Comments by "Xyz Same" (@xyzsame4081) on "Jim Carrey w/ Bill Maher: Canadians Are Nice Because We Have Healthcare" video.
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in 1976 the U.S. Supreme court decided that rich people can pay political ads - it equals free speech. That was the beginning of the end. After WW2 into the 1960s the income tax for wealthy people was high (90 %) Providing healthcare by the employer was a loophole, that sort of increased the wage - but was tax free.
Healthcare then was not as expensive, many of the may potent but expensive drugs or surgery and intense care was not around. People died of strokes, cancer etc. they can survive today.
Outsourcing wasn't a thing so the manufacturing jobs provided benefits. Sure minorities often fell throught the cracks, but they did not exist in the meda landscape and it served the general racism of many - that not everyone could have good care.
More and more money in political campaigns also suited the private TV networks, they got more political ads additionally to the medical ads. So they would not embarrass a) mainstram politics and b) the healthcare related industrie.
Fast forward: medicine becomes more potent and expensive people are getting older, the goodd jobs with benefits are outsournce and the service secotor jobs without healthcare replace them.
Mainstream edia and money in politics become completely dysfunctional and corrupt. Congress and Senate is mostly paid and bought for. The Financial crisis is not helpful.
a Black man becomes president, he runs an extraordinary campaign. In the deep crisis he gets a mandate like FDR - but as soon as he is in office it becomes clear tha he is a sellout, to be seen by his actions and cabinet appointments. And how the Dems USE their majority - FDR strongarmed the Dems to vote for his measures. Since the Podesta emails were leaked we KNOW it. citibank sent an email with cabinet proposals, they were all followed. the wolves in charge of the henhouse.
healthcare was an issue during the campaign. They start out weak, kill the public option right away, they have a Senate hearing in 2009 where the industry is invited, single payer advocats and experts not - it is not even discussed. From there one the weaken the bill.
But in the era of the internet and with Sanders running his campaign the genie is out of the bottle.
Recent poll 51 % of Republicans and 70 or 80 % of Democrats want universal healthcare.
The information monopoly of the mainstream media is broken. Media MUST discuss it. They avoid it if they can, they misprepresent, but it does nnot go away.
Townhalls in spring 2017, Republicans get heat for wanting to abolish ACA. Democrats are asked too - what about Single payer. They are in many cases deflect with rightwing arguments.
it is the one and only Big donor party with a D and a R wing.
There are definitely trolls in the comment section. But in real life people DO WANT European style healthcare, they just never, ever heard it reasonably discussed. And they are not in the habit to look what other citizens in other nations are getting.
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World Bank data of 2014 per capita healthcare expenditures of nations ins USD : CH 9,600, U.S. 9,200, Germany 5,600, Australia 6,000, Norway plus 8,000, U.K 3,900 (but completely underfunded) or Japan with 3,800 (beating us all - must be the food, they have an older population).
At least the Swiss have good healthcare for everyone !, and they pay the staff well (attracting German doctors, nurses, ...)
Time to start a referendum then (importing drugs from Germany would bring prices down. Having a public non profit insurance company - the insurers will not like it of course ....
Universal healthcare may not be wrong - as far as I know it is mandatory to have it, no ? And insurance companies are likely not allwoed to refuse payment. Dan they discriminate according to risk (higher costs ? or ending cover ? Like - they pay for the cancer treatment once but then they kick you out in case the cancer comes back in 2 years ?
Switzerland does not have single payer - that means one (or several) public non-profit insurance agencies.
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+ Fattlittle Kid WHERE are you living * and WHAT are you talking about ?? The EU alone has 530 million people and approx. 27 countries ! I know the German and Austrian system well and from experience (8 resp. 85 million people). - I would compare the U.S. to the WEALTHY European countries.
* [ edit: fatlittlekid is all over the comment section - menitoned also to be from Norway. Which I find confusing since they are a rich country, have oil revenue and spend plus 8,000 USD per capita, vs. U.S. 9.200 vs. Germany 5,600 ]
Germany and Austria have approx. 55 - 60 % of the per capita healthcare expenditures of the U.S. Note that the population is on average older which gives the U.S. a significant cost advantagge.
