Top Ten Happiest Places on Earth in 2019
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@dyasny 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.
It's like that in Israel - there are several private companies competing for customers, each has hospitals and clinics and whatnot. They aren't paid by the customers though, but by the portion of health taxes collected, relevant to their portion of the overall taxpaying population. If they want people subscribing to them, they have to provide good service, so there's healthy competition, and yet as a patient, I'm not paying any premiums, it's all in the tax. The only problem is, in Israel the taxes are insanely high (I was paying 56%) and could be much lower, but the system itself seems to work very well
Clearly it doesn't though - taxes are to high - likely due to corruption.
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
Clearly it doesn't though - taxes are to high - likely due to corruption.
Here we go again. I'm not talking about how high the taxes are, I'm talking about how a combination of taxes and private companies can create healthy competition, while keeping healthcare at a good level and easily accessible.
This is what it looks like:
Under Israel’s health care system, all citizens are entitled to basic medical services. The costs are covered mainly by a national health tax: Wage-earners and self-employed individuals pay 3.1 percent of their monthly salary up to 5,804 shekels (about $1,600), and 5 percent on everything earned beyond that. Women who do not work outside the home are exempt, while students, retirees and others who do not earn a fixed salary are required to pay a small fee of about $25 a month in exchange for coverage. All children are covered free of charge through the army.
In addition, Israelis pay very small co-pays for visits to the doctor and most medicines.
Services are provided through four main health maintenance organizations, known in Israel as kupot holim, which compete for patients. Beyond the basic government-guaranteed services, the HMOs also offer enhanced insurance plans for additional fees.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
I'm talking about how a combination of taxes and private companies can create healthy competition, while keeping healthcare at a good level and easily accessible.
That's the key to finding the balance.
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@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.
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
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.
Do people with unhealthy life styles end up having higher health care costs though? Compare an obese, heavy-drinking smoker - he could well die from a heart attack/stroke without ever going to the doctor, whilst a super-health person could live to 100 but require 20 years of expensive age related costs (dementia, physical frailty). I'm sure there have been studies on this.
Also, in Europe, this is somewhat mitigated against by putting heavy taxes on alcohol and tobacco, so unhealthy people indirectly fund their extra medical care.
Anyway, in the US, aren't you still subsidising unhealthy, don't give a shit, people as that's the nature of insurance? You're just paying private insurance rather than public insurance.
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
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.
Thankfully it works the opposite. So your concerns are exactly why you'd be passionate about it too!
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@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.
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@Carnival-Boy said in Top Ten Happiest Places on Earth in 2019:
Anyway, in the US, aren't you still subsidising unhealthy, don't give a shit, people as that's the nature of insurance? You're just paying private insurance rather than public insurance.
Yup, even moreso than in Europe. but with with a facade of "fairness" to make an emotional reaction that goes contrary to reality for exactly this reason.
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@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
We need to stop calling these things free and call them tax payer funded.
Actually, it's BETTER than free. It actually pays for itself AND makes money. Only in America do we screw it up so much that we have to pay into it. Good healthcare actually IS free. Taxes are used has a mechanism, but the taxes are also generated by it.
Calling it "tax funded" makes Americans often feel like it loses money. And in America it does. But the system people are proposing does not.
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@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
We need to stop calling these things free and call them tax payer funded.
And those taxes are lower than they would be otherwise by MORE than the total amount of healthcare. Ergo... free!
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@Dashrender said in Top Ten Happiest Places on Earth in 2019:
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.
You have to include ALL taxes, and that includes your healthcare as insurance is a tax by any standard. So state, county, federal, healthcare, etc. You put it all together.
Mine was 52% living in Texas!
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@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.
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@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.
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@dyasny 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.
It's like that in Israel - there are several private companies competing for customers, each has hospitals and clinics and whatnot. They aren't paid by the customers though, but by the portion of health taxes collected, relevant to their portion of the overall taxpaying population. If they want people subscribing to them, they have to provide good service, so there's healthy competition, and yet as a patient, I'm not paying any premiums, it's all in the tax. The only problem is, in Israel the taxes are insanely high (I was paying 56%) and could be much lower, but the system itself seems to work very well
The problem is, in systems like this, they don't reasonably accommodate emergency services. WHen you are dying, you go to whomever responds, there is no choice.
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@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
@JaredBusch said in Top Ten Happiest Places on Earth in 2019:
I may be too American, but I refuse to believe that privatized healthcare can ever actually be valid.
Talk to someone who has experienced the VA for healthcare. You will then get an idea of what government healthcare looks like. It isn't always pretty.
What government healthcare looks like in a system without government healthcare. It's a contrived system to support a private healthcare mechanism. You cannot use ths as a guide. By that logic, look at France and see what government healthcare looks like. Clearly just looking at what governments do isn't enough, clearly you have to 1) have them do it and 2) make them do it and 3) hold them accountable.
You can't have teh public decide to create a broken system to prove a point, then say it proves a point. That only fights the false assumption that no one has ever had that government based systems are magic and can't fail.
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@Mike-Davis said in Top Ten Happiest Places on Earth in 2019:
@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
In the US my tax rate was 52%, that's higher than Finland, and the healthcare coverage was abysmal.
I thought Texas had no personal income tax and the highest federal rate is 37%. How do you figure 52%?
Simple. Add up the taxes. Healthcare is one of the biggest taxes in the US. Texas isn't immune to it. So NY could hit around 60% tax rate!
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@Nic said in Top Ten Happiest Places on Earth in 2019:
@Mike-Davis he might be factoring in property tax and sales tax.
Nope, but you should. But it was only straight federal/state level taxes including required healthcare coverage.
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@Dashrender 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.
help me understand what you mean. America is basically all private healthcare - not saying that it's valid though.
He's saying that he's learned from it and knows that corruption is endemic to a system of that nature.
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@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!"
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@scottalanmiller said in Top Ten Happiest Places on Earth in 2019:
The problem is, in systems like this, they don't reasonably accommodate emergency services. WHen you are dying, you go to whomever responds, there is no choice.
Nope, emergency services are totally covered. You can go to any hospital, the entities running them will bill each other transparently to you.
The one thing they do practice there is the actual veritability of the reason for using emergency services. If you're having a heart attack, and call an ambulance, you will not pay a dime. If you coughed a few times and decided to use them as a taxi to an ER, you'll get a bill (about $200 iirc, not even close to the 4 figure numbers you would see in NA).
