Ich Bin Ein Berliner: An American Attempt at Adopting the German Healthcare System

The United States is a young country. Often, we have looked to Europe when building our political, social, linguistic, and economic institutions– even if it was just to ignore them or figure out exactly what not to do (particularly when it comes to monarchies). Sometimes we swap things right round, with our politicians becoming politicians by way of their celebrity status, instead of celebrities getting on Strictly Come Dancing or I’m A Celebrity… Get Me Out of Here! by way of their political status.[1] Television is our national religion (which like it or not, is a vast improvement over other creeds such as “Queen and Country”, “God Save the Queen”, or the “Protestant Work Ethic”),[2] guns are fine, and our films have plots. Nevertheless, when it comes to infrastructure and services we are rather similar. I was readily able to acclimate to Europe without any sort of Tiresian guide. At Selwyn, I felt right at home, with nothing aged over 140 and a room with a view of young but made-to-look-old red bricks enriched by perpetual grey.

So what happened to healthcare? Why didn’t our post-war consensus governments using their nationalist momentum, might, and man-power follow similar trajectories in this respect? In the 1940s, London consulted the great American builder Robert Moses when road planning, asking, “Why don’t the Brits have great expressways and traffic congestion like the Americans in NYC?” Why didn’t Americans look to Europe, who has the finest health care institutions in the world, and become so insular? Well, it turns out, Americans have not had horse blinders on when it comes to healthcare, and the Executive Branch has defined the overwhelming failure of American healthcare relative to European models. In fact, we have had, for over 30 years, an overwhelming desire to be German. First a bit of sloppy history.

Roosevelt was the first president who seriously considered creating a nationalized health service (and could realistically do so), however, the protests of doctors (specifically the American Medical Association [AMA], afraid of the inevitable cut in the profits of doctors) was enough to drive any hope of the inclusion of such a healthcare provision into his Social Security legislation into quietude. Clement Attlee had a similar showdown with British doctors when creating the NHS, however, Attlee and the British people emerged the victor. Truman continued to create plans for national health reform and most of his proposals were realized in LBJ’s Social Security Amendments of 1965, which created Medicare and Medicaid. Medicare provides health insurance for the elderly (aged 65+) and a small select group of young people with certain disabilities and exceptional lobbying skill. Medicaid, on the other hand, helps cover the medical costs of health insurance for those with insufficient means.

As we edged closer to universal healthcare, the 1970s happened and the U.S. adopted the ethos of New Federalism, which in the words of Richard Nixon, considered “centralizing power…a bureaucratic monstrosity, cumbersome, unresponsive, ineffective”.[3]  Nixon, asked for American employers, rather than the government, to provide their employees’ health insurance in 1972. In fact, by 1974 Nixon considered creating a mandate to this effect, however a certain scandal got in the way. Then the U.S. had an awful recession, which officially ended all our Post-World War II economic expansion, and scared off Republicans (Ford refused to expand Social Security in any way) and Democrats (Carter only expanded the employer mandate in a limited way) alike.

It was not until Ronald Reagan that healthcare would be reconsidered seriously. Reagan expanded Social Security between 1982 and 1988, mandating coverage for “children and pregnant women receiving cash assistance, emergency treatment of illegal immigrants, and expanding the low-income populations that states could choose to cover.”[4] Reagan felt the U.S. was on the brink with respect to health coverage. In a statement on proposed “Catastrophic Health Insurance Legislation” Reagan considered the modern intolerable choice not to be between “liberty or death” but that of “bankruptcy [caused by soaring medical costs] or death”.[5] Reagan wasn’t far off, between 1970 and 1982, health care costs went up nearly 600%. That same year, health care costs consumed 10.5% of GNP, and the American government wasn’t even covering half its citizens! Though Reagan’s Medicare Catastrophic Coverage Act of 1988, which indeed ended in catastrophe, because, in the words of Representative Forney H. Stark of California, “We failed to explain the bill well”, only meant to cap rising costs for seniors and derelict pregnant women, his shift to the national government to provide health related mandates was momentous.

Bill Clinton, the new way candidate, the great centrist, the man that inspired Blair, did some outward introspection. He was the first president to look out the eastward facing White House window and wonder why the United States spends more than “any nation on Earth on health care and yet, insures fewer people”.[6] Clinton was ruthlessly comparative, stating, in an exchange with reporters in 1993, “every other major country with which we compete provides some basic health care to everybody, something we don’t do”,[7] and in another 1993 statement, “if you lived in any other advanced country in the world, you wouldn’t have this problem, none of these problems”.[8] What system did Clinton admire most? The English and Australian systems were well and good, but too socialist (that is, all government owned) for the likes of us. The Canadian system had its charms, but proved too ruthless a duchess, as she would require the U.S. to cancel all premiums and convert them into a tax. Again, Americans, are in the words of Simon and Garfunkel, skeptical of changes in their cages. The German system, however, was “more similar to what we’re trying to do”.[9] That is about as much official credit as we are willing to give the Bismarck Model, to which we owe an incredible debt. Clinton wanted the percentage of our income going to healthcare to be at German lows[10], he wanted to insure people indirectly through employers “as in Germany”.[11] The Affordable Care Act undoubtedly and conscientiously follows the German model, “multi-payer, compulsory, employer-based, highly regulated, and fee-for-service”.[12] On the state level, Maryland has looked to Germany, who, in 1977, regulated “how much all of the state’s hospitals can charge” and created caps on hospital spending.[13] The United States, therefore, hardly earns its reputation as wholly insular when it comes to healthcare. Yes, our system is deplorable and the situation increasingly precarious, but for those Democrats making an effort to salvage the ACA, La Nouvelle Union readers would be happy to know, that they are making a German one.

[1] Omarosa Manigault, former Apprentice villain turned former Director of Communications for the Office of Public Liaison for the White House, turned Celebrity Big Brother star, represents the phenomenon coming full circle. Joseph Campbell’s forthcoming “The Celebrity with a Thousand Channels” will indeed be on every HSPS student’s reading list next year.

[2] Rader, Rob. “Rob Rader: The Early Years” Robert Rader 1994. Print.

[3] Richard Nixon: “Address to the Nation on Domestic Programs”, August 8, 1969. The American Presidency Project.

[4] “Did President Reagan Expand Medicaid ‘Three or Four Times?’” Committee for a Responsible Federal Budget 27 August 2015.

[5] Ronald Reagan. “Statement on Proposed Catastrophic Health Insurance Legislation” 12 Feb. 1987 The American Presidency Project.

[6] Bill Clinton. “Presidential Debate at the University of Richmond” 15 Oct. 1992 The American Presidency Project.

[7] Bill Clinton. “Remarks and an Exchange with Reporters on Health Care Reform” 25 Jan. 1993 The American Presidency Project.

[8] Bill Cinton. “Remarks in Response to Letters on Health Care Reform” 16 Sept. 1993 The American Presidency Project.

[9] Bill Clinton. “Remarks and a Question-and-Answer Session with Small Business Leaders on Health Care reform” 16 Sept. 1993. The American Presidency Project.

[10] Bill Clinton. “Presidential Debate at the University of Richmond” 15 Oct. 1992 The American Presidency Project.

[11] Bill Cinton. “Remarks in Response to Letters on Health Care Reform” 16 Sept. 1993 The American Presidency Project.

[12] Khazan, Olga. “What American Healthcare Can Learn From Germany” 8 April 2014 The Atlantic.

[13] Ibid.