The state of the US health system

[LanghamP]

One of the interesting things about being a public servant working for government health care is that I get to see prices all over (I am in IT, and write the business rules for billing and have written reports for pharmacy drug costs). 

When I say I have an idea of the cost the various parties get charged, then you should believe me. When I say I have an idea of who our whales are, it isn't because I read that in an article but rather because I do reports at the state, hospital, and regional level, using Phi and breaking that down by demographics. 

Procedures vary by who you are. If we, a state agency, get charged by a private party, then what happens is the charge is rejected and a counter offer given. And they do the same until certain business rules are accepted. Yes, that's right; our computers bargain with their computers for prices. We informally called that a billing chain because you could follow the price bargaining. Do you think a private individual has access to that method? 

I remember once seeing the price of a certain high blood pressure drug (at that time I was attached to a private contractor although the State paid my salary). It cost us $4.99. We billed the Feds $500. Per pill. Another drug, same class; it cost the private pharmacy a few thousand but it cost us $65,000 per month. For one patient. You could buy a corvette each month for that one patient. What age do you think this patient was, so that we could bill his provider? Hazard a guess? Anyone?

 

[dmethvin]

5 hours ago, Keith said:

3 times my optician has insisted my eyes need replacement lenses and each time the NHS hospital says they do not, despite not being able to drive at night or fly my models anymore. Privately, which of course I neither have or can afford insurance for, will be £4000 to have them done. At the same time my dentist tells me that if I do not fit implants the bone in my jaw will waste away, I.e. dentures are not a good idea, to have 3 teeth replaced that way will be £4400 - NHS support for dentistry is pretty much non-existent, even dentures are likely to not leave much change from £1000.

So despite having paid into a system all my life, when I need it, it is not there, I wonder if I would have been any worst off with the American system?

Wow Keith, sorry for all your troubles! 

As crazy as it sounds, I suspect your medical and dental care would be much more expensive in the US. Dental insurance isn't that common here and when people do have it there are generally high deductables and copays (like 50% is common). I had one implant done 6 years ago and it cost $4,000. Then it failed (actually came out of my jaw) last year and I had to have it redone. The oral surgeon I used had retired but the person who took over his practice gave me a 20% discount for this second time around. Whoopee.

10 hours ago, Rehab1 said:

Wow did this topic get derailed. First I have worked in emergency rooms and have never heard of a case where uninsured patients are being charged 4Xs the prevailing rate for a procedure. Second: hospitals are required to tell you what the cost of an elective procedure is.

Oh definitely, everyone gets charged the same rate. All the price chicanery occurs in the back office. The insurance companies get lower prices for everything, either by negotiating agreed-upon payment schedules or by grinding down the receivables department with delays and arguments until they take less money. If you are uninsured there is none of that and you are asked to pay whatever the "standard rate" is for the care you received. You can attempt to negotiate a better price ex post facto but you have no leverage at that point. If they think you can pay you will pay, even if it's over time and with interest. If you cannot pay they will sell the debt to a collection agency for pennies on the dollar and those people will pester you all hours of the day. And your credit will be ruined for important things like buying a house.

Yes, hospitals will tell you how much a procedure costs. Of course, the doctor you chose may only have privileges at a small number of places, possibly just one. The price of using Doctor A at Hospital B may be very different from Doctor X at Clinic Y. This is nothing like comparing prices of a standard product where you can hop on the Internet and look. Not only do you need to consider the opinion of the doctor and their perceived competence, but the cost of whatever they recommend.

 

[steve454]

I had an MRI done on my knee, the statement showed over $2000 was billed to my insurance company, insurance disallowed most of it, only paying a little over $200 for the procedure, my cost share was around $50 something dollars.  If I had no insurance, I would probably have had to pay whatever they wanted to charge.  Same with medicine,  insurance pays way less than the pharmacy charges.  I get my generic thyroid medicine for free, most other medicines have been very inexpensive.  I can see on my monthly statement exactly what the healthcare provider charged, how much the insurance paid, and what my share is.

[LanghamP]

1 hour ago, dmethvin said:

 

Oh definitely, everyone gets charged the same rate. All the price chicanery occurs in the back office. The insurance companies get lower prices for everything, either by negotiating agreed-upon payment schedules or by grinding down the receivables department with delays and arguments until they take less money. If you are uninsured there is none of that and you are asked to pay whatever the "standard rate" is for the care you received. You can attempt to negotiate a better price ex post facto but you have no leverage at that point. If they think you can pay you will pay, even if it's over time and with interest. If you cannot pay they will sell the debt to a collection agency for pennies on the dollar and those people will pester you all hours of the day. And your credit will be ruined for important things like buying a house.

