Gregory's Server@kDelta @QasimRashid Aah, sorry, I misunderstood the phrasing. Right, in Germany it's the G-BA that decides which treatments are available under the GKV. But of course you can get PKV and get much more treatments covered, so there's certainly still inequality. GKV covers a much broader portion of the population and is more accessible than Medicaid in the US of course.
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64 comments
 @Schouten_B @QasimRashid The funny thing is as we discuss this you have reminded me that my employer gives me private healthcare as part of my job too! Yet I never even think about it! 🤭  @kDelta @QasimRashid Funnily enough my company gives my German and US colleagues private health care. But here in NL they don't have a plan and I just need to pay for my own private health care. So while my US colleagues get great coverage that doesn't come out of their salary, I pay 200 euros a month for mine with a 800 euro deductible :p. But yeah, it says something about my bubble that everyone in Germany I know is under PKV. @Schouten_B @kDelta @QasimRashid For comparison. I'm in the US. I have an insurance plan through my employer. It's a family plan covering myself, my wife, and my son. Total bi-weekly premium is $914.26. I pay $409.58 every paycheck, the company pays the remainder. Over $10k in just premiums this year out of my pocket. Over $20k in total. I pay that regardless if I use the insurance at all There is also a $3,200 deductible per individual. With a $6,400 family deductible. @finner @kDelta @QasimRashid Those are actually pretty good deductible by US standards. But yeah, the US health care system is -crazy- expensive. Some of that is the fault of the people (no, you don't need an MRI scan every time you have a headache or a knee is sore, or an antibiotic every time you sneeze), but a significant portion is also health care providers, pharmaceutical companies and others all grifting money from the system. Not changing with the GOP in charge though. @Schouten_B @kDelta @QasimRashid Crazy expensive is right. I know this country has more than it's fair share of entitled assholes, but unless you have some data to throw out I think I'm going to call bullshit on blaming people for the issues of the expensive costs of healthcare in this country. People that can't afford to cover a few hundred dollar emergency expense aren't paying $500+ for an MRI because they have a headache. Most people I know, myself included, avoid care due to costs. @finner @kDelta @QasimRashid But the US is doing several times the amount of medical imaging per capita of any other developed nation (only Japan and Germany get close I believe), most of which is terribly wasteful. You're right that that isn't just the people, it's probably also people who own MRI machines and CT scans wanting to make money, but based on what I know from doctors in the US the people are also a part of the problem, but I can look for some data. @finner @kDelta @QasimRashid (And when I say crazy-expensive, I don't mean crazy-expensive for the individuals necessary. But as a society it is paying incredible amounts per capita. Both Medicare and non-medicare per capita cost are a lot higher than that of any health care system in the Western world.)  @Schouten_B @finner @kDelta @QasimRashid The problem with healthcare is there is usually a marginal benefit. Consider shoulder injury. Say 50% heal, 50% complete tear. We can wait 8w of PT and they sort out for the few who do PT. Or we do MRI and operate on half. @Schouten_B @finner @kDelta @QasimRashid If MRI were cheap we would just do MRI on all. But it is not cheap now. Probably one day. In single payer costs are limited by the MRI queue. In US by all kinds of kludgy things. @jgordon @finner @kDelta @QasimRashid Yeah, some single payer systems (like the UK) are notorious for their lengthy queues, not great either. @Schouten_B @jgordon @finner @QasimRashid Again, you are mixing up two different heath systems, NHS England has half out sourced and sold off itself, and queues down there are longer and services worse than NHS Scotland where the people have insisted in maintaining public ownership. Regardless nobody England or Scotland would ever want to give up this system for the US system. @kDelta @jgordon @finner @QasimRashid Do you have sources for that in the UK the queues are correlated with things being outsources or sold off? Overall for-profit medical imaging resources have shorter queues than public medical imaging resources. But the UK could be different here somehow (and one could imagine different reasons for that)? @Schouten_B @kDelta @QasimRashid If it's crazy expensive in general, how is it not crazy expensive for the individual? Who is paying the bill if it's not the individuals either through premiums, co-pays, deductibles, tax dollars for the portion that isn't privatized? Per capita means per individual right? Yeah, I understand that some individuals are subsidized, but they are subsidized through the higher costs to other individuals. Ultimately we, the consumer in need of medical care, pays all. @finner @kDelta @QasimRashid The difference that I think is meaningful here is that if it's society as a whole, those are high cost spread equally (or in an income dependent way) over people. The US -also- has crazy expensive healthcare on an individual level, what I mean by that is that the high cost of the system also falls significantly to the individuals requiring treatment. Which makes the high cost (which is always problematic for any society), even more problematic. @finner @kDelta @QasimRashid As you rightfully said, ultimately we the people as consumers pay all of the cost. But some of us need more care than others, and the thing about health care systems is to think about how much of that cost you put on the individuals requiring care, and how much you share among the healthy population. If you're overall cost per capita is just way too high, for whatever the reason, both of those portions go up. @Schouten_B @kDelta @QasimRashid So you acknowledge that the cost is out of control. And that the cost is a problem for society and the individual. Yet you seem to continually say that none of the reason for the out of control