[flexblue]

> Because for-profit healthcare is immoral, wasteful, and inevitably results in scenarios like the above.

There's no such thing as a healthcare system where nobody profits in some way. Lots of people working in "non-profit" organizations are still lining their pockets.

> A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US

You must be alluding to the German system. We actually have two-class healthcare: Private insurance for those who are self-employed or who earn well enough to afford it and public insurance for everyone else (15% of income).

Those with private insurance get preferred treatment at almost any level, because while price controls exist for both public and private treatment, the amount of money doctors get for public patients is a joke.

It doesn't stop there of course, salaries for all healthcare workers are extremely low, as is the budget for cleaning personnel. Pretty disgusting, but also dangerous. Our rates of MRSA are extremely high, for instance.

Lots of German healthcare workers are moving to Switzerland (private system, but compulsory), being replaced by Eastern-Europeans. That doesn't bother me per se, but if we didn't have that kind of cheap labor, the system would just collapse.

In effect, I can tell you how to get "affordable" healthcare, whether it is public or private: Just pay your healthcare workers dramatically less money. Instate price controls. You'll have a lot of frustrated workers in a system constantly working at the brink of collapse, but it does work.

[Nosewelder]

"Bismarck" is a class of healthcare systems, referring to employer/employee financed insurance-based healthcare. It is used in Germany, the Nederlands, and Switzerland I think. Other models are Beveridge (like the UK) and National Insurance like Canada.

The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.

For example, a US medical doctor makes about 100 000 $ more than the European average, although a few countries pays doctors more. There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.

[flexblue]

> It is used in Germany, the Nederlands, and Switzerland I think.

Germany today has a public/private mixture, Switzerland and Netherlands is fully private. I'm making this distinction because private profits do exist in these system, while the original comment I replied to lamented them.

> The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.

Are you sure about this? Last time I looked it up, I came to a different conclusion: Administrative overhead (~8%) is neither a huge part of costs, nor is it massively different than in Europe. Drugs prices also only account for 10%.

Salaries for workers on the other hand are a significant chunk, and those are easily double than those in Germany in most cases. Note that I'm talking about all salaries, doctors, nurses, clerks, cleaners...

I agree with the overprovisioning being much costlier, but those are due to legal liabilities being more expensive in the US in general. In Germany, even if you win a malpractice suit, you get a pittance.

> There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.

Again, this disregards the vast majority of worker salaries involved.

[mcv]

> "Switzerland and Netherlands is fully private."

Private insurance in those countries works because those markets are highly regulated, and they don't have a corporate culture of trying to rip off people as much as they can.

[dthul]

I guess the point is: No matter whether you are privately or publicly insured in Germany, a transport in an ambulance, an emergency helicopter ride, a long-winded illness like cancer, or any other medical treatment won't ruin you financially. The same goes for most (all?) of Europe.

[flexblue]

Doesn't insurance in the US cover these cases? I think it ultimately comes down to whether people can afford healthcare or not. For instance, healthcare costs are covered with unemployment benefits in Germany.

If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.

The issue with the US system is that you can't have it be both non-compulsory but also that coverage must be offered to everyone, no matter their state of health. Then you'll have a few healthy people pay huge premiums to finance treatment for those who never bought insurance until they're sick.

It is my understanding that a compulsory purchase (as in Switzerland) would be unconstitutional, so I guess "Medicare for all" in the form of a tax would actually be the next best thing. Just keep in mind that with US levels of healthcare salaries, that wouldn't come cheap.

[Faark]

> If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.

The difference is GKV being the default, and opting out of that kind of hard. You have to earn €5,062+ per month, for a start [0]. And the step is intentionally hard to reverse. I consider that a decent compromise. At that point people have to actively shoot them self in the foot, and I've little pity for those.

If you didn't opt out, thus are still under the GKV, the system will cover emergency services. Even if you haven't payed (yet).

[0] https://www.bundesaerztekammer.de/weitere-sprachen/english/h...

[flexblue]

> The difference is GKV being the default, and opting out of that kind of hard.

It's not hard at all, just go self-employed and you have the option.

> And the step is intentionally hard to reverse.

Yes, so that people towards the end of their lives don't profit from a system they never paid into. You're stuck with expensive private insurance for the rest of your life. In the US however, you would qualify for Medicaid.

> At that point people have to actively shoot them self in the foot, and I've little pity for those.

It's actually not that uncommon for people to fall into the trap of working self-employed for most of their lives, then retiring poor because they never paid into the pension system and their private insurance costs them over 500€/month.

[hannasanarion]

Compulsory purchases are constitutional, as long as Congress can reasonably invoke its taxation power in application of the penalty. Americans are already compelled to buy health insurance, but as of the 2017 Republican tax bill, the penalty for not doing so is $0.

[flexblue]

Then it's not a compulsory purchase, it's a tax. The money doesn't go to the insurer. Even before the penalty was $0, it was too low to be effective.

In Switzerland, it is compulsory to purchase insurance, there's a basic plan that all insurers must offer, and if cost exceeds a certain fraction of the income, the state chips in.