The state of the US health system

[Marty Backe]

43 minutes ago, meepmeepmayer said:

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.

--

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.

Surely there must be some problems, such as rationing or long wait times for non-life threatening issues. A totally 'free' system with zero wait times or rationing would go broke very fast for what I think are obvious reasons. That's what many Americans fear about government mandated health.

I suppose if the 'tax' that everyone pays is high than their wouldn't be problems. And that's one of the reasons EUCs are so much more expensive in your neck of the woods (trying my best to relate the discussion to EUCs )

[litewave]

52 minutes ago, meepmeepmayer said:

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.

--

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.

Thanks for clarifying. It's been over 20 years since I visited a German doctor, but a lot has changed since.

I think your question is a good one: are potential or new riders deterred from trying it out or sticking with it due to perceived risks? I think the answer is definitely yes. Even with health insurance, there is possible loss of employment in case of injury. No job -> no insurance -> death spiral. And in some countries, there is no guarantee that the medical care will cover everything even with insurance, or that the quality will meet standards of care.

 

[litewave]

14 minutes ago, Marty Backe said:

Surely there must be some problems, such as rationing or long wait times for non-life threatening issues. A totally 'free' system with zero wait times or rationing would go broke very fast for what I think are obvious reasons. That's what many Americans fear about government mandated health.

I suppose if the 'tax' that everyone pays is high than their wouldn't be problems. And that's one of the reasons EUCs are so much more expensive in your neck of the woods (trying my best to relate the discussion to EUCs )

New Zealand has a mostly free system. It works OK for routine problems. There is also private health insurance available at a lower cost than in the US. Unfortunately, the two compete with each other for the same resources, as most/all doctors work part-full time in the public system and also see patients 'privately' to make more money. The quality of care is basically the same, and although wait times to see a specialist in the public system can be much longer, wait times for private consults can be long as well. If the situation becomes urgent, a GP will just send the patient to the public hospital emergency room. There has been a lot of public outcry that the previous National (read: Republican-esque) government habitually starved healthcare, but the problems are, in my mind, more complicated and global.

[meepmeepmayer]

37 minutes ago, Marty Backe said:

Surely there must be some problems, such as rationing or long wait times for non-life threatening issues. A totally 'free' system with zero wait times or rationing would go broke very fast for what I think are obvious reasons.

Not really. Of course there's the fact that doctors prefer "private" patients where they get more money than the compulsory rates, but it's not really too bad. Even then, that's a big part of the discussion of having everyone in one compulsory system eventually.

I think whether it works or not is less a question of the system, and more of how much money there is in it, and whether it is being sabotaged to open up profiteering options from "extra" , "voluntary" insurances (see NHS in the UK) and similar parasitic appendages.

I guess there's also less procrastinating health issues due to cost concerns, less freedom of the American kind (aka limited availability of how you can fuck up your health and make treatment more expensive, e.g. basically every half-serious medication here needs a referral from a doctor this side of Aspirine, you can't just buy pretty much anything from a supermarket like in the U.S., less fat people, less drug (opioid or whatever) problems, ...) and other such cultural factors that make it cheaper overall. And the elephant in the room, the inflated American health costs, don't exist here (like 150% more of GDP than other first world countries with comparable quality). No $100000 bills for having a baby here.

All in all, it works pretty well.

(I'm no expert!)

37 minutes ago, Marty Backe said:

I suppose if the 'tax' that everyone pays is high than their wouldn't be problems. And that's one of the reasons EUCs are so much more expensive in your neck of the woods (trying my best to relate the discussion to EUCs )

It's like 2-2.5% or your wages (depending on the insurer you choose), and the employer pays more or less the same again. So maybe 5% overall?

VAT has nothing to do with it. Or any other taxes. Barely any cross-subsidying going on as far as I know. The price gouging with EUCs (and everything else) is due to import/export taxes (30% or whatever it is? No such taxes of any kind on the way from China to the U.S. for electronics!) and the fact that Euros are (perceived as) richer overall (in terms of how many people can afford X).

[litewave]

On 12/24/2017 at 10:16 AM, LanghamP said:

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.

Therein lies the fundamental problem of healthcare in the US and the rest of the world: an industry that is immune from legal and judicial oversight, and a false market that is run by a few corporations.

On 12/24/2017 at 10:16 AM, LanghamP said:

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?

It was a great post until the last line. Oh well.