8 ms·

> "After my surgery, I had to pay 25€ for the taxi ride home" I'll take that over the multi-million US-american hospital bill, any time.

by zython 9y ago

fastball 9y ago
I don't know a single person that doesn't want to spend less money on anything...
- majewsky 9y ago
  As a counterpoint, charities are a thing.
adventured 9y ago
You mean, $30,000 to $40,000, the median cost in the US, nearly all of which would be covered by insurance. No sense in fabricating magical numbers, like a multi-million dollar bill, everyone knows the flaws in the US system as is. It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.
- lispm 9y ago
  It's paid by people/companies who pay into the German universal health insurance system, not by the tax payer.
  - ams6110 9y ago
    You are splitting hairs. "people/companies who pay into the German universal health insurance system" are effectively being taxed, whatever the wording is.
    - lispm 9y ago
      No, they are insurance membership contributions in Germany. The contributions are specifically used to finance the health system, here the specific health insurer. Taxes generally are not paid for a person, but for things and values, etc.. Taxes are also not bound to a specific purpose, but are going into the general budget of the country/state/town. Taxes and insurance fees are different finance models. In Germany there are basically three types of financing for services: 'Steuern' = taxes , Gebühren = fee, Beiträge = contributions. In Germany the health care system is based on 'Beiträge', i.e. membership contributions to a health insurance.
      - germanier 9y ago
        In International discourse and comparison (e.g. those done by the OECD) most of those typically run under the label "taxes". The German distinction doesn't translate well into other systems. It should be noted that (based on the vague description from the article) her insurance probably got compensation payments from the federal government for her insurance (if it was in fact free through her husband).
        lispm 9y ago
        https://en.wikipedia.org/wiki/Universal_health_care https://en.wikipedia.org/wiki/Universal_health_care > Most universal health care systems are funded primarily by tax revenue (like in Portugal[24] Spain, Denmark, and Sweden). Some nations, such as Germany and France[25] and Japan[26] employ a multipayer system in which health care is funded by private and public contributions
        germanier 9y ago
        > Vorweg ist anzumerken, dass die in Deutschland vorgenommene Trennung zwischen Steuern und Sozialabgaben in vielen Staaten nicht üblich ist. Daher verstehen internationale Organisationen unter dem Begriff „Steuern“ („Taxes“) in der Regel die Summe aus Steuern und Sozialabgaben und behandeln die Sozialabgaben („Social Security Contributions“) als Teilbetrag der Steuern. http://www.bundesfinanzministerium.de/Content/DE/Monatsberichte/2010/03/Artikel/analysen-und-berichte/b04-indikatoren-steuer-abgabenbelastung/indikatoren-steuer-abgabenbelastung.html http://www.bundesfinanzministerium.de/Content/DE/Monatsberic...
        lispm 9y ago
        Paper published by the World Health Organization http://www.who.int/health_financing/taxed_based_financing_dp_04_4.pdf http://www.who.int/health_financing/taxed_based_financing_dp... > Tax-Based Financing for Health Systems: Options and Experiences > social insurance, private insurance and general taxation Social insurance is the German model. > By contrast, Germany's policy to combine its sickness funds into a social health insurance system -- generally credited as the first effort to enact universal health insurance coverage -- dates from the second half of the 19th century. or see: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.628.5428&rep=rep1&type=pdf http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.628... > Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD SHI -> German model. > it was in Germany and neighboring countries that SHI began Also see: https://www.kingsfund.org.uk/publications/how-health-care-is-funded https://www.kingsfund.org.uk/publications/how-health-care-is... Options discussed: Taxation, Private Health Insurance, Social Health Insurance, User charges as an additional source of financing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628174/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628174/ > Current Trends in Health Insurance Systems: OECD Countries vs. Japan > There are three major types of social health-care systems: social insurance systems like Japan, France, and Germany, tax-based system like the United Kingdom and Sweden, and the United States—limited service to the elderly or disabled, called Medicare (Table 1). Again, Germany has a social insurance system, not a tax-based system.
- Karnickel 9y ago
  It's not paid by taxes but by health insurance. We have both a private and a semi-public system (managed by "Krankenkassen", independent insurance entities, that compete for members; it's... complicated, but less so than in the US, and it does not depend on the employer). Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).
  - wirrbel 9y ago
    I don't know if I would understand the German "insurance" system from that explanation. Maybe to complement your explanation another try at it: Germany has two insurance-like systems to pay for medical treatments: (1) insurances, with fees aligned with damage risk associated with the policy holder. (2) a system of "funds" that provide insurance benefits for insurants, however, are not organized like an insurance. The system (2) is quite old (dating back to the 19th century) and has a few peculiarities: * fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others). * half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck. * family members can be insured, too, without increasing fees. * fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc. The alternative to this fund are insurances that work on a risk-based pricing scheme - item (1) in the list: * in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe). * pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc. * for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above. For both systems, treatment prices are kind of fixed (as a rule of thumb, doctors can charge the insurance a bit more than the public funds, by a constant factor of 2-3, but I heard from doctors that this depends on the treatment).
- Hackwar 9y ago
  I don't really know what you are trying to say. If you are saying that health care in Germany in total cost is cheaper than in the US, then you are right. If you are insinuating that the system is infused with tax money, then you are wrong. It is completely financed by the premiums of the insured people. Not saying that the german system is without issue, but compared with the USA, it is lightyears ahead.
- zython 9y ago
  Sorry I was being sarcastic. Also the german healthcare system is not all financed by tax payers. "paid for by the public health care system" would be a better sentence.
  - kgwgk 9y ago
    “Not at all” is too strong [edit: and actually it was “not all” which is correct and even an understatement], but it’s true it’s a small (and declining) contribution: http://www.hspm.org/countries/germany28082014/Lists/LivingHiT_Library_Figures/Table33.png http://www.hspm.org/countries/germany28082014/Lists/LivingHi... However, that table doesn’t include subsidies for the SHI. All in all, 10% is funded with taxes. http://www.hspm.org/countries/germany28082014/livinghit.aspx?Section=3.2%20Sources%20of%20revenue%20and%20financial%20flows&Type=Section http://www.hspm.org/countries/germany28082014/livinghit.aspx...
    - DoreenMichele 9y ago
      The parent said not all, which means not entirely. Adding at in the middle changes the meaning substantially.
      - kgwgk 9y ago
        I just noticed that I misread the comment.
- ddebernardy 9y ago
  If I read this story correctly the other day, giving birth to premature twins in the US can max out your $2M insurance cap and leave you with $450k of medical debt to boot: https://www.theguardian.com/us-news/commentisfree/2018/jan/16/bankrupted-by-giving-birth-having-premature-twins-cost-me-everything https://www.theguardian.com/us-news/commentisfree/2018/jan/1... In my own back of the woods in Europe, the same would cost you nothing.
  - masonic 9y ago
    back of the woods in Europe, the same would cost you nothing. Sure, it would be much cheaper when one or more patients doesn't survive in the first place, for example. Keep in mind that story is a donation appeal and is weak in details -- for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) The article also misstates ACA numbers.
    - DanBC 9y ago
      > for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) Yes, of course it would. Stop believing the myth that Europe just kills people when they get too ill.
- DanBC 9y ago
  > nearly all of which would be covered by insurance. No, the US government pays almost as much per capita for health care as the German government. https://visual.ons.gov.uk/how-does-uk-healthcare-spending-compare-internationally/ https://visual.ons.gov.uk/how-does-uk-healthcare-spending-co...

