5 ms·

The US private healthcare system has lots of problems and I'm not trying to defend it. However, the public European model is very misleading. The reason is that

The US private healthcare system has lots of problems and I'm not trying to defend it. However, the public European model is very misleading. The reason is that most people who can afford it pay for private insurance, even in Europe. Otherwise they need to wait months for a doctor appointment.

lentil_soup 7y ago
How healthcare works in Europe changes quite a lot per country. Which country specifically are you talking about?
- tinyhouse 7y ago
  Ones I know of based on friends and family are Israel (follows the European public healthcare model) and Spain. I'm not saying it's the same everywhere in Europe, but I wouldn't be surprised if it's the case in many European countries.
  - igravious 7y ago
    In Spain the rate is 4.4% Israel is not in Europe, but anyway the rate there is 10.3% This indicates to me that the circle of people that you know is not representative of the population at large at least when it comes to health insurance coverage. There's no need to infer statistics about the whole of Europe from your small sample size. All you have to do is look up† the data. Page 4 (Figure 2.1) here: http://www.euro.who.int/__data/assets/pdf_file/0005/310838/Voluntary-health-insurance-Europe-role-regulation.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0005/310838/V... The majority of countries (38 versus 11) are below 5%, only 5 are above 10% --- † I googled: percentage private health insurance european countries
    - tinyhouse 7y ago
      I guess it depends what qualifies as private insurance. See Figure 7.2: https://www.oecd-ilibrary.org/docserver/health_glance-2015-39-en.pdf?expires=1575305434&id=id&accname=guest&checksum=9D19D04B300E74512459F5C13EC2C57F https://www.oecd-ilibrary.org/docserver/health_glance-2015-3... Israel is 83% and not 10%...
      - igravious 7y ago
        Figure 7.1, Health insurance coverage for a core set of services – Percentage of total population Total public coverage: Israel 100% Figure 7.2, Private health insurance coverage, by type, 2013 (or nearest year) Note: Private health insurance can be both duplicate and supplementary, in Australia; both complementary and supplementary in Denmark and Korea; and duplicate, complementary and supplementary in Israel and Slovenia Israel: type = Supplementary = 82.9% . What is supplementary? “Most OECD countries have achieved universal (or near-universal) coverage of health care costs for a core set of services, which usually include consultations with doctors and specialists, tests and examinations, and surgical and therapeutic procedures (Figure 7.1). Generally, dental care and pharmaceutical drugs are partially covered, although there are a number of countries where these services must be purchased separately (OECD, 2015)” “Private health insurance offers 95% of the French population complementary insurance to cover cost-sharing in the social security system. The Netherlands has the largest supplementary market (86% of the population), followed by Israel (83%), whereby private insurance pays for prescription drugs and dental care that are not publicly reimbursed. So this doesn't mean that 83% of the market is private, you understand? It means that 83% of the market (whatever that market is) that isn't covered by government access is covered on a supplementary basis. How large is that portion? If you look at the 2019 publication: https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expires=1575478336&id=id&accname=guest&checksum=3DD43B3AC2A0FBC2411927BD1BA0DACF https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expi... Figure 7.11. Health expenditure from public sources as share of total, 2017 (or nearest year) Israel: 64% What's important here is that the % in the US (wealthiest country in the world) is 50%, far below the OECD average of 71% which is the point being made here. don't view the world through the anecdotes of your friends and family. They are not a representative sample of the world's population. When quoting statistics make sure they are the correct ones.
  - dragonwriter 7y ago
    > Ones I know of based on friends and family are Israel (follows the European public healthcare model) While every developed country (and every OECD country, which are overlapping but distinct sets which are not subsets of each other in either direction), except the US in both cases and maybe Mexico in the OECD case, as I've seen sources going both ways on Mexico and universality, has a healthcare system providing universal access to comprehensive medical care with a substantiallty larger percentage of total healthcare funding coming from public sources than the US (though often not more per GDP or especially per capita public spending), there is not, whether in Europe or more generally, single model for this, there are many, fairly radically divergent models from the government-as-provider model of the UK NHS, to the government-as-exclusive-insurer-of-core-services, to mandatory-and-need-subsidized-insurance-with-a-default-public-option, among others. So, except for “don’t emulate the US’s broken system”, there is nothing even approximating a single “European public healthcare model”.
claudeganon 7y ago
Nope. My grandmother and extended family in the UK received great, high quality care as working class people for all of their lives. There have been more issues with access to care since right wingers started attacking and defunding the NHS, but hopefully Corbyn will soon put an end to all of that.
- DiogenesKynikos 7y ago
  The Tories in the UK have been following the "starve the beast" strategy: constrict funding to the NHS until the system starts to fall over, and then argue that privatization is the solution.
- wlll 7y ago
  > hopefully Corbyn will soon put an end to all of that. Unfortunately it is very likely that this will never happen. Realistically we're getting Boris as the next Prime Minister. To be clear, I don't want this, but Corbyn getting in is a long shot. The best thing he could have done for the Labour party and the left in general was to stand down years ago.
brazzy 7y ago
Germany ringing in: nope, we don't.
wlll 7y ago
A couple of thoughts: 1. In the UK the number of people with private medical insurance was (a couple of years ago) around 12% (according to one source). I don't know anyone who has it personally, I don't (and I can afford it). Do you know what the figures are for other European countries? 2. Is it possible that having a (relatively) cheap and functional state provided health care system keeps insurance costs down? If you're charging some large amount of money for health insurance and the alternative is effectively free* then you'd think that people wouldn't bother with it. * you pay for it anyway in taxes, it's not a lot of money, or it's free, depending on your income level.
- igravious 7y ago
  According to the WHO the rate for the UK is 3.4% – the reason why you personally don't know anybody who has it is because hardly anyone (1 in 33 people) has it. source, WHO: http://www.euro.who.int/__data/assets/pdf_file/0005/310838/Voluntary-health-insurance-Europe-role-regulation.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0005/310838/V...
standardUser 7y ago
Who cares if you have to wait 3 days or 3 months? What matters is outcomes. If you wait three months, are properly treated and have a good outcome, that is a healthcare success. If you wait 3 days, go deep in to debt, and get the exact same outcome, how is that better? Obviously, people are not dying as they wait for their appointments throughout Europe. Otherwise their health metrics would not be so consistently better than in the US. Maybe focusing on wait times is not the right way to look at the issue.
dragonwriter 7y ago
> However, the public European model is very misleading. The phrase “the public European model” is misleading, because there are lots of European models which provide universal healthcare, and while almost all of them involve a vastly greater public share of all expenditures than the US system which fails at universality, in some, IIRC, a substantial share of that is through publicly subsidized private insurance. The British model is not the French model is not the German model, etc.; the two things they have in common is universality and not being as ludicrously inefficient as the US model.

