Top Ten Happiest Places on Earth in 2019
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
- Emergency services are anything but a corner case. They are, in fact, the only truly important case.
That is one case where you don't have a choice, anywhere, under any system, if you cannot decide where to take yourself, someone will have to decide for you. If you can decide, then decide and go where you want, it's your choice. I really don't see a problem here
- Are you really saying that you have choice when the cornerstone of care is when there is no choice? That choice when it doesn't matter is enough to override when it does?
Again, you pick the care provider you like best, price is the same, it's in the taxes, so what you really choose is the GP you want and the kind of service you want to receive. When it comes to ERs and hospitals it's even easier - you just go to the hospital you want, nobody checks which provider you belong to, it makes no difference to them.
Bottom line - you are never presented with a bill unless you go for non-covered stuff like plastic surgery and dental care or massages etc. Your GP and the specialists he might direct you to for whatever reason, all come from your healthcare provider, but hospitals and ER are open to all customers equally, no matter which provider runs them.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
Emergency services are anything but a corner case. They are, in fact, the only truly important case.
That is one case where you don't have a choice, anywhere, under any system, if you cannot decide where to take yourself, someone will have to decide for you. If you can decide, then decide and go where you want, it's your choice. I really don't see a problem here
Absolutely, which is why we want the government, and no private person or company, to ensure equal care, and public oversight.
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@scottalanmiller government-only management is prone to abuse, unneeded bureaucracy and other wonders we see here in Canada. The Israelis found a way to combine government/tax based care with private sector competitiveness. Might not be the best approach, but it seems to be working quite well, better, at least, than the Canadian govt-only or US private-only approaches.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
government-only management is prone to abuse, unneeded bureaucracy and other wonders we see here in Canada.
Sure, but private is WAY more likely. Because it has all the problems of government, none are removed as it is still part of the government, but then the private risks on top of that. Nothing is perfect, but we can reduce the points of corruption or failure.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
The Israelis found a way to combine government/tax based care with private sector competitiveness.
But we established that when it matters... emergencies... there is no competition. So private not only doesn't have to be competitive, but without government controls can overcharge by anything that they want since you can't agree to the price ahead of time (that's how the US does it, all prices are after the fact.)
Healthcare by definition can't be a competitive market for the parts that matter and anyone actually discusses.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
Sure, but private is WAY more likely. Because it has all the problems of government, none are removed as it is still part of the government, but then the private risks on top of that. Nothing is perfect, but we can reduce the points of corruption or failure.
The idea is, when there is good competition, there is no room for corruption or abuse of the system. You go corrupt or do generally bad things, and people will simply go to the competition. This would work under normal conditions, but here the accessibility of medical care is so low, you have no choice bu to go to the corrupt, overexpensive and generally badly managed service providers. This is something the govt should be stopping, instead of quietly ignoring
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
The idea is, when there is good competition, there is no room for corruption or abuse of the system
But there is no competition. So there is unlimited room for abuse. This is exactly what they tell Americans - it's private, so the competition protects you. But healthcare by definition cannot be competitive nor private, it is always an arm of the government whether honestly or through corruption, and cannot be competitive because when it matters, when the money is big, you have no say in the matter and pricing is hidden.
It's not a theory that competition makes healthcare cheaper or less corrupt, it's the ultimate in corruption that a government even thinks that it can get away making such a claim to its populace.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
You go corrupt or do generally bad things, and people will simply go to the competition.
Unconscious people have no say in the matter.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
But we established that when it matters... emergencies... there is no competition. So private not only doesn't have to be competitive, but without government controls can overcharge by anything that they want since you can't agree to the price ahead of time (that's how the US does it, all prices are after the fact.)
Healthcare by definition can't be a competitive market for the parts that matter and anyone actually discusses.
I'ts like with bus management companies. If they want to take over a popular route which is sure to bring in money, they are required to establish operations on less popular routes, and maintain them. The same works in Israel for medical providers - if they want a chunk of the tax money, they have to maintain hospitals and ERs as well.
