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With Universal Health Insurance as all other developed countries do

Thanks. I never understood why intelligent people, comparing for example the German to the US system can even blink and decide that the German system doesn’t work.

Yes, there is quite a bit to improve in the German system. No doubt there. But if I compare it to the abysmal situation in the richest country on this planet, I am left standing awestruck asking myself why. I really, genuinely cannot wrap my head around.

It's largely not up to people. 59% of Americans support Medicare for All[1], including over 1 in 3 Republicans, but how many politicians even talk about it?

[1]https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabRepor... via https://truthout.org/articles/6-in-10-americans-back-medicar...

If you vote republican, you do not "support medicare for all" no matter what you say to the poll.

Your vote has consequences, and republicans have been voting for people who objectively and loudly tell their voters that they have no intention of doing those things.

It's time for people who vote republican to own that they suck at picking who to vote for.

Tons of them also say they want recreational weed, but it's only republicans working to prevent that in most states, often literally ignoring citizen's initiatives and court cases to accomplish that.

I would take my insurance over public German healthcare in an instant. I would not trade.

Now maybe when I stop working that may be a different comparison. And its not like there is a choice, voting for a D doesn't magically get German healthcare.

It's almost like healthcare and the well-being of people should be gasp a non partisan issue.
That doesn't say how you would fund it, only what form of insurance is in place.

If the US were to shift to that model today, a country already heavily in debt would have to either take on more debt PR increase revenues in a manner that they wouldn't have been willing to in order to fund our already growing debts.

The debate over whether public or private healthcare is better is all well and good, but first we should be debating how the US would pay for it in the first place.

A Single-Payer-System would also be cheaper in the US. Nobody expenses as much on administrative cost, nobody pays so much as a % of GDP on Healthcare as you, still you have the worst health outcomes of all developed nations.

Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Looks like I don't have access to the full paper, but I would be extremely skeptical of any claims with such accuracy or certainty.

The healthcare industry in the US is massive and already full of corruption and inefficiency. Even if we are to assume giving politicians and bureaucracy more control over the system will reduce both issues, we can't predict how successful that will be.

Similar claims were made regarding the hopes for ACA reducing costs and here we are.

You are, of course, aware that the current US single payer system (Medicare) subcontracts their administration to private health insurance companies? And that the "overhead" typically discussed when talking about Medicare doesn't include said companies but is instead only the overhead of what it takes to shovel money from the IRS to private insurance companies?

No, this is not Medicare Advantage, in which Medicare just directly pays private health insurance premiums for enrollees.

The overwhelming administrative cost in the US Health Care System includes all forms of Insurance wether they are private or public. It is around 10%

Other public systems vary between 1-4%

There's also an often-overlooked issue, which is that some of the crowdfunded treatments are for things deemed "experimental" or whatever other label and thus not covered for even an insured person. This situation exists in both public and private healthcare systems. I'm not arguing in favor of a for-profit system with this, but people often miss this when they haven't personally run into uncommon health problems.
If a treatment isn't approved yet, you can usually submit a request for getting it paid.

You need to show that it has a chance of working (literature etc...) and it will be reviewed by a doctor from the "Medical Service" which is independent from the Health Insurers.

If they decide it should be paid, it will be paid (which is most of the time the case).

Otherwise you can go through the social courts. (No court costs for the insured person. You can get a lawyer reimbursed if you're poor)

Interesting. Do people win in any significant number of cases, or is it more like the "appeals" process in for-profit systems, where it's supposedly possible to win but generally does not happen?
From my limited experience it usually already gets approved by the Medical Service.

Especially within the University Hospitals who administer these treatments they already have the experience how to write these applications and know their counterparts

Expensive health treatments can easily bankrupt any western government. None of those developed countries can afford to spend their money indiscriminately on them. So instead they turn to waiting lists, death panels and very often saying no but not in your face (since that is politically frowned upon) but thought delays and countless committees and bureaucracy until the patient expires...
I know that's what you hear and read on Fox News and other "News Sources" daily. But here in Germany, there are no "death panels" or long waiting times for cancer treatment.

