In April 2017, my 84-year-old moth­er suf­fered a severe stroke.

If my mother were to need around-the-clock care, her costs could balloon to $120,000 a year.

For my moth­er, who moved to the Unit­ed States from her native Philip­pines in the 1950s when she was just 25, held a job for four decades, took care of my dying father for three years and then lived inde­pen­dent­ly for five years after­ward, the stroke was a cru­el and dev­as­tat­ing tran­si­tion into elder­ly depen­dent care — and it came with a shock­ing­ly high price tag.

Fol­low­ing her stroke, I moved my moth­er into a senior care facil­i­ty in Sacra­men­to, where I live. The facil­i­ty cost $80,400 last year, and the fee will increase by 6.4 per­cent in 2019.

Lat­er this year, my part­ner and I plan to mar­ry and move to Cologne, Ger­many, where he lives, and we agreed to bring my moth­er with us. So, last Sep­tem­ber, I vis­it­ed the Res­i­denz am Dom, a senior care facil­i­ty in Cologne, and met with Marie-Luise Wrage, a social work­er who coun­sels fam­i­ly mem­bers of poten­tial residents.

When it came time to dis­cuss costs, Wrage appeared slight­ly flus­tered, con­cerned that the amounts would be off-putting. First she explained to me that the Ger­man health­care sys­tem uni­form­ly clas­si­fies stages of dis­abil­i­ty and that costs are strict­ly reg­u­lat­ed based on a patient’s needs. The month­ly fees for my moth­er to be housed, fed and cared for at the Res­i­denz, she final­ly revealed, would come to about $3,200 — at which point I revealed that my moth­er pays more than twice that in Sacramento.

We laughed, but jok­ing aside, agreed: Grow­ing old — or falling ill — in the Unit­ed States is not for the poor.

The nation­al medi­an cost in the Unit­ed States for a one-bed­room unit in an assist­ed liv­ing com­mu­ni­ty is now $4,000 per month, or $48,000 per year. Alzheimer’s or demen­tia care increas­es that cost by an addi­tion­al $1,200 per month. Seniors must also often plan for out-of-pock­et expens­es, in some cas­es up to $2,000 in copays, coin­sur­ance and pre­scrip­tion drugs, as well as ameni­ties not pro­vid­ed by care facil­i­ties, such as toi­letries and non­pre­scrip­tion medicines.

Why the dis­par­i­ty between Ger­many and the Unit­ed States? Ben­jamin Veg­hte, research direc­tor at the advo­ca­cy group Car­ing Across Gen­er­a­tions (CAG) — who, like me, lived for 15 years in Ger­many — explains, ​“There is no orga­nized sys­tem for elder­care in the Unit­ed States, while Ger­many has a social insur­ance pro­gram. Also, health­care in the Unit­ed States is most­ly pri­vate providers, and since indi­vid­u­als have no lever­age to bar­gain, costs are high­er. In Ger­many, there is a bud­get for health­care, where­by the gov­ern­ment nego­ti­ates prices with providers. Every­one pays in, cre­at­ing a whole nation of clients and a viable busi­ness model.”

He notes, too, that, unlike the Unit­ed States, oth­er indus­tri­al­ized coun­tries like Ger­many designed their health­care sys­tems a cen­tu­ry ago — long before there were vest­ed inter­ests rep­re­sent­ed by health­care lob­by­ists with license to influ­ence policy.

“The Unit­ed States is unique,” he says. ​“Health­care here is near­ly 20 per­cent of the econ­o­my and the indus­try wants to pro­tect its income.”

The ben­e­fits of the Ger­man sys­tem were famil­iar to me. In 2012, when I was liv­ing in Ger­many, I was diag­nosed with can­cer. Hav­ing nev­er dealt with seri­ous ill­ness, my first thought was, ​“How am I going to work dur­ing treat­ments so I can afford this?” As an Amer­i­can, the words ​“med­ical bank­rupt­cy” kept parad­ing across my mind. I’ve giv­en to sev­er­al GoFundMe cam­paigns of friends in the Unit­ed States who found them­selves unable to work because of treat­ments like chemother­a­py and radi­a­tion that phys­i­cal­ly exhaust­ed them, and they’d mean­while used up all of their allot­ted vaca­tion days and sick leave.

I, on the oth­er hand, nev­er saw a sin­gle invoice for any­thing relat­ed to my care in Ger­many. Whether one is pri­vate­ly or pub­licly insured, health­care there is com­pre­hen­sive and reli­able. I was allowed a year off of work with full pay and also a six-week stay at a health­care resort, none of which is unusu­al by Ger­man stan­dards. I can still remem­ber how per­plexed my Ger­man col­leagues were at my ini­tial anx­i­ety sur­round­ing my insur­ance and whether my job would be in jeop­ardy if I couldn’t work. For them, it was a giv­en that I would be treat­ed so well — as if I were, you know, recov­er­ing from a life-threat­en­ing disease.

