4 ms·

Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.

Retric 2y ago
Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 non profit insurance programs looks like private insurance but … https://en.wikipedia.org/wiki/Healthcare_in_Israel https://en.wikipedia.org/wiki/Healthcare_in_Israel For the health tax, wage-earners and the self-employed must pay 3.1% of their monthly salary up to 60% of the average prevailing market wage (appx. NIS 6,300 in 2020), and 5% of anything earned above it.[25] Employers are legally obligated to deduct insurance contributions from their employees' salaries, while the self-employed must arrange payment on their own. Pensioners have contributions deducted from their pensions, as do those receiving unemployment benefits. Those who are not working but have income must pay 5% of their income in health tax, while those who are not working and have no income must pay NIS 104 a month. Switzerland has a similar system with mandatory participation and non profit insurance programs. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
- JamesBarney 2y ago
  Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.
  - Retric 2y ago
    Each of things individually is lowering healthcare costs. Medical billing is a significant multiplier for US healthcare costs, and going to a highly regulated nonprofit only system would help. There’s other factors like our obesity rate, but we’re basically intentionally shooting ourselves in the foot when it comes to healthcare costs because cost savings is lost profits for someone else.
  - vundercind 2y ago
    The unifying factor of ~all other developed-world systems is price controls, de facto (e.g. government monopsony or [near-]monopoly) or de jure (outright pricing sheets)
  - emeril 2y ago
    > It's not that easy to fix. Medicare for everyone seems like an "easy" fix but we have too many red state neanderthals in the US who oppose policies that clearly benefit them claiming "personal responsibility" though they oddly still think schools, police, fire departments, etc. are just fine...
    - JamesBarney 2y ago
      Medicare for everyone fixes the under and uninsured problem. It doesn't fix the cost problem, only moves it from paying private insurance companies to the government. It's true Medicare pays less per procedure but that is not because those procedures are more efficient it's because relies on pricing power. Many hospitals would go out of business or have to layoff a significant amount of their staff if they were exclusively paid Medicare rates.
  - cherry_tree 2y ago
    Seems like you’re misrepresenting these countries in stating that they “rely” on private insurance (these are countries with public healthcare). Are you able to point to a completely private system that is insurance based and works well? Or what do you think public systems that also include private insurance add to the table that is missing from the US market?
raincom 2y ago
US population is 300M, whereas Israel/Switzerland/Netherlands population is about 10M.
- atombender 2y ago
  You would expect healthcare cost to scale pretty linearly with population size, I think? Number of doctors, hospitals, drug prescriptions etc. are entirely population-driven. Medications also don't cost more or less based on population size. Although in a single-player market monopoly, I suspect a larger country should have greater cost negotiation power, so this should actually benefit a larger country like the U.S. A greater factor than population size may be demographics. Countries with older and less healthy citizens would have a larger cost burden. A poorly designed government structure could also disadvantage a large country like the U.S. This has been observed in the U.K., where successive Conservative governments have centralized the healthcare system over the last two decades, reducing efficiency and increasing cost. Not sure about Switzerland, which is also a federation of states (cantons).
Cthulhu_ 2y ago
NL may be better than what's in the US but it's quickly deteriorating after the 2006 reforms. We've got dozens of competing health insurance companies big and small, but their base coverage package is the same because that's legally required. So the main thing they differentiate is with nonsense; minor differences between competitors, but mainly marketing, bullshit apps, etc. That is, a nontrivial portion of health insurance payments is spent on marketing. Then there's the other big problem. Base insurance, which btw goes up to €150 / month next year (per adult), only covers cheap generics whose purchase prices are negotiated by the government (or something like that). The consequence now is that the manufacturers are not willing to pay the import fees for their generics, because the profit margins are too slim. Thousands of types of medications are now no longer available, difficult to get, or will only be available again in X months. This is stuff like basic painkillers, adhd, diabetes, etc. The system is failing, is all I'm saying.

