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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/taxe

by 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.

germanier 9y ago
While it certainly makes sense to discuss the difference, for a US-based audience it doesn't make much sense to pedantically point out that these aren't taxes. Social insurance contributions are mandatory, based on income, and to a state entity (though independent from the government) enforced through exactly the same channels as regular taxation (as opposed to private debt). The important difference is that they are legally committed to a certain issue (in this case: health insurance) and can't be appropriated to something else. That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that.
- lispm 9y ago
  That's simply not the case. It is exactly for an US audience important, because the German system is vastly different: universal health care, regulated by the government, 99.9% coverage, run by a system of 100+ insurers and various health care providers. > Social insurance contributions are mandatory Mandatory is to be insured. > based on income in a range, or if one is privately insured one pays based on risk/age Family members (wife/husband + kids) without income are insured. Plus various other regulations. > to a state entity Krankenkassen and Krankenversicherungen are not generally state entities. Would you call something like the Audi BKK a state entity? https://www.audibkk.de/english/ https://www.audibkk.de/english/ > enforced through exactly the same channels as regular taxation No, health care contributions are paid directly to the Krankenkasse/Krankenversicherung where one is a member, not the tax administration (Finanzamt). > That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that. Obviously not. In the health care domain, the Social Insurance systems and tax-based health care systems are different models.
  - ams6110 9y ago
    > Mandatory is to be insured. While I will admit there are varying interpretation, for me, living in the USA, if I am mandated to pay for something, it's a tax. I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances?
    - kuschku 9y ago
      > I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances? You could opt out of the public system, and get a private insurance company. But once you have done so you can never re-enter the public system. And private insurances are cheaper for young people, but significantly more expensive later in life, so much that you’ll end up paying several times more over your lifetime.
    - germanier 9y ago
      You can't opt-out completely. Some people (including probably most HN readers) can purchase highly-regulated private insurance instead but even that isn't possible for the vast majority of the population.

by lispm 9y ago

germanier 9y ago

While it certainly makes sense to discuss the difference, for a US-based audience it doesn't make much sense to pedantically point out that these aren't taxes. Social insurance contributions are mandatory, based on income, and to a state entity (though independent from the government) enforced through exactly the same channels as regular taxation (as opposed to private debt). The important difference is that they are legally committed to a certain issue (in this case: health insurance) and can't be appropriated to something else. That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that.

lispm 9y ago
That's simply not the case. It is exactly for an US audience important, because the German system is vastly different: universal health care, regulated by the government, 99.9% coverage, run by a system of 100+ insurers and various health care providers. > Social insurance contributions are mandatory Mandatory is to be insured. > based on income in a range, or if one is privately insured one pays based on risk/age Family members (wife/husband + kids) without income are insured. Plus various other regulations. > to a state entity Krankenkassen and Krankenversicherungen are not generally state entities. Would you call something like the Audi BKK a state entity? https://www.audibkk.de/english/ https://www.audibkk.de/english/ > enforced through exactly the same channels as regular taxation No, health care contributions are paid directly to the Krankenkasse/Krankenversicherung where one is a member, not the tax administration (Finanzamt). > That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that. Obviously not. In the health care domain, the Social Insurance systems and tax-based health care systems are different models.
- ams6110 9y ago
  > Mandatory is to be insured. While I will admit there are varying interpretation, for me, living in the USA, if I am mandated to pay for something, it's a tax. I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances?
  - kuschku 9y ago
    > I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances? You could opt out of the public system, and get a private insurance company. But once you have done so you can never re-enter the public system. And private insurances are cheaper for young people, but significantly more expensive later in life, so much that you’ll end up paying several times more over your lifetime.
  - germanier 9y ago
    You can't opt-out completely. Some people (including probably most HN readers) can purchase highly-regulated private insurance instead but even that isn't possible for the vast majority of the population.