The per capita expenditures are within the average range more to the higher side for a wealthy European nation - see World Bank per capita healthcare expenditures of nations. USD 5400/5,600 versus the U.S. with 9,200.
What you say (work accidents, companies go bankrupt, paying for small stuff) does not apply - for the wealthy nations.
I know for instance that Bulgaria has problems. Germany is recruiting / stealing their doctors - they can't be bothered to train enough (and Switzerland likes to hire them !) In Bulgaria they cannot afford to pay them enough - even considering lower costs of living in Bulgaria. A lot of Germans study medicine in Austria where there are no limitations for the number of applicants. Well, Austria profits from Germany and is wealty, so that burden can be shouldered. (University is free).
The healthcare system in Greece was run into the ground by the Troika and austerity. I assume Romania or the Baltic states are struggling as well and that might affect funding.
That has to do with the fact that the neoliberal policies do not work for the population - the countries of the former Warsaw Pact were not given the chance - New Deal style - to develop under sheltered conditions like Western Europe after WW2. The now wealthy nations could weather the assault of neoliberalism and globalization that goes on since the mid 1990s better. And they had to reserves to deal with the Great Financial Crisis.
So many countries struggle and it shows in insufficient budgets for the healthcare system.
I also compare the costs of the wealthy nations. The costs of living influence wage levels, which impact the costs of the healthcare system.
So Germany can be compared with France, Sweden, Australia, Japan - but not with Hungary or Poland.
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+ Fattlittle Kid Smaller companies, start-ups may pay less in wages - but when they recruit they for sure do not compete with larger already profitable companies over the healthcare benefits. And they have not disadvantage because of their size (negoatiating power). All companies have the same payments to make, it is a percentage of wage with caps (they match the contributions of the workers so it is not the world).
A profitable !! company also pays taxes and part of that will end up as government funding for the healthcare system (incl. specialized hospital for accidents or rehabilitation - be it work related or not).
A start-up or a company that makes little profits has ONLY the wage related costs for healthcare, usually they do not pay taxes on profits in the first year(s) - and that's it.
When it comes to healthcare their employees have no disadvantage - an U.S. company has a different situation, if they want to provide good healthcare for the employees to recruit talent they do not get that for cheap. And even if they work in a sector which lower pay - their workers will have good coverage (the same as highly paid employees in other companies).
People are often willing to accept less pay if they believe in a project. - However, when it comes down to having or not having comprehensive and reliable healthcare for the family - that can make or break a hiring or getting a friend into the team.
Pre-existing conditions (family member or the working person) do not prevent someone from starting a business, go into farming, starting an education or changing jobs. They do not have to stay with a company to have good healthcare. or because their acquired an "insurance risk" while working for this company (like a stroke, or a woman has a difficult pregnancy).
Cancer survivor (6 years ago, so hopefully it is over), wife is pregnant, first pregnancy was with complications , the child had heart surgery and will need another surgery later - it does not matter for costs or coverage. Not for employees, not for entrepreneurs, or farmers.
Entrepreneurs have fixed contributions in the first 3 years (it is assumed that they pay themselves a modest wage and the mandatory healthcare contribution is calculated accordingly ). And there are some goodies in the first 3 years. The idea being these are the most difficult years.
Another wage related contribution (worker and company) is "accident" insurance. That partially funds specialized hospitals, rehabilitation.
As for treatment: they do not differentiate if the accident happened during work, way to work in your car, or privatley.
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+ Fattlittle KidSociety and the public healthcare insurance agency have good reason to avoid accidents and they monitor companies closely - establishing high standards can avoid a lot of costs (these inspectors are civil servants they are not paid by the healthcare system)
It is not possible to monitor the citizens - but they have a strict regime with companies. . They do not bankrupt the companies - it makes much more sense to make sure that accidents (and work related damages) do not happen in the first place.
I know people in construction. If the companies have people working off the ground - good chance to see an inspector. These are the really bad accidents - if the workers fall from the roof.
The companies know the drill. The workers know they must wear protective gear. if they are found w/o it the company pays a fine. High fines for repeated offenders.
Used to be that many carpenters lost a part of a finger (often the tip, sometimes half a finger - circular saw accident). Protective measures were demanded, the machine builders reacted - had to. The workers usually adjusted to it - even if it may be sometimes inconvenient to use the protection ALL the time.
