Don’t Make Me Sick

For my second full week back in the United States, I got to experience the joy and delight of having a cold.  I’ve been meaning to write a post about healthcare in Germany for ages, and being sick for the past week is a perfect lead in to the topic.  Being sick in the United States is a very different experience than being sick in Germany.

“Sick Days” are a very American concept.

While I was employed at our German office, I had German health-care and I followed the local rules for being sick.    In the German office, if you are sick, you go to the doctor on the very first day, and the doctor will give you a slip of paper that basically says don’t go back to work for however many days they specify.  There’s no “sick time” in the German office-  my benefits there included a generous count of vacation days, but the concept of “sick time” just isn’t used.  If you’re sick, you’re sick.  German employment laws are fiercely protective of the worker, and a company can’t easily fire someone while they’re out sick.  So, sick people stay home from the office in Germany, and rarely come in to get their colleagues sick.  That’s a very American behavior.

In the US office, however, the rules are different.  I came back to the US with a very finite amount of sick time, so I was only able to stay out of work for the first day of my cold.  On the second day, I schlepped myself into the office with my bag of cold medicine, tissues, and so forth.  Nobody wants to see you in the office when you’re sick, but if you have no available sick time, you must go or risk a disciplinary action.

Socialized medicine is actually pretty nice.

When the Affordable Care Act first started to gear up in the US, I remember seeing this comic in one of the local newspapers.  I saved it back then because I knew I’d be writing about this at some point:

healthcare01

 

My personal experience with socialized medicine doesn’t at all fit the negative talking points of the FOX News narrative.    I found the entire system to be uncomplicated and reasonable.   While I was in Germany, I had Techniker Krankenkasse, a large and ordinary public health insurance which was arranged with the assistance of my employer.  Private insurance is available in Germany, of course-  you just have to be willing to pay more.  I never found it to be necessary.

Because this insurance is subsidized by the government, my tax rate was higher and I saw less of my paycheck.  However, I went to the doctor several times in Germany without ever paying a cent.  One of those visits included a very small procedure which even required after-care, and there was no additional cost.   When I needed antibiotics, I paid only five Euros.    The same doctor visits here in the US would be $20 or $35 per visit, and the generic antibiotic wouldn’t be less than $10.   The higher tax rate in Germany was worth it, if only for the convenience of not having to pay anything to the doctor’s office.

The actual visit to the Doctor’s office.

I only went to one doctor in my time there, so I don’t have a frame of reference to tell you if my experiences are common.  My doctor’s office was a nice, naturally lit affair with pleasant decor.  The starkest part of the office was the waiting room, a square room with a table in the center and magazines to read-  in other words, it’s just like every doctor’s waiting room you’ve ever seen.

healthcare02

Whenever somebody arrives to the waiting room, everyone already waiting says hello.  Germans aren’t typically this inclined to greet people they don’t know, so I assume this is one of those cultural expectations that I just have to accept.

The checkup room is a big airy space.  And this is the part of writing the post where I realize that my meager count of doctor experiences in Germany leaves me with very little to talk about in this post.  Let’s move past this admittedly lovely checkup room, to talk about drugs.

healthcare03

Pharmaceuticals auf Deutsch.

One of the things that was difficult to get used to when I arrived in Germany was that you can’t get drugs in the grocery store.  In the US, you can get aspirin or Tylenol in Publix.  In a shop like Walgreens, you can get a can of coke, develop your film, buy a toy, and still fill your prescription.  In Germany, everything is separated-  food in the grocery store, drugs in the Apotheke.

Pharmaceuticals are more or less the same everywhere in the world, but the packaging is different.  Germany doesn’t use those amber plastic pill vials that are so ubiquitous in the United States; most drugs are distributed in flat packs like the one pictured below.

healthcare04

Where an American pharmacy would print a label with specific instructions on how to take your medicine, a German pharmacist will just write the instructions on the box.  See the handwritten 1-0-1 above?  That means take one in the morning, none at lunchtime, and one at night.   When they hand you the pills, they go over it verbally just once, and in my case, the pharmacist reminded me to be sure to finish the prescription.

Beyond that, things are more or less the same.    The individual pain killers are all available in Germany, just under different names.  Tylenol is Paracetamol, for example.  Vicks products are sold as Wicks.  Aspirin is still called Aspirin, though- Bayer is a German company, after all.  The only drug that I was never able to find a German analog of is Sudafed.  Any time someone visited from the United States, I had them bring me some 12-Hour Sudafed- that stuff is worth its weight in gold to me.

Being able to go to a Publix at 9pm here to get two more types of cold medicine, including one that will theoretically knock me out:  That experience is priceless, and it made me realize that if I have to be sick, I’d rather do it here, even though it’s significantly more expensive.

Have you ever visited a doctor outside of your home country?

17 thoughts on “Don’t Make Me Sick

  1. I’m with Techniker Krankenkasse 😀

    Having to get a Krankmeldung on the first day isn’t typical! Where I work, we can be off for 3 days without a Krankmeldung, then we have to go to the doctor. I think it’s the same for my boyfriend as well.

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  2. JJE

    I just noticed this over the past few weeks, but apparently American expats in Germany seem to have trouble finding a suitable replacement for Sudafed, more so than for any other medicine.

    Rhinopront is more or less the exact same thing: http://www.recordati.de/rhinopront-kombi-tabletten

    Like the old Sudafed it contains both pseudoephedrine and an antihistamine and is available prescription-free at any Apotheke.

