Doctor reports on poverty and illness in GermanyAround 15.5 million people in Germany are at risk of poverty or social exclusion. That is about one fifth of the population. More and more people remain permanently poor. (Source: t-online. Poverty in Germany: About one fifth of the population is considered poor. Is at risk of social exclusion. (Source: t-online.de)
If you want to know what's going wrong in Germany, you have to go to Bad Segeberg. There treats Dr. Uwe Denker free of charge Patients who are destitute and ill. He reports for t-online.de, how poverty makes people ill in Germany.
My "practice without borders in Bad Segeberg looks like a normal doctor's office. But my patients are not only sick, they have no money. I treat them free of charge, out of Christian charity, without asking questions. If desired, completely anonymous, no one has to identify himself, prove his poverty, tell his story.
My patients want to talk
But many of my thousand or so patients want to talk, to tell me about the misfortune that has thrown them off their bourgeois track. How round their life used to be, with a family, a good income, a car, a great apartment and a good job. I often refer to my clientele as "the downtrodden middle class". There are hardly any homeless people, rather homeless people who sleep on the sofa of friends or family.
Dr. Thinkers in the "practice without borders in Bad Segeberg. Here he treats destitute patients. (Source: private/t-online)
Poverty makes sick and sickness makes poor, that is my experience of the last years. Because who cannot pay the contributions to the health insurance, is fast not or not sufficiently insured. In Germany, this concerns at least 500.000 people. I also include those who are still in a health insurance fund but can no longer pay their premiums and who are in debt to the health insurance fund. They are downgraded to an emergency tariff, receive treatment only in emergencies or when they are in pain. And that happens quickly, after just four or five unpaid monthly premiums. Privately insured patients end up in a "basic tariff".
What constitutes an emergency is determined by the health insurance company
The premiums for private health insurance become so expensive with increasing age that people with little money can no longer afford them. Many then say to themselves, "I'm not sick, I've paid my contributions for 35 years, now I'm going to take a break." And that is not possible. Because then immediately comes the downgrading to the emergency tariff. What constitutes an emergency is determined by the health insurance company.
2010 opened the first "Practice without borders" for the Bad Segeberg region. The doctor's office without insurance is open once a week on Wednesday from 3 to 5 p.m. Six specialists hold the consultation hours in rotation. There have been nine other practices based on this model, u. a. in Flensburg, Hamburg and Solingen. Donation account at Volksbank Raiffeisenbank IBAN: DE 6121 2900 1600 5680 0000, BIC: GENODEF1NMS
One of my patients was a self-employed journalist from Mecklenburg-Western Pomerania. He could no longer write articles because his family was breaking up. His wife became mentally ill and tried to kill herself. The man tried to save his wife and child, was unable to write anymore. The mother was taken to the psychiatric hospital. The man was seriously ill himself, he had intestinal bleeding. He drove over 300 kilometers to my practice. He was not insured, had not paid his contributions. I examined him, a colonoscopy was done. He had colon cancer that needed immediate surgery. He could not have an operation because he was not insured.
We then took over the costs, it was about 15.000 euros. Unfortunately, the help came too late, he died a few weeks later.
Treatment room in Bad Segeberg: Those who come here have a downhill climb behind them. (Source: private/t-online)
The Minister of Health, Jens Spahn, with whom I had an appointment in Berlin the other day, says that such cases can go to the Social Welfare Office after all, and that the patient just has to explain his plight there. But that would have delayed the treatment, you can't do that in 14 days. That's where we step in. Filling a gap.
"Too proud for the support"
Many people from the middle class shy away from going to the social welfare office. In 2015, 4.9 million people who were over-indebted waived Hartz IV. That means: "Too proud for the support". That saved the state 20 billion euros. I wrote down all these bad numbers for a while. I have now given up on this, because it has shaken me so much. These are numbers that break all dimensions for me.