Since medical care in Israel is so good, they actually make money there as well - millions come in from medical tourists
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
This would work under normal conditions, but here the accessibility of medical care is so low, you have no choice bu to go to the corrupt, overexpensive and generally badly managed service providers. This is something the govt should be stopping, instead of quietly ignoring
That a government can be bad is another matter. If you added private healthcase, it cannot solve the government issues, it can only take advantage of them.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
I'ts like with bus management companies. If they want to take over a popular route which is sure to bring in money, they are required to establish operations on less popular routes, and maintain them. The same works in Israel for medical providers - if they want a chunk of the tax money, they have to maintain hospitals and ERs as well.
Right, but that's not actually private. It's just government by another name to trick people into thinking it is private. Same as in the US.
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US system makes tons of money on medical tourism, too. But the good healthcare goes to the foreigners not the Americans. Because when it is private, they can sell top dollar to those from the outside, and provide whatever the government mandates to the citizens.
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So the US is very interesting. We have possibly the world's largest inbound medical tourism market and the world's largest outbound!
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
@dyasny said in Top Ten Happiest Places on Earth in 2019:
- Free-ish medicare
You know this doesn't exist anywhere - right? If it's free - it's paid by taxes.. Now that said - I have no clue what the actual typical tax rate is in Europe say compared to the USA ( I know that my tax rate between state and Fed is around 17% - that doesn't seem right, but this is based on my actual pay, not the post standard deductions pay, which would clearly be much higher.
Don't forget the sales tax, gas tax, airport tax, and hotel tax, etc... you probably pay quite often. It all adds up. Americans pay a lot more tax than they think they do.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@Carnival-Boy said in Top Ten Happiest Places on Earth in 2019:
Do people with unhealthy life styles end up having higher health care costs though?
They do from studies that I know. But universal healthcare lowers all of the costs way, way more. So his concern would make him totally passionate about it if cost was actually his concern.
Where is the proof in that - and how is it accomplished? does it remove high paid doctors? does it remove high paid administrators? does it remove wasteful spending in hospitals to keep costs respectable? Where is this savings coming from?
Also how long as the lines for non cold/flu related issues - like cancer treatments, or organ transplants? I've had friends in Canada say the lines/wait times are epic.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@JaredBusch said in Top Ten Happiest Places on Earth in 2019:
@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
I like the Dutch system of health care vouchers. It gives everyone coverage, but is competitive because private companies compete for the voucher money.
I may be too American, but I refuse to believe that privatized healthcare can ever actually be valid.
I agree. Privitization sounds good, but it ignores the fact that the bulk of healthcare is a utility and has no possibility of being in a competitive position.
now that I completely agree with.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@Nic said in Top Ten Happiest Places on Earth in 2019:
@Dashrender said in Top Ten Happiest Places on Earth in 2019:
@Nic said in Top Ten Happiest Places on Earth in 2019:
Doesn't matter how much or how little you pay in taxes when a major medical problem will guarantee you go bankrupt in the US. All that money you saved on taxes goes out the window, plus your house, your truck, and your savings.
I know Scott believes in the public healthcare solution - I just have a hard time paying for everyone else's lack of giving a shit about their health that leads to huge health care costs. if we could hold people accountable for their expenses (not counting things like accidents against them) I think that would make me 'feel' better.
I see the value in some public services - law enforcement/roads/national defense, but I still have a hard time seeing public healthcare as a public good.
I suppose if there is proof that public healthcare raises the quality of life of it's citizens more than it costs those citizen, that would go a long way to convincing me.
I understand the reasoning, but in practice US pays more for worse health outcomes overall:
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countriesIn practice the savings of getting rid of the bureaucracy and milking by execs is vastly more than the cost from people going to the doctor more.
Exactly. Although his argument, like those of most Americans, is that they don't care how much they pay, they only care that they pay fairly. This is the fundamental reasons why Europeans and Americans argue and NEVER agree on healthcare - they fundamentally want different outcomes.
Europeans want everyone to be healthy and to pay as little as possible. Americans want to pay their fair share, regardless of if it is more than necessary or how many people don't get healthcare because of it.
So Europeans say "we pay less and get more" and Americans go "you idiots, that isn't fair!"
