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.