Top Ten Happiest Places on Earth in 2019
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@dyasny you'll still sometimes get billed because while the hospital is in network, the anesthesiologist isn't. There are some regulations to prevent this now, but it can still be a mess and a pain in the ass to deal with even if you do prevail. That's the problem with US healthcare. Even if you have insurance, and even if you do everything the right way, when you have a major medical emergency you are still going to:
a. get big bills (the 10% that is your share of the inflated bill they send to the insurance) and probably have to go bankrupt
b. spend the equivalent of a second part time job calling insurance companies and appealing decisions to avoid getting billed for shit you shouldn't have been.I'm seriously considering just going off insurance and paying out of pocket for routine stuff. I suspect I'd save money paying the uninsured rate with doctors, if I didn't have premiums to pay.
Then for real catastrophes I'd either get simple catastrophic insurance, or just move back to Australia if I got cancer.
Basically medical insurance for routine stuff is like getting extended warranties at Best Buy. Best Buy always makes money on those and you always lose, in the long run. To conflate the two types of insurance (routine vs major medical emergency) is a bit silly and confuses the argument.
For example, if I get the flu and go to urgent care and pay a $50 copay, I'd bet that is the same amount that insurance has negotiated with the urgent care location. I think I'm getting a deal, but really I'm paying the full cost. All I'm paying the insurance for is them negotiating the price down to something reasonable.
But fundamentally the real reason US healthcare is too expensive is because the govt doesn't fix prices. If they did that, like the rest of the world does, even private insurance and medical care would be affordable.
There's a reason Breaking Bad exists.
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@Nic this is the case in the US, true. In Israel it is not. All medical staff, except private clinics who do not participate in public healthcare, are covered. You never get billed for anything that is covered, no matter where you get treated, as long as it's at an institution that is part of the programme (most of them are) and your reason for treatment is justified and covered under the list of covered treatments (99% of the surgeries and things like cancer and AIDS are covered so no loopholes there).
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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:
The problem is that when you are bleeding out or unconscious you can't pick. Just a fundamental fact of being unconscious
WHen it is a broken leg or ruptured appendix, of course you get choices.
I don't see why that is a problem. In such a scenario you are taken to the nearest ER and treated there. If the hospital is not run by the company you subscribe to, it doesn't matter, you still don't have to pay anything extra, the companies bill each other. If you come around and decide you want to be in a different hospital, you can request a transfer, and either just go to another hospital or get transferred in an ambulance (if the transfer is medically justified, it's free, otherwise, you get a bill).
Billing is okay, but what's the point of choice if you can't make it. It kind of defeats the whole purpose as location alone matters.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
@Nic this is the case in the US, true. In Israel it is not. All medical staff, except private clinics who do not participate in public healthcare, are covered. You never get billed for anything that is covered, no matter where you get treated, as long as it's at an institution that is part of the programme (most of them are) and your reason for treatment is justified and covered under the list of covered treatments (99% of the surgeries and things like cancer and AIDS are covered so no loopholes there).
Far better for sure. But comparing to the US isn't good as it is so bad. US makes everyone else's situation look good.
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@Nic said in Top Ten Happiest Places on Earth in 2019:
Then for real catastrophes I'd either get simple catastrophic insurance, or just move back to Australia if I got cancer.
I'd fly to Medellin!
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
You've lived in some pretty sparsely populated parts of the country. What would public transport cost in Piffard, NY? I think cars would like a cheap and reasonable alternative to busses running down all the country back roads every hour
I have, and I still believe that cars should be a luxury... as should living in rural areas be. Just because people currently choose to live in places that require cars can't be used as a reason to subsidize cars, which is what we do today. Make cars go away (private cars at least) and people will stop living in places like Piffard just because "cars are cheap, so why not?"
Basically, America creates the rural problem so make an excuse for pushing cars. Rural should not be the cheap place to live, because it costs everyone a fortune.
I'm not getting a car here. It would be so inconvenient. For example, the train to work takes 36 to 40 or so minutes. And I spend that calm time on edX and ideally DL. In a car it would take well over an hour, plus lots of walking because parking is hard and not cheap.
For about $230 a month, I can ride all the trains, subways, and busses in both Stockholm and Uppsala.
In San Diego, just the car payment alone costs that... And that's excluding insurance, gas, maintenance, registration, etc... Times two cars!
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.
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@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.
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
Billing is okay, but what's the point of choice if you can't make it. It kind of defeats the whole purpose as location alone matters.
Are you telling me that if there is a corner case when you are unconscious, and can't tell the ambulance where to take you, that means there's no choice about which GP you go to, for example?
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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:
Billing is okay, but what's the point of choice if you can't make it. It kind of defeats the whole purpose as location alone matters.
Are you telling me that if there is a corner case when you are unconscious, and can't tell the ambulance where to take you, that means there's no choice about which GP you go to, for example?
- Emergency services are anything but a corner case. They are, in fact, the only truly important case.
- 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?
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In America, where there is no choice, we still have total choice during a non-emergency. @Nic would just go to Australia. I'd just go to Colombia. Those cases, where it is a non-emergency, are a non-issue. The entire problem rests with the emergency cases where those choices vanish. Every system has choices under non-emergency conditions. The entire concept of the discussion is unique to the emergency conditions - the ones that are life destroying, unavoidable, and uncontrollable.
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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.