costs is due to the fact that it's mostly all privatized and for profit. I guess it's just expensive for "reasons" and we'll never know. @finner @kDelta @QasimRashid I'm saying the evidence for that is poor. Because most European health care systems are privatized and for-profit, and don't have these problems. And most of them outperform for example the single-payer Canadian system by quite a bit. So there seem to be other factors that play an important role here. :) @Schouten_B @kDelta @QasimRashid So the other countries probably have better regulations that prevent the for-profit enterprises involved in health care from making all decisions based solely on what's most profitable. I read that as for-profit being the -root- cause problem. You can fix that through regulation of the for profit enterprises or by getting rid of them entirely and going publicly funded. Either way you're addressing the root cause of them being solely driven by profit. @Schouten_B @kDelta @QasimRashid I'd be happy to hear what other root cause problem there may be or better/alternative fixes to the issue if you have any. @finner @kDelta An example here is that the US spends more on end-of-life care than most. It's important to not spend crazy amount of resources keeping someone alive (often with a poor QOL). Large parts of the population (probably those with decent insurance :p) also seek medical care far quicker than most developed nations (despite the cost). Patent law is another issue, the fact that you can re-patent a drug by adding an arbitrary ingredient prevents competition in the drug production market So, do we spend more on end-of-life care because we try to keep people hanging on longer than other countries? Or is it because it's a money maker for a for-profit company? You seem to be bent on blaming the people for the situation rather than the actual companies (and government for lack of regulation) with all the power and making the decisions for how the system is designed and operates. A company isn't going to simply do what people want unless it generates a profit. @finner It depends, an individual can say 'it's okay, I'm ready to die now', and society could respect that, and normalize it, that would help a lot. I'm not saying companies are never to blame, but considering this thread is plenty of focused on the things companies do wrong I think it's good to also put attention on the things people do wrong. I feel in general the climate on Mastodon is too people friendly :P. Most of the crap in the world is because people are terrible, myself included 🙂. I agree that the US has more than its fair share of shitty people. And in my opinion, the worst ones tend to be the ones in positions of power. The capitalists and executives that own the companies and make the decisions and buy the politicians to deregulate and shape every single aspect of our lives so that the only things that are valuable are the things that can generate a profit. The shittiest poor person has incredibly low impact, if any, for why things are the way they are. @finner Maybe it's that I worked in a bar for 10 years but I have a very different view on where the shittiest people are :p. Although of course they are everywhere 🙂. @finner (you're right that a single shitty person in a position of power, say Rupert Murdoch, can do a lot more damage, so it's more important to keep shitty people out of power. But then again the shittiness of people happens and they elect Donald Trump. Someone who is so obviously a pile of human garbage you cannot possibly excuse the people voting for him. @finner I find that generally the shittiest people in power are not the most capitalist ones though. Some are pretend capitalist oligarchs for sure. But they don't actually do much to prevent monopolies or competition, so not really any more or less capitalist than Xi Jinping, Hugo Chavez or Putin in their palaces :p. I would reckon that the vast majority of anyone in the US that is in a position of power is either a capitalist themselves or bribed by capitalists, thereby vaulting said capitalist into a position of power through influence. Not to mention the $$$$$ they have at their disposal to buy into spreading misinformation. What people in positions of power are you referring to that aren't themselves or at the very least in bed with the capitalists? @finner I think you have a very odd definition of capitalist. I'm not sure but I'm guessing in your definition somebody like Alisher Usmanov or Mikhail Fridman are also capitalists. They're not. Capitalists aspire towards a market with competition, where multiple players are forced to compete for the best price/service ratio to acquire and retain customers. Say a Jeff Bezos actively uses anti-market practices with Amazon that run counter to the foundations of capitalism. @finner Essential to healthy capitalism (as opposed to some for of Laissez-Faire capitalism that no country is really doing), is authorities regulating the markets, preventing monopolies, ensuring companies don't control access to markets (say through an AppStore or a PlayStore). The worst offenders in the US in power, say someone like Musk, is completely opposed to this. You could describe them as Laissez-Faire capitalists perhaps. Not many economists in that stream though. @finner Wanting to be rich and using that power to get richer and dominate society is not really related to the economic system. Look at Chavez, Xi Jinping, Putin, Stalin, Chairman Mao, they all had/have similar goals of amassing wealth and power for themselves in very different economic systems. Of course Marx famously suggested social class differentiation was the result of capitalism, but there really isn't much evidence for that in history, nor on the planet today 🙂. Capitalism as an economic system is the private ownership of the means of production and relies on the extraction of surplus value from the labor of others. A capitalist is a person who, within a capitalist society, has capital and owns or controls the means of production. Any owner, controlling partner, or executive in a major corporation in the US I feel should fit the definition of a capitalist. They own capital and control the means of production. @finner No. That is not what a capitalist is. And if it were it wouldn't me limited to a capitalist economic model. You can have capital in any economic model. But a capitalist is a supporter of the capitalist economic model. A poor person can be a capitalist, and a CEO of a Fortune 500 company can be a communist just fine. Also only the first part of your definition of capitalism is correct. 