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> Statistically, most people won't need to use the safety net As a person, you'll around 100% likely to the doctor. In any Western Europe country, you don't ha

> Statistically, most people won't need to use the safety net As a person, you'll around 100% likely to the doctor. In any Western Europe country, you don't have to think about it. In the US, you either think about it because of your copay or your don't go because you don't have money.

rayiner 8y ago
Most Americans have insurance through their employer, or under Medicare/Medicaid. (And that was true before ACA.) Copays are small ($20-30 typically) and similar to what they are in say Sweden or Finland: https://megaphoneoz.com/why-sweden-gets-away-with-health-co-payments https://megaphoneoz.com/why-sweden-gets-away-with-health-co-....
- thatfrenchguy 8y ago
  I make a good six figures. I have a $20 copay. The copay in France is usually €1. I have delayed going to the doctor in the US because "do I really want to spend 20 bucks on this ?" and ended up going a week after while in a worse state. Most people I know here are like this. Also, 12.4% of all Americans are uninsured and 28% are underinsured: http://fortune.com/2019/02/07/americans-health-care-underinsured-rate/ http://fortune.com/2019/02/07/americans-health-care-underins... . Don't pretend the current situation in the US is anywhere near healthy.
  - rayiner 8y ago
    The whole point of copays is to dissuade you from using services unnecessarily, which is why many countries, even ones with socialized medicine, have copays or similar out-of-pocket charges (Sweden, Norway, Netherlands, Finland, etc.). In the typical case where you're not sick, it works out. As to your point about the uninsured--I'm not debating the merits of various healthcare systems, I'm trying to contextualize the experience of the typical American. The typical American has health insurance (and is not underinsured), pays $25 or so for their annual checkup, and lives in a house two and a half times bigger than their counterpart in the U.K. (That American is also a job loss + health scare away from significant financial problems. Both things are true.)
    - thatfrenchguy 8y ago
      Copays are pretty universally known to lead towards worse care, while making access inequality worse. (There is also no copay to go to the GP in the Netherlands) 40% of those Americans are not your “typical” American. Americans also on average take 10 days of vacation, while 24% of private industry workers don’t have any day of vacation, and have no job security because they can be fired at any time. They also have to pay for their kid’s college education or have them take r The median wealth of the US is also 97k$, compared to 113k€ in France. That’s not counting the fact that all retirement in France is publicly managed, meaning it doesn’t count into your wealth when it does in the US (except for social security)
      - rayiner 8y ago
        Yet, co-payments and the like are quite common. (France has low co-pays, but quite substantial co-insurance requirements.) Indeed, a lower percentage of American healthcare expenditures come out-of-pocket than in a number of European countries: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7852.pdf https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7.... As to wealth. I don't know what source you're looking at. This report shows the U.S. compares quite well to say Germany: https://www.credit-suisse.com/corporate/en/research/research-institute/global-wealth-report.html https://www.credit-suisse.com/corporate/en/research/research... (pages 40, 44). 28.4% of Americans have under $10,000, while 33.6% have $100,000-$1m. In Germany, 40% are under $10,000, while 34.5% are $100,000-$1m. Switzerland does better than both--just 13.7% under $10,000, and 52.1% in $100,000-$1m. Also, American wealth is not as high as you'd expect because America's savings rate is very low (5%, versus 10% for the EU and almost 15% in France). This is a trend that long predates things like soaring healthcare expenditures, and it has more to do with American consumer culture.
        thatfrenchguy 8y ago
        > France has low co-pays, but quite substantial co-insurance requirements Not sure what you mean here. Do you mean things like le forfait hospitalier ? Which is like 20 bucks a day you're in the hospital (if your complementary insurance doesn't reimburse you). Usually you're at 80-90% coinsurance when you go to the hospital in the US with a top-tier insurance (which is going to run you ~1000-10000$ a day). Your source is also a 2003 document, which predates a lot of the current health crisis in the US. > This report shows the U.S. compares quite well to say Germany You're cherry-picking here: Germany is pretty well known to have lower wealth because of a prevalence of renting.
- SilasX 8y ago
  Wait, what? runako: If you make $23k, you don't have a job that gives you health insurance. rayiner: None of this is a big deal, because most Americans have health insurance through their employer. Er, what? Yeah, most do, I guess ... the part making much more than $23k.
  - rayiner 8y ago
    Even among households making less than $25,000 per year, the large majority (85%) of people have health insurance. Within that group, more people have employer-provided health insurance than lack coverage: https://www2.census.gov/programs-surveys/cps/tables/hi-01/2018/hi01_1.xls https://www2.census.gov/programs-surveys/cps/tables/hi-01/20.... (See row 200.) Even among the groups most likely to lack health insurance (households of unrelated individuals making less than $25,000), uninsured + direct purchase (having to buy your own health insurance) only accounts for 1/3 of people in that segment. (Row 210.)
    - acchow 8y ago
      > the large majority (85%) of people have health insurance From row 200 of that table, looks like you're reading off the "Covered by some type of health insurance during the year" (85%) column. This is ambiguous. It could mean there was at least some period during the year where you had some sort of coverage. Or it could mean that you had some coverage for the entirety of the year. Which is it?
  - amanaplanacanal 8y ago
    Yeah, they are talking about two very different groups of people.
deleted 8y ago
[deleted]

rayiner 8y ago

Most Americans have insurance through their employer, or under Medicare/Medicaid. (And that was true before ACA.) Copays are small ($20-30 typically) and similar to what they are in say Sweden or Finland: https://megaphoneoz.com/why-sweden-gets-away-with-health-co-payments https://megaphoneoz.com/why-sweden-gets-away-with-health-co-....

