The United States is the only industrial country that leaves 20 percent of its' people uninsured without access to health care. Yet we spend more per capita on health care than any other nation. The cost of health care is rising at twice the rate of inflation and last year, 12.2 percent of our gross national product went to pay for health care. A definite change is needed in the U.S. health care system. A nation that leads the way for human rights cannot deny 20 percent of its' citizens access to health care. To provide health care to all U.S. citizens, the federal government should adopt a nationalized health care system based on Germany's health care system.

The German system has two main advantages over its counterpart, the Canadian system. Unlike the Canadian system, Germany's health care system would not require complete restructuring of our current health care policies. The German system appears to be compatible with America's way of providing health care by maintaining a role for the insurer and a role for private physicians in office-based practices. Canada's system is too expensive for the United States to consider as a solution for our health care crisis, but Germany's system is less expensive.

Germany's health care system operates similar to health insurance companies. In 1883, Otto von Bismarck mandated health care for citizens through "sickness funds." Any German earning less than $36,000 a year must join a sickness fund through an employer, union, local group, or professional association. This system is financed by a split 50-50 between employer and employees. The total deduction to pay for the sickness funds comes to about 12.2 percent of payroll, which is a hefty sum by U.S. standards, but this amount of money buys the best health coverage in the world. Those who are self-employed or earn more than $36,000 a year can buy private health insurance. About 10 percent of Germans take this route. Germany's health coverage includes: complete medical, dental, hospital, eye care, drugs, income support during illness, and a maternity leave policy. Germany's maternity leave policy allows mothers to take a maximum of 14 weeks off from their occupation and then pays for 100 percent of the replacement salaries. Health care costs are controlled on a quarterly basis by checking the actual volume of services against the expected volume. If the service rises unexpectedly, the conversion factor is adjusted so the total physician payroll stays within the predetermined spending caps. Germany also has more doctors and hospital beds per person than the United States.

Even with all its advantages, the German health care system has four main drawbacks. One, Germany is efficient in its use of medical technology through large, well-equipped hospitals. But patients in Germany usually are hospitalized an average of nine days' longer than in the United States since their hospitals are paid a per diem rate.

Second, the system does not allow most office-based doctors to practice in hospitals and usually does not allow hospital physicians to practice ambulatory care. This segregation of doctors allows duplication of tests.

The third problem is that Germany's sickness funds aren't mandated to have large reserves to fund future liabilities. Experts worry that the system could be ruined as the German workforce ages. If the German system was enacted in the U.S., doctors would have to work longer to keep their current salaries.

The German health care system's problems can all easily be resolved if a similar system was enacted in the United States. If Germany's system was enacted in the U.S., hospitals could be paid more so patients would not stay as long.

The 20 percent of Americans without access to health care would rather spend more time in a hospital than not have any access to hospitals when sick. Doctors in America often perform tests that are only marginally justified. These marginally-justified tests are merely performed to protect the doctors from a malpractice suit. The American Medical Association figures that defensive medicine costs the United States about $15 billion a year. Simply duplicating a few tests would be the lesser of two evils. In this case, either way some financing is wasted.

To solve the third problem if a German type system was enacted here the U.S. government could easily mandate that the sickness funds have large reserves of capital. The money to help finance the sickness funds could come from defense cuts, and/or an increase in the deduction of employee's payroll by about .5 percent. American doctors would have to simply adjust to loner hours to solve the fourth problem.

The German system of providing health care is superior to the United States's system. All Germans are granted generous health insurance coverage if they cannot afford private insurance. Germany only spends 8.1 percent of its' capita on health care compared to the 12.2 percent of the ineffective U.S. system. The German system's drawbacks can be abolished by slight alterations in the system. The United States has the moral right to guarantee each of its' citizens access to health care. For this reason, a U.S. health care policy similar to Germany's must be enacted.

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