Our largest clientele of middle-class people are still outwardly gastronome, web designer, sociologist, builder, butcher, occupational therapist, soldier. 46 different professions I have counted so far. I often ask them "Why don't you go to the social welfare office?? Why don't you apply for a basic income support?" And they often have good reasons why they don't. Many say, I have been there, have been shot down, have had to bring many proofs. I was pushed back and forth between the job center and the health insurance company. Many do not understand the system, it is too complicated for them and they need medical help immediately. They get it with us, quickly and without bureaucracy.
A patient with diabetes had a dead toe. This is an emergency, it had to be amputated the next day. This is what we organized and paid for. And afterwards we'll see if we can get him back into a health insurance company. After two, three years he could be insured again. It's not possible on short notice.
Whoever comes to our practice will be helped, that is my Christian principle. Without names, without discrimination. I also once treated a felon without knowing it. Later the police called .
Poor people die earlier
Most of my patients want to talk, want to tell their fate to someone, are looking for advice. My advice is: try to get into a health insurance company. Not having health insurance is life-threatening and life-shortening. Poverty makes ill! Poverty shortens life! If you live in poverty, eight years are stolen from your life as a woman, eleven years as a man! This is what poverty researchers have studied. A large part of my patients who died came to us too late. They had serious diseases that have not been treated for a long time. They didn't go to the doctor for so long because they didn't have insurance and couldn't pay for insurance. There are about half a million non-payers.
Many general practitioners treat their patients for free! They are very generous in this respect. For real emergencies. These are also the ones that show up in our shop. No dazzlers. These are quite reasonable people, often men, who sit here and burst into tears. They say I can't take it anymore. Never get out of the swamp. They tell us here, it often takes an hour. A doctor has seven and a half minutes maximum. Paid even less by the cash registers.
Denker treats people without asking questions. Many patients still want to talk. (Source: private/t-online)
We have a volunteer consultant here who helps when patients want to return to the health insurance. But very few make it, it's too complicated. Maybe 40, 50 of my patients. There are far too few of them! We have a large team of voluntary helpers here, my wife Christa is always there, they do all this without payment. Our expenses are financed only by donations. And we finance everything, even surgeries and births, as long as the donations allow it. For example, we have to pay the medicines from it, at the full price with high VAT rate. Such a thing annoys me very much.
bailouts are for banks, not for sick people
Why there are so many poor people in such a rich country? This is the big question. First of all, there is over-indebtedness. This amounts to an average of 35.000 Euro. The paths that lead into debt are different. For many it is ignorance. Lack of precaution. They rattle in there. About one percent of all patients fall through the social net, probably more. In a rich country, in a feel-good phase! If these uninsured sick people were a bank, it would have been saved long ago. Then one would have loosened billions, as with the rescue of the HSH Nordbank. This is a great social injustice! This bailout exists for banks, not for uninsured sick people. And their number is growing. A monster wave of poverty is rolling towards us! We have to protect the dikes, otherwise we will all drown. We sound the disaster alarm, but no one reacts. The ie of old-age poverty has no party for me. Not a top politician on the radar. "Germany is impoverishing quietly, slowly and steadily" I heard once. This is very true. What you see, for example homeless, are only a very small part. Most poverty is hidden. Want to remain so. I recognize poverty not by the clothes, that is picobello, but by the missing teeth. Because for this then the money is missing. One of my patients is French. Owns a bistro for seven years. He can no longer pay the health insurance because his store does not bring in enough money. For the self-employed, the causes of poverty are often poorly run businesses. Especially solo self-employed people carry a very high risk. They have to pay their health insurance premiums completely themselves.
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The man got lymph node cancer, which is fatal if not treated. We would have paid for the treatment, but fortunately he was still insured in France. I sent this one to France, he goes to Lille every four weeks and gets treated there. In France, the health insurance continues even if he is eliminated. There are considerable differences in Europe.
Increasing poverty disturbs social peace in Germany. Health politicians must react to this, so that the sentence of Pope Francis does not become true: "The blatant social inequality will inevitably lead to violence." We hope that the welfare state will be preserved.
The conversation was recorded by Helge Denker. He is head of digital at t-online.de and son of Dr.