Monday, November 21, 2011

Health, Health Insurance, and Totalitarianism

[This post is a bit of a moan. Apologies in advance.]

It’s been 21 days since I left my job, on purpose, to become something else; a better Toby Russell, a better husband, a better father, and a better Earthling. Though I had wanted to leave work for many years, the decision was, I can assure you, very difficult to reach; I have a wife and two daughters and happen to be, for many reasons, our family’s sole bread-winner. Nevertheless, my wife and I arrived at that decision together (I did all the pushing, it must be said!), and I still believe it to have been both brave and wise. And noble too.

This latest leap into the unknown has not, however, been without its shocks, even in these first few weeks. The one I want to discuss in this post was served to us cold by Germany’s health system.

My wife and I, plus one three year old daughter, arrived in Berlin in July 2000. I had no job, no German, and no health insurance. None of this was a ‘system problem,’ since I had both savings and income from my recently deceased father’s dry cleaning chain. And, back in 2000, one was allowed to live in Germany without health insurance. That is, any visits we made to the doctor before I had found employment, we paid for in cash. This included my wife’s overnight stay in a hospital for an operation she needed after miscarrying shortly after our arrival in Berlin.

Three weeks ago, we learned precisely that loose, temporary ‘opting out’ we enjoyed eleven years ago is no longer legal. I am not allowed to step out of the system and receive medical care, even though I could afford it should such prove necessary, even for a few months while I train myself to become an English teacher. It is illegal not to have explicit health insurance. I have paid roughly 65,000 euros over ten years into the German health system, but my enforced ‘largesse’ has afforded me close to nothing, it seems; now that my income is zero for a while appears to be irrelevant. Even though I am now income-poor, still I must pay a hefty amount to cover our four-person family, close to 600 euros a month, from zero income, if things don’t go my way.

Here’s the deal. I plan to become self-employed (all things being equal), which is a social status distinct from employed, unemployed, student, housewife, and so on. The reason for this is to stay as far away from corporations as possible, and as close to gift and alternative currency communities as I can manage. But when you’re self-employed, the health insurance companies, as instructed by the government, assume you enjoy an income of around 3,700 euros a month, which equates to health insurance contributions of close to 600 euros per month. That, or they take your last year’s income and calculate from there. In my case, that happens to equate to about 600 euros a month, even though I’m changing from an income to no income.

Now, our family costs the health system nowhere near 600 a month, which, while employed I didn’t mind, since that excess pays for those who earn less than I did. Or so I thought. Now that I am earning much less than I did, so as to do something noble and brave, I am asked to pay as I did before. Pray tell, whither did that 65,000 go?

Of course, if it turns out that in the first year of my life as a self-employed person I only earn a total of nothing, they’ll pay back a portion of my contributions, but that doesn’t help me now. And that I could pay the monthly 600 for a while isn’t really the point; my family does not cost the health system anywhere near that much. Combined, we visit the doctor a total of something like ten times a year.

Here’s a brief rundown of our load on the system these last ten years. My wife gave birth to our second daughter in a hospital in Berlin, and her pregnancy included two or three yoga classes, one night in the hospital, and two post-natal visits by a midwife. Maybe that cost one to two thousand euros. I had a shoulder operation and physiotherapy, but paid for the three nights at the hospital, and about 20% of the therapy sessions before and after. I should point out that the operation was necessary in the first place because of medical incompetency (five week delay of the MRT and two false diagnoses of the originating problem). I did not sue, because I know no system is perfect, and hate all that acrimony, not to mention it would take years and get me nowhere at all.

Anyway, too much griping for one post I’m sure (and others have it far harder than I do), but what I’m getting at is the state’s inability to deal with us citizens as unique human beings. It is utterly irrelevant that I try to live honourably, that I try not to burden the state, that my shoulder operation came from a cycling accident (I cycle to be environmentally friendly and stay healthy), that I did not sue the health insurance company for the delayed MRT, nor the doctors who erroneously misdiagnosed my condition. The state simply cannot perceive any of this. The state is too big, my life details too tiny, too unusual. We each exist in the state’s clumsy eyes as something that must fit into one box or other. If we don’t, we are an annoyance, something to be sorted, categorised somehow, which means extra work, hassle, etc.

