[timmb]

> Between direct public spending and compulsory, tax-driven insurance programs, Germany spent about $380 billion in health care in 2022; France spent around $300 billion, and so did the U.K.; Italy, $147 billion; Spain, $105 billion; and Austria, $43 billion. The total, $1.2 trillion, is about two-thirds of what the U.S. government spent without offering all of its citizens the option of forgoing private insurance.

Is it fair to include Germany here? I thought the German system required everyone to have private insurance through their (breadwinner’s) employer. But I’ve only heard this via self-employed people complaining of having to pay €300 a month in health insurance. To me it sounds more like the American system than the UK one of everything just being free and state-funded. But as I say, I only know through hearsay.

[Longhanks]

This is false. As a regular employee, the system is fully regulated by the state. You can choose your "state-regulated" healthcare provider (gesetzliche Krankenkasse, but the differences between those are only in extras, which are neligible - something like rewards for going to the gym, living healthy). You and your employer pay monthly fees to the healthcare provider. You never get to see the employer's part, and you never see the money that you have to pay, because it is deducted from your monthly salary before your net salary is transferred to your bank account. The monthly fee is regulated (https://www.bundesgesundheitsministerium.de/beitraege). If ylur gross salaray is lower than about 62.000€, it is mandatory to stay in this state regulated system. With higher salaries, you can choose to opt out into the private healthcare system.

If you are self employed, you can choose to stay in the regulated system. However, since you are now both employer and employee, you have to cover both sides of the fee. For many self employed people, switching to a private healthcare provider saves them money, because there the fee, depending on some factors, is usually lower - it does no longer depend on the gross salary, but on the insuranced person's personal circumstances. However, private healthcare provides are to some degree also state regulated; there is a minimum set of service they are required to provide.

The cases of regular employees that don't go with state regulated healthcare providers are low. The cases of self-employed people that don't go with private healthcare are low. If you make enough money, you can start calculating wether switching to the private sector is benefitial to you. But it is impossible not to have health insurance, and it is impossible to go bankrupt because of health related costs in Germany.

[glow8]

Private insurance in Germany only applies to those self-employed or, optionally, those employed who are above a considerable yearly salary threshold. Otherwise, it's public, and the cost depends on your salary.

If you're employed, your company pays for half the insurance cost, be it private or public. This means that it's expensive for self-employed people.

[ivan_gammel]

In addition to what’s already said in other comments, in some cases in Germany you don’t even pay for your insurance. It can go as part of your unemployment benefit, included in the insurance of your spouse at no extra cost or payment can be suspended while you are on parental leave and have no income.

[cgeier]

Most employees are part of the public health insurance system in Germany. People who are not employees and people with an income above a certain threshold can (or sometimes must) choose a private health insurance.