Top Ten Happiest Places on Earth in 2019
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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).
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Smokers do indeed save money over the long term by dying sooner:
https://www.webmd.com/smoking-cessation/news/20130604/smokers-cost-employers-thousands-more-than-nonsmokershttps://medicalxpress.com/news/2009-04-smokers-society-money.html
Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents.
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@dyasny said in Top Ten Happiest Places on Earth in 2019:
Nope, emergency services are totally covered. You can go to any hospital, the entities running them will bill each other transparently to you.
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.
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@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).
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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.