 

Oh goddammit that's right. Yes, we all get charges the same but all pay differently. I mean to say in my posts we pay differently depending upon who we are. 

[Marty Backe]

8 hours ago, Keith said:

I’ve moved these posts into its own off topic thread.

Just to put the wonderful UK National Health System into perspective, I got stressed/bullied at work until I had a breakdown and was forced to take early retirement, before that I was paying well over 50% of my salary in tax and national insurance for years. That breakdown seemed to ruin my health such that I’ve gone from good fitness to developing quite bad cataracts and losing several teeth in less than 2 years. 3 times my optician has insisted my eyes need replacement lenses and each time the NHS hospital says they do not, despite not being able to drive at night or fly my models anymore. Privately, which of course I neither have or can afford insurance for, will be £4000 to have them done. At the same time my dentist tells me that if I do not fit implants the bone in my jaw will waste away, I.e. dentures are not a good idea, to have 3 teeth replaced that way will be £4400 - NHS support for dentistry is pretty much non-existent, even dentures are likely to not leave much change from £1000.

So despite having paid into a system all my life, when I need it, it is not there, I wonder if I would have been any worst off with the American system?

I suspect that once you become dependent on the government for your health care, the results are similar regardless of the country that you live in. This is why many Americans (me included) do not want the government taking over our health care system (single-payer as it is called here). People here who do not have good private insurance have the same stories as you tell. People with private insurance generally do not.

Our family health care insurance is provided by my employer and we never get push-back regardless of the services provided. If I need an X-ray (which I have because of some EUC experiences ) I got it that same afternoon. I had a cat-scan a few years ago, prescribed by my primary physician, and I got it the next day. Just two simple examples for me, but I could go on and on. Fortunately I'll be a position to maintain private insurance after I retire so I won't be wholly dependent on government health care, which scares me.

[Marty Backe]

2 hours ago, dmethvin said:

Wow Keith, sorry for all your troubles! 

As crazy as it sounds, I suspect your medical and dental care would be much more expensive in the US. Dental insurance isn't that common here and when people do have it there are generally high deductables and copays (like 50% is common). I had one implant done 6 years ago and it cost $4,000. Then it failed (actually came out of my jaw) last year and I had to have it redone. The oral surgeon I used had retired but the person who took over his practice gave me a 20% discount for this second time around. Whoopee.

Oh definitely, everyone gets charged the same rate. All the price chicanery occurs in the back office. The insurance companies get lower prices for everything, either by negotiating agreed-upon payment schedules or by grinding down the receivables department with delays and arguments until they take less money. If you are uninsured there is none of that and you are asked to pay whatever the "standard rate" is for the care you received. You can attempt to negotiate a better price ex post facto but you have no leverage at that point. If they think you can pay you will pay, even if it's over time and with interest. If you cannot pay they will sell the debt to a collection agency for pennies on the dollar and those people will pester you all hours of the day. And your credit will be ruined for important things like buying a house.

Yes, hospitals will tell you how much a procedure costs. Of course, the doctor you chose may only have privileges at a small number of places, possibly just one. The price of using Doctor A at Hospital B may be very different from Doctor X at Clinic Y. This is nothing like comparing prices of a standard product where you can hop on the Internet and look. Not only do you need to consider the opinion of the doctor and their perceived competence, but the cost of whatever they recommend.

 

I've had a couple of implants and sadly am getting another one early next year. My implants have cost ~$2000 and another ~$1000 for the crown that goes on the implant. Like you, my insurance covers 50% (which is certainly better than nothing). Looks like implants are more expensive on the East coast 

I do hate the non-transparency of the American medical system. It's always a mystery what you are going to pay and it would be awful if I didn't have health insurance. Fortunately the vast majority of Americans do have health insurance. Yet even with all of its problems I would take it verses government provided health care for everyone because then it becomes the DMV experience with long lines and rejected requests for service.

[Rehab1]

57 minutes ago, Marty Backe said:

I've had a couple of implants and sadly am getting another one early next year. My implants have cost ~$2000 and another ~$1000 for the crown that goes on the implant. 

