Top Ten Happiest Places on Earth in 2019
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
@JaredBusch said in Top Ten Happiest Places on Earth in 2019:
@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
I like the Dutch system of health care vouchers. It gives everyone coverage, but is competitive because private companies compete for the voucher money.
I may be too American, but I refuse to believe that privatized healthcare can ever actually be valid.
help me understand what you mean. America is basically all private healthcare - not saying that it's valid though.
He's saying that he's learned from it and knows that corruption is endemic to a system of that nature.
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@Nic said in Top Ten Happiest Places on Earth in 2019:
@Dashrender said in Top Ten Happiest Places on Earth in 2019:
@Nic said in Top Ten Happiest Places on Earth in 2019:
Doesn't matter how much or how little you pay in taxes when a major medical problem will guarantee you go bankrupt in the US. All that money you saved on taxes goes out the window, plus your house, your truck, and your savings.
I know Scott believes in the public healthcare solution - I just have a hard time paying for everyone else's lack of giving a shit about their health that leads to huge health care costs. if we could hold people accountable for their expenses (not counting things like accidents against them) I think that would make me 'feel' better.
I see the value in some public services - law enforcement/roads/national defense, but I still have a hard time seeing public healthcare as a public good.
I suppose if there is proof that public healthcare raises the quality of life of it's citizens more than it costs those citizen, that would go a long way to convincing me.
I understand the reasoning, but in practice US pays more for worse health outcomes overall:
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countriesIn practice the savings of getting rid of the bureaucracy and milking by execs is vastly more than the cost from people going to the doctor more.
Exactly. Although his argument, like those of most Americans, is that they don't care how much they pay, they only care that they pay fairly. This is the fundamental reasons why Europeans and Americans argue and NEVER agree on healthcare - they fundamentally want different outcomes.
Europeans want everyone to be healthy and to pay as little as possible. Americans want to pay their fair share, regardless of if it is more than necessary or how many people don't get healthcare because of it.
So Europeans say "we pay less and get more" and Americans go "you idiots, that isn't fair!"
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
The problem is, in systems like this, they don't reasonably accommodate emergency services. WHen you are dying, you go to whomever responds, there is no choice.
Nope, emergency services are totally covered. You can go to any hospital, the entities running them will bill each other transparently to you.
The one thing they do practice there is the actual veritability of the reason for using emergency services. If you're having a heart attack, and call an ambulance, you will not pay a dime. If you coughed a few times and decided to use them as a taxi to an ER, you'll get a bill (about $200 iirc, not even close to the 4 figure numbers you would see in NA).
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Smokers do indeed save money over the long term by dying sooner:
https://www.webmd.com/smoking-cessation/news/20130604/smokers-cost-employers-thousands-more-than-nonsmokershttps://medicalxpress.com/news/2009-04-smokers-society-money.html
Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
Nope, emergency services are totally covered. You can go to any hospital, the entities running them will bill each other transparently to you.
The problem is that when you are bleeding out or unconscious you can't pick. Just a fundamental fact of being unconscious
WHen it is a broken leg or ruptured appendix, of course you get choices.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
The problem is that when you are bleeding out or unconscious you can't pick. Just a fundamental fact of being unconscious
WHen it is a broken leg or ruptured appendix, of course you get choices.
I don't see why that is a problem. In such a scenario you are taken to the nearest ER and treated there. If the hospital is not run by the company you subscribe to, it doesn't matter, you still don't have to pay anything extra, the companies bill each other. If you come around and decide you want to be in a different hospital, you can request a transfer, and either just go to another hospital or get transferred in an ambulance (if the transfer is medically justified, it's free, otherwise, you get a bill).
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@dyasny you'll still sometimes get billed because while the hospital is in network, the anesthesiologist isn't. There are some regulations to prevent this now, but it can still be a mess and a pain in the ass to deal with even if you do prevail. That's the problem with US healthcare. Even if you have insurance, and even if you do everything the right way, when you have a major medical emergency you are still going to:
a. get big bills (the 10% that is your share of the inflated bill they send to the insurance) and probably have to go bankrupt
b. spend the equivalent of a second part time job calling insurance companies and appealing decisions to avoid getting billed for shit you shouldn't have been.I'm seriously considering just going off insurance and paying out of pocket for routine stuff. I suspect I'd save money paying the uninsured rate with doctors, if I didn't have premiums to pay.
Then for real catastrophes I'd either get simple catastrophic insurance, or just move back to Australia if I got cancer.
Basically medical insurance for routine stuff is like getting extended warranties at Best Buy. Best Buy always makes money on those and you always lose, in the long run. To conflate the two types of insurance (routine vs major medical emergency) is a bit silly and confuses the argument.
For example, if I get the flu and go to urgent care and pay a $50 copay, I'd bet that is the same amount that insurance has negotiated with the urgent care location. I think I'm getting a deal, but really I'm paying the full cost. All I'm paying the insurance for is them negotiating the price down to something reasonable.
But fundamentally the real reason US healthcare is too expensive is because the govt doesn't fix prices. If they did that, like the rest of the world does, even private insurance and medical care would be affordable.
There's a reason Breaking Bad exists.
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@Nic this is the case in the US, true. In Israel it is not. All medical staff, except private clinics who do not participate in public healthcare, are covered. You never get billed for anything that is covered, no matter where you get treated, as long as it's at an institution that is part of the programme (most of them are) and your reason for treatment is justified and covered under the list of covered treatments (99% of the surgeries and things like cancer and AIDS are covered so no loopholes there).
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
The problem is that when you are bleeding out or unconscious you can't pick. Just a fundamental fact of being unconscious
WHen it is a broken leg or ruptured appendix, of course you get choices.
