Politicians who argue either the pros or cons of the health care issue, invariably up the English system. I am an American who has been working abroad for 45 years on three continents. I have seen and used a lot of medical systems, and in my opinion the English NHS system is the absolute worst. As I understand it, this is essentially the same system Bernie Sanders proposed. I can only think the British system is so often used as a benchmark because these politicians only speak English and do not know others exist. I would like to describe the most copied medical system in the world, which is also the oldest. It was founded, along with the oldest social security system in the world, in 1874, not by a radical left wing do-gooder, but by an ultra-right militarist, none other than Otto von Bismarck. It has been of course been modernized, but has been fundamentally the same for 143 years. In my opinion Germany has by far the best medical care in the world, and I have seen a lot of them. I conceived and developed a number of large medical computer system in various countries. No matter what you use as a benchmark of medical quality, e.g. life expectancy, infant mortality, maternity deaths, patient satisfaction, etc., the United States ranks right down there with third world countries. Yet the United States pays more for medical care than any country in the world. Never-the-less politicians often say we have the best medical care in the world. Here are the basic points of the German system. 1. It is insurance based. 2. Has little government involvement. 3. Many private insurance companies successfully compete against the many participating companies 4. It covers everyone in the country by payroll deduction. 5. Care is all inclusive, outpatient, hospital, dental, pharmacies, home care for elderly and disabled, etc. 6. It costs a fraction of what the United States pays for medical care and gives better service. Yet, it seems our politicians have never heard such a system exists, and in fact has existed for almost a century and a half. I think this system would satisfy the most conservative Republicans, while providing more, and better, care than the far left-wing Democrats want or expect. Here is how it works from the government and the insurance company’s point of view The German system is insurance based. There are many private health insurance companies in Germany that successfully compete with the many insurance companies in the government sponsored system. Everyone must have health insurance, but can choose the company they prefer. If they chose the government plan they can choose the provider they like. Every employed person has the fee, a percentage of salary up to a maximum fee, deducted from his or her salary each month. Therefore, low earners pay less than high earners. The employer matches this, and pays directly to the insurance company, not through the government. Non-working spouses and children are covered under their spouse’s plan. Children are covered until the end of their education. If no one in the family is employed the insurance is covered by social services. The patient does not pay directly for any of these services, and doctors do not even need to waste resources dealing with the insurance companies themselves. Each state in Germany has an association to which doctors submit their bills every quarter. These associations submit the bills in bulk to the insurance companies, collect the money and deposit it in the doctor’s accounts. These associations also negotiate terms and conditions. In addition each medical specialty has its own association which negotiates terms and conditions. Doctors can elect to work outside of the government sponsored system, and rely on privately insured patients, or they can take both private and government sponsored patient. Here is how it works from the patient’s point of view. I receive a health care card, with my photo, from my chosen provider. I present this card to my doctor once a quarter, if I make a visit that quarter. I can go to any doctor I want. If I don’t like the doctor I can simple go to another one, with no need to even inform the insurance company, much less the government. I can visit any specialist or dentist I want, without a referral, and simply present my card. Unlike what the senator you interview said, I have never had to wait long for an appointment or an operation, even routine non-urgent ones. I pay nothing for any of these services. However, there are some procedures and laboratory tests that the scientific community agrees are not efficacious, and they are not covered. If the patient believes they work and wants them, he can obtain them from his own doctor, and pay it himself. I have done this a few times myself, but noticed no benefit at all. Private insurance companies do cover some of these services, to better compete against the government supported system, but a disadvantage of private companies is they usually require the patient to pay his bills himself, and reclaim the money. Government sponsored patients pay nothing for care. Inpatient hospital visits are by referral and are fully covered, including the complete cost of drugs, laboratory, radiology and other services, with one exception. It is assumed that the patients must eat, weather he is in the hospital or not. They are charged a very nominal fee for meals per day up to a maximum number of days. Other outpatient services, such as physical therapy, laboratory work and prescription drugs are covered, but the patient pays the first $3 for outpatient physical therapy and the first $5 for a drug prescription, up to an annual limit based on his or her salary. Some drugs are exempt from this fee, and some people, such as people with serious disabilities and low income people are exempt. The pharmacies are required to use the lowest cost approved manufacturer for each drug dispensed. Special care is provided for the disabled and the elderly. Wheelchairs, home visits for physical therapists, doctors and other home care providers, rebuilding showers and toilets, and installing elevators, etc. in private houses is subsidized. Assisted care homes for the elderly are subsidized. Conclusions So the government is not much involved in the day to day operation. Naturally it sets the rules, makes sure the rules are followed and avoids costs getting out of hand. But health care givers and insurance companies work within the rules and go unhindered about their daily business. The result is everyone has good quality health care from doctors, dentists, hospitals and pharmacies of their own choice. No one has to worry about not getting needed care, or going bankrupt from medical costs. Infant mortality is lower, longevity is higher, people live better lives, patients are more satisfied and costs are significantly lower. This system more or less answers every criticism even the most conservative Republicans have, while providing far better universal care than the most left wing Democrats want. It is amazing that our politicians do not appear to even know such a system exists. One last comment. One often hears write your senator. That is a useless exercise. I sent this same information to every senator and representative on the health committees, and never got one reply. However, now that they have my E-Mail address they besiege me for donations. I would suggest that Republicans and Democrats, stop quibbling about trivialities, which they appear to know nothing about anyway, and send a bipartisan delegation of experts to Germany to learn how this system works. It should simply sail through congress and everybody will be better off. On a related subject, most representative and senator’s internet sites have fixed formats that requires a U.S. Address and telephone number and will not accept messages without it. There is no possibility for an American abroad to send a message. Also many will not accept message unless the address is in their own district. This includes Paul Ryan. I think as leader of the house, he represents us all and is obligated to accept messages from the entire U.S.A and from Americans abroad. Regards, William McCreight