My wife had the same procedure. Very expensive. I look at her smile and then say to myself: “I could have had 2 new EUCs!”  

 

57 minutes ago, Marty Backe said:

I do hate the non-transparency of the American medical system. It's always a mystery what you are going to pay and it would be awful if I didn't have health insurance.

Charges for elective procedures (unless there are complications) are commonly stated upfront. My wife had gastric bypass this year and we knew exactly what the cost would be. Non- elective procedures are a completely different story especially when ER or ICU are involved. 

 

[Marty Backe]

30 minutes ago, Rehab1 said:

My wife had the same procedure. Very expensive. I look at her smile and then say to myself: “I could have had 2 new EUCs!”  

 

Charges for elective procedures (unless there are complications) are commonly stated upfront. My wife had gastric bypass this year and we knew exactly what the cost would be. Non- elective procedures are a completely different story especially when ER or ICU are involved. 

 

True. And Plastic Surgery is also a demonstration of how efficient medical care can be when insurance is removed from the picture. Exact costs are known up front and the prices are competitive.

The question must be asked, how many EUCs would you trade for breast implants   Did I just say that? 

[The Fat Unicyclist]

6 minutes ago, Marty Backe said:

The question must be asked, how many EUCs would you trade for breast implants   Did I just say that? 

Back the bus up...  

Did @Marty Backe just say he's trading in some of his wheels to get some breast / pec implants?

[Marty Backe]

5 minutes ago, The Fat Unicyclist said:

Back the bus up...  

Did @Marty Backe just say he's trading in some of his wheels to get some breast / pec implants?

[nute]

I feel i should add to my earlier post...having thought about it over dinner and a glass of port...or three...I have to say that my only personal experiences of our system have been actually good, I wasn't impressed by my fathers care (or my farther in laws in the US) but the only time I've had an Xray it was same day, no waiting, sent to the hospital by my GP, turns out i have kidney stones

More seriously, my eldest son had a rugby injury which could have killed him. The injury was something the surgeons see only rarely and the Oxford University hospital guys  said they see only a handful over the course of a career. The broken bits ended up being rebuilt by the surgeon who rebuilt Martha Lane Fox and now, 6 years on he has no ill effects thank god. I have to say his care was brilliant ... but i guess it depends on what you've got wrong and who deals with it.

[Rehab1]

7 hours ago, Marty Backe said:

The question must be asked, how many EUCs would you trade for breast implants   Did I just say that? 

Lol....Actually just the opposite. Yep I can have my cake and eat it to.  

7 hours ago, The Fat Unicyclist said:

Back the bus up...  

Did @Marty Backe just say he's trading in some of his wheels to get some breast / pec implants?

There may be some new forum members that wished they have never joined.   But if @Marty Backe does show up on video with a pumped up chest it might actually increase membership.

[dmethvin]

8 hours ago, Marty Backe said:

Plastic Surgery is also a demonstration of how efficient medical care can be when insurance is removed from the picture. Exact costs are known up front and the prices are competitive.

Definitely. When the person making the decision and getting the service is paying the bill directly, the system works.

Of course the typical situation is that the person getting the service is being told what they should do by the doctor who is influenced by the drug rep, with the bill being paid by the insurance company and the premiums being paid by the person's employer who is unable to know what is being done due to privacy rules. 

In our system, having all those people involved means sharing a bunch of data about you. The insurance companies share a ton of information about your health history to evaluate their financial risk, so they can decide whether to deny you coverage in the future. The doctors and hospitals file a bunch of electronic forms to justify their billing for procedures, which are reviewed by the insurers who argue, deny, and sometimes pay claims. Insurers tell employers how much health care their employees are costing in aggregate, which influences the company's premiums for the next period. But hey at least it's not the government keeping all that data?

As you might guess, the effect of even a few sick people on a small company is to drive the company's insurance costs way up, which gives the company an incentive to either fire or avoid hiring people who might need expensive care. If you're a big company this effect isn't as bad, since your risk pool is large. As an employee since your insurance is tied to your place of employment you have to be very careful about making job choices. If you have a child that needs expensive treatment you probably won't be able to quit your big-company job and start your own small business because then your insurance premiums will be sky high, assuming you can get insurance at all.

No sane person would have designed this US health care system. It only exists this way today because the interests making money from it are paying huge amounts of money to lawmakers to keep it in place.