Furthermore, my health insurance company, “Barmer GEK”, is a corporation under public law, a strange Germanic institution I don’t fully understand. It is public, hence not categorised as private, but this seems to be more a nicety than anything else. However, it is not funded by taxes generally, but by members’ payments; an employer is obliged to pay half an employee’s contribution, but the wage slips only shows, in the taxation section, the half paid by the employee; mine used to show about 300 euros. A self-employed person pays 100%, hence I would be asked to pay 600 if I adopted that status. Barmer also has legal autonomy; it, not the state, runs it. Its public nature is therefore somewhat cloudy and impenetrable. I’ve been unable to work out its ownership structure and profit requirements.

I went to Barmer for for face to face advice, trawled its enormously confusing web site for information, and the strong sense I get is that it wants as much money out of me as possible, not what’s best for Toby Russell. The very notion that 600 euros is a lot of money for someone on no income does not compute. I, a 45 year old ‘head’ of a family, just should not give up a paying job to do something ‘nobler.’ The woman I saw at Barmer could not relate to my story at all, and advised me to register as unemployed, because, I assume, that way tax payers would be footing my bills, but at least Barmer would be getting its money. (I will not register as unemployed.)

(Most likely the health system/financial category I must assume is that of ‘student,’ since that is what I am right now—students pay far lower contributions of around 150 euros a month (still very high in my opinion). However, whether the state is capable of recognising me as a student remains to be seen; I’m doing a remote learning course from a college based in England, though it’s affiliated with an American university.)

This is all very personal stuff, most unlike what I normally write for Econosophy. My reason for burdening you with all this runs as follows; to work towards something better than that which currently exists, we must at least irritate existing structures, and thereby isolate ourselves too. Doing so quickly makes very plain how cumbersome and inhumane The System is, how machine-like, how insensitive. In the (purported) interest of ‘efficiency’ and handling enormous numbers of human beings in as uniform a way as possible, we have murdered most of our humanity, destroyed our ability to deal with each other sensitively, case-by-case, with familiarity, community and care. This feeds through into our treatment of the environment of course. This includes too our broader concept of health, which, in a Money-God System such as ours, must make a profit (whatever that is). Which means disease and ill health are good for GDP, which is Good by default. Which means my tiny attempt to Do Good for family, humanity and environment alike are in fact problems, not cures, are greeted with suspicion and annoyance, not with open arms. And this while we all complain that things have to change.

What is hard during transition is finding a minimal platform within the system strong and free enough to be the financial/economic ground I can stand on, while launching myself and my family into a new way of being. The German system has a strong grip on its citizens. We are not allowed, for example, to take our children out of school and teach them at home. Alternative schools pursuing a healthier and wiser attitude to teaching children all cost lots of money, and state sanctioned ones are quickly losing their funding. Organic food costs far more than its poisoning counterpart. Hence, only the rich can afford not to damage the environment, to put their children through a sensible school system. Or, put another way, it costs more to do good than bad. Unhealthy. Unsane. There can be no true profit in such a system.

It may well be that a radical change of life-style is soon necessary for my family and me, including selling our flat and leaving Germany (to where??), but that has to wait for now. For now this awkward middle road is a necessary evil.

My conclusion is that doing good is ‘bad’ and painful when the good you choose to do fundamentally opposes the paradigm of the existing system. It is not that this system can do no good, but rather that all paradigms outlive their usefulness eventually. That’s when the trouble starts. Today, The System is global, tightly integrated, monstrously banal, insensitive and greedy. It is an immature, growth-addicted beast screaming for more, and can only rage at those voices calling for it to no longer be what it is. Any fundamental change is effectively death (systems are what they do), and even what I am doing with my attempt to earn less, do more for community, submit less tribute to The System, is infuriating anathema to it. And though what I am doing is peaceful in intent, it can only be perceived as ‘violent’ by the monster it threatens. In fact the more peacefully I oppose, the more threatening, violent and alien my actions appear. This truism scales up of course. So though I am small, and want to stay that way, though the net effect of what I have thus far ‘accomplished’ is infinitesimal, we are many. The more of us cohesively ‘opting out,’ pursuing new ways of building and being community, the more upheaval we will unleash. We must know this, and deeply. Knowing this we must, as the main part of our opting out, Build the New; food networks, transportation networks, currency networks, skill networks. Unless we have some roughly viable collection of systems and methodologies well practiced and (almost) running, all we are doing by opting out on masse is initiating chaos. An angry revolution is not going to cut it. Only the mad want that. Not being mad (I hope!) I’m thinking long term, but within the context of The System I am not permitted to escape, even my little beginning is an annoyance, and filled with daunting frustrations.