lentil_soup 7y ago

How healthcare works in Europe changes quite a lot per country. Which country specifically are you talking about?

tinyhouse 7y ago
Ones I know of based on friends and family are Israel (follows the European public healthcare model) and Spain. I'm not saying it's the same everywhere in Europe, but I wouldn't be surprised if it's the case in many European countries.
- igravious 7y ago
  In Spain the rate is 4.4% Israel is not in Europe, but anyway the rate there is 10.3% This indicates to me that the circle of people that you know is not representative of the population at large at least when it comes to health insurance coverage. There's no need to infer statistics about the whole of Europe from your small sample size. All you have to do is look up† the data. Page 4 (Figure 2.1) here: http://www.euro.who.int/__data/assets/pdf_file/0005/310838/Voluntary-health-insurance-Europe-role-regulation.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0005/310838/V... The majority of countries (38 versus 11) are below 5%, only 5 are above 10% --- † I googled: percentage private health insurance european countries
  - tinyhouse 7y ago
    I guess it depends what qualifies as private insurance. See Figure 7.2: https://www.oecd-ilibrary.org/docserver/health_glance-2015-39-en.pdf?expires=1575305434&id=id&accname=guest&checksum=9D19D04B300E74512459F5C13EC2C57F https://www.oecd-ilibrary.org/docserver/health_glance-2015-3... Israel is 83% and not 10%...
    - igravious 7y ago
      Figure 7.1, Health insurance coverage for a core set of services – Percentage of total population Total public coverage: Israel 100% Figure 7.2, Private health insurance coverage, by type, 2013 (or nearest year) Note: Private health insurance can be both duplicate and supplementary, in Australia; both complementary and supplementary in Denmark and Korea; and duplicate, complementary and supplementary in Israel and Slovenia Israel: type = Supplementary = 82.9% . What is supplementary? “Most OECD countries have achieved universal (or near-universal) coverage of health care costs for a core set of services, which usually include consultations with doctors and specialists, tests and examinations, and surgical and therapeutic procedures (Figure 7.1). Generally, dental care and pharmaceutical drugs are partially covered, although there are a number of countries where these services must be purchased separately (OECD, 2015)” “Private health insurance offers 95% of the French population complementary insurance to cover cost-sharing in the social security system. The Netherlands has the largest supplementary market (86% of the population), followed by Israel (83%), whereby private insurance pays for prescription drugs and dental care that are not publicly reimbursed. So this doesn't mean that 83% of the market is private, you understand? It means that 83% of the market (whatever that market is) that isn't covered by government access is covered on a supplementary basis. How large is that portion? If you look at the 2019 publication: https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expires=1575478336&id=id&accname=guest&checksum=3DD43B3AC2A0FBC2411927BD1BA0DACF https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expi... Figure 7.11. Health expenditure from public sources as share of total, 2017 (or nearest year) Israel: 64% What's important here is that the % in the US (wealthiest country in the world) is 50%, far below the OECD average of 71% which is the point being made here. don't view the world through the anecdotes of your friends and family. They are not a representative sample of the world's population. When quoting statistics make sure they are the correct ones.
- dragonwriter 7y ago
  > Ones I know of based on friends and family are Israel (follows the European public healthcare model) While every developed country (and every OECD country, which are overlapping but distinct sets which are not subsets of each other in either direction), except the US in both cases and maybe Mexico in the OECD case, as I've seen sources going both ways on Mexico and universality, has a healthcare system providing universal access to comprehensive medical care with a substantiallty larger percentage of total healthcare funding coming from public sources than the US (though often not more per GDP or especially per capita public spending), there is not, whether in Europe or more generally, single model for this, there are many, fairly radically divergent models from the government-as-provider model of the UK NHS, to the government-as-exclusive-insurer-of-core-services, to mandatory-and-need-subsidized-insurance-with-a-default-public-option, among others. So, except for “don’t emulate the US’s broken system”, there is nothing even approximating a single “European public healthcare model”.

