A nation whose health care system is akin to Minnesota's in many respects, yet spends about 40 percent less, is well worth examining.

That notion sent some of the state's top health policy leaders to Germany in September, some of them for the third time in recent years, in a weeklong quest for what has become state government's holy grail -- more-affordable health care.

The bipartisan group of 19, led by Lt. Gov. Yvonne Prettner Solon, reassembled Monday for a debriefing hosted by one of the trip's sponsors, the University of Minnesota's Center for German and European Studies.

Germany's health care structure piques Minnesota interest because it's not British-style "government-run health care," which has become a bogeyman for some Americans.

The German system has more-familiar contours. It relies on employer funding, private health care providers and "sickness plans" that, like Minnesota insurers, are not-for-profit and compete with one another.

They are funded through "contributions" (Germans avoid the word "taxes") by both employers and employees. Various arms of government, including the unemployment insurance fund, pay contributions for those who are not employed; children are covered on their parents' plans, as is typical here.

But there are important differences. While German health care is not government-provided, it is highly government-regulated. The policy tourists came home pondering these differences:

• The German government decides which services will be covered by the sickness plans. The plans are left to compete on narrow customer-service grounds.

• Drug prices are set at the national level. A new drug cannot be dispensed at a higher cost than an older one unless it produces demonstrably better outcomes for patients.

• Medical education is financed by taxpayers without piling heavy debt burdens on students, as happens here. That produces two benefits: More medical students choose to become much-needed primary care doctors, and medical prices are not inflated to finance debt service on student loans.

• Though Germans employ state-of-the-art medicine, it's practiced in aging facilities. Germans evidently don't mind bedding down in hospital wards rather than private rooms. Doctors even say patients can recover sooner in sociable settings.

• The German lifestyle is less sedentary. That means the population is less obese than America's.

Perhaps most significant:

• Germany mandates that all citizens have health coverage. Citizens can opt out of the sickness plans and buy more generous private coverage than the sickness plans allow, but only 5 to 10 percent of the German population makes that choice. They cannot go without coverage.

That mandate is accepted without controversy in Germany. A similar requirement is the most contentious feature of the 2010 U.S. health reform law.

Tuesday's U.S. Court of Appeals decision upholding the constitutionality of that mandate is far from the final word on the matter, either in the courts or the court of public opinion.

The Minnesotans identified a key reason for Germany's acceptance of a coverage mandate. Germans explicitly rest their system on a foundation of national solidarity.

Evidently Germans more readily accept what U.S. economists contend: When health care costs go up for one, they go up for everyone.

Those without insurance often wait too long to seek medical care and obtain treatment in the most costly setting, an emergency room. Those costs are borne in one way or another by every consumer.

If those ideas were easy for Americans to swallow, this nation likely would not have nearly 50 million people without health insurance, or a major party hell-bent on repealing the new federal law's coverage mandate.

Looking to Germany should help Minnesota leaders understand the price that Americans pay for failing to see that every citizen has a stake in everyone's well-being.

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