American health insurance companies are well aware of that. America's Health Insurance Plans, a trade group, filed an amicus brief with the Supreme Court in January saying the required coverage mandate cannot be divorced from Obama's health-care reforms. In a convoluted press release it wrote:
"A wide range of experts has consistently agreed that enacting guarantee issue and community rating has severe unintended consequences unless they are paired with a strong commitment to achieve universal coverage through an effective and enforced personal coverage requirement."
In plain English, this means that if only sick people sign up for insurance it is impossible to insure people regardless of pre-conditions, or to limit insurance companies' ability to set prices based on an individual's history and risk. Everyone has to take part -- sick and healthy people -- for the system to work.
This is understood in Germany, even by some American business people who know their corporate health insurance costs could be much lower in the U.S., where no coverage is required.
"As an employer I would never question hiring somebody and not insuring them," says Seattle native-turned Berlin café owner Cynthia Barcomi. She opened Barcomi's, a café in the trendy Kreuzberg neighborhood, in 1994.
Three years later Barcomi's Deli opened in the central Mitte district. Between the two ventures she now has around 40 employees. Under German law, she pays roughly half her employees' healthcare premiums as part of their labor contracts. The actual sum is based on what a worker earns. Even though it costs her a lot, she's a staunch believer in the system.
"The national health-care system is an incredibly important thing for everybody, for the entire society and for the health of the society," she says. "You just cannot have people falling through the grid because they don't have health care, because they are not healthy. The basis for everything is people's health, not just your own health but the health of your neighbor."
The American entrepreneur said she'd offer health insurance to her employees even if she weren't required to by law, as she is in Germany, because people are more productive if they think their employer cares about and believes in them.
"It's part of a working relationship; It's a tit for tat," she says during an interview at her Kreuzberg café. "If I want people to work well for me and if I want them to be satisfied with me as an employer, I have to offer them something that's more than just the minimum wage."
This attitude toward healthcare -- which seems so foreign in the U.S. -- gives Germany a competitive advantage, Barcomi and other businesspeople say. A healthy workforce is a more productive workforce and recent German statistics would back that up. The country has relatively low unemployment and in many sectors the economy is booming.
Yet, in the U.S., which spends more than any other developed nation on health care, an increasing number of businesses are "less competitive globally because of ballooning health-care costs," according to an article published by the Council on Foreign Relations in March. Indeed, despite the ample spending on health care, the system remains inefficient, and the U.S. ranks with Turkey and Mexico as the only members of the Organization for Economic Cooperation and Development (OECD) without universal heath coverage, it adds.
Don't Religious Americans Love Their Neighbors?
There are other reasons why Germans are confused about the U.S. health-care debate. The U.S. comes across to not only Germans, but to many Europeans, as a religious country. God seems to be part of many U.S. debates, especially ones surrounding the presidential campaign. In secular European politics, the Almighty is rarely if ever invoked.
"For me the U.S. is a very religious country. It doesn't matter which religion I look at -- love thy neighbor is a very, very important point in religion," says health insurance spokesperson Marini. For her, the apparent deep religiousness of many Americans doesn't jibe with their unwillingness to be part of a health-care community.
Politician Wolfgang Zöller, a member of Bavaria's conservative Christian Social Union party, argues that Christian principles support a national health care system and both are compatible with capitalism.
He wonders how a working class man with a family who doesn't have insurance pays for an operation when he becomes sick.
"The question of health insurance is a humane question," he says. "I want every person -- independent of age, independent of income or pre-existing conditions -- to have the possibility to be helped when he is sick."
That is not happening in the United States, according to numerous statistics.
The U.S. ranks last out of 16 industrialized countries on a measure of deaths that might have been prevented with timely and effective care, according to a study released last year by the Commonwealth Fund, a private foundation that supports independent health care research. Germany was in ninth place, according to the "National Scorecard on U.S. Health Performance."
Premature death rates are 68 percent higher in the U.S. than in the best-performing countries. As many as 91,000 fewer people would die prematurely if the U.S. could achieve the leading country rate, said the report. Instead, the study notes that "access to health care significantly eroded since 2006," with more than 81 million working-age adults -- some 44 percent of those aged 19 to 64 -- uninsured or under insured in 2010. This was an increase of 35 percent from 2003 levels.
Other advanced countries are managing to outpace the U.S. in providing "timely access to primary care, reducing premature mortality, and extending healthy life expectancy, all while spending considerably less on health care and administration," the study goes on.
That's exactly what Zöller says he's talking about. When people become sick they should be helped regardless of their financial or social situation, he says.
"Otherwise you're left with the famous saying, 'the poor die young'. And I don't want that."
Intellpuke: You can read this article by Spiegel journalist Miriam Widman in context here: www.spiegel.de/international/germany/german-attitude-toward-barack-obama-s-healthcare-reform-a-832002.html