To prevent medical debt, the U.S. could learn from Germany's health care system : Shots - Health News What would a world without medical debt look like? In Germany's former coal-mining region medical debt is almost unknown, despite economic challenges and health problems. Here's why.

Lessons from Germany to help solve the U.S. medical debt crisis

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ARI SHAPIRO, HOST:

About a hundred million people in the U.S. carry medical debt. NPR has been exploring this crisis all year with our partner, Kaiser Health News. It's a uniquely American problem.

Reporter Noam Levey traveled to Germany recently to find out what a world without medical debt looks like. Good to have you here.

NOAM LEVEY, BYLINE: Nice to be with you.

SHAPIRO: So when we say that this problem is uniquely American, how big is the disparity with other wealthy countries?

LEVEY: I mean, in a word, it's huge. Now, I mean, we all know that a trip to the hospital in this country can leave anyone with thousands of dollars in bills. Close to half of Americans pay more than a thousand dollars out of pocket for medical care in a year. That's according to a survey from the Commonwealth Fund. By comparison, just 10% of French patients pay that much. It was 16% for Germans, and only 7% in the U.K. Of course, big bills in the U.S. often mean debt. In other wealthy countries, medical debt's virtually unheard of. When I traveled to Germany, I discovered they don't even measure it because it's so rare.

SHAPIRO: Well, tell us about where you went and what you found there.

LEVEY: So I went to a place called the Saarland, which for centuries was a major coal mining center in Germany. The last mine there closed a decade ago, and it's been tough, I mean, in the same way that the decline of mining has been a challenge for places in the U.S. like West Virginia, which actually has the highest medical debt in the U.S. In the Saarland, a lot of people are living with the effects of mining - lung disease, lots of chronic pain - but debt just isn't an issue. I spent an afternoon with a physician there. And when I'd ask his patients if they were worried about going into debt, they looked at me like I had two heads.

SHAPIRO: Well, what's the difference? Why don't they have to worry about medical debt?

LEVEY: It's pretty simple, actually. Germany, like the U.S., has a largely private health care system - private doctors, private hospitals. It's not government insurance. But Germany has long done something the U.S. doesn't. It strictly limits how much patients have to pay out of their own pockets. So a trip to the doctor is usually free. Co-pays for most prescription drugs are capped at 10 euros or less, or about $10. And a hospital stay cost patients only 10 euros a day. A lot of people I talked to said that's helped the region weather its economic struggles. Here's Dr. Eckart Rolshoven. He's the doctor I visited.

ECKART ROLSHOVEN: If we wouldn't have this system, I think there would be much more social conflicts. So the social - so social life is really calm because these things are regulated.

SHAPIRO: What lessons does this have for the United States? I mean, I'm trying to imagine if somebody paid $10 a day to stay at a hospital, would that hospital go out of business? It costs a lot, right?

LEVEY: It does. It does. But I - you know, when you think about the way the whole system is organized, I think there are lessons that we can take for it. I mean, the U.S. has put some limits on how much patients can be asked to pay out of pocket. The Affordable Care Act said patients couldn't be asked to pay more than $9,000, but that's a lot of money. Germany has been able to do what it does because it regulates the prices that hospitals and doctors and drug companies can charge, and that's made all these medical services much less expensive than they are in the U.S. So the problem is that for decades, the American health care industry has fiercely resisted anything like price regulation. So as usual, our politics here around health care are tough.

SHAPIRO: That's Noam Levey, a reporter with Kaiser Health News. And for more of his reporting on how medical debt in the U.S. compares to countries like Germany, you can visit npr.org. Thanks, Noam.

LEVEY: Thank you.

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