> "After my surgery, I had to pay 25€ for the taxi ride home" I'll take that over the multi-million US-american hospital bill, any time.

by zython 9y ago

> "After my surgery, I had to pay 25€ for the taxi ride home" I'll take that over the multi-million US-american hospital bill, any time.

fastball 9y ago

I don't know a single person that doesn't want to spend less money on anything...

majewsky 9y ago
As a counterpoint, charities are a thing.

adventured 9y ago

You mean, $30,000 to $40,000, the median cost in the US, nearly all of which would be covered by insurance. No sense in fabricating magical numbers, like a multi-million dollar bill, everyone knows the flaws in the US system as is. It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.

lispm 9y ago
It's paid by people/companies who pay into the German universal health insurance system, not by the tax payer.
- ams6110 9y ago
  You are splitting hairs. "people/companies who pay into the German universal health insurance system" are effectively being taxed, whatever the wording is.
  - lispm 9y ago
    No, they are insurance membership contributions in Germany. The contributions are specifically used to finance the health system, here the specific health insurer. Taxes generally are not paid for a person, but for things and values, etc.. Taxes are also not bound to a specific purpose, but are going into the general budget of the country/state/town. Taxes and insurance fees are different finance models. In Germany there are basically three types of financing for services: 'Steuern' = taxes , Gebühren = fee, Beiträge = contributions. In Germany the health care system is based on 'Beiträge', i.e. membership contributions to a health insurance.
    - germanier 9y ago
      In International discourse and comparison (e.g. those done by the OECD) most of those typically run under the label "taxes". The German distinction doesn't translate well into other systems. It should be noted that (based on the vague description from the article) her insurance probably got compensation payments from the federal government for her insurance (if it was in fact free through her husband).
      - lispm 9y ago
        https://en.wikipedia.org/wiki/Universal_health_care https://en.wikipedia.org/wiki/Universal_health_care > Most universal health care systems are funded primarily by tax revenue (like in Portugal[24] Spain, Denmark, and Sweden). Some nations, such as Germany and France[25] and Japan[26] employ a multipayer system in which health care is funded by private and public contributions
        germanier 9y ago
        > Vorweg ist anzumerken, dass die in Deutschland vorgenommene Trennung zwischen Steuern und Sozialabgaben in vielen Staaten nicht üblich ist. Daher verstehen internationale Organisationen unter dem Begriff „Steuern“ („Taxes“) in der Regel die Summe aus Steuern und Sozialabgaben und behandeln die Sozialabgaben („Social Security Contributions“) als Teilbetrag der Steuern. http://www.bundesfinanzministerium.de/Content/DE/Monatsberichte/2010/03/Artikel/analysen-und-berichte/b04-indikatoren-steuer-abgabenbelastung/indikatoren-steuer-abgabenbelastung.html http://www.bundesfinanzministerium.de/Content/DE/Monatsberic...
        lispm 9y ago
        Paper published by the World Health Organization http://www.who.int/health_financing/taxed_based_financing_dp_04_4.pdf http://www.who.int/health_financing/taxed_based_financing_dp... > Tax-Based Financing for Health Systems: Options and Experiences > social insurance, private insurance and general taxation Social insurance is the German model. > By contrast, Germany's policy to combine its sickness funds into a social health insurance system -- generally credited as the first effort to enact universal health insurance coverage -- dates from the second half of the 19th century. or see: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.628.5428&rep=rep1&type=pdf http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.628... > Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD SHI -> German model. > it was in Germany and neighboring countries that SHI began Also see: https://www.kingsfund.org.uk/publications/how-health-care-is-funded https://www.kingsfund.org.uk/publications/how-health-care-is... Options discussed: Taxation, Private Health Insurance, Social Health Insurance, User charges as an additional source of financing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628174/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628174/ > Current Trends in Health Insurance Systems: OECD Countries vs. Japan > There are three major types of social health-care systems: social insurance systems like Japan, France, and Germany, tax-based system like the United Kingdom and Sweden, and the United States—limited service to the elderly or disabled, called Medicare (Table 1). Again, Germany has a social insurance system, not a tax-based system.
