Sure, if you have life threatening condition that needs to be addressed ASAP or else you'll die, you usually get taken care of without it ruining you financially like in the US would, but since the public system is massively understaffed and underfunded, then many health issues which are not life threatening but still impact your quality of life, can end up being out of packet, which sucks, as most Europeans aren't exactly rolling in disposable income (but at least they're not heavily in debt either).

For example, in Austria, the amount of free care you get in case of an accident depend on where it happened. If it's at work, or on your way to/from work, then everything is fully covered, but if you get injured in your spare time, then only life threatening stuff is covered, for the rest, quality of life issues, you have to pay out of packet to have them fixed or have private accident insurance. Basically the public healthcare covers as little as to get you able-bodied to get back to work again, that's it. If you also want to feel 100% again, then you gotta pay up out of pocket.

Since medical school is basically free, Austria has 3x the doctors per capita than the US, yet waiting times for specialists or some procedures are far longer. Why is that, you ask? Because most doctors here don't like being burned out in the understaffed public system, so once they served their "minimum sentence" in the public system to cover their "debt" for their public education, they go into private practice, which means that despite having 3x the doctors than the US, the public system is in a perpetual shortage of personnel.

The state just doesn't have enough money to pay for every heath issue for everyone, but only the gravest of heath issues, and with our ageing population and stagnating economy, the situation is getting worse by the year. I heard Sweden, Finland and other rich EU countries have similar issues in their public system.

In the US, the left assumes (and usually operates as per) that all healthcare plans outside the US are "100% free", single-payer like the UK NHS or Canadian Medicare, as opposed to the actual norm being something closer to that of France, Germany, Austria, or the Netherlands.

France = 30% copay is the norm

German/Switzerland/Netherlands = Everyone chooses from one of dozens of competing insurance plans. Basically Obamacare, except there are no loopholes like the ones that allow 9% of Americans to not get insurance

Austria = Like US, but you don't get to choose the plan (no equivalent to US annual shopping period)

Australia = Both private and public insurance. Those on public are strongly encouraged to move to private

https://twitter.com/BadEconTakes/status/1228143455399858176

A better way to understand our problems is that our medicaid and medicare programs are the most generous in the world - so much so that extending it universally is so friggin expensive.

I laughed out loud at the idea of the US thinking universal healthcare would be expensive considering all the trillions spent without blinking to pay for two pointless wars, the 1.7 trillions to be spent on a stealth plane that can't fly in the rain, and the trillions printed in the last couple of years and dumped on the stock market.

This talking point really undersells the order of magnitude difference in cost.

Also, hospitals in the US don't need to be decked out like an oil-sheik's mansion with expensive frivolities. In Europe, they're really spartan on luxuries as they're just places where you go to get treated, not art galleries.

My point is, a lot of the massive costs in US healthcare is just down speculation and waste, both of which could be reduced of desired without sacrificing quality.

I've been on state Medicaid in the US. I've also been on a single payer in Europe. People really have no point of comparison on how much more luxurious Medicaid is. You are still visiting the oil-sheik mansion, but with no out of pocket and no limitations on how much or often.

Hospital will still shake you down for all your money, but the government has no problem footing the bill.

I don't doubt it. In the US, doctors and hospitals are incentivized to treat you like a cash cow and to do as many tests or procedures as possible, even unnecessary ones, knowing that your insurance company or the government will foot the bill no questions asked.

Whereas in Europe, the doctors and hospitals in the public system are incentivized to do as much cost cutting as they can by doing as little tests and procedures as necessary, to reduce costs and waiting times, and have strict regulations on when they can refer you to specialists or more expensive test, needing to justify it when they do.

This means that sometimes you can end up with some undiagnosed condition going chronic on you because the public doctor didn't want to, or wasn't allowed to refer you to an MRI scan when you first showed some light symptoms, because your light symptoms weren't severe enough to warrant such an expensive test. I sh*t you not, this happens more than I'd like to hear. It's why health tourism is booming in Europe, where people from richer EU countries go to the Eastern states for private tests or treatments since preemptive care in the European public system is failing people big time and they can't afford the private system in their wealthy countries.

Sometimes, having a fully private health system, really does have its benefits.

One slight addition. They might be medically unnecessary, but have become legally necessary in some cases. Either because medical protocol has adapted to try to charge more, or because if you don't you might get sued because "Every other doctor would have run that test", etc.

But it is still very much about the money. When I got my wisdom teeth extracted, I had to go in for a 10 minute consult with xray on one day, then go in on a second day (even though it could be done on a single day). Why? Because insurance will not pay for a consultation if it happens on the same day as the extraction.

As for the government footing the bill in the US. Some procedures are deprioritized by hosptials of the patient is on Medicaid. The Medicaid reimbursement rate is generally lower than that of other insurance, so they prioritize the people/insurance that pay more.

I generally agree. But I have heard that they will push lower priority (non-life-threatening) operations to the back in order to get other insurance holders to the front of the line. Basically because the reimbursement rate from other insurance tends to be higher than Medicaid.

So would we just end up with a government plan that we still need to pay premiums, deductibles, co-pays, etc on? And where are the systemic savings (providers still need to have billing agents to deal with this and private insurance, government overhead peobably isn't that much better than business overhead)? Do the people who can't afford it go on Medicaid to cover the balance like they do if they can't afford current Medicaid? Or are the suggestions really just misnamed and are totally different?

There a certainly some areas of interest to be address, like how to protect from bankruptcy even when someone has insurance, or what edge cases many of these uninsured people fit into that aren't covered by employers, the exchange, CHIP, Medicaid, and Medicare. Although in many discussions this is glossed over or not touched on at all. It would be interesting to see if requiring coverage for part time and contractors would affect anything. Especially if that would help pull people into the middle class (no idea if it would).

Only 4% of US bankruptcies are because of medical bills (<https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...>). A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect regardless of country.

Of course sometime to comes down to people making medical coding issues on a bill. I've been dealing with that for 6 months now.