7 ms·

I don't buy it, due to first-hand & second-hand experiences of friends and relatives I have in the US. Let me give you one example: my friend(and at the time b

by ido 6y ago

I don't buy it, due to first-hand & second-hand experiences of friends and relatives I have in the US. Let me give you one example: my friend(and at the time business partner)'s wife got cancer in the US. It was fairly "mundane"/common cancer that got treated and everything was alright at the end. He was working as a software developer (normal employee, not self-employed - our venture was a side project) with the aforementioned "good health insurance" well paid professional middle-class Americans get. At the end of the ordeal he was stuck with a $65k bill (presumably that's just the tip of iceberg and insurance paid more). Years later I had a malignant tumor here in Germany. Again everything is fine at the end, but it was in many ways a worse case than my friend's wife (due to where the tumor was) & I spent several weeks in a (very nice) hospital in Berlin. I also get an MRI every 6 months to keep track of the situation. I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). My twice-yearly MRIs are free. When I was diagnosed with the tumor they offered me an appointment for surgery for 3 days later (I ended up taking it a week later than that as I wanted to get a 2nd opinion). Neither mine nor my friend's experiences are exceptions.

metalliqaz 6y ago
Yep. That's because in Germany, "healthcare" is about caring for your health. In the US "healthcare" is about keeping laborers productive. Anyone who can generate value for capital will get the care they need to remain productive. When the cost of that care exceeds the value they generate, they are not covered. Public assistance programs are really just the bare minimum that is necessary to keep the following QOL issues from popping up in view of the upper class: homeless overrunning the streets, shantytowns and slums, rioting, black markets.
- lester_jango 6y ago
  While I don't wish for this level of utilitarianism and inequality, I do wish our system here in the US had this level of organized clarity that you are describing. I think instead much more of the problem needs to be attributed to sheer incompetence and bureaucratic inefficiency. Recently I went to the local medical center and had got some basic checkups and diagnostics. The healthcare was fine, but the billing and medical record interactions were terrible. The negotiation about the amount I owed, which was always in the $50-150 range, was dragged out over six months and involved five different corporations (the medical center, their independent billing agency, the collections agency, my insurer, and my insurer's third party negotiation firm). It went to collections even though all parties had agreed it should be on hold pending the "investigation", which never seemed to bring any new details to light. Then finally they lowered it significantly at the end and never provided a reason why it was different.
lettergram 6y ago
If I had cancer in the US a $65k bill really isn’t bad. Consider in the US taxes are typically <20%. So if you make $100k a year, you pay $20k in taxes. So you have $80k, minus insurance (let’s eat $500/month) you have $74k In Germany (if I recall) it’s closer to 50% taxes so $50k a year. Presumably you can expect cancer once or less, but effectively you only need ~4 years of income to make up for that $65k bill in the US. Not bad at all. Obviously that differs based on income, but you can a see how (for many people in the US) the system works great
- ido 6y ago
  Total income-related taxes+health insurance in California are IIRC similar or higher than Germany. Also in either case the taxes on $100k/year are way less than 50%. EDIT from what I can tell from very quick googling total taxes on $100k in California would be ~29% (not including health insurance) where as in Germany they would be ~34% (on $100k = ~€92k, including health insurance). So I guess whatever's better in that example depends on if you think German health insurance is worth 5% of your income. Your $500/m amount to 6% of income so similar to Germany either way. Keep in mind this is for single & childless, and Germany has outrageously generous tax breaks for having children as well as being married when one spouse earns a lot less than the other.
  - BeatLeJuce 6y ago
    After taxes, health care and Solidaritätszuschlag, your taxrate for 100k ist closer to 42% in Germany
    - ido 6y ago
      Not sure what you put in to get that number (keep in mind that $100k is roughly €92k) but there are many possible variables that can change your tax rate. In my personal case it is significantly lower than the number I posted above. I used mostly default values in the first online calculators I found for both California & Germany in the example in my original post.
cactus2093 6y ago