That's because we don't believe it. I only hear about ridiculous tax rates in Europe in the 60%+ range.
I said above that my tax rate on actual income is around 17% (state/fed/fica). I add the cost of my insurance on that (which I also have to add to my income as well) and it brings it up to 21.4% I can't get anywhere near your 52% number... I must be doing something wrong. Again, I'm using my whole income, not the post allowed deduction income.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@Obsolesce said in Top Ten Happiest Places on Earth in 2019:
If I need to go somewhere rural or outside train or bus convenience, I will simply rent a car, which is cheap.
Here, cars are a luxury and is how I feel it should be. I agree with the purposely created rural problem in the States.Even living in suburban Texas, one of the most "need a car" states, I'm at a point where I'd not buy another one. When my current one dies, I'm done.
And then what?
Until recently, the nearest store of any kind to my house was 3.5 miles (a Casey's gas station opened about a month ago that's 9 blocks away).
I don't consider a cab/uber really reasonable in the area I'm in - there are no public buses anywhere near where I live - I think I'd have to go the 3.5 miles at best to get to a bus stop.
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@Nic said in Top Ten Happiest Places on Earth in 2019:
@Dashrender said in Top Ten Happiest Places on Earth in 2019:
@Nic said in Top Ten Happiest Places on Earth in 2019:
Doesn't matter how much or how little you pay in taxes when a major medical problem will guarantee you go bankrupt in the US. All that money you saved on taxes goes out the window, plus your house, your truck, and your savings.
I know Scott believes in the public healthcare solution - I just have a hard time paying for everyone else's lack of giving a shit about their health that leads to huge health care costs. if we could hold people accountable for their expenses (not counting things like accidents against them) I think that would make me 'feel' better.
I see the value in some public services - law enforcement/roads/national defense, but I still have a hard time seeing public healthcare as a public good.
I suppose if there is proof that public healthcare raises the quality of life of it's citizens more than it costs those citizen, that would go a long way to convincing me.
I understand the reasoning, but in practice US pays more for worse health outcomes overall:
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countriesIn practice the savings of getting rid of the bureaucracy and milking by execs is vastly more than the cost from people going to the doctor more.
Exactly. Although his argument, like those of most Americans, is that they don't care how much they pay, they only care that they pay fairly. This is the fundamental reasons why Europeans and Americans argue and NEVER agree on healthcare - they fundamentally want different outcomes.
Europeans want everyone to be healthy and to pay as little as possible. Americans want to pay their fair share, regardless of if it is more than necessary or how many people don't get healthcare because of it.
So Europeans say "we pay less and get more" and Americans go "you idiots, that isn't fair!"
That's because we don't believe it. I only hear about ridiculous tax rates in Europe in the 60%+ range.
I said above that my tax rate on actual income is around 17% (state/fed/fica). I add the cost of my insurance on that (which I also have to add to my income as well) and it brings it up to 21.4% I can't get anywhere near your 52% number... I must be doing something wrong. Again, I'm using my whole income, not the post allowed deduction income.
Are you adding in the full 15% for the Social Security tax? Don't forget local sales tax, property tax, and government fees. It all adds up. In a low sales tax county in Ohio, I figured my total actual taxes paid was around 57% on ~$38,000 back in 2016 when I sat down and figured it all out.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@dyasny said in Top Ten Happiest Places on Earth in 2019:
The Israelis found a way to combine government/tax based care with private sector competitiveness.
But we established that when it matters... emergencies... there is no competition. So private not only doesn't have to be competitive, but without government controls can overcharge by anything that they want since you can't agree to the price ahead of time (that's how the US does it, all prices are after the fact.)
Healthcare by definition can't be a competitive market for the parts that matter and anyone actually discusses.
What percentage of cases in the US are in this emergency - can't decide where/how to be treated? 1%? 4%? more? I'm curious.
My wife had cancer - was it life or death? yes - was it emergent? I'd say yes - but not this instant emergent - like a week emergent. So she had time to 'shop' around on price, etc if she wanted to. So again I ask - what percentage of cases are - car wreck, unconscious, can't decide how/where to be treated?