[LanghamP]

Pharmaceutical companies must have deep pockets.

When I was working at a hospital, the pharmaceutical companies would have our doctors fly out to Hawaii to give a speech. They would pay them a couple to ten thousand dollars for a 15 minute speech where they could say anything, and the rest of the week the doctors were free to do what they wanted, along with most (or all) of the expenses paid for. You can imagine if that was just the money flowing to the doctors as (legal) kickback, then what a pile of money the pharmaceutical companies must have been making.

I don't know the specifics but I suspect the majority of medical profits comes from drugs and not from procedures. Most people should not be on drugs most of the time because of both the side effects and the expense, but it seems to me most Americans are on some kind of drug, and specifically anti-depressants seem ubiquitous.

My pet theory is that most Americans watch too many ads on TV and on Facebook, and ads work by creating a need in a person who is then depressed until that need is met, which of course doesn't work at all because while they thought they needed that granite topped kitchen or fancy new juice squeeze, what they really wanted was the Gotway MSuper!!

Hint: if you buy something, enjoy using it, and feel great for some time after you put it away, then that's probably a good indication the thing you just bought is a useful addition instead of useless crap.

If you're an American, you should ask for a breakdown of your salary compensations. You might be surprised as how expensive medical insurance is (you would not see the cost unless you asked HR for it), and I think that's why our salaries haven't increased hardly at all in the past decade. Our salaries actually have been increasing by quite a lot, only it's being gobbled up by health care costs.

[Marty Backe]

23 minutes ago, LanghamP said:

Pharmaceutical companies must have deep pockets.

When I was working at a hospital, the pharmaceutical companies would have our doctors fly out to Hawaii to give a speech. They would pay them a couple to ten thousand dollars for a 15 minute speech where they could say anything, and the rest of the week the doctors were free to do what they wanted, along with most (or all) of the expenses paid for. You can imagine if that was just the money flowing to the doctors as (legal) kickback, then what a pile of money the pharmaceutical companies must have been making.

I don't know the specifics but I suspect the majority of medical profits comes from drugs and not from procedures. Most people should not be on drugs most of the time because of both the side effects and the expense, but it seems to me most Americans are on some kind of drug, and specifically anti-depressants seem ubiquitous.

My pet theory is that most Americans watch too many ads on TV and on Facebook, and ads work by creating a need in a person who is then depressed until that need is met, which of course doesn't work at all because while they thought they needed that granite topped kitchen or fancy new juice squeeze, what they really wanted was the Gotway MSuper!!

Hint: if you buy something, enjoy using it, and feel great for some time after you put it away, then that's probably a good indication the thing you just bought is a useful addition instead of useless crap.

If you're an American, you should ask for a breakdown of your salary compensations. You might be surprised as how expensive medical insurance is (you would not see the cost unless you asked HR for it), and I think that's why our salaries haven't increased hardly at all in the past decade. Our salaries actually have been increasing by quite a lot, only it's being gobbled up by health care costs.

I believe that most large companies (Fortune 500, etc) already report the exact cost of medical insurance that they provide. I know mine does. They make a point of showing you how much they are paying for your medical coverage in addition to whatever you have to contribute out of your salary. HR is not involve - it's in plain site. The companies what you to know what generous benefits that they are providing.

[LanghamP]

6 hours ago, Marty Backe said:

I believe that most large companies (Fortune 500, etc) already report the exact cost of medical insurance that they provide. I know mine does. They make a point of showing you how much they are paying for your medical coverage in addition to whatever you have to contribute out of your salary. HR is not involve - it's in plain site. The companies what you to know what generous benefits that they are providing.

Public and semi-public entities must disclose what they pay to the general public, but certain compensation such as pensions and medical are harder to get. For example, try finding out the true compensation of Illinois public schoolteachers. For excellent reasons that's difficult to get until, whoops, your state has encumbrances so high it's insolvent. 

Some examples are ridiculous such as Uber having no compensation except for cash, and General Motors having their CEO make one dollar per year, but with stock compensation worth millions. I know GM isn't a public company, well maybe they are post bailout... 

[Marty Backe]

3 minutes ago, LanghamP said:

Public and semi-public entities must disclose what they pay to the general public, but certain compensation such as pensions and medical are harder to get. For example, try finding out the true compensation of Illinois public schoolteachers. For excellent reasons that's difficult to get until, whoops, your state has encumbrances so high it's insolvent. 