To add my own anecdote about US healthcare, I needed a hernia repair surgery in my early 20’s. My dr referred me to a specialist, I asked if he was in network for my insurance and everything seemed good. But in what I have since come to realize is a quintessential US healthcare experience, it turns out the facility that this independent surgeon used and the anesthesiologist were not in network. Nobody bothered to tell me about this before the surgery, so I went through with it. Later I see the bill is about $39k, and my insurance has decided they’ll pay $1174. I was freaking out, but I got a call from the billing department and they asked if I could just pay $200, which I did and they called it a day and everything was settled. It makes just as little sense as any of the horror stories I’ve heard, but somehow worked out pretty reasonably for me. I still have no idea how this happened. Did I get incredibly lucky? Or are more of these horror stories you hear where someone “ended up with a $50k medical bill”, just on paper and those amounts rarely actually need to be paid?
- dhimes 6y ago
  Makes me think they can write it off their taxes as "uncollectable."
  - rhino369 6y ago
    Yes, but they also had to add 50k of uncollectable revenue. So its not really doing anything for them for their taxes. It's mostly a game played between insurance provider and medical provider. They ask for 50k--knowing it the insurance is going to low ball them.
    - ncmncm 6y ago
      If they write off $39k, that counts against $39k in other income they actually get that they then don't have to pay taxes on.
- jshevek 6y ago
  Two anecdotes in support of your last sentence: I once paid cash up front for a procedure, charged at 25% of the insurance rate. This was put in writing as the total cost of the procedure. Afterwards, they billed me as if I owed 75% of the other rate, with threats of legal action accompanying invoices. I did not immediately locate in my files my copy of the initial contract. Like you, I was freaking out. Even after finding my copy, and knowing that I would prevail in court if it came to it, I worried about all the indirect ways the situation could harm me. Eventually they dropped the issue. A friend agreed to a few procedures without knowing the price, and was then charged a bizarre, absurd amount of money (I comparison researched, after the fact). He offered to pay 50%, and they gladly, eagerly accepted. I heard the call, they sounded surprised and happy. Clearly he could have paid much less.
pierrebeaucamp 6y ago
> I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). IMO, this is a somewhat misleading statement as Germanys public insurance (that everyone can sign up for), costs quite a lot. Normally the employer would cover 50% of the contribution, but as you mentioned being self-employed that could easily be over 800 Euros per month. That doesn't quite tip the scale in favour for the US, but the differences between the two health care systems are more nuanced as you're making it out to be. PS: From personal experience, I find that health care providers in North America will jump to expensive tests or hospitalization much quicker than European counter-parts. I don't know if that's common (I don't have enough data-points) but this could be another factor explaining the difference in cost.
- ido 6y ago
  If you read down-thread I compare total taxation+insurance costs. I believe that outside the absolute top couple of % of wage earners German total costs are similar to high-tax US states like California.
- srrr 6y ago
  The costs for public health insurance is 14-15% of your income with a lower income bound of 1061,67€ and an upper bound of 4687,50€. Thus the minimum cost is 148€ and the maximum is 656€ (for the exact same service). In addition you need to pay 3% Pflegeversicherung (nursing care insurance). https://www.krankenkassen.de/gesetzliche-krankenkassen/krankenkasse-beitrag/selbststaendige/ https://www.krankenkassen.de/gesetzliche-krankenkassen/krank...
sizzle 6y ago
I thought everything is covered after you got your total out of pocket expense (~$6k IIRC) in the traditional PPO healthcare plan? How did your friend get hit with $65k?? Out of network doctors/hospital?
- ido 6y ago
  I have no idea, I didn't dig in as it seemed a touchy subject. But I have heard similar anecdotes from other Americans.
pragmatic 6y ago
I don't buy your story either. Extraordinary claims require extraordinary proof.
- ido 6y ago
  Which is the extraordinary one, my friend getting handed a massive bill or me getting a small one? It's very possible he could have haggled it down but why should you need to? Especially in a vulnerable situation like after getting out of cancer treatment. I can guarantee you I wouldn't have had the wherewithal to fight it in his spot. I barely managed to do anything for 6 months after getting out of my own cancer treatment (and for psychological, not pyshiological reasons).