I also know a carpenter - the owner - "who got into the machine" anyway. he just wanted to finish something - quickly. They couldn't sow it back on, but he did not have to pay - not in money.
On another occasion I heard a plant manager saying: Now that we implemented the personally adapted hearing protection for workers at the assembly line - don't let me catch any of you guys not wearing it.
They had the mandatory protection - of course they had, visit by the inspector and it's industry standard anyway.
The workers board representative (union guy) had been approached by a company that sells that and management had agreed to invest in that - more agreeable for the workers so they would not resist to wear it.
(That runs under workplace security as well)
If accidents happen out of gross negligence of the bosses, the worker might sue them.
I heard it discussed that companies should be held accountable (to some degree) and compensate the public insurance agency - but that was never enacted.
Large companies usually have good standards. If they - or their workers - make mistakes it is seen as "Fate struck us". Humans make mistakes. Even stupid, totally preventable mistakes. As long as it does not happen too often the system can absorb that.
Once the bad thing happen, what is the use of having lawsuits, etc.
It would have little acceptance in the population.
People know that folks get into troubles because of driving too fast, challenging hobbies, accidents when working at home, etc. And they do not have to pay for it extra.
So why would a company be disproportionally punished for a mistake. It is true that they half the duty to care for the employees.
If the accident was serious they already have trouble and they are going to be fined.
Or in severe cases if might end before court. (Will not break the bank it is not the U.S. system, but still).
Now exposing workers criminally and intentionally to toxic substances and dangers is another story. Again it is the job of the inspectors to have an eye to that. It helps that many companies have an elected representative of the worker - even medium sized companies, especially in the blue collare professions. obvious dangers will not be tolerated. The representative also cannot be let go (not w/o a court confirming that) - so he or she does not need to hold back - and could inform the authorities about health risks.
Companies that deal with toxic substances or work in certain challenging fields are KNOWN (they need a special operating licence) - and they are visited more often.
Women working in a drycleaning company announcing her pregnancy - 2 - 3 months ? They either have a job in that company where she has no contact with those chemicals - or she will go into maternity leave right away. (She cannot be let go during pregnancy, and it would be hard to find a job if it is know that she is preganant. And she certainly will not be exposed to those chemicals.
A company must report a pregnancy - so they can expect a visit.
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A system that makes patients pay for "small" things is an extra adminstrative burden for doctors, and hospitals. You can consider ALL the costs of healthcare - small and large - as a total for society and as an average per person.
the system can be set up with comprehensive funding and letting patients and doctors alone with the small expenditures, bills and what not.
Bills are not always paid on time (people are sloppy) so the adminstrators have to chase payments or handle a lot of small cash. They do the billing with the insurance agency anyway, once a month - and from them they get the money as bank transfers w/o hassle and w/o handling cash. And they use a unified software, so it is very efficient.
Doctors (with a contract with the insurance agency, which are 80 % of the doctors) will sometimes charge for services that are not covered like accupuncture. Or a dentist - some braces for children are covered, but not for "optics" only. Or ceramic or gold inlays..
Getting a bill from the doctor or paying in cash is not at all the norm in Germany or Austria. There might be countries where they always pay a little- I think Netherlands - every country developed their own version of single payer after WW2. - It makes adminstration more complicated. The wage deductions could be 0,01 % higher or the cap a little higher, or slightly more more tax funding - and avoid that red tape. Which will show up as extra cost in the system (for the doctors) and inconvenience for the patients.
The assistant of the doctor has to handle the cash, they must keep the books on that as well, money can be stolen, handling cash from many sick people is a hygienic issue (colds, …) occasionally someone forgets the purse or can't pay, …
if they give out bills, they need to chase the payments and use the printer more.
10 % of Germans have their coverage with a private insurance company (that is historically grown). The private segment is strictly regulated, those patients profit from the 90 % that keep the system cost-efficient.
Not everyone can even chose to be insured with a private company. Certain professions have the right to chose (teachers, civil servants with tenure) - or if they have a good income. When they are healthy they will often opt for the private insurance, if they have pre-existing conditions (or the family) they opt for the public system. That means the private insurers get a cherry picked group on a silver platter and are able to make a good offer.
