In Scotland prescriptions are "free", i.e., I don't pay anything for my inhalers, or anything else prescribed by my doctor.

This costs the Scottish health service £1.3bn (https://www.scotsman.com/news/bill-for-prescriptions-in-scot...). I don't know how sustainable that cost will be, but I don't hear anyone complaining about the policy, except for opposition parties.

I also pay 1.45% of all income for Medicare, which I will not be eligible for until I'm 65, a few decades away. My employer pays an additional 1.45% on my behalf and I pay an additional 0.9% surcharge on all household income over $250k.

I'd love to start my own company but health insurance costs are a big impediment. I have young kids, I can't leave my family underinsured. We're healthy now thankfully, but what if one of us gets cancer or is in a car accident and we're hit with $500k+ bills (or worse - if we can't get the right treatment)? I don't know how other people do it.

That said, don't worry that you do not get enough back from your health insurance. This will come soon enough when you get older ;-)

Intellectual property law is a way for government to grant exclusivity to one firm. This whole "you can get it for x in Canada and y in Germany" is a silly conversation. It's not like it costs 1000x to manufacturer the drug here vs there. The R&D and marketing costs are amortized over the period of exclusivity. Saying "you can just go to Canada to get it" just means "im going to circumvent intellectual property law." It's kind of like, but not quite, piracy. You're choosing where and when which laws apply to you. It also kicks the can down to the rest of the people buying the drug, because we know the pharma actuaries arent going to price their drug at a loss. And then on top of that, like you say, these prices people pay AFTER insurance arent what the cost of the drug is to the population, its an already subsidized price.

Germans and Canadians are getting the drug cheaper not only because they have different laws, but because the R&D recovery isnt evenly split between country, they take their money where they can get it.

Insulin SHOULD be generic by now (the patent on long-acting synthetic insulin expired in 2014), but the companies continually improve it and always sell the latest variant. And of course Doctors are going to prescribe what works best.

1. A lot of drug patents are bought by hedge funds that just raise prices to reap profits and never invest in R&D

https://www.nytimes.com/2015/09/21/business/a-huge-overnight...

2. Drug companies spend more on marketing than R&D:

https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

3. Because of lobbyist, Medicare can’t negotiate drug prices - unlike the VA in the US and every other country.

https://www.forbes.com/sites/johnwasik/2018/08/10/why-medica...

This point, which always comes up in these threads, has already been debunked both in those other threads, but it was even debunked here before you made this comment.

I have never heard of such outrageously priced healthcare plans (private providers excluded, of course).

Basically, the insurance cost is a percentage of income (14.6%) up to 4,537.50 €/month (gross income). If you earn more, your absolute health insurance costs will stay the same at 662.48€.

Keep in mind that in Germany, half of your health insurance is covered by your employer (by law).

Edit: The above is for the "public" insurance system, as noted in the comments. If you are above the Beitragsbemessungsgrenze, you can opt for private insurance which will very likely be significantly cheaper while you are young. But it carries the risk of steep price hikes which you might not be able to handle later in life (think retirement). And the path back into the public system is not straight forward and might include having to file for personal bankruptcy or similar drastic measures.

(Details:

You can go back once you're covered by public insurance for 12 months, no matter through which status, so family insurance helps get these months. For family insurance your income needs to be below EU435/month + some exceptions.

The outcome changes a bit when you're older than 45 because you need ~20 years (in raw terms: more than 90% of the second half of your working life) in total in the public insurance scheme to be able to apply for the "public health insurance for pensioners" system when you retire. That complicates matters.

Even more details for people not used to the German health insurance system:

By default people are in the public health insurance system. Exceptions are self-employed folks, public officials and people with income beyond the cap mentioned upthread: they can choose whether to use the public system or some private health insurance.

The reason why you can't just move from private insurance to public insurance is that otherwise the private insurers would try to get ahold of all the healthy youngsters and their (usually significant) money while offloading them to the public system as soon as they start to cost more than they bring. That would break the economics of the public insurance system.)

Are you sure you don't mean total social security (of which health care is a subset) with that number.

Because that's how it is here in Austria. The deduction for social security is significant, but health care is only a small fraction of it.

Edit: I checked and I stand corrected, thanks to the replies clearing this up.

When I take an average salary (3000 euro monthly gross salary) and put it into a tax calculator, the net salary comes back as about 1950 euro, so the different between gross and net salaries is about 35% in that tax bracket.