Some examples are ridiculous such as Uber having no compensation except for cash, and General Motors having their CEO make one dollar per year, but with stock compensation worth millions. I know GM isn't a public company, well maybe they are post bailout... 

When you say Public do you really mean government? I usually think of Fortune 500 companies as publicly traded companies verses private companies.

California is right behind Illinois on the bankrupt train.

[LanghamP]

22 minutes ago, Marty Backe said:

When you say Public do you really mean government? I usually think of Fortune 500 companies as publicly traded companies verses private companies.

California is right behind Illinois on the bankrupt train.

Maybe. Yes. Um, no? Possibly I mean part of the executive branch, but maybe I could also mean non profits although it seems half the non-profits are just some billionaires tax free slush fund for legally compensating friends and family. When you see NPOs with administration costs (a legal disclosure compliance) approaching 100% then that's probably a good indication that it's a bribe machine. All perfectly legal of course. 

California has low property taxes but high income taxes so it's in good shape. Maybe even great shape. What isn't good is local government not taxing large corporations in order to get them to relocate there. Worse yet is having to pay large corporations to relocate there. 

Examples are sports stadiums, Walmart, and large tech companies. Yes, pay for our infrastructure and you can collect a pittance from sales tax... 

[Marty Backe]

3 minutes ago, LanghamP said:

Maybe. Yes. Um, no? Possibly I mean part of the executive branch, but maybe I could also mean non profits although it seems half the non-profits are just some billionaires tax free slush fund for legally compensating friends and family. When you see NPOs with administration costs (a legal disclosure compliance) approaching 100% then that's probably a good indication that it's a bribe machine. All perfectly legal of course. 

California has low property taxes but high income taxes so it's in good shape. Maybe even great shape. What isn't good is local government not taxing large corporations in order to get them to relocate there. Worse yet is having to pay large corporations to relocate there. 

Examples are sports stadiums, Walmart, and large tech companies. Yes, pay for our infrastructure and you can collect a pittance from sales tax... 

I wish my property taxes were low. Keep in mind that a shack goes for half a million dollars here. So even supposedly (according to you) low property taxes take a mighty bite out of your income.

You need to look at that actual absolute dollars being paid in property taxes by the masses, not the tax rate.

[litewave]

From my experience, Tort reform has dramatically, adversely impacted the quality of healthcare in the US, making malpractice unsuccessful and unprofitable except for extreme, isolated, high-profile cases. With the ongoing, systematic dismantling of regulations and oversight at the federal level and in many states, there are few options, especially for the elderly, to advocate effectively. Without relief through the courts, or the threat of punitive oversight by state medical boards or CMS, there is little to no accountability to patients. The US spends far more on healthcare yet the results are the worst compared to other first-world countries. Healthcare has become the new economic bubble.

I can't say that New Zealand is any better, despite 'free' access to healthcare. The trade-off for New Zealanders is that its no-fault approach to malpractice precludes personal legal redress. Although it has a Health and Disability Commissioner, it is slow, bureaucratic, and reviews less than 10% of all complaints, with only a tiny minority resulting in any action. There are often stories in the NZ media (which tends to suppress negative news) of cases like this botched hip surgery or failure to diagnose meningitis like these cases in 2015 or 2016.

I did utilise Australia's healthcare system a few times and was overall impressed. They do have their challenges as well, but their national healthcare system consistently rates higher than the US and NZ.

Since this topic was started by @meepmeepmayer, it would be interesting to compare the BRD's healthcare system to other nations in the EU, and to the UK and US.

[LanghamP]

9 hours ago, Marty Backe said:

I wish my property taxes were low. Keep in mind that a shack goes for half a million dollars here. So even supposedly (according to you) low property taxes take a mighty bite out of your income.

You need to look at that actual absolute dollars being paid in property taxes by the masses, not the tax rate.

Proposition 13 provides an effective tax rate that is much lower than any other state, while sales and corporate taxes are higher than most (all?) other states.

Interestingly, I think this prop 13 is a progressive tax because only richer people pay it, as the tax on property is reassessed only when the property is sold. However, there's something feudal about it in the sense that it stakes people to the land for generations.

In my opinion, lack of housing is one of the easiest problems to solve, much more so than health; you just build more houses. There's nothing technical about it, and house building follows prefab assembly with unskilled labor. Yet housing in California is extremely limited because they only built 60,000 units last year. Insane, but people already in houses fight tooth and nail to make sure their property values stay high.