Also we don't need "pre-auth" and other Bullshit before we start standard treatments.

The real death panels are sitting in your Insurance Companies Offices as seen by the news coverage around United Healthcare et al lately

I live in Eastern Europe and my "news sources" are friends in hospitals asking us to donate for desperate causes.

Governments-paid treatments are god-sent but many times the funds are limited so they only cover older, cheaper treatments. Approval and funds for newer ones come so late, sometimes too late.

Germany has one of the most developed economies on the planet so naturally has more spend on healthcare. But that can change and when the money is tight, tough choices have to be made. I'd make those choices for myself rather than trust the State to do it for me.

What country are we talking about?

Slovakia?

The German health insurance system also has a deficit of 6 billion euro, while doctors are leaving the profession. Do you think that's sustainable?
For a country with a $4.5 trillion GDP, a 6 billion deficit is a drop in the bucket and easily covered from taxes. It’s just a political question of what you want to fund.

For comparison, the New York City public transport system (MTA) runs a deficit of about $3 billion. Six billion for universal healthcare in a country of 83.5 million people seems like a total bargain.

> Do you think that's sustainable?

Yes.

To help you think a bit more clearly: the health insurance system is not a for-profit system, even though some people mistakenly hold on to the idea that it should be. It is a risk spreading mechanism.

Not everything needs to be profitable.
I lived under the very system this principle enabled and I can tell you that without the profit motive we were cold and starving since there was no motivation for people to work and sew clothes or grow food.
I didn't write "nothing needs to be profitable".

I live under a system where even very expensive treatments are covered by the state using taxpayer money, and I'm not starving. Sometimes you need to optimize for human dignity.

10 Billions of that deficit are coming from the State paying insufficient contributions for unemployed insured people. It is a policy choice to offload those costs onto Publicly-Insured-People (excluding rich and healthy people) instead of funding them through taxes (including those groups).

The German Healthcare System also has some historically developed peculiarities that don't make much sense in today's age, but they are difficult to address without pissing people off (The duality of Private and Public Health Insurance, allowing the first one to get rich and very healthy people out of the risk pool, and then loopholes to switch back into the public system when they grow older and don't want to pay the then high prices in private insurance)

The Hospital Reform is already working to reduce costs by reducing the number of small hospitals, and concentrate them into bigger ones. (As a side effect, quality of care will increase too, since outcomes are correlated with experience)

Also more care will be shifted to outpatient setting.

Otherwise we are fighting with the demographic change. But these problems are also hurting all other developed nations including the US, where funding problems in Medicaid are also expected in the next decades

tl:dr We have problems due to the demographic change, but these are in line with other developed nations. There are some efforts to address them, but politicians are hesitant to do real reforms, because old people have the most voting power

I am yet to see any western nations go bankrupt for universal healthcare.

I have three second-hand cancer experiences from family here in Australia (Dad, Mum and my half-sister - under 35/yo). All three were detected early thanks to regular checkups and screening (covered under Medicare), treated in major hospitals (Dad was in a rural hospital, Mum and half-sister in Metro major city hospitals) and are all alive and certainly not in debt. The biggest cost was parking at the hospital, drinks from the vending machine and the PBS medication (all PBS medicine costs $31.60 for adults, and $7.70 for concessions).

Any PBS medication has the full-cost price printed on the label for reference, more often than not the printed prices go from $300 - $2,000, but I remember that these aren't the full price anyway since our government collectively bargains for cheaper prices on OS medication).

I can't imagine having to pay for treatment AND the insane full price of medications, it must be so much more stressful for families going through cancer treatment.

Americans, don't let the media and your government tell you otherwise. Universal healthcare is cheaper [0] and more effective than whatever archaic system you have now.

I am so god damn proud of our system in Australia, it's not perfect, but damn it's so efficient for critical care, thank heavens for Medicare and the PBS.

