MADELEINE BRAND, host:

This is Day to Day from NPR News. I'm Madeleine Brand. Here in the United States, nearly 18 percent of Americans do not have health insurance. Compare that with Germany. The number there? Point-two percent. As part of NPR's series on healthcare, Meghan Collins Sullivan found that that number makes a huge difference in treatment.

MEGHAN COLLINS SULLIVAN: If you're uninsured in Washington, D.C., you could try to get an appointment at La Clinica del Pueblo.

(Soundbite of clinic waiting room)

COLLINS SULLIVAN: There are four doctors. It's open 8:30 to five, five days a week, and it stays open late on Wednesdays, but it's always fully booked.

Dr. MEREDITH JOSEPHS (Director, La Clinica del Pueblo): At our busiest days, I have to say that we usually have 50 or 60 patients coming through. The waiting room is often packed.

COLLINS SULLIVAN: The director of the clinic is Dr. Meredith Josephs. She says that only a quarter of the people who walk into the clinic without an appointment get seen.

Dr. JOSEPHS: We are still, unfortunately, turning folks away.

COLLINS SULLIVAN: Dr. Josephs works 11-hour days and still goes home frustrated.

Dr. JOSEPHS: It's definitely emotionally difficult sometimes. You know, I sort of try and live life sort of focusing on the ones that I can help, and you know, I'm kind of coldhearted towards the others, because if I were to spend my time trying to figure out how to serve all the people who can't get in the door, I think I would just go crazy.

COLLINS SULLIVAN: Dr. Josephs isn't alone. There are 10 free clinics like this in Washington, D.C., dedicated to caring for uninsured patients, and thousands more across the United States. The story is very different in Germany, where there are only eight free clinics for the uninsured in the whole country.

Dr. HERBERT BREKER (Malteser Clinic, Cologne, Germany): (German spoken)

COLLINS SULLIVAN: Dr. Herbert Breker is beginning his day at the Malteser Clinic for the uninsured in Cologne. This is a small, three-room clinic, a tiny office, exam room and waiting area, attached to a private charity hospital. It's nine a.m. Dr. Breker looks out the window and checks the waiting room for patients.

Dr. BREKER: No. It's empty. There's nobody.

COLLINS SULLIVAN: He sits at his desk, makes some calls, and gets some paperwork done. Fifteen minutes later, his first patient shows up.

Dr. BREKER: (German spoken)

COLLINS SULLIVAN: The patient is a middle-aged man suffering from vertigo. He's one of only two German citizens who come into the clinic this day. That's because almost all Germans have health insurance.

Dr. BREKER: (German spoken)

COLLINS SULLIVAN: Dr. Breker sends the man home with a referral to get additional tests. Now, Dr. Breker has some more downtime.

Dr. BREKER: I take a quick look to see whether somebody arrived meanwhile, but I see that it's empty. I look out the windows. And I don't see anybody, so no, nobody's coming.

(Soundbite of laughter)

COLLINS SULLIVAN: Dr. Breker pours himself a cup of coffee. He explains why the man is uninsured. All Germans, he says, can get medical insurance through their employers. This man didn't qualify. He was self-employed. For awhile, he bought insurance on his own. Then, as he got older, it became too expensive.

Dr. Breker tells us that kind of problem won't last much longer. Germany has passed a law that will get people in that situation covered by health insurance. It will take effect next year. Breker says people who have no insurance in Germany are usually living in the country illegally. That's who most of his patients are.

Dr. BREKER: You can see where the people are from, Germany, Turkey, Romania, Germany, Morocco, Romania, Germa - Bosnia, Romania, Poland, Costa Rica, Nigeria.

(Soundbite of doorbell)

Dr. BREKER: Business.

COLLINS SULLIVAN: Late in the day, two people show up at once. A Romanian woman pleads for medicine for her husband, and a frantic American walks in. Dr. Breker greets him at the door.

Dr. BREKER: Hello.

Mr. MICHAEL DAVIS (Patient, Malteser Clinic, Cologne, Germany): Hello.

Dr. BREKER: My name is Herbert Breker. And you're American?

Mr. DAVIS: Yes. I have a cardiac condition, yeah, and I'm not insured.

COLLINS SULLIVAN: The man's name is Michael Davis. He's nervous that Dr. Breker will turn him away.

Mr. DAVIS: I had a dual bypass.

Dr. BREKER: Yeah.

Mr. DAVIS: Yeah.

Dr. BREKER: And your age, how old are you?

Mr. DAVIS: Thirty-five.

Dr. BREKER: Thirty-five?

COLLINS SULLIVAN: Davis says he suffered a massive heart attack in Germany last summer while on vacation. He spent a couple of weeks in the hospital. They told him he would have to have bypass surgery. He flew back to the U.S. and saw a cardiologist.

Mr. DAVIS: The cardiologist said right then and there we must admit you. If you - we let you leave, liability-wise we could be in serious trouble, because we know that you're just a walking time bomb.

COLLINS SULLIVAN: So, he had the surgery right away, but he didn't have insurance. His employer didn't offer coverage for part-time workers like him.

Mr. DAVIS: I was never offered the opportunity to be able to get some type of healthcare, whether it was either I pay into it or whether it was supplemental.

COLLINS SULLIVAN: He says he's still dealing with more than 50,000 dollars in bills from his heart attack in Germany and bypass surgery.

Mr. DAVIS: Medicaid's supposed to cover the hospitalization and the bypass from the United States, but Medicaid's saying that I made too much money, even though I didn't work from April until September. And I've gone through so much of an ordeal because of it.

COLLINS SULLIVAN: Davis is now living in Germany, and he hopes to get a job, and get married to his German partner soon. Then he'll have healthcare coverage. But those bills won't go away.

Dr. BREKER: (German spoken)

COLLINS SULLIVAN: Dr. Breker examines Davis, then sends him for additional tests.

Dr. BREKER: Look, what I tried to do, I referred you to the service of this hospital.

Mr. DAVIS: Mm-hm.

Dr. BREKER: They'll give you an appointment for an echocardiogram.

Mr. DAVIS: OK.

Dr. BREKER: And it's just EKG.

Mr. DAVIS: OK.

Dr. BREKER: Which, I think, is very important to see how much your left ventricle is damaged.

Mr. DAVIS: OK, great.

Dr. BREKER: OK.

Mr. DAVIS: Great. Thank you so much.

Dr. BREKER: OK.

COLLINS SULLIVAN: Davis' shoulders drop, and he leans against the counter. You can see him relax.

Mr. DAVIS: I wasn't expecting to be treated like this, let alone to get such immediate care, as quickly as this occurred I'm actually shocked right now.

COLLINS SULLIVAN: At two p.m., Dr. Breker closes up shop for the day.

Dr. BREKER: That's about time now we close.

COLLINS SULLIVAN: So, by the end of the day, Dr. Breker's seen eight patients, given them treatment, medicine and referrals to the specialists they need. It's a situation Dr. Meredith Josephs at La Clinica del Pueblo in Washington can hardly imagine.

Dr. JOSEPHS: Wow, that's amazing. I wish I could say it were the same here.

COLLINS SULLIVAN: Meghan Collins Sullivan, NPR News.

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