Nat Friedman

I’m going to tell just this one story about my experience as an American expat with the health care system here in Germany.

One night a few months ago I had sharp stomach pains that got worse and worse and kept me from sleeping. This had never happened before, and it was a little scary.

At 3am, after hemming and hawing, I finally gave in and took a taxi to the emergency room at one of the hospitals here in Munich.

At first I thought the place was closed, because there was just a receptionist on duty behind plexiglas. No one rushing around, and it was a bit dark. She was reading a novel.

I told her about my stomach, and she buzzed me into a room with three hospital beds and some nurses and doctors. An old woman was lying on the far bed near the window, her husband seated in the chair next to her. A nurse told me to take the bed nearest the door. The middle bed was empty. There were no other patients.

Two nurses hooked me up to an EKG immediately. One brought the printout to a doctor while the other took my blood. These are the admittance exams they give everyone who comes to the emergency room — it’s automatic.

Somewhere in the middle of this experience, I realized that I’d shown up at an emergency room in the middle of the night, and I’d been seen immediately.

I hadn’t been asked to sit in a waiting room for 8 hours like the time I had a concussion in Boston.

A few hours later, after my abdominal ultrasound was clear, I poked around the hallway near the main entrance just to confirm what I’d been wondering about.

There was no waiting room.

There were a few chairs in the hallway — six or eight, all empty — but nothing like the hospital waiting rooms I knew from the US.

How was this possible?

A week later the bill for my ER visit arrived. I have no German health insurance so I pay all my health care costs out of pocket. In theory I can send these to my US insurer to get reimbursed but so far that hasn’t worked out very well.

I opened the envelope nervously, and there it was in black and white: 264 euros. The total cost of the best emergency room visit I’ve experienced in my life.

Health care in Germany is not a single-payer model. There’s a public insurance option which is more affordable for families and a private insurance option which offers better care. Some doctors only accept the private insurance because they make more money from it. Poor people get government subsidies to cover their health insurance and preventative care.

The result is that everyone has health coverage, and my uneducated guess is that this is why there was no waiting room at the hospital I visited. In the US the ER is a service provider of last resort for people who have no other option for routine care. And a lot of routine and preventative care is delayed until the issue becomes acute, triggering even more ER visits.

So another system is possible. And the people debating the health care system in the US who have never experienced another system don’t have the whole picture.

(By the way, the routine blood test they did during my admission picked up a previously undiagnosed Thyroid condition called Hashimoto’s Thyroiditis, which I am treating with a daily pill.)

For our wedding in Florence this summer, we created an Italian language learning CD for all of our guests.

Our CD is only 30 minutes. That’s all it takes to achieve fluency, right? The CD teaches you the basics of Italian, and gives an overview of Italian coffee, culture, driving regulations, and history since 1920.

And we threw in a few key phrases for attending weddings.

Anyway, it seemed a shame that our guests were the only ones to benefit from this highly concentrated language education resource, so you can listen to the CD here:

1. Introduction
2. Basic Phrases
3. Ordering in a Restaurant
4. Numbers
5. Lightning Round
6. Wedding Phrases

(Thanks to Flavio Castelli for his help with a few parts of the script.)

The list of American companies founded by immigrants has gotten pretty impressive.

It’s a wiki, so feel free to edit if you can improve it.

In this editorial in the Detroit News, Alex Nowrasteh of OpenMarket.org makes a strong, related point:

Of the eight American citizens who received Nobel Prizes in the science categories, five are immigrants to the United States.

This should be a counterweight to the persistent critics of immigration, but it remained unknown. In the immigration debate, the contribution of highly educated and skilled immigrants to American technology and science is often ignored.

One-quarter of American Nobel Prize winners since 1901 have been immigrants. Today, a third of all the scientists and engineers in Silicon Valley are immigrants or foreign-born. Furthermore, 40 percent of the Ph.D. scientists working in the United States are foreign-born. Unfortunately, our immigration laws ignore these facts.

The whole editorial is worth reading and says it better than I could.

America has always had the most dynamic culture, and the intelligence and customs and drive of immigrants have always powered that dynamism.

In the face of clear and overwhelming data that immigration is good for the country and the economy, the anti-immigration crowd are simply cowards.

Talking to my wife Stephanie last night, we realized that “entrepreneur” literally means “between-taker” in French.

And Stephanie pointed out something interesting: the German word for entrepreneur is Unternehmer – literally “below-taker” (or “undertaker”).

So the French take between and the Germans take below.

I wonder if there’s a language which uses “above-taker” to mean entrepreneur?

This morning over muesli I read this TechRadar article about Facebook’s growth, titled “Farmville is bigger than Twitter,” which breathlessly reports various exciting numbers, including this gem:

When it comes to the site’s online chat function, 1.6 billion messages are sent every single day and 1.4 million photos are uploaded a second.

Ok, so this photo number is wrong: 1.4million photos per second is 3.6 trillion per month, or roughly 20 photos uploaded for every person on the planet every day.

You could call this a typo, but the fact that not even very basic fact checking was done on this article makes all the other figures suspect as well.

But don’t worry, TechRadar, you’re not alone.  A few weeks ago Fortune magazine reported about Facebook game Farmville that:

On any given day 500,000 tractors are sold on the Internet. But don’t start buying stock in John Deere or Caterpillar just yet. These are $20 “virtual” tractors that belong to the 50 million players of FarmVille, the largest and fastest-growing social game on the Internet.

That’s $10 million in tractor-revenue per day, or $3.6 billion a year. I’m sure Zynga is doing well, but not that well. Yet Fortune put this plainly-false figure in the lede of their article.

What’s going on here?

Not journalism, that’s for sure.

“It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat.”

“Citizenship in a Republic,”
Theodore Roosevelt’s Speech at the Sorbonne, Paris, April 23, 1910