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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 spen

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.
    - turtlesdown 8y ago
      You can't win a bad argument by just moving to an adjacent position (which is still wrong)

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.
  - turtlesdown 8y ago
    You can't win a bad argument by just moving to an adjacent position (which is still wrong)