That's pretty easy, at least in Germany: if you are self employed you are not automatically insured, you need to pick a plan from a private insurance company on

That's pretty easy, at least in Germany: if you are self employed you are not automatically insured, you need to pick a plan from a private insurance company on your own (or go with one of the expensive "voluntary" plans of the public insurances). If you don't, you simply don't have insurance. I don't know what happens when they find out that you're uninsured, however it's possible to have no health insurance. At the doctors or at the hospital just say you have private insurance and you'll get a invoice after the treatment. My whole point is, the invoice amount would be not quite close to what that Amarican hospital charged. [Edited for clarification]