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Re-post of response to Obama's Op-Ed piece in yesterday's NY Times:

As a US citizen, a medical doctor currently living in Germany, a country where health care is universally available for its residents at affordable rates, I might have some perspectives on this debate you haven't yet run across.

What I find most astounding about our US health care system is not only how many people don’t have coverage (some 46 million, and going up). But rather, how fragile and precarious health care coverage is for so many people who think they are well insured.

How does our US health care system compare? Let's go through some important points in the universal health care system in Germany, which I'm very familiar with:

Here in Germany you are mandated to have standard comprehensive health insurance:

*your employer pays half the monthly family premium, you pay the other half,

•you don't get rejected because of any previous condition,

•you don't pay more or less working for a large or small business,

•you don’t pay more or less if you are male or female, black or white, German or foreign born, gay or straight,

•the rates don't go up if someone in the small (or large) business gets sick,

•health insurance is not a consideration when changing jobs or careers because you take the policy with you,

•you don’t lose your policy if you get sick, if you become unemployed, or even if your employer goes out of business,

•you won’t be billed for “out of network” services in hospitals or elsewhere - these services are part of your coverage, no matter which hospital or team of doctors treats you,

•you don’t have annual, lifetime, disease-related, or disease-recurrence caps,

•you won’t be billed at 20%, 30% or more for expensive medications (“price-tiered” pharmaceuticals), because there is no "tiering", legally approved pharmaceuticals are fully covered when you need them, even if they're very expensive,

•nor will you ever go bankrupt due to unpaid and unaffordable medical bills piling up, - that simply doesn't happen – you enjoy completely comprehensive coverage.

•Also, forget expensive copays ($40/year max. for doctor visits @$10 per quarter, a few dollars per prescription, a minimal meals expense during a hospital stay.

•Forget too the denials, the constant slog of endless 0800 calls (yours and your doctor’s) to your insurance company for requests for coverage or adjustments, wasting huge amounts of people's time, energy, and productive capacity every business day - this doesn't happen in Germany, because this is a comprehensive coverage system (which is an important reason why it's so efficient).

I might add that Germany is a democratic country with a freely elected government; its residents are free people – this is not "Russia". In fact, this is the country with long stretches of Autobahn without speed limits, right? (Here, it’s your responsibility to drive safely, and most do.) People here freely change jobs, careers, and locations without any regard for health insurance, and they are free of the fear of going bankrupt or losing their homes or life’s savings if they were to get seriously ill, because their comprehensive insurance protects them from that!

Germany and its residents are not going broke paying for this, either. On the contrary, this fair, efficiently run health care system costs roughly a third less per person that the US system - that's right, about 1/3 less per capita – despite (or because?) everyone being on board and receiving comprehensive health care.

That figure doesn’t come from rationing, long waits to see a doctor, or long waiting lists to get an operation, either - that doesn’t happen here. What that figure does reflect, however, is just how much waste, duplication, and gouging of consumers must be taking place in the US health care system every day.

My point in describing the German health care system is not to encourage you all to move to Germany, but to prove to you, that for one-third less money than you currently already spend, you should be getting comprehensive, universal health care, like every resident of Germany does (yes, including all immigrants!). But you're not.

May I humbly suggest: advocate, and work with your friends and neighbors for health care reform now, absolutely including a strong public plan, which is the lynchpin for any meaningful reform.

Don't let the lobbyists, their surrogates on TV, or their gun-toting mobs and pre-organized advocates at town hall meetings, scare you, confuse you, or drown out your voices yet again.

It is time to face up to this national challenge as adults, and finally join the peoples of the 17 (seventeen!) other advanced democracies (not "Russia", but, yes indeed, Germany, Switzerland, the Netherlands, Norway, Australia, Japan, S. Korea and even Taiwan!) around the world, who already enjoy the benefits of universal, comprehensive, and affordable health care.

We absolutely can grab this bull by the horns, and get this job done this year!!!

Dr. med. Frederick B. Lacey Jr.
Frankfurt am Main, Germany