So if you earn EUR 1000 (just to have a nice round number), it's EUR 150 for health insurance, of which EUR 75 come from your gross pay, and another EUR 75 are itemized as coming from the employer.

That makes the 14-15% look scarier than they are (for the employee).

I find this perfectly valid and think we should get rid of private health insurance at all. It's undermining our system, pretty much like pension for state workers and alike. We really need to unify this system, imho.

> I paid 500€ per month for healthcare

You misquoted that as:

> 500EUR for your use of healthcare that month

(Emphasis mine.) Their original statement was correct (assuming that is what they paid!) and didn't sound like a complaint to me, just a factual correction.

The premium is based on your monthly salary.

If you’re not free not to pay it it’s a tax. It may be a well designed, special purpose tax that stops people doing stupid things but it’s still a tax.

If you pay taxes, the state may do whatever it suits with the money. If they decide once day to no longer maintain the public infrastructure using your taxes but instead increase politicians salaries they are free to do this.

If you pay an insurance, on the other hand, you have a legally enforceable right to receive the insurance benefits if you meet the pre-defined criteria for an insurance case.

In German law the insurance contribution may not be a tax because payment of it entitles you to certain services. That doesn’t stop it being an involuntary payment, mandated by the government, a tax by common definition.

That doesn’t make the legal definition wrong, but it isn’t really relevant outside a legal context just as a chef won't argue with a botanist that actually a tomatoe or a pumpkin is a vegetable not a fruit. Botanically they’re right but who cares?

https://en.wikipedia.org/wiki/Tax

A tax (from the Latin taxo) is a mandatory financial charge or some other type of levy imposed upon a taxpayer (an individual or other legal entity) by a governmental organization in order to fund various public expenditures.[1] A failure to pay, along with evasion of or resistance to taxation, is punishable by law. Taxes consist of direct or indirect taxes and may be paid in money or as its labour equivalent.

They also get Humalog much cheaper[1]. £29.46 vs $240.18

There's no sane way you can see discrepancies like this and not see something untoward happening.

[0]: https://bnf.nice.org.uk/medicinal-forms/salbutamol.html

[1]: https://bnf.nice.org.uk/medicinal-forms/biphasic-insulin-lis...

Kind off, people do pay national insurance, also a part of the overall tax goes into the NHS as well.

In England* there is a cost (£9250/year), but it's slightly misleading to think of it like that because of how Student Loans work here.

You pay nothing on your Student Loan up to a certain income (£25k, or $33k), 9% past that point, and then the remainder gets forgiven after 25 years. So in practice, it's an additional marginal tax rate for having gone to university.

(* different elsewhere in the UK - e.g. free in Scotland)

Lots of proponets of our system avoid mentioning this when comparing, but it is dishonest and gives an incomplete picture. Total taxation in Norway is 50-75% of gross pay, for an average employee (of which only 50% are employed in the private sector).

It's easy to look at your own tax receipt and think it's expensive but a) it's a boatload cheaper than it would be (cite: US healthcare atrocities) and b) not everybody earns enough to pay tax in these countries.

The people in group b still get treated. Equally. You're not left to suffer and die of readily treatable chronic conditions if you can't afford tax.

I bet manufacturer (pharma company) receives only $2 or less of these money.

£3.60?

Seems an odd restriction, but it explains why I didn't find it.

Also, if you don't have a job or if you don't earn over a certain amount it won't cost anything at all.

Prescription requirements for ordinary inhalers is a time-wasting money-making scam run by doctors.

But they want it that way.

They see us over here in Europe as some kind of "socialism" because our taxes will also go into public healthcare, so you don't have to worry about whether you can pay the bill if you have to see a doctor or go to the hospital.

Call it "ease of mind" or whatever you want, but I prefer paying monthly, although if not using it, over anything else.

edit: As someone pointed out, this might even come out to 0 once you get older and probably get ill more often or need more expensive services. So, it looks unfair when you're young and healthy but it will help you once this changes.

very much this.

It's like playing in a lottery that you win almost every month, and if at some point you lose, you get a lot of money.

When healthcare cost is being discussed, the cost on society should be what's being discussed, not to what extent it's paid for by tax money. Those are two different things and they're only slightly related (in that if healthcare is perceived to be cheaper, people might use it more, which may drive up total cost) (or drive it down through better prevention).