passage of the Affordable Care Act, enrollment in Medicare Advantage will increase 42 percent to an all-time high of over 16 million, and Medicare Advantage premiums will have decreased by 6 percent.

For people with Medicare, this is good news in how they receive care. Plans that are higher rated deliver a high level of care, such as improving the coordination of care, managing diabetes or other chronic conditions more efficiently, screening for and preventing illnesses, making sure people get much-needed prescription drugs, or getting appointments and care quickly. A high rating also means these plans give better customer service, with fewer complaints or long waits for care.

If you have Medicare and need assistance, you can visit, call 1-800-MEDICARE (1-800-633-4227), or contact your State Health Insurance Assistance Program (In this state, it’s GeorgiaCares, whose phone number is 866-552-4464, option #4).

You should have received the 2015 “Medicare & You” Handbook and important notices from your current plan, Medicare, or Social Security about changes to your coverage. If you’re satisfied with your current coverage, there’s nothing you need to do.

Better quality in Medicare health and prescription drug plans isn’t the only good news for people with Medicare. For most seniors who have Original Medicare, the 2015 Part B premium will stay unchanged for a second consecutive year at $104.90. This means more of seniors’ retirement income and any increase in Social Security benefits will stay in their pockets. The Part B deductible will stay the same as well.

Medicare is working hard to make sure this good news continues so that seniors and people with disabilities will continue to get the health care coverage they deserve.


Marilyn Tavenner is administrator of the Centers for Medicare & Medicaid Services.

Georgia’s health is bad and getting worse

Dr Harry Heiman

Dr. Harry Heiman

By every measure, Georgia is failing to meet the health and health care needs of its citizens. Not only are our health outcomes poor, they are declining relative to the rest of the country. Despite political rhetoric that lauds the health and prosperity of our state, objective data tell a very different story. Through a health lens, our state is going from bad to worse, a trend that will continue without a change in course.

Georgia ranked 45th out of 50 states and the District of Columbia in the Commonwealth Fund’s 2014 state health rankings, down from 36th in the fund’s 2009 report across dimensions ranging from access and affordability to healthy lives and equity. Today, Georgia has the third-highest rate of uninsured persons in the country.

We are among the worst states in the country for low birth-weight babies, obesity and diabetes, and both racial/ethnic and rural disparities in health status. These are not trends that align with health and prosperity.

Despite compelling data that Medicaid expansion would improve access to care for low-income Georgians, grow jobs, and support rural hospitals and the communities they serve, our state Legislature has chosen inaction. Actually, worse than inaction, they passed two bills that created additional barriers to access to health care for low-income Georgians — a glaring example of failed state leadership.

But health is much more than health care.

Socioeconomic status, level of education, and the social and environmental context in which people live, learn, work, and play are now understood to be the strongest drivers of health. Unfortunately, we are failing here as well.

Almost 1 in 5 Georgians lives at or below the poverty level, a number that is higher for rural Georgians and children, where it is more than 1 in 4. Georgia’s unemployment rate is the highest in the country, even surpassing Mississippi. Our high school graduation rate ranks 45th in the country. We recently received a grade of “F” for food insecurity and food deserts — communities without affordable access to healthy foods.

These are not statistics that reflect prosperity or conditions that support good health. These are statistics reflecting conditions that predictably lead to worse health.

Through the lens of health and prosperity, our state leadership is failing, and all Georgians, but especially the most vulnerable Georgians, are paying the price. State leadership that fails to adequately prioritize and fund education, fails to adequately manage and staff food assistance programs (jeopardizing federal funding) and child protective services (jeopardizing the welfare of our most vulnerable children), and fails to take action to provide affordable access to health care for low-income Georgians, is not the leadership we need.

Georgia needs and deserves leadership and a proactive policy agenda that is truly aligned with the health and prosperity of our state. Georgia needs leaders who are prepared to take action to both ensure access to affordable, quality health care for all Georgians and to align policies across all sectors that advance the health and prosperity of our state. The status quo is unacceptable. Rhetoric in the face of failing policies and failing metrics is no longer acceptable. Our children, our communities and our state deserve better.


Harry J. Heiman, MD, MPH, is director of health policy for the Satcher Health Leadership Institute at the Morehouse School of Medicine. He is active in Georgians for a Healthy Future and the Georgia Academy of Family Physicians.

Why legalize cannabis oil in Georgia? So children can live

State. Rep. Allen Peake

Rep. Allen Peake

As the clock approached midnight on March 20, the final night of the 2014 Georgia legislative session, it became apparent that a final vote to send a medical cannabis oil bill to the governor’s desk for his signature was not going to happen this year.

So I decided to avoid the usual “Sine Die” celebration in the House chamber because I knew I needed to be in the Senate gallery with the families that fought so courageously for the bill. The mood was obviously somber among the parents, some of whom had brought their children with them, hoping to watch as history was made. The families were crushed and defeated, feeling that the Legislature had failed them. And I shared their frustration.

The feeling of despair that evening was not from anger at the process failing. Instead, we were all aware of the terrifying thought that some of the children that the bill was intended to help would not survive until the start of the next legislative session in January 2015, when we could try again to legalize medical cannabis oil. A Georgia child, or maybe several, would die because they didn’t have access to a medicine that has had life-changing positive effects on children in states where it is legal.

Which one of these families would fall victim to the nightmare of every parent who has a child suffering from a seizure disorder – the one final seizure that takes that precious loved one from this earth? That was my fear that night.

Well, now we know which child. His name was Abe. He was the 6-year-old son of Mike and Kelli Hopkins, who live in Covington. In July, he died as a result of a seizure.

