To be eligible for the Pre-Existing Condition Insurance Plan,
You must be a citizen or national of the United States or reside in the U.S. legally.You must have been without health coverage for at least the last six months. Please note that if you currently have insurance coverage that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan. You must have a pre-existing condition or have been denied coverage because of your health condition.

I’m 59 & pay $426 a month to be in PCIP.

 ”if you ever have need to see or interfere in the underlying machinery you may well run the risk of being ground up in it”

Quoted for truth. But, I do appreciate that for the vast majority of my German friends, it is a smooth, invisible care-taking, and that the system is leagues ahead of, say, the USian system.

Do I think its wrong that just anyone can rock up at a hospital and get treatemnt, even if theyve never had a job, been in the country ten minutes, or is an ilegal immigrant?

Yup.

But I would far rather that than this hideous situation where if you havent got the money, well, sorry bout that, but can you please just piss of and die quietly..

Surely keeping the populace healthy and able to work and contribute in all the myriad ways that people do to a society is cheaper in the long run than letting these money grubbing corporations bleed us all dry by making profit from healthcare….

Universal healthcare covers more people with better outcomes at lower cost everywhere else. In fact with government health care programs the overhead is down to a couple of percent -as opposed to 10-25% for the insurance companies and their phalanx of people who do nothing but find reasons to deny care. 

But facts don’t matter to right wingers anymore. If Romney gets elected and (heaven forbid) Republicans keep the house and take the Senate, we’re in for decades and decades of ever declining health care. Not to mention all the other misguided ideological evils that will ensue -and Americans will have brought it all on themselves.

Pre-existing condition. Coverage declined.

It’s just not designed for people with Unusual Life Choices.

It’s not a one-size-fits-all system. Far from it, it’s very flexible and accomodating,  but the flexibility and accomodation is based on a few factors which just really really don’t work for modern  ‘guns-for-hire’. Or for ex-pats.  Or for anyboday who might decide they want to do something different at an age above about 25. The whole concept of ‘I’ve done dozens of different jobs in my life’ that seems to be the stock-in-trade of many Americans would both horrify most Germans and confuse this system hopelessly.

It basically recognizes only a limited number of life scenarios, and if you wind up outside of these, your seen as on yer own, matey:

a) You have a job as a normal employee in a recognized industry. Everything’s hunky-dory. Your employer pays a contibution toward your health insurance. Nothing to worry about. The system works as designed. Even if you’re made unemployed.

b) You are self-employed as a member of a recognized trade (say, a plumber) or member of a recognized caucus (farmers, for instance). Note that for most of these, you can’t just turn up and pay membership dues- there’s usually an apprenticeship or practical eduction scheme involved at some point. The system is very much geared towards a job-or-trade-for-life model. You start an apprenticeship at 16 or 18 and work your way through and up (there’s even provision for you to upgrade to degrees in engineering and agronomy, for instance, via technical colleges). But there is more-or-less zero provision for somebody turning up at age 45 and saying they’d like to join the club.

c) You are self-employed in a high-income profession (Law and/or Medicine, for instance) or a company owner, and thus judged by default wealthy enough to afford the private health insurance you are obliged by law to have if your income exceeds a certain threshold.  The system changes in this case. You have to pay up front for your medical treatment, and get reimbursed. Insurance isn’t cheap. 

d) You’re a pensioner. The state pension pays your employer contributions towards health insurance. Everything works out OK, too.

e) You receive some sort of payment from the myriad possible sources that indicate you are unable to work due to ill health (from an industrial accident, for example). Whoever is providing the payment probably also pays  your health insurance coverage in the same insurance you were in before you got ill.

f) You fall into one of the recognized categories of charitable wackiness that already existed in early postwar Germany, and more-or-less date back to various charitable orgnizations from the Empire or Weimar. Basically, special provisions are made for trades (like journalists, freelance writers, merchant seamen and itenerant showmen)  with highly irregular incomes, as well as artists (and artistes) of various stripes.

g) You’re completely destitute- social services pay your health insurance. Except in some very odd scenarios. Most of which admittedly require a great deal of fault on your part to get into. However, once in, you can be more-or-less screwed.

The system causes any number of severely bonkers problems for people who manage to fall through the cracks. As a German national who hasn’t lived and worked abroad for any time you have to really, wilfully, work at it, but you can, and the results are deeply unpretty. I’ve seen it once in the case of the alocholic husband of a relative, who managed to get himself expelled from his trade health insurance for non-payment of dues. Resulted in his wife being unable to go to the doctor for a while, except for cash payment.

The other way to do it is to try something entrepreneurial, make lots of money for a short time, and then screw up. Bankrupt your one-man company, fail to pay your employer’s contributions to healthcare, or your private medical, and things get very messy very fast.

 The basic private health insurance (which they’re now luckily _obliged by law_ to sell you independently of status) if you can’t wind up in a normal employee’s health insurance because you’re  over the income threshold or self-employed, is around €600 per month. The problem is that the income threshold is retroactive, so if you have a fat year, you may be forced for quite some time, possibly forevermore,  to pay private even if your income isn’t very high now.

The other place it has severe problems is Furriners of all shades. Specifically, ones like glittertrash who aren’t really part of the German system from youth, and not from the EU (where lots of mutual agreements kick in for short term visitors) and aren’t in regular employment. 

And that tends to include any Gernan nationals daft enough to have left the embrace of the Fatherland and then demonstrate the temerity to return sufficiently far in the future without their fortune made….getting back in to health insurance if you’re not an employee (or wealthy enough to afford private) can be next to impossible as most of the obligations to take anyone who’s still warm expire for health insurers in the case of ex-pats.

Oh, and ‘downshifting’- really really bad idea in Germany- screws up your state pension provisions. The pension state calculation heavily favours people with both long years of service and very high incomes near the end of their career. If you quit and do a low-income job for a few years you can actually wind up with less pension than if you’d stayed unemployed….

Let’s not even get started with the the weird banding in progressive taxation which means you can have a literal take-home pay cut by being paid more….

So the system is not nearly as perfect as some would make out. It works, invisibly most of the time, for the ordinary citizen. But if you ever have need to see or interfere in the underlying machinery you may well run the risk of being ground up in it.

On the very significant up-side of that, however, is the fact that actual health care costs are shockingly cheap here. Like I said, I pay the entire cost of all doctor visits & medications out of pocket. It costs 10-30€ to go to the doctor, 20€ for a prescription, and when I had a major wisdom tooth infection a few weeks back, the entire experience (antibiotics, x-rays, 5 dental visits in one week) cost me less than 150€. This is not being subsidised by my insurer, who wanted nothing to do with this- this is actually how much it costs. That is astonishingly, astoundingly cheap compared to Australia or the US (once you disregard the additional, next-to-useless 300€ a month I am required to pay to my insurer). So the market here is getting something right.

‘Jesus’, in this case, being Jesus Rodriguez, the 26lb boy from whom the 33lb tumour was removed.

/Disgusting pedant