The Way is long and hard it seems.


Debra said...

You have all my sympathy, Toby.
I dealt with the self employed bit for several years, and the first year is a bitch ; you have to pay "plein pot", as we say, or top dollar everywhere, collecting your reimbursement the NEXT YEAR.
I am toying with the possibility of writing up my experience of watching our local volunteer library move from a manual system to a computerized one.
Because when looking at the evolution of our structure, it is evident to me that "tools" are quite different from THINGS WE CONTROL... the computer in our little structure has significantly modified 1) the relationship between the people working in the structure 2) the relationship between the employees and the readers 3) the way the work is organized 4) the AMOUNT of work generated and done 5) the actual physical nature of the work involved.
I call that... A REVOLUTION....
With the result that the nature and quality of the work itself has considerably deteriorated since we initiated this system, at the same time as everyone is gung ho about how technology has improved the workplace...
The "system" is very much about computer technology, Toby, and replacing living, breathing, emoting, speaking human beings by machines.
When the machines are in place, they contribute to uniformizing the work to an exponential degree...
You probably already know that being an expatriot is already a guarantee that you will not fit into any pre-designed box...
Good luck.

Toby said...

Yes. Ouch. Luck indeed.

But it's the system that's the machine, not the machines themselves. Funny statement. Try again.

We have a fundamental Us and Them view of reality which leads to a machine-like appreciation of what is going on 'out there.' After Descartes, for example, 'scientists' experimented on dogs by nailing them to boards, alive, and exploring their inner 'workings.' Their howls of agony were understood as the wheezings of windbags and pumps. We are 'ghosts in flesh machines' even today, in most people's way of thinking, even if the ghost is a mote of consciousness, or a socialized rational being, or whatever. We project Machine onto reality. And all this long before even the industrial revolution.

We have yet to appreciate, deeply anyway, the ages old golden rule: "What you do unto others, so you do unto yourself." Hunter gatherers experience this, live it; we do not. Failure to live this 'truth' creates The Machine. Our failure to perceive our 'interbeingness' is the root cause of our machine-like implementation of science, education, industry, automation, bureaucracy, government, etc. There need be no piece of metal or silicon chip anywhere in sight. We are and will remain machine-like, and so too our systems of governance, until we learn and respect and love our embededness in All That Is.

I fear no technology. I hurt in the face of our (and my) ongoing alienation. A powerful illusion it is.

Malagodi said...

We're moving toward the same system here in the States, which is why I adamantly opposed the ACA, or 'Obamacare'.

It institutionalizes the commodification of health care by private corporations whose product, insurance, not health care, is mandated by the power of the state.

Not a very good idea for the well-being of humanity, but a great idea for the well-being of corporations.

Debra said...

I totally agree with your appreciation of machine/system, and particularly with your localizing it in the Cartesian experience.
Under Louis XV, Vaucanson is the man who will undermine the artisanal organization of work, setting up the conditions for the Jacquard loom to be introduced, and the first.. LUDDITE manifestations in France against it. Precursors of the industrial revolution...
And with the Jacquard loom you can already see how UNIFORM (not unique...) the finished work has become.
But as I like to remind people, it was in the Avignon art museum that I first saw the RENAISSANCE mass produced Madonnas in the Botticelli mode, in true.. DEMOCRATIC FASHION ? to make luxury available to the largest number of people...
Mass produced... the goal of the industrial revolution. Production for.. THE MASSES.
Over in Russ's saloon, somebody has naively attempted to convince me that the machines, this technology, CAN BE DIVORCED FROM CAPITALISM, and made to work FOR (and not against...) US, "THE MASSES".

Toby said...

Bang on, Stephen. The point is we do not have a health system, we have an insurance system with which money can be cycled through the pockets of the rich in the interests of growth, not health, not well being, not happiness. If any of those latter phenomena emerge, it can only be as an accidental by-product of this machine.

Debbie, I saw that Bookchin quote from papermac (??) and quite liked it, actually. While I agree with your observation of the Masses (nature produces masses of all sorts of things, but human industrial mass production for monetary profit is a different kind of mass production), I don't see your position as in opposition to Bookchin's. My take would be this: imagine all humans gone from earth, with only machines left behind. What would machines be then? Just various elements and compounds decomposing, being reabsorbed into nature's cycles. Add humans and you add animals that can use those machines in one 'purposeful' way or another (I'm not at all sure that decomposition is not purposeful!). It's how and why we put machines to use that's important, not their existence in the first place. Though, of course, their "existence in the first place" can only happen in conjunction with intent, purpose, socioeconomics, philosophy, paradigm. Nevertheless, I think my crude thought exercise at least slightly useful...

