The ER is quite expensive to run, they’re designed to handle the riskiest kinds of situations.

Imagine how expensive a software dev team would be with 24/7 work, and full cycle scrum sprints every 72 hours to allow for constant pivoting, with injects from one to a bus load of product owners.

I paid $400 for a plumber to do 30 minutes of work this week.

A doctor has more training and a lot higher infrastructure costs and overhead, and thus a higher hourly fee.

Same thing happened to me with a plumber 12 years ago.

I spent a couple hours on YouTube and now I can solder my own copper pipes, install a new toilet and anything else I need.

Even being a software engineer I couldn’t compete with the hourly rate of a plumber so it makes financial sense for me to do the work myself.

But plumbers have to deal with a lot of nauseating stuff. "Amount of nauseating substances you have to deal with" should be a huge factor in pay rate.

What do you think doctors do? My last visit involved their fingers, a glove, and my butt.

Okay, so a $200 surcharge every time they have to deal with butts. $100 for urine, $50 for vomit. Charge it to the insurance anyway, they're used to paying $40000 a day for a hospital bed, they can pay $200 for dealing with a butt.

Plumbers have to deal with the aftermath of butts MUCH more often and they don't have the luxury of someone's insurance they can just throw arbitrarily high charges to.

You realise there’s medical professionals who deal with poop right?

There’s also the whole ‘all your clients are sick, some are contagious’ thing.

I’m not saying america isn’t insane, but to try and pretend plumbers have it far worse isn’t quite accurate.

Okay, so pay those poop-doctors double salary? They're basically gastrointestinal plumbers.

doctors are paid roughly equivalent, and the cost of healthcare is substantially lower in other companies, so I’m not really sure what you think you’re solving here, but I don’t see your plan ever working either.

And yet ironically, in the US at least, there’s a decent chance that plumber actually makes more than a physician.

Unlikely, but if he does it’s because he’s the “owner of a plumbing business” not just a plumber.

Possibly upto a point, if you factor in that the physician has to contend with paying back $400K in loans and $1M+ in lost income from not working during earlier years in life.

Yes, and it would be even more expensive in Germany. But in both countries the insurance covers normally 50% of it, wherever you go. If not all. (Other sickness are covered normally 80% if not entirely whatever insurance you have)

What are you talking about? As long as you are not private insured - which is not difficult to do usally - if you have a job you are insured (a percentage of your pay is used for insurance, if you study you are insured (90 eur) or you can join on your own for 200eur/month depending on your income if you are working on your own.

You pay nothing for ER, 10eur/day for the hospital and a few eur for medication - but nothing even in the range for 50% or 80%

dental is also covered to a large degree but if you want state of the art you have to pay the difference yourself - but you can also add a private insureance for that for 100 to 300eur/year to have everything covered.

you can still fall through if you can't pay the monthly fee - but emergencies are also free even if you don't pay.

private insurance can be expensive but should usally cover also everything.

Did you actually read my comments in this conversation? Are you aware that in Germany clinics have different prices than the ones you pay after insurance? I have always talked about prices before insurance, which is what I'm arguing looks completely out of place.

I'm public insured in Germany and no, dental is not really covered, I had to pay my routine treatment last time at the praxis, and it was not cheap.

Do you know that if you don't have insurance (which is however mandatory in Germany) you get an actual bill for the medical services?

Yes, the price before insurance is generally higher, but reguated by the public insurance. See one of the price catalogs here: https://www.g-drg.de/aG-DRG-System_2021/Fallpauschalen-Katal...

You do not need to pay extra for dental if you choose the most basic treatment. Most people like their dental work to look like their natural teeth which does not count as most basic. That is why you had to pay, but only the price difference to the basic treatment.

And, of course, the doc likes to sell you some extra treatment (say "professional tooth cleaning") which will make her/him some extra money.

Same for glasses. The most basic option is free. If you don't like the coke bottle bottoms then you will have to cover the difference yourself.

I misunderstood your comment then. Sure what is billed is a different thing. Sorry.

For the dentist: They often bill you for stuff that is covered but it lucrative to add something to the bill.

Would be much less in Taiwan for example. I don’t know exactly but I’d have to guess $50 USD? I’ve been to clinics that charged about $15-30 for a doctor visit (cash price as a foreigner—Taiwan has national healthcare but they can’t charge to that for me). ER would probably be double that.

It’s not like you’re taking up a hospital bed. It’s a sew up and show you the door operation.

@garmaine I'm talking about the one the most prestigious clinic in South America in Santiago [1], and that's before insurance. I never paid that myself, because it was covered by the insurance.

[1] https://www.clinicaalemana.cl/

Marginal vs fixed costs.