Karnickel 9y ago
It's not paid by taxes but by health insurance. We have both a private and a semi-public system (managed by "Krankenkassen", independent insurance entities, that compete for members; it's... complicated, but less so than in the US, and it does not depend on the employer). Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).
- wirrbel 9y ago
  I don't know if I would understand the German "insurance" system from that explanation. Maybe to complement your explanation another try at it: Germany has two insurance-like systems to pay for medical treatments: (1) insurances, with fees aligned with damage risk associated with the policy holder. (2) a system of "funds" that provide insurance benefits for insurants, however, are not organized like an insurance. The system (2) is quite old (dating back to the 19th century) and has a few peculiarities: * fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others). * half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck. * family members can be insured, too, without increasing fees. * fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc. The alternative to this fund are insurances that work on a risk-based pricing scheme - item (1) in the list: * in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe). * pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc. * for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above. For both systems, treatment prices are kind of fixed (as a rule of thumb, doctors can charge the insurance a bit more than the public funds, by a constant factor of 2-3, but I heard from doctors that this depends on the treatment).
Hackwar 9y ago
I don't really know what you are trying to say. If you are saying that health care in Germany in total cost is cheaper than in the US, then you are right. If you are insinuating that the system is infused with tax money, then you are wrong. It is completely financed by the premiums of the insured people. Not saying that the german system is without issue, but compared with the USA, it is lightyears ahead.
zython 9y ago
Sorry I was being sarcastic. Also the german healthcare system is not all financed by tax payers. "paid for by the public health care system" would be a better sentence.
- kgwgk 9y ago
  “Not at all” is too strong [edit: and actually it was “not all” which is correct and even an understatement], but it’s true it’s a small (and declining) contribution: http://www.hspm.org/countries/germany28082014/Lists/LivingHiT_Library_Figures/Table33.png http://www.hspm.org/countries/germany28082014/Lists/LivingHi... However, that table doesn’t include subsidies for the SHI. All in all, 10% is funded with taxes. http://www.hspm.org/countries/germany28082014/livinghit.aspx?Section=3.2%20Sources%20of%20revenue%20and%20financial%20flows&Type=Section http://www.hspm.org/countries/germany28082014/livinghit.aspx...
  - DoreenMichele 9y ago
    The parent said not all, which means not entirely. Adding at in the middle changes the meaning substantially.
    - kgwgk 9y ago
      I just noticed that I misread the comment.
ddebernardy 9y ago
If I read this story correctly the other day, giving birth to premature twins in the US can max out your $2M insurance cap and leave you with $450k of medical debt to boot: https://www.theguardian.com/us-news/commentisfree/2018/jan/16/bankrupted-by-giving-birth-having-premature-twins-cost-me-everything https://www.theguardian.com/us-news/commentisfree/2018/jan/1... In my own back of the woods in Europe, the same would cost you nothing.
- masonic 9y ago
  back of the woods in Europe, the same would cost you nothing. Sure, it would be much cheaper when one or more patients doesn't survive in the first place, for example. Keep in mind that story is a donation appeal and is weak in details -- for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) The article also misstates ACA numbers.
  - DanBC 9y ago
    > for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) Yes, of course it would. Stop believing the myth that Europe just kills people when they get too ill.
DanBC 9y ago
> nearly all of which would be covered by insurance. No, the US government pays almost as much per capita for health care as the German government. https://visual.ons.gov.uk/how-does-uk-healthcare-spending-compare-internationally/ https://visual.ons.gov.uk/how-does-uk-healthcare-spending-co...