claudeganon 7y ago

Nope. My grandmother and extended family in the UK received great, high quality care as working class people for all of their lives. There have been more issues with access to care since right wingers started attacking and defunding the NHS, but hopefully Corbyn will soon put an end to all of that.

DiogenesKynikos 7y ago
The Tories in the UK have been following the "starve the beast" strategy: constrict funding to the NHS until the system starts to fall over, and then argue that privatization is the solution.
wlll 7y ago
> hopefully Corbyn will soon put an end to all of that. Unfortunately it is very likely that this will never happen. Realistically we're getting Boris as the next Prime Minister. To be clear, I don't want this, but Corbyn getting in is a long shot. The best thing he could have done for the Labour party and the left in general was to stand down years ago.

brazzy 7y ago

Germany ringing in: nope, we don't.

wlll 7y ago

A couple of thoughts: 1. In the UK the number of people with private medical insurance was (a couple of years ago) around 12% (according to one source). I don't know anyone who has it personally, I don't (and I can afford it). Do you know what the figures are for other European countries? 2. Is it possible that having a (relatively) cheap and functional state provided health care system keeps insurance costs down? If you're charging some large amount of money for health insurance and the alternative is effectively free* then you'd think that people wouldn't bother with it. * you pay for it anyway in taxes, it's not a lot of money, or it's free, depending on your income level.

igravious 7y ago
According to the WHO the rate for the UK is 3.4% – the reason why you personally don't know anybody who has it is because hardly anyone (1 in 33 people) has it. source, WHO: http://www.euro.who.int/__data/assets/pdf_file/0005/310838/Voluntary-health-insurance-Europe-role-regulation.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0005/310838/V...

standardUser 7y ago

Who cares if you have to wait 3 days or 3 months? What matters is outcomes. If you wait three months, are properly treated and have a good outcome, that is a healthcare success. If you wait 3 days, go deep in to debt, and get the exact same outcome, how is that better? Obviously, people are not dying as they wait for their appointments throughout Europe. Otherwise their health metrics would not be so consistently better than in the US. Maybe focusing on wait times is not the right way to look at the issue.

dragonwriter 7y ago

> However, the public European model is very misleading. The phrase “the public European model” is misleading, because there are lots of European models which provide universal healthcare, and while almost all of them involve a vastly greater public share of all expenditures than the US system which fails at universality, in some, IIRC, a substantial share of that is through publicly subsidized private insurance. The British model is not the French model is not the German model, etc.; the two things they have in common is universality and not being as ludicrously inefficient as the US model.