thatfrenchguy 8y ago
I make a good six figures. I have a $20 copay. The copay in France is usually €1. I have delayed going to the doctor in the US because "do I really want to spend 20 bucks on this ?" and ended up going a week after while in a worse state. Most people I know here are like this. Also, 12.4% of all Americans are uninsured and 28% are underinsured: http://fortune.com/2019/02/07/americans-health-care-underinsured-rate/ http://fortune.com/2019/02/07/americans-health-care-underins... . Don't pretend the current situation in the US is anywhere near healthy.
- rayiner 8y ago
  The whole point of copays is to dissuade you from using services unnecessarily, which is why many countries, even ones with socialized medicine, have copays or similar out-of-pocket charges (Sweden, Norway, Netherlands, Finland, etc.). In the typical case where you're not sick, it works out. As to your point about the uninsured--I'm not debating the merits of various healthcare systems, I'm trying to contextualize the experience of the typical American. The typical American has health insurance (and is not underinsured), pays $25 or so for their annual checkup, and lives in a house two and a half times bigger than their counterpart in the U.K. (That American is also a job loss + health scare away from significant financial problems. Both things are true.)
  - thatfrenchguy 8y ago
    Copays are pretty universally known to lead towards worse care, while making access inequality worse. (There is also no copay to go to the GP in the Netherlands) 40% of those Americans are not your “typical” American. Americans also on average take 10 days of vacation, while 24% of private industry workers don’t have any day of vacation, and have no job security because they can be fired at any time. They also have to pay for their kid’s college education or have them take r The median wealth of the US is also 97k$, compared to 113k€ in France. That’s not counting the fact that all retirement in France is publicly managed, meaning it doesn’t count into your wealth when it does in the US (except for social security)
    - rayiner 8y ago
      Yet, co-payments and the like are quite common. (France has low co-pays, but quite substantial co-insurance requirements.) Indeed, a lower percentage of American healthcare expenditures come out-of-pocket than in a number of European countries: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7852.pdf https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7.... As to wealth. I don't know what source you're looking at. This report shows the U.S. compares quite well to say Germany: https://www.credit-suisse.com/corporate/en/research/research-institute/global-wealth-report.html https://www.credit-suisse.com/corporate/en/research/research... (pages 40, 44). 28.4% of Americans have under $10,000, while 33.6% have $100,000-$1m. In Germany, 40% are under $10,000, while 34.5% are $100,000-$1m. Switzerland does better than both--just 13.7% under $10,000, and 52.1% in $100,000-$1m. Also, American wealth is not as high as you'd expect because America's savings rate is very low (5%, versus 10% for the EU and almost 15% in France). This is a trend that long predates things like soaring healthcare expenditures, and it has more to do with American consumer culture.
      - thatfrenchguy 8y ago
        > France has low co-pays, but quite substantial co-insurance requirements Not sure what you mean here. Do you mean things like le forfait hospitalier ? Which is like 20 bucks a day you're in the hospital (if your complementary insurance doesn't reimburse you). Usually you're at 80-90% coinsurance when you go to the hospital in the US with a top-tier insurance (which is going to run you ~1000-10000$ a day). Your source is also a 2003 document, which predates a lot of the current health crisis in the US. > This report shows the U.S. compares quite well to say Germany You're cherry-picking here: Germany is pretty well known to have lower wealth because of a prevalence of renting.
SilasX 8y ago
Wait, what? runako: If you make $23k, you don't have a job that gives you health insurance. rayiner: None of this is a big deal, because most Americans have health insurance through their employer. Er, what? Yeah, most do, I guess ... the part making much more than $23k.
- rayiner 8y ago
  Even among households making less than $25,000 per year, the large majority (85%) of people have health insurance. Within that group, more people have employer-provided health insurance than lack coverage: https://www2.census.gov/programs-surveys/cps/tables/hi-01/2018/hi01_1.xls https://www2.census.gov/programs-surveys/cps/tables/hi-01/20.... (See row 200.) Even among the groups most likely to lack health insurance (households of unrelated individuals making less than $25,000), uninsured + direct purchase (having to buy your own health insurance) only accounts for 1/3 of people in that segment. (Row 210.)
  - acchow 8y ago
    > the large majority (85%) of people have health insurance From row 200 of that table, looks like you're reading off the "Covered by some type of health insurance during the year" (85%) column. This is ambiguous. It could mean there was at least some period during the year where you had some sort of coverage. Or it could mean that you had some coverage for the entirety of the year. Which is it?
- amanaplanacanal 8y ago
  Yeah, they are talking about two very different groups of people.

deleted 8y ago

[deleted]