By schorschi


On Tuesday I finally felt fit enough to call my GP and reschedule the cancelled appointment to have the iron infusion I need. As they are closed Wednesday, today was the first available date.

And so off to Erkheim, a few minutes early and was asked to take a seat in the waiting room for a minute. As there was nobody else in the reception area, assumed everyone in the county must be fighting fit. Opened the waiting room door and nearly fell over - at least 20 people waiting! I have never seen it so full, ever. Took one of the last remaining chairs and after 5 minutes, not a single person had been called.

Oh ah, looks like the doctors must all be ill. Then to make matters really bad, one of the assistants half opened the door and called my name. You can probably imagine the stabbing pains I felt in my back from 20 pairs of eyes who had been there before me!

Germany has a mandatory Health Insurance system that all employees must be members of. Non-working wives and children are included in the husband's payments (NOT sexist! Sorry I simply don't know the rules for working Mums with houseman doing the work at home but suspect it is identical). Self-employed people must also be insured but can choose more freely.

However, it is possible if you earn above around €5,000 p.m. Gross, that you can opt for a "Private health insurance" also regulated within the state system but gives more options that the mandatory cover does not offer, such as acupuncture, alternative medicines, some extra medicines on prescription. There is a potential downside in that it costs more and as one gets older and sicker and where your personal "risk" gets calculated. In the pure basic state system, all pay the same % of monthly income and that is also the case if a single person or a married man with a wife at home and 6 children (* as above not #metoo). A blood-curdling socialist and solidarity concept, a nightmare for any free marketeer, neo-liberal, money-coming-out-of-the-pot-bellied-tailored-trousered-Brexiteer or US Republican.

For a 25-year-old, single person suddenly getting pay to reflect their university studies, the monthly rates are even cheaper than the basic health system and thus very attractive. And once you opt out into the private system, it isn't always so easy to get back. Suddenly one night you meet someone at the disco and shortly afterwards a partner moves in, three children are delivered by the stork, stress at work causes the first heart murmurs, the docs bills for the ECG reports land in the insurance companies data files and at the next annual premium review the rates creep up. And these private health insurers are profit based companies, so a double-edged sword.

But from a docs point of view, the private insurance patients are good news as patients generally have to pay upfront for the treatment before getting it back themselves from the insurance, the insurance pays for more for the simple checks, allows more lucrative treatments, pills and potions. Thus these people tend to get preferential, queue jumping privileges. Has been a source of great anger over the years as the divide seems to have grown more and more as the basic insurance companies struggle to keep up with the increasing cost of healthcare and are constantly reviewing what they will pay.  A two class health system which everyone in politics tries to deny and in 2018 officially banned.

You can easily test this - try phoning a specialist (not GP) doctor where you invariably need an appointment. Bet the first question will be "Mandatory or privately insured?" Your appointment will then be within days/weeks in one case, or months in the other!

I should add that the German NHS, i.e. the basic insurers who are not private companies but more cooperatives who should make no profit, had a €2 billion surplus in the first three quarters of 2018 and at the end of September a record-breaking €21 billion reserve! The government is trying to force them to reduce the unnecessary reserve by reducing the monthly payments for the members/patients and thus ease the Gross/Net pay issues such as France was experiencing and which caused the now hijacked yellow vest movement.

Anyway, I am not opted-out privately insured and of course, my seemingly preferential treatment was purely because I had the appointment which took place in one of the extra treatment rooms, a doc only having to quickly come in and stick the needle in my arm. The helpers do everything else.

Same thing for simple wound dressings etc. More serious routine post-op wound dressings and even infusions which can practically only be done at home are carried out by private organisations on behalf of the health insurers on prescriptions issued by the GP. Long term home care of elderly and disabled persons is covered by a completely different mandatory government insurance scheme and that like everywhere in the world is struggling to keep up with the actual costs & our increased life expectancy.

To cut a short story long, I was told to be very still while the infusion was done - 500ml of salt water with the iron added - as they only use a temporary short needle, unlike the monsters one gets in hospital. Being a Bliper & family WhatsApp news sender, I had to take some photos and moved around a lot bit and sure enough suddenly felt a slight pain and saw the swelling as the liquid went into the arm rather than the vein. Turned it off, pressed the "finished/panic" button and said I had NO IDEA how it could have happened and doc had to redo it in the other arm. I then behaved myself. So 30 minutes became an hour!

As I left, the post lady turned up with letters and parcels for the GP. The German Post/DHL bought an electric car manufacturing company called "StreetScooter" in 2014 that had been developed by the very large RWTH University in Aachen and was a very basic startup. Post/DHL plan to replace their fleet of 70,000 with electric driven vehicles and slowly the production is increasing and the rollout is getting into more rural areas. Both Erkheim, where the GP is, with its 3,000 inhabitants and Ottobeuren with 8,000 are now served by these "trucks".

No beauty prizes but seemingly very practical and cheap to build. I think around €20,000. The load surface is relatively high to avoid lifting problems but also means the load area has no wheel arches in the way. In the early days, there were apparently complaints that the electric heating in winter months made the range of the batteries very short but it seems the problems are sorted.
2015:     237
2016:  1,669
2017:  3,863
2018:  4,214

I think a second factory came on stream late 2018 with the aim of making 10,000 vehicles a year. They have been given a contract by the UK's "Milk & More" for 200 vehicles.

They are also now also getting into smaller variations for very densely populated inner cities including handcarts, bikes and trikes. I can personally confirm that they are 99.9% silent and to my dismay, noted that they don't even beep when reversing where the driver has little vision - I must admit I didn't check if they have rear cameras but I did watch the lady look in her rear view mirrors, so assume not. I guess DHL don't want their drivers going backwards.

Just a side note - the "ad" on the side of the vehicle is from Post/DHL pleading for employees. Like almost all businesses around here, there is a desperate shortage of skilled and non-skilled workers. And while I know Post/DHL are comparatively humane in their employment record, the employees of post/packet delivery businesses (UPS etc) are under enormous pressure to do more, quicker, more cheaply and no doubt soon 24/7. And yes, I am one of those internet/Amazon shoppers who look to get the best deal preferably with "free shipping", so can't really complain or claim to be a social justice champion.

Back home very uplifting experience as I enjoyed my late morning cup of coffee & brunch. Sky News' Kay Burley interviewing "normal" Irish people, publicans and farmers on the Northern Ireland side of the inner Irish border both Leave and Remain voters. They talked such amazing sense that I think the Brexit friendly Burley & Sky News were quite shocked. I whacked out loads of thank you messages on Facebook and Twitter to the people involved that I could find, regardless of their beliefs. They were simply fighting for "sense". Really gave a shot in the arm that there could still be a solution - which of course is to cancel Brexit.

PS: HOLY SMOKED MACKEREL. Just realised that something isn't quite right with what my doc is doing. How can he put my iron in a Saline NaCl solution and not expect me to seize up one day? I won't be venturing out on the pavements and roads until late spring and the snow clearing vehicles are safely stored away.

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