Retric 2y ago

Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 non profit insurance programs looks like private insurance but … https://en.wikipedia.org/wiki/Healthcare_in_Israel https://en.wikipedia.org/wiki/Healthcare_in_Israel For the health tax, wage-earners and the self-employed must pay 3.1% of their monthly salary up to 60% of the average prevailing market wage (appx. NIS 6,300 in 2020), and 5% of anything earned above it.[25] Employers are legally obligated to deduct insurance contributions from their employees' salaries, while the self-employed must arrange payment on their own. Pensioners have contributions deducted from their pensions, as do those receiving unemployment benefits. Those who are not working but have income must pay 5% of their income in health tax, while those who are not working and have no income must pay NIS 104 a month. Switzerland has a similar system with mandatory participation and non profit insurance programs. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

JamesBarney 2y ago
Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.
- Retric 2y ago
  Each of things individually is lowering healthcare costs. Medical billing is a significant multiplier for US healthcare costs, and going to a highly regulated nonprofit only system would help. There’s other factors like our obesity rate, but we’re basically intentionally shooting ourselves in the foot when it comes to healthcare costs because cost savings is lost profits for someone else.
- vundercind 2y ago
  The unifying factor of ~all other developed-world systems is price controls, de facto (e.g. government monopsony or [near-]monopoly) or de jure (outright pricing sheets)
- emeril 2y ago
  > It's not that easy to fix. Medicare for everyone seems like an "easy" fix but we have too many red state neanderthals in the US who oppose policies that clearly benefit them claiming "personal responsibility" though they oddly still think schools, police, fire departments, etc. are just fine...
  - JamesBarney 2y ago
    Medicare for everyone fixes the under and uninsured problem. It doesn't fix the cost problem, only moves it from paying private insurance companies to the government. It's true Medicare pays less per procedure but that is not because those procedures are more efficient it's because relies on pricing power. Many hospitals would go out of business or have to layoff a significant amount of their staff if they were exclusively paid Medicare rates.
- cherry_tree 2y ago
  Seems like you’re misrepresenting these countries in stating that they “rely” on private insurance (these are countries with public healthcare). Are you able to point to a completely private system that is insurance based and works well? Or what do you think public systems that also include private insurance add to the table that is missing from the US market?

raincom 2y ago

US population is 300M, whereas Israel/Switzerland/Netherlands population is about 10M.

atombender 2y ago
You would expect healthcare cost to scale pretty linearly with population size, I think? Number of doctors, hospitals, drug prescriptions etc. are entirely population-driven. Medications also don't cost more or less based on population size. Although in a single-player market monopoly, I suspect a larger country should have greater cost negotiation power, so this should actually benefit a larger country like the U.S. A greater factor than population size may be demographics. Countries with older and less healthy citizens would have a larger cost burden. A poorly designed government structure could also disadvantage a large country like the U.S. This has been observed in the U.K., where successive Conservative governments have centralized the healthcare system over the last two decades, reducing efficiency and increasing cost. Not sure about Switzerland, which is also a federation of states (cantons).

Cthulhu_ 2y ago

NL may be better than what's in the US but it's quickly deteriorating after the 2006 reforms. We've got dozens of competing health insurance companies big and small, but their base coverage package is the same because that's legally required. So the main thing they differentiate is with nonsense; minor differences between competitors, but mainly marketing, bullshit apps, etc. That is, a nontrivial portion of health insurance payments is spent on marketing. Then there's the other big problem. Base insurance, which btw goes up to €150 / month next year (per adult), only covers cheap generics whose purchase prices are negotiated by the government (or something like that). The consequence now is that the manufacturers are not willing to pay the import fees for their generics, because the profit margins are too slim. Thousands of types of medications are now no longer available, difficult to get, or will only be available again in X months. This is stuff like basic painkillers, adhd, diabetes, etc. The system is failing, is all I'm saying.