Oh and for those that say "well doctors aren't paid very well"... they are. My brother-in-law is a surgeon and he's doing pretty well for himself, bought a new Audi last month for his wife, heading to Europe for a month-long holiday with his family and just moved into a new house.

[0] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?most_...

> I am yet to see any western nations go bankrupt for universal healthcare.

Boy are you in for a ride. France will be first and Germany is on a good track for it within the next two decades.

Western nations do not go bankrupt since they discovered that little trick of printing money until the end of time.
This is actually how the US is getting away with their twice-as-expensive-as-the-rest-of-the-OECD setup for a little while longer.

The end of ACA subsidies is probably gonna collapse that approach.

> but thought delays and countless committees and bureaucracy until the patient expires...

So then you would expect life expectancy in the US to be higher than in Germany, France, UK?

It is not.

> So then you would expect life expectancy in the US to be higher than in Germany, France, UK?

Pretty soon, actually. EU countries are falling further and further behind economically. Health care costs are increasing, taking up an ever increasing slice of the government budget. Labor force participation rate is decreasing due to generous welfare and high taxes. Natality is plummeting. Attempts to increase retirement age are met with riots.

We're a technological backwater. AI research is done in USA and China - the benefits will mainly go there too. We can't even cool our cities: we're losing more people every year to heatwaves than the USA to gun violence. We're closing down nuclear power plants after years of shamelessly funding the Russian war machine for cheap energy.

Years of redirecting defense spending into social programs are coming back to bite us. Russia is hungry and aggressive, while the US is not protecting us anymore. What do you think will be the life expectancy under drone and rocket attacks?

Get real, even the poorest districts in the UK have the same average life expectancy than in the US

American life expectancy compares extremely unfavourably with the UK. The English seaside town of Blackpool has been synonymous with deep-rooted social decline for much of the past decade. It has England’s lowest life expectancy, highest rates of relationship breakdown and some of the highest rates of antidepressant prescribing. But as of 2019, that health-adjusted life expectancy of 65 (the number of years someone can be expected to live without a disability) was the same as the average for the entire US.

https://www.ft.com/content/653bbb26-8a22-4db3-b43d-c34a0b774...

Also what you conveniently forget to mention, all European countries still spend less on Healthcare than the US, as a percentage of their GDP. In absolute numbers this comparison would look even worse

So this isn't Defense Spending redirected to Healthcare

Private/public here in Japan works okayishly well. I have never heard of anyone getting bankrupted over medical bills, and have had loved ones going through surgeries and other complex issues.
As soon as you said "death panels" you invalidated your entire point, I'm sorry.
Theres a (now old) memo that specifically outlines which talking points carry most salience amongst the audience. Those terms are present here in your comment. (Luntz - The language of Healthcare 2009)

Even with waiting lists, people get healthcare. They get better health outcomes per $ spent. America can provide excellent cutting edge healthcare, which is especially great if you can afford it. At some point, you have to decide whether having most of the bell curve taken care of, is more / less important in terms of rhetoric and priority.

Did you make all of this up or just so credulous that you repeated what someone else made up?
I don't know, are your opinions about life and reality made up or you're just so credulous you are repeating whatever you see on social media?

Is it so hard to believe in today's day and age that somebody tries to learn and understand how the world around works using observation, published facts and deduction from as close to first principles as possible?

Is there a legitimately good reason for all those treatments to be so expensive, or is that, to a large degree, capitalism extracting capital from the market? Why is American insulin so expensive when compared to that from other countries?
> Is there a legitimately good reason for all those treatments to be so expensive

We can't really know, since only free markets can determine the price of a good or service (it's driven by supply and demand) and health care market is tightly regulated.

> Why is American insulin

Because of the regulatory barriers not allowing other providers to enter and sell insulin on the US market.

> waiting lists, death panels and very often saying no

As we all know, American insurance companies never deny coverage, nor do you ever have to wait in an American hospital. /s

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