by ido 6y ago

metalliqaz 6y ago

Yep. That's because in Germany, "healthcare" is about caring for your health. In the US "healthcare" is about keeping laborers productive. Anyone who can generate value for capital will get the care they need to remain productive. When the cost of that care exceeds the value they generate, they are not covered. Public assistance programs are really just the bare minimum that is necessary to keep the following QOL issues from popping up in view of the upper class: homeless overrunning the streets, shantytowns and slums, rioting, black markets.

lester_jango 6y ago
While I don't wish for this level of utilitarianism and inequality, I do wish our system here in the US had this level of organized clarity that you are describing. I think instead much more of the problem needs to be attributed to sheer incompetence and bureaucratic inefficiency. Recently I went to the local medical center and had got some basic checkups and diagnostics. The healthcare was fine, but the billing and medical record interactions were terrible. The negotiation about the amount I owed, which was always in the $50-150 range, was dragged out over six months and involved five different corporations (the medical center, their independent billing agency, the collections agency, my insurer, and my insurer's third party negotiation firm). It went to collections even though all parties had agreed it should be on hold pending the "investigation", which never seemed to bring any new details to light. Then finally they lowered it significantly at the end and never provided a reason why it was different.

lettergram 6y ago

If I had cancer in the US a $65k bill really isn’t bad. Consider in the US taxes are typically <20%. So if you make $100k a year, you pay $20k in taxes. So you have $80k, minus insurance (let’s eat $500/month) you have $74k In Germany (if I recall) it’s closer to 50% taxes so $50k a year. Presumably you can expect cancer once or less, but effectively you only need ~4 years of income to make up for that $65k bill in the US. Not bad at all. Obviously that differs based on income, but you can a see how (for many people in the US) the system works great

ido 6y ago
Total income-related taxes+health insurance in California are IIRC similar or higher than Germany. Also in either case the taxes on $100k/year are way less than 50%. EDIT from what I can tell from very quick googling total taxes on $100k in California would be ~29% (not including health insurance) where as in Germany they would be ~34% (on $100k = ~€92k, including health insurance). So I guess whatever's better in that example depends on if you think German health insurance is worth 5% of your income. Your $500/m amount to 6% of income so similar to Germany either way. Keep in mind this is for single & childless, and Germany has outrageously generous tax breaks for having children as well as being married when one spouse earns a lot less than the other.
- BeatLeJuce 6y ago
  After taxes, health care and Solidaritätszuschlag, your taxrate for 100k ist closer to 42% in Germany
  - ido 6y ago
    Not sure what you put in to get that number (keep in mind that $100k is roughly €92k) but there are many possible variables that can change your tax rate. In my personal case it is significantly lower than the number I posted above. I used mostly default values in the first online calculators I found for both California & Germany in the example in my original post.

cactus2093 6y ago

To add my own anecdote about US healthcare, I needed a hernia repair surgery in my early 20’s. My dr referred me to a specialist, I asked if he was in network for my insurance and everything seemed good. But in what I have since come to realize is a quintessential US healthcare experience, it turns out the facility that this independent surgeon used and the anesthesiologist were not in network. Nobody bothered to tell me about this before the surgery, so I went through with it. Later I see the bill is about $39k, and my insurance has decided they’ll pay $1174. I was freaking out, but I got a call from the billing department and they asked if I could just pay $200, which I did and they called it a day and everything was settled. It makes just as little sense as any of the horror stories I’ve heard, but somehow worked out pretty reasonably for me. I still have no idea how this happened. Did I get incredibly lucky? Or are more of these horror stories you hear where someone “ended up with a $50k medical bill”, just on paper and those amounts rarely actually need to be paid?

dhimes 6y ago
Makes me think they can write it off their taxes as "uncollectable."
- rhino369 6y ago
  Yes, but they also had to add 50k of uncollectable revenue. So its not really doing anything for them for their taxes. It's mostly a game played between insurance provider and medical provider. They ask for 50k--knowing it the insurance is going to low ball them.
  - ncmncm 6y ago
    If they write off $39k, that counts against $39k in other income they actually get that they then don't have to pay taxes on.
jshevek 6y ago
Two anecdotes in support of your last sentence: I once paid cash up front for a procedure, charged at 25% of the insurance rate. This was put in writing as the total cost of the procedure. Afterwards, they billed me as if I owed 75% of the other rate, with threats of legal action accompanying invoices. I did not immediately locate in my files my copy of the initial contract. Like you, I was freaking out. Even after finding my copy, and knowing that I would prevail in court if it came to it, I worried about all the indirect ways the situation could harm me. Eventually they dropped the issue. A friend agreed to a few procedures without knowing the price, and was then charged a bizarre, absurd amount of money (I comparison researched, after the fact). He offered to pay 50%, and they gladly, eagerly accepted. I heard the call, they sounded surprised and happy. Clearly he could have paid much less.

pierrebeaucamp 6y ago

> I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). IMO, this is a somewhat misleading statement as Germanys public insurance (that everyone can sign up for), costs quite a lot. Normally the employer would cover 50% of the contribution, but as you mentioned being self-employed that could easily be over 800 Euros per month. That doesn't quite tip the scale in favour for the US, but the differences between the two health care systems are more nuanced as you're making it out to be. PS: From personal experience, I find that health care providers in North America will jump to expensive tests or hospitalization much quicker than European counter-parts. I don't know if that's common (I don't have enough data-points) but this could be another factor explaining the difference in cost.

ido 6y ago
If you read down-thread I compare total taxation+insurance costs. I believe that outside the absolute top couple of % of wage earners German total costs are similar to high-tax US states like California.
srrr 6y ago
The costs for public health insurance is 14-15% of your income with a lower income bound of 1061,67€ and an upper bound of 4687,50€. Thus the minimum cost is 148€ and the maximum is 656€ (for the exact same service). In addition you need to pay 3% Pflegeversicherung (nursing care insurance). https://www.krankenkassen.de/gesetzliche-krankenkassen/krankenkasse-beitrag/selbststaendige/ https://www.krankenkassen.de/gesetzliche-krankenkassen/krank...

sizzle 6y ago

I thought everything is covered after you got your total out of pocket expense (~$6k IIRC) in the traditional PPO healthcare plan? How did your friend get hit with $65k?? Out of network doctors/hospital?

ido 6y ago
I have no idea, I didn't dig in as it seemed a touchy subject. But I have heard similar anecdotes from other Americans.

pragmatic 6y ago

I don't buy your story either. Extraordinary claims require extraordinary proof.

ido 6y ago
Which is the extraordinary one, my friend getting handed a massive bill or me getting a small one? It's very possible he could have haggled it down but why should you need to? Especially in a vulnerable situation like after getting out of cancer treatment. I can guarantee you I wouldn't have had the wherewithal to fight it in his spot. I barely managed to do anything for 6 months after getting out of my own cancer treatment (and for psychological, not pyshiological reasons).