And remember, if we are to transcend the Cartesian split, and oh boy do I want to, we have to include industrial mass production as something nature has brought about. Man is not separate from nature. To believe so is to remain in the Cartesian paradigm.

Anonymous said...

Keep your options open Toby. Some part of social transformation can be done by changing existing systems from within. For instance, rather than being adamant about avoiding corporations, you may find some employee-owned cooperatives that are more progressive. Have you seen the WorldBlu list of democratic workplaces? Some are quite transparent organizations (finances and salaries are open, workers vote on hiring/firing, etc.).

Toby said...

Hi Karl,

yeah, I'm trying to keep my options as open and possible, and understand what you mean about corporations, but I want to get as close as possible to what's healthy for me and my family, and the planet too. Thanks for the link (you are a rich vein of interesting links!), I'll look into it...

Charlie said...

"Now, our family costs the health system nowhere near 600 a month, which, while employed I didn’t mind, since that excess pays for those who earn less than I did. Or so I thought. Now that I am earning much less than I did, so as to do something noble and brave, I am asked to pay as I did before. Pray tell, whither did that 65,000 go?"

Well, it's paying for the healthcare of other people - just as your car insurance has paid for other people's accidents.

If you break your neck you might get your money back!

Perhaps you should just feel fortunate that your and your family have avoided being able to get your money's worth.

Of course, the problem with voluntary health insurance would be - what happens to those who 'choose' not to take it out for them or their children?

The libertarians argue that's their problem, but many of us are grateful that the UK's system of pooled risk has - until now - removed the fear of having to find the money up front for medical bills, or jump through the hoops of private insurers intent on finding reasons not to pay out. And we are desperately trying to stop the move to the U.S. model (which costs twice as much and still leaves millions uninsured and many of those who are insured bankrupt).

Your post reminds me of the headline: 'Libertarian reluctantly calls fire brigade'

What happens if one of your children breaks their neck?

Toby said...

Hi Charlie,

if one of my daughters breaks her neck, she dies. If any of us needed medical help over the next few months I'd pay for it, just as I point out in the post, just as I did back in 2000 for various visits to the doctor and an operation for my wife. I'm not wanting to lean on the state here, just pay my way for a stretch while I redesign my life.

Like I said in my post, I don't mind paying into the system to support those who need help. What I mind is having to pay the same amount during the period I'm earning nothing, retraining, a student learning a skill I believe is more useful to society. The other thing I mind is a system that profits from sickness, that has no incentive to build in more prevention. It's a cure-based system, not a prevention-based one. Making profit off sickness is both inhumane and wasteful, but in this bizarre system any GDP growth is a good thing, regardless of the reason the money is changing hands.

I'm not sure you understood what I wrote at all. The "Whither did that money go?" question references the fact that I'm being asked to pay a maximum contribution on a minimum income. The other part of that question is why health care costs so much. Doctors don't earn much, neither do nurses and ambulance drivers, and the physiotherapists I spoke earn little too. The entire system is geared far too heavily to the insurance side, and not enough to the health side. Fixing it requires fixing much else besides, including the entire money system, but that's why I write here at the blog, and why I'm doing my best to do the best I can for my family and society.

Longhaired blog said...

Hi Toby Catching up.
Self employment being an entrepreneur is not encouraged at all the current stage of the monopolistic capitalism we are at is out lawing it almost as self provisioning was outlawed as part of the process of primitive accumulation.
Good luck with winning your freedom from the system it is much harder these days I'm about to look at the democratic work places link my own efforts are all working towards a cooperative based business federation don't forget we do live in a Kleptocracy and corporations and Government are not on the side of the Citizens.

Toby said...

Thanks Roger, your words of support are very encouraging. It's nice to hear from others treading the same path. I think I'll be looking into cooperatives too, only as an English teacher, I suspect my future is going to follow one of two directions; working at a private or state school, or as a self-employed teacher.

Raizu said...

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Toby said...

Adam, that's just advertising. I doubt you'll read this, and doubt you want to post here again, but if you do, please don't advertise on this blog.