Despite all the cherrypicking and much better regulation and price control than in the U.S. that is more expensive - it looks good for young and healthy people.
People that opted for "private insurance" cannot just switch back to public if they do not like the price increases that come along every year. It adds up.
There are discussion to let that fade out and switch to fully public. The insurance industry likes their little cherry picked niche of course.
These patients do get bills for the not so expensive procedures or pay out of pocket and get reimbursed (which means of course they have to apply for it). The big bills in the hospitals go to the insurers. the regulations do not allow the insurers to have high deductibles or co-pays.
Having a payment or bill every time would only make sense to give an incentive to AVOID going to the doctor. The assumption can only be that people use that option in a frivolous manner. My overwhelming experience is to the contrary, people delay when they should go earlier, and they usually do not like to go, nor do they consume the preventive examantions as they should. Even though they do not have to pay for it. The insurance agencies sends letters to persons of a certain age to encourage the use of the yearly health checks, prostate examination, mammography, …
Most people take the meds the doctors tells them to take. people pay about 5 or 6 USD per package in the pharmacy (not if they are low income). There are bulk packages if someone needs more, so they pay the 5 USD only once for a 2 weeks or monthly supply.
Doctors have a hard time convincing the patients they should take their high blood pressure meds or finish the antibiotics - when they are (already) free from symptoms. Money should not come into it. The patients do mostly not influence if and what they get prescribed - and charging or not charging money does not change it.
The costs that matter come with surgery, intensive care, organ transplants, chronic illnesses, heart attacks and strokes. Or symptoms ignored too long. Or traffic accidents.
Forget about the little stuff.
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One reason European style healthcare is so much more cost-efficient (50 - 60 % of the U.S. !! and that is the average range of the weatlhy countries - incl. Australia, Canada, NZ) is that they keep things streamlined.
Avoiding the incentives of for-profit - which are toxic for a "product" like healthcare allows to streamline admin. It is a lot of work to deny care and make patients jump through hoops, to chase after the money to the point of forclosure.
The government must subsidize, the wage contributions matched by employers would not be enough, they are very affordable. So that the low(er) income people can have the same treatments in the same facilites like everyone else.
Where doctors decide what is medically warranted. sometimes with your input - sometimes deciding for you (in case of emergencies and accidents). Not what your policy or the insurance staff allows for.
They ask for some daily MODEST contribution for every day in hospital, they argue you would need food at home as well. Not for low income people though. And extra for Cable TV maybe. - it is like that in EVERY wealthy ! European country, Australia, Canada etc.
It is not free - of course not, wage deductions and government funding. But with a public non-profit insurance agency, hospitals are public OR strictly regulated (and come from a charitable tradition). Pharmacies and doctors are like small entrepreneurs.
the mandatory contributions are affordable, a percentage of wage with caps, people know in advance how much (and it is deducted anyway), no large unexpected bills later. The hospital sends the bills to the non-profit public insurance agency (they have the bill for the daily fee to handle, but else they do not bother).
Pharmacies ask for a fee per package. If a person needs a lot they can ask the doctor for a prescription for larger packages. (that needs permission from the agency). And low income persons get a card and get the prescribed meds for free in the pharmacy. (The pharmacists has a monthly billing with the insurance agency as well).
The hospital is either a private institution (almost always run by a church then) or it is a publicly run hospital. Both have contracts with the public insurance agency. I think the private ones may make a small profit - but they can be benchmarked with the non-profit hospitals run by cities. They do not compete. There are enough hospitals but not too many. They are spread over the country, and each one has enough cases.
Patients can often but not always chose where to go. (Broken arm, no problem) Some specialized surgery, usually your general practicioner or specialized doctor will refer you. They might consider your wishes. Or your hear recommendations, when a hospital has a good department.
Some departments in certain hospital specialize in procedures - hip replacement, eye surgery. Which means a high case load, lots of experience.
And transplants, bad accidents, cut off fingers, limbs, too early born children often need very specialized care. Transport may by by helicopter to save time. - depends what the doctor at scene decides. (if medically warranted airlift is covered by the insurance).
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