'Extracting value from the labour of others', is not accurate. @finner Just as to amass wealth in a Leninist society you don't need to be a Lenenist. You don't need to be a capitalist in a capitalist society to amass wealth. You can work to be 'successful' (or at least wealthy) within a system without actually caring much for that system. Often the best way to get wealthy is actually to subvert the system, use game theory to exploit the weaknesses of the system. Both in capitalist, socialist and communist societies do people do this. I'm not aware of capitalism requiring that the participants in capitalism shouldn't form a monopoly or need to maintain free markets. In order for capitalism to be sustainable for a long period of time, it requires an external force, like a government, to regulate it to keep it from destroying itself. In a capitalist economic system, the point of capital is to be used to amass more capital. @finner No. It could be hard to find an economist that holds that definition of capitalism. The wiki page actually has a pretty reasonable definition. @finner (but as with socialism or communism, this all isn't set in stone.. You could come up with all kinds of weird systems that by some definition would fit the mold of capitalism, socialism or communism. But for the sake of simplicity let's define capitalism as the system that most free marker countries attempt to practice, I.e. the wikipedia definition that considers monopolies bad for capitalism 🙂) @finner @kDelta @QasimRashid Well eliminating for-profit entirely might (some would argue) reduce the drive for efficiency in the system. But that is a separate discussion. I think in general you are right, the US could have much better regulations. But it goes well beyond the system itself. I'll give some examples on your other toots :). @Schouten_B @kDelta @QasimRashid Idk, in my 30 years of working within corporate American manufacturing, it looks to me like the only thing for-profit enterprises are incredibly efficient at is generating profit at the expense of literally anything and everything else. If efficient profit making is the only real metric you care about, then sure, unregulated for-profit systems are great. Personally, I don't like the primary incentive for health care, prisons, and education, to be profit based. @finner @kDelta @QasimRashid Americans by many standards have some of the highest standards of living in the world. (There's plenty wrong with the US, don't get me wrong) It's been doing pretty well in some ways beyond profit. Having said that, I'm inclined to largely agree, although in my experience profit incentives in health care can work to improve efficiency as well, but those incentives need to be well structured and regulated. @Schouten_B @finner @QasimRashid “Americans by many standards have some of the highest standards of living in the world.” @kDelta @finner @QasimRashid You missed the next sentence. Also.. Have you ever been to Paris, Vancouver or Toronto? :p @Schouten_B @finner @QasimRashid I have not, but if you live in any of those places, or anywhere in the EU, or in the backwards UK, you will likely live longer than the average American https://worldpopulationreview.com/country-rankings/oldest-people-by-country @kDelta @finner @QasimRashid A large part of that is that you're significantly less likely to be severely overweight and get diabetes :p. Also less likely to get shot. Lots of reasons for that unrelated to the health care system ;-). @Schouten_B @kDelta @QasimRashid Correct, I would venture to say that in the vast majority of cases, it's not the individual requesting an MRI or any other other procedure. The doctors should be requesting required tests to determine the appropriate treatment plan. But you have an entire for profit industry in bed with each other that has far more incentive to generate profit than it does to do the right thing regarding any individuals health. @finner @kDelta @QasimRashid Still that problem is much worse in the US.. for reasons. Most European countries have for-profit health systems (even most that have single-payer systems), but none suffer from the same level of poor decision making. This isn't about the profit aspect, it's about regulations and integrity. The framework in which profits are to be made. @Schouten_B @kDelta @QasimRashid So poor decisions are made because "reasons" but it's not because decisions are being made in the name of profit but that we haven't properly regulated the decision making and profit generating resulting in all decisions being made solely in the name of unregulated profit. You really seem to want to cheerlead and make excuses for the capitalists and for-profit enterprises. @Schouten_B @finner @QasimRashid You blame the people for that? Is it not the hospitals who see a headache with cash in their eyes? 🤑 I can get 16 paracetamol from a shop for 30 cents, how much does a US hospital charge for two? @Schouten_B @QasimRashid That’s alright, I kept it brief toot style 😁 I was going to add that as a weird oddity the UK does not have a healthcare system that spreads across the whole country, NHS Scotland and NHS England are actually entirely separate and the medications and treatments you can get can vary a bit. With that said if I broke my leg in London and got treated down there it’d still be zero paperwork for me. So most in the UK don’t even realise they are separate systems 😁 @kDelta @QasimRashid Yeah, and treatment coverage are decided by NICE which actually -is- a single body for the entire UK I think. |
@kDelta @QasimRashid Note that the ACA also has Essential Health Benefits which describe what insurers must cover. But the legal maximum for out of pocket expense is quite high (~$10K for an individual or like $15-20K for a family). Which is obviously much more than the highest deductible you can get at GKV or any PKV that I'm aware of.