His parents had come to the Capitol last session to beg legislators to pass HB 885, the medical cannabis bill. They are some of the most courageous parents I have ever met. They had three special-needs children, and one healthy daughter. The Hopkins family didn’t have the option of moving to another state to obtain cannabis oil for Abe. The logistics, finances and travel challenges were too great. Therefore, they pinned their hopes on Georgia enacting a law that would allow them to give their child this life-changing oil.

Rep. Allen Peake with the Hopkins family.

Rep. Allen Peake with the Hopkins family.

This strain of cannabis being proposed for medical use here has elevated levels of CBD but is low in THC (the psychoactive component in marijuana). It has been drastically reducing seizures for kids in Colorado and other states where cannabis oil is legal. This particular cannabis oil cannot make their child “high.” CBD can only help reduce or even eliminate seizures.

But they couldn’t obtain this particular strain of cannabis in Georgia. So the Hopkins family worked to help pass the bill, and when it failed, they prayed that Abe would not have that final, fatal seizure before the next session in January 2015. Tragically, he did.

So now we are left to wonder: How many more children won’t make it until next year? How many more funerals will those fighting for this cause have to attend? How many more parents will have to bury their child as a result of a seizure?

Over the next several weeks, the Medical Cannabis Study Committee will be holding meetings all over the state to hear from families, law enforcement, the medical community and medical cannabis experts about why and how to draft legislation in 2015 to legalize medical cannabis in Georgia. You can find out more at the Facebook page “Georgia Medical Cannabis Study Committee,” or call my office. We want to hear from citizens regarding this issue.

My colleagues – Democrat and Republican, black and white, liberal and conservative – support this legislation and are committed to passing a good bill that works in Georgia. And Gov. Nathan Deal has taken the leadership role to find a solution within current state and federal law through clinical trials at Georgia Regents University. This effort is about helping citizens in our state, giving hope to families, and offering relief to those who are suffering.

Many people have taken bold stances to fight for this cause, and I couldn’t be more proud to stand with them. House Speaker David Ralston has become a passionate supporter of finding a solution for Georgia families. The momentum is there. We just need the wisdom to find the right solution, one that really does work for Georgia. We owe that to our citizens.

We owe that to Mike and Kelli Hopkins. We owe that to Abe. To honor him, and the memory of his short life.

We cannot move fast enough.


Rep. Allen Peake represents the citizens of District 141, which includes portions of Bibb and Monroe counties. He was elected to the Georgia House of Representatives in 2006, and currently serves as the secretary and treasurer of the House Majority Caucus, as vice chairman of the Ways & Means Committee, and the Ex-Officio of the Appropriations Committee. He also serves on the Health & Human Services, Rules, and Small Business Development committees.


To help struggling hospitals, replace Georgia’s malpractice system

Wayne Oliver

Wayne Oliver

A panel of health care and political leaders appointed by Gov. Nathan Deal kicked off its work this summer to address the ongoing crisis in rural medical care. Its focus: the very survival of hospitals outside metropolitan communities through the state.

The Rural Hospitalization Stabilization Committee is holding hearings to identify potential solutions to keep open the doors of these struggling hospitals – from Eastman to Royston, from Byron to Hiawassee, among many others.

Four rural Georgia hospitals have closed in the past two years. They include Lower Oconee Community Hospital, which suspended operations for a second time in late June – sending emergency patients 30 minutes away for care.

Under the Affordable Care Act (Obamacare), the federal government is about to cut a little-known government subsidy to hospitals that covers uncompensated care and Medicaid shortfalls.

Reductions under the Medicare and Medicaid Disproportionate Share Hospital (DSH) programs will reach $17.6 billion across the country by 2020. In Georgia, cuts to hospitals could total an estimated $390 million from 2016 to 2020, thereby putting many rural facilities in grave peril.

While some continue to urge the governor to expand the state’s Medicaid rolls as a solution to the hospitals’ financial challenges, there is a healthier avenue to create revenue to sustain these hospitals.

Under the proposed Patients’ Compensation System (PCS) before the General Assembly, state taxpayers could save $6.9 billion over the next decade. That state revenue could be reinvested in rural hospitals that are barely surviving and others losing these federal grants.

Under PCS, which the Legislature is expected to consider again in January 2015, no doctor or hospital would ever be sued again. As a result, health insurers (private and public plans) as well as individuals would see billions in health care savings, as doctors would no longer feel the threat of litigation and would reduce the practice of defensive medicine (doing unnecessary tests and treatments to avoid lawsuits).

The health care economics firm BioScience Valuation issued a recent report on what the PCS solution would mean for Georgia taxpayers. The economists at BioScience Valuation found savings to Medicaid at $3.1 billion and an additional $3.8 billion in savings for the state employee benefit plan over 10 years. Those funds could then be used to help ailing rural hospitals that formerly received DSH payments.

Under the PCS plan, patients who are medically injured would no longer take their cases to court. Instead, they would file claims with an administrative panel of experts who would determine if a patient had been injured by a medical treatment or procedure.

With litigation eliminated, health insurance costs are expected to drop for all of us – those with private health plans and those with government plans including Medicaid, Medicare and the state employees’ insurance program.

Since most rural hospitals serve a large population of patients on Medicaid or Medicare, the PCS solution is particularly appealing as it will provide this huge cost savings to Georgia taxpayers and big revenue that could be redirected to essential rural hospitals.

Our governor has repeatedly said that the state cannot afford to expand its Medicaid program to save these hospitals. The PCS solution may be the best way to not only reduce health care costs for all of us – bringing quick access to justice for patients who have been harmed – but also to provide a financial route to saving our state’s hospitals on the critical list.


Wayne Oliver is executive director of Patients for Fair Compensation, a nonprofit working in several states to replace the malpractice system with a no-blame, administrative system that reduces the practice of defensive medicine, increases access to justice and allows for more patient safety.

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