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  3. tormuck

    I think the convenience to save $25, $35 or even $100 for treatment and drugs to heal a cold is not really worth the monthly amount you pay for public health care in Germany. But what happens if you get really sick, like $20.000-sick. Or even more? E.g. when you need cancer treatment. Health treatment in Germany is (at least partly) based on a solidarity principle so that everybody has access to expensive health care if needed. How does this work in the US? Do less affluent people have access to expensive medical treatment?

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    1. It depends entirely on what insurance you have. Prior to the Affordable Care Act,there was a much higher number of people who simply had no insurance at all. Many people have horror stories about how a medical incident cost them tens of thousands of dollars, or even drove them to bankruptcy.

      Nowadays with the ACA, more people have access to those treatments than ever before, but it’s still not as evenly distributed as it is in Germany.

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      1. tormuck

        Thanks for your answer. I guess it is a good thing to have health insurance for everybody and share the costs of it among everybody, even with a little “socialism” involved, meaning that those who earn more have to contribute higher insurance costs, comparable to a tax system. However, the German system is far from perfect: those who earn a ceartain amount per month are allowed drop out public health insurance and have (sometimes cheaper!) private health insurance, i.e. the solidarity principle is left to those who earn less.

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  4. Do you know why Vicks are Wicks in Germany? Because Vick might sound like fick.

    Agree with the previous poster that it’s a bit unusual to have to get a Krankmeldung on the first day.

    Anyhow, we (unfortunately) had lots of experiences with German medical care and found it awesome and inexpensive. When H was in the hospital for a couple of weeks, the whole ordeal (including everything; ambulance, urgent care, meds, hospital stay, what have you) cost us less than 50 eur.

    Japanese healthcare seems to be pretty good too, but we do end up paying a bit more. Maybe 8 eur per appointment. Generally the public insurance scheme pays 70% of all your costs and you pay 30% but there’s a cap for large costs so you never end up paying a huge sum.

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  5. bunny42

    Much of the negative press I’ve heard about socialized medicine relates to availability of care. Long waiting periods for specialized care, even if it isn’t elective, for one thing. Did you hear about or experience anything like that during your stay? My niece recently tore a knee ligament on the job, and had to wait almost a month for treatment, but that was not due to availability. It had to do with being required to use workman’s comp and having to wait for bureaucratic approval. That’s my biggest fear with ACA or socialized medicine: who decides if you can receive treatment? Or do you just automatically get treated for anything in Germany? And how long must you wait?

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  6. ilona

    Maybe the laws have changed since I lived in Germany way back in the 80s, but it used to be that you could be out sick for 6 weeks at a time, then you would roll to short-term disability automatically. There was one coworker at the time who took advantage of that for years. He’d come to work for a week, then go back on sick leave for 6 weeks. He alternated his illnesses between stress and “Kreislauf” condition (another uniquely German thing :P). Because of this, we had to hire an additional person to do his work because he was effectively never there yet he was paid 100% salary. So, yes, the system has its advantages, but also has some downfalls.

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  7. Our system can drive anyone nuts. If you get really sick or have a chronic illness in our system, be prepared to spend time wading through paperwork and arguing with the insurance company about coverage. (I wrote a long ridiculously detailed post about American health insurance because it is SO different than what people in most other systems deal with.)
    My European friends can not fathom the idea of ‘sick leave’, particularly when it comes to serious illness such as cancer. It definitely is frustrating if you share an office or work out in an open area, and people with colds and the flu and random virsuses come to work only because they cannot or do not wish to use their sick leave, thus ensuring that their illness will be passed on! It also translated to kids often being sent to school when they shouldn’t, because parents cannot take time off from work to stay home with them.

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  8. Amelie

    I got sick while traveling in Venice, enough that I needed to see a doctor. I had purchased travel insurance, so the process was fairly simple,friendly, and inexpensive. The doctor didn’t speak English, but he did speak some Spanish, so that saved me. He was very kind and concerned about me, and I was in and out in less than 2 hrs, which was surprisingly fast for emergency care mixed with language barrier. 😛 Funny things: There was a take-a-number ticket dispenser in the waiting room, just like the one at the Publix deli. Also, the doctor mentioned more than once that I was “too old” for that kind of throat infection, and he attributed it to my “American life style.” And at the very end, I mentioned offhand I couldn’t sleep well, and he mentioned that was one of the reasons I couldn’t shake the infection, so he very willingly gave something for sleep that turned out to be a strong benzodiazepine similar to Xanax.

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  9. I had two GPs in Frankfurt. One, in my building, was a grumpy old man who was very rude, but would give time off work papers and drugs without much thought. The other, a woman a few blocks away, was kind and happy and would listen to you explain what’s wrong with you.

    Overall, I was really happy with the level of care in Germany. I missed being able to self prescribe, though.

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  11. ryk

    nice post! I found this video in the “Hamburger Morgenpost”. I think It shows the failure within the american healthcare system (from my german pov). Instead of all-4-one and one-4-all it allways me,me,me…homeless people are homeless because they wasted their chance…bla,bla,bla…what’ s happend to the guy in the video could happen th everyone in every country. It’s about how a system deals with it. will it catch the fallen citizen or create another homeless? http://youtu.be/AUBTAdI7zuY

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