All of this was cov­ered by my pub­lic insur­ance through my employ­er (a non­prof­it can­cer research soci­ety), for which I paid twice as much in month­ly pre­mi­ums as I pay now at my job in Cal­i­for­nia. Polit­i­cal con­ser­v­a­tives might well balk at this. I am grate­ful for the care and time off to recover.

I was required, by Ger­man law, to have health insur­ance. In the Unit­ed States, how­ev­er, the Sen­ate vot­ed in 2017 to elim­i­nate the Indi­vid­ual Man­date Clause of the Afford­able Care Act, which required indi­vid­u­als to pur­chase health insur­ance or pay a penal­ty. More than 12 per­cent of Amer­i­cans did not have health insur­ance in 2017, a per­cent­age that experts believe will increase when the indi­vid­ual man­date is sus­pend­ed in 2019.

But that’s not the only way that Germany’s sys­tem is more social­ized than the Unit­ed States’. While no pub­lic option for health­care cov­er­age exists here, the vast major­i­ty of Ger­man res­i­dents are insured by pub­lic ​“sick­ness funds,” or Krankenkassen. In Ger­many, about half the hos­pi­tals are pub­lic and about a third are pri­vate but not-for-prof­it, with the rest pri­vate for-prof­it. There are both pub­lic and pri­vate insur­ers, but all insur­ers are required by law to cov­er every­one and to cov­er a stan­dard set of ben­e­fits, which includes most pro­ce­dures and med­ica­tions. Every Ger­man can access these funds because their insur­ance rates are adjust­ed based on their income. Mean­while, mil­lions of Amer­i­cans fall into what’s called the ​“Med­ic­aid gap,” earn­ing too much to qual­i­fy for Med­ic­aid but too lit­tle to qual­i­fy for the Afford­able Care Act’s subsidies.

The dif­fer­ence in qual­i­ty of care is notable as well. In Sacra­men­to, my moth­er has to share a room and is unhap­pi­ly con­fined in her facility’s mem­o­ry care ​“neigh­bor­hood,” which is essen­tial­ly a sequestered wing of the build­ing; at the Res­i­denz, how­ev­er, she would have her own room and more free­dom to roam the premis­es, which are built around a cor­ri­dor and court­yard, with shops and an adja­cent hotel.

In tak­ing over my par­ents’ estate, I saw how care­ful­ly they had planned for their retire­ment and health­care. Both were pen­ni­less when they immi­grat­ed to the Unit­ed States (my father fled Hun­gary in 1956), but they saved dili­gent­ly and paid off their mort­gage and also my col­lege edu­ca­tion. Yet, despite all this plan­ning, my mother’s safe­ty net could break with just one emer­gency; if she were to have anoth­er stroke and need around-the-clock care, her costs in Sacra­men­to could bal­loon to $120,000 a year.

All of which has left me absolute­ly baf­fled at the Repub­li­can Party’s sub­terfuge against health­care reform. We need a trans­par­ent, fair and reg­u­lat­ed sys­tem. A major­i­ty of Amer­i­cans already sup­port one solu­tion: sin­gle-pay­er health­care, a sys­tem in which a pub­lic enti­ty (i.e., the gov­ern­ment) would cov­er the costs of all med­ical­ly nec­es­sary ser­vices, includ­ing long-term care. Pub­licly fund­ed insur­ance has a proven track record: Accord­ing to the 2015 Glob­al Age Watch Index, the top five coun­tries for elder­ly well­ness (Switzer­land, Nor­way, Swe­den, Ger­many and Cana­da) all have pub­licly fund­ed insur­ance for long-term care.

Thank­ful­ly, groups such as Car­ing Across Gen­er­a­tions — a nation­al cam­paign to improve elder­care in the Unit­ed States — are push­ing for changes to our elder­care sys­tem. CAG calls for the cre­ation of a fed­er­al ​“com­pul­so­ry long-term care insur­ance pro­gram,” paid fam­i­ly leave to ease the bur­den on those car­ing for elder­ly fam­i­ly mem­bers and an ini­tia­tive to ​“incen­tivize and recruit fam­i­ly care­givers into the paid work­force.” These rec­om­men­da­tions would fix gaps in cur­rent elder­care cov­er­age and reduce the costs of car­ing for an aging relative.

For now, how­ev­er, when I think of my mother’s expen­sive dai­ly care, my own past ill­ness and the med­ical chal­lenges that my old age could bring, it’s sober­ing — and dis­ap­point­ing — to acknowl­edge that Amer­i­ca has failed to offer us a more secure life.