Health Insurance (Here and Abroad)

On September 19, 2012, at approximately 11pm Berlin time, I became a statistic. I didn’t get a divorce, have an abortion, or discover that I had a chronic illness. Rather, I simply lost my health insurance.

I can’t say for certain that this is actually when it happened, but it’s approximately the moment I chose to check my email before going to bed, and found a message from my father informing me that, according to the company that used to cover me, I had no longer been eligible for health insurance as early as May 1, 2012.

Why they had waited nearly five months to notify my parents of this fact at my home address in New York, I will never know. Why they had even waited so long to drop me is also a mystery to us all. Up until then, I had been covered under my mother’s plan as a “young adult.” My mother had been covered by her own plan through her work only until 2010, when she was forced out of her job of nearly forty-years by a new boss who wanted a younger, apparently less-experienced crew. When she went on my father’s plan, however, for some reason my health insurance stayed where it was.

Until now. My first impulse upon receiving this news was to panic…simply because it seemed as if, through email, my parents were panicking too. My dad, the characteristic doctor he always is, immediately offered possible solutions. My mom just told the story, and how she almost sat in the kitchen crying afterwards. She forwarded me emails from the HR department of her former workplace as they tried to investigate what had happened, and reading through them a few weeks later feels like reading an absurd satire—or at the very least an article from the Onion. “I had been insured but I shouldn’t have been.” “I could have lost my insurance years earlier but I didn’t.” And, my favorite, “good thing you didn’t tell them you’re married because you would have lost coverage immediately.” What about marriage in the United States makes you miraculously uninsurable? No one ever explained that to me.

But then, after a couple of minutes, I realized I live in Germany. Germany, where I have been insured since practically the moment I sent foot here. Germany, which requires all its citizens, residents, and even sort of long-term visitors to get health insurance. And not just any form of health insurance, but a health insurance plan that the German government approves. Three years ago I found this to be entirely absurd; I was fully insured in the US and my plan extended to overseas travel, so the 150-200 Euro a month I would be spending on my freelancer’s coverage basically amounted to a very expensive tax on getting a visa. But at least I could get freelancer’s coverage.

Back then, when I had left my internship at a small advertising agency and was looking to strike it out alone, I had a run-in with an insurance company (DKV or the Deutsche Krankenversicherung) that left me nearly in despair. Because the health insurance rep asked me to (and because I’ve heard tell of the consequences of lying when applying for health insurance in the states), I told the truth. About everything. The only thing it turned out might hurt me was my chronic asthma, which I’ve had since childhood. In my discussion with the rep, I disclosed my entire medical history and told him that my asthma had grown exponentially better since my early years. (Example: I used to start wheezing and coughing the moment I was forced to run as part of my school’s “fitness testing” week—a torturous rite of passage which seemed to happen with alarming frequency. Now, I go jogging four or five times a week, and can hike, swim, and do regular workouts without a single problem.) I was told that I would have to pay out of pocket for general and dental checkups to confirm the good health I claimed, and that, in addition, I would have to pay a couple of hundred Euros extra for the privilege of breathing into a machine that would assess how “mild” my asthma really was.

A couple of weeks later, the results were in: the doctor pronounced my breathing apparatus so healthy, it was hard to believe I had asthma at all. Then, a couple of weeks after that, the real results were in. The DKV, who had initially quoted me a price of around 150 to 200 Euro per month for coverage, had decided that a doctor’s word was not good enough. Because of my apparently life-threatening asthma condition, my monthly premium would be nearly doubled, to around 390 Euro a month. I promptly canceled the whole thing, also panicked quite a bit as my visa appointment was only a few days away and I needed coverage—_any_ coverage—to show the official at the Ausländerbehörde. I did end up getting it—a mediocre plan for expats from a company operating out of the UK that was miraculously accepted by Germany—but I had already lost several hundred Euro merely applying for coverage with the DKV, which I would never get back.

I think back to this experience when I think about the healthcare options offered in most European countries (I really think Germany’s is one of the worst), and about the healthcare system Obama is fighting to push through, which actually isn’t too far from what Germany already has, and therefore, still really isn’t that great. Will the premiums really go down with the Affordable Care Act? Will insurance companies really be forced to cover everyone without penalizing them for pre-existing conditions? If I were to move back to the states with J one day, would an honest assessment of all the various health problems I’ve had over the years mean that my premiums would still be too high for me to able to afford coverage? And even if I gain coverage, is the entire country, as described in this recent New York Times blog post, headed in the direction of boutique care (or “concierge services,” as some call it) for those who are so rich they don’t even need to rely on insurance companies? And what would become of J, who has lived off of the same reliable, partially government-funded health insurance and pension package for artists and freelancers for decades now? Would the KSK somehow agree to insure him in America if an emergency were to happen? One thing’s for sure: any European healthcare provider willing to insure someone longterm in America would either have to be insane, or blackmailed. (The one time I was hospitalized in Germany, a whole day’s visit cost me around 60 Euro. In America, I feel sure it would be closer to $6,000.)

Here in Germany, the questions and reactions I’ve gotten over the years to the healthcare situation in America could be placed in two categories. The first is misunderstanding, the second, disbelief. The first has manifested itself in honest-to-goodness conversations I’ve had with Europeans (mostly German, a few British) who, after discussing the travesty that is the American system with me, ask innocently, “but if you can’t afford private healthcare in America, can’t you just go with the public option?” This, I think, is telling. You see, most Europeans who are only nominally aware of what’s going on in America in terms of healthcare (and why would they want to take the time to find out more? After all, they’re insured) and don’t have too many American friends ranting at them nonstop about it are under the impression that America, Western, über-wealthy nation that it is, actually has a public option. This false assumption would be rather cute if it weren’t so sadly and squarely pointing out what a mess we’re in. The second, disbelief, can be summed up best in a conversation I had with, for lack of a better signifier, my in-law’s in-laws (that is, the parents of the wife of my husband’s brother). The first time I met them, when the topic turned to politics in Germany and abroad, they turned to me, the only non-German at the table, and asked, quite earnestly, “WHY do Americans not want universal health insurance? Maybe you can explain this to us?” They were, of course, asking the impossible. For Americans to oppose a plan to provide affordable healthcare to all US citizens, the lack of which is one of the main things keeping the entire country down, making it impossible for anyone to take a risk by starting a new business, to feel secure about building up a freelance career, to donate an organ (as we’ve just learned) or even dare to imagine a safe and healthy future for the children they may not have yet, they would have to be either insane, or blackmailed.

I’m a statistic now, but I’m a lucky one. It’s a shame more Americans without health insurance can’t just move to Germany to get it.