I don't see why that is a problem. In such a scenario you are taken to the nearest ER and treated there. If the hospital is not run by the company you subscribe to, it doesn't matter, you still don't have to pay anything extra, the companies bill each other. If you come around and decide you want to be in a different hospital, you can request a transfer, and either just go to another hospital or get transferred in an ambulance (if the transfer is medically justified, it's free, otherwise, you get a bill).
Billing is okay, but what's the point of choice if you can't make it. It kind of defeats the whole purpose as location alone matters.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
@Nic this is the case in the US, true. In Israel it is not. All medical staff, except private clinics who do not participate in public healthcare, are covered. You never get billed for anything that is covered, no matter where you get treated, as long as it's at an institution that is part of the programme (most of them are) and your reason for treatment is justified and covered under the list of covered treatments (99% of the surgeries and things like cancer and AIDS are covered so no loopholes there).
Far better for sure. But comparing to the US isn't good as it is so bad. US makes everyone else's situation look good.
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@Nic said in Top Ten Happiest Places on Earth in 2019:
Then for real catastrophes I'd either get simple catastrophic insurance, or just move back to Australia if I got cancer.
I'd fly to Medellin!
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
You've lived in some pretty sparsely populated parts of the country. What would public transport cost in Piffard, NY? I think cars would like a cheap and reasonable alternative to busses running down all the country back roads every hour
I have, and I still believe that cars should be a luxury... as should living in rural areas be. Just because people currently choose to live in places that require cars can't be used as a reason to subsidize cars, which is what we do today. Make cars go away (private cars at least) and people will stop living in places like Piffard just because "cars are cheap, so why not?"
Basically, America creates the rural problem so make an excuse for pushing cars. Rural should not be the cheap place to live, because it costs everyone a fortune.
I'm not getting a car here. It would be so inconvenient. For example, the train to work takes 36 to 40 or so minutes. And I spend that calm time on edX and ideally DL. In a car it would take well over an hour, plus lots of walking because parking is hard and not cheap.
For about $230 a month, I can ride all the trains, subways, and busses in both Stockholm and Uppsala.
In San Diego, just the car payment alone costs that... And that's excluding insurance, gas, maintenance, registration, etc... Times two cars!
If I need to go somewhere rural or outside train or bus convenience, I will simply rent a car, which is cheap.
Here, cars are a luxury and is how I feel it should be. I agree with the purposely created rural problem in the States.
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@Obsolesce said in Top Ten Happiest Places on Earth in 2019:
If I need to go somewhere rural or outside train or bus convenience, I will simply rent a car, which is cheap.
Here, cars are a luxury and is how I feel it should be. I agree with the purposely created rural problem in the States.Even living in suburban Texas, one of the most "need a car" states, I'm at a point where I'd not buy another one. When my current one dies, I'm done.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
Billing is okay, but what's the point of choice if you can't make it. It kind of defeats the whole purpose as location alone matters.
Are you telling me that if there is a corner case when you are unconscious, and can't tell the ambulance where to take you, that means there's no choice about which GP you go to, for example?
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
Billing is okay, but what's the point of choice if you can't make it. It kind of defeats the whole purpose as location alone matters.
Are you telling me that if there is a corner case when you are unconscious, and can't tell the ambulance where to take you, that means there's no choice about which GP you go to, for example?
- Emergency services are anything but a corner case. They are, in fact, the only truly important case.
- Are you really saying that you have choice when the cornerstone of care is when there is no choice? That choice when it doesn't matter is enough to override when it does?
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In America, where there is no choice, we still have total choice during a non-emergency. @Nic would just go to Australia. I'd just go to Colombia. Those cases, where it is a non-emergency, are a non-issue. The entire problem rests with the emergency cases where those choices vanish. Every system has choices under non-emergency conditions. The entire concept of the discussion is unique to the emergency conditions - the ones that are life destroying, unavoidable, and uncontrollable.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
- Emergency services are anything but a corner case. They are, in fact, the only truly important case.
That is one case where you don't have a choice, anywhere, under any system, if you cannot decide where to take yourself, someone will have to decide for you. If you can decide, then decide and go where you want, it's your choice. I really don't see a problem here
- Are you really saying that you have choice when the cornerstone of care is when there is no choice? That choice when it doesn't matter is enough to override when it does?
Again, you pick the care provider you like best, price is the same, it's in the taxes, so what you really choose is the GP you want and the kind of service you want to receive. When it comes to ERs and hospitals it's even easier - you just go to the hospital you want, nobody checks which provider you belong to, it makes no difference to them.
Bottom line - you are never presented with a bill unless you go for non-covered stuff like plastic surgery and dental care or massages etc. Your GP and the specialists he might direct you to for whatever reason, all come from your healthcare provider, but hospitals and ER are open to all customers equally, no matter which provider runs them.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
Emergency services are anything but a corner case. They are, in fact, the only truly important case.
That is one case where you don't have a choice, anywhere, under any system, if you cannot decide where to take yourself, someone will have to decide for you. If you can decide, then decide and go where you want, it's your choice. I really don't see a problem here
Absolutely, which is why we want the government, and no private person or company, to ensure equal care, and public oversight.
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@scottalanmiller government-only management is prone to abuse, unneeded bureaucracy and other wonders we see here in Canada. The Israelis found a way to combine government/tax based care with private sector competitiveness. Might not be the best approach, but it seems to be working quite well, better, at least, than the Canadian govt-only or US private-only approaches.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
government-only management is prone to abuse, unneeded bureaucracy and other wonders we see here in Canada.
Sure, but private is WAY more likely. Because it has all the problems of government, none are removed as it is still part of the government, but then the private risks on top of that. Nothing is perfect, but we can reduce the points of corruption or failure.