Yes, that's right, the most liberal state in the Union has the most regressive and conservative housing market in the Union.

[meepmeepmayer]

9 hours ago, litewave said:

Since this topic was started by @meepmeepmayer

Actually, it wasn't I responded with a half sentence to a half sentence where the argument was that healthcare differences might influence whether people ride EUCs or not (Which sounds ludicrous at first, but gets actually more valid the longer you think about it). Then somehow this snowballed into a EU vs US healthcare fight (offtopic extraordinaire) and was split off. I wasn't involved

The idea (my argument) is, while emergency or acute care may be equally available between the two systems, there are no "I can't afford to get an MRI for my ..." or "I can't afford the treatment that would be necessary for my ..." situations here, while there are in the U.S.

So what might put people off EUC riding in the U.S. is having no health insurance (or just being worried about the craaaaaazy deductibles that apparently are everywhere) and being afraid of a (maybe only minor) issue that needs longer and preventative (as opposed to reactive) care, but which you have to be able to afford to get treated.

I was specifically thinking of @Dingfelder who was soooooo enthusiastic about EUC riding, just got his first wheel (msuper V3 1600Wh, not bad!!), stated he had no health insurance, then had a simple torn ligament or just sprained ankle from a simple unlucky step (not EUC related) and vanished of the face off the earth (= this forum). Seriously, what happened to the guy?

Might very well be a consideration when people think "I don't want to risk something even just minor and then have a limp or whatever chronic problem because I can't afford an otherwise simple procedure to fix it" and this influences how safe they feel regarding EUCs (the same nagging safety concern once you realize how sketchy your Gotway is after your first hardware problem/crash with it). So it's not only about broken-skull-crazy-crash healthcare (where nobody will be left for dead), but the simple healthcare background noise that may influence things.

--

9 hours ago, litewave said:

it would be interesting to compare the BRD's healthcare system to other nations in the EU, and to the UK and US.

For the record, how the German system works: if you work, you get deducted some percentage of your income automatically and that's it, you're insured (you have to be by law, you can choose your compulsory insurance company, but they offer 99% the same by law). You have a health problem, you go to a doctor and don't even see any bills (only your insurance company sees them).

Or, if you're too rich or self-employed (aka hated, in this case), you have to insure yourself with a private insurance instead. There, you go to the doctor, pay for everything yourself, give the bills to your company, and you'll get reimbursed (with a not too big deductible, think 1000€ or less, per year).

You're required to have one of those (and mostly only have one of the options).

Current discussion is removing the second option (e.g. it is unfair to self-employed people who are forced to go private but do not make the money that this usually asssumes; or having a two class system where doctors prefer "private" patients; compulsory insurances have to take everyone while the others can cherry-pick) and putting everyone into the first (more or less, with some modifications).

But the devil is in the details, not the kind of system. E.g. the UK NHS being sabotaged in favore of private insurance companies.

[LanghamP]

7 minutes ago, meepmeepmayer said:

 

For the record, how the German system works: if you work, you get deducted some percentage of your income automatically and that's it, you're insured (you have to be by law, you can choose your compulsory insurance company, but they offer 99% the same by law). You have a health problem, you go to a doctor and don't even see any bills (only your insurance company sees them).

Or, if you're too rich or self-employed (aka hated, in this case), you have to insure yourself with a private insurance instead. There, you go to the doctor, pay for everything yourself, give the bills to your company, and you'll get reimbursed (with a not too big deductible, think 1000€ or less, per year).

You're required to have one of those (and mostly only have one of the options).

 

Sorry, man, I had to down vote you since thinking and experiencing German versus US health care pisses me off.

The few times I've gone to get health care in Germany were great, especially since my records, once entered, were available everywhere. In contrast, I have to fill out my information again for the same damned clinic. I'd go full communist Marxist just for that alone, as I loath filling out paperwork again with information they already have.

The Germans pragmatically see government health care as being stewards of people's health while in the US profit concerns override accessibility and affordability.

[meepmeepmayer]

Haha, ok

[meepmeepmayer]

5 minutes ago, LanghamP said:

The Germans pragmatically see government health care as being stewards of people's health while in the US profit concerns override accessibility and affordability.

Don't worry, they're doing their best to throw it to the profit-seeking wolves here as well