

No Waiting Room - IsaacSchlueter
http://nat.org/blog/2009/12/no-waiting-room/

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JustAGeek
Ok, I'm German, so I guess I'm qualified to put this into perspective. ;)

First off, this sounds far more than a health paradise than it is in reality.

If you go to a regular doctor, you definitely have to sit in a waiting room -
unless you are an emergency. Some weeks ago I injured my ankle and had to sit
in there for 3 hours for a total of 10 minutes examination by the doctor...

I don't know about hospitals, never been there. Here in Germany you only go to
hospital if you're seriously sick/injured (eg accident or something) and/or if
it's in the middle of the night otherwise you go to your doctor.

And there are loads of other problems coming with our health care system, eg
it's expensive, sometimes paradoxically inefficient and what not.

That being said, I think it's still a great system that ensures the stability
of society and does more good than harm. Well, and I'm born here, so there are
probably a lot of things that I take for granted but aren't available in other
countries.

Just wanted to point out that this isn't the land of milk and honey... ;)

~~~
IsaacSchlueter
Oh, I'm sure that there are unintended consequences in any system that
complex. But I'll tell you from unfortunate personal experience, if you go to
an ER in the middle of the night in any American city, you'll see a crowd of
people in the waiting room. Most of them are uninsured and poor, and thus
don't have a doctor to go to for routine things, so they go without medical
care until it _is_ an emergency.

It's not efficient.

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nicara
Maybe I missed his point, but first of all, yes, hospitals do have waiting
rooms - just (obviously?) they're not filled in the middle of the night, as
only people with, well, emergencies tend to go to the hospital in the middle
of the night. Secondly, e.g. going to the dentist is almost guaranteed to be
an hour's wait (at least where I live), even if you have an appointment. Say,
you do have an appointment for 1500, then what many people around here do is,
check in at 1455, ask how long the wait might be, and then actually leave to
do some shopping or similar and come back in whenever their wait is nearly
over.

So really, I don't see how this could be superior to any other system.. And is
he pleasantly surprised at the 250ish Euros or did he consider it too high? In
case of the latter, I don't know why he doesn't have German insurance in the
first place. I currently pay less than that amount per year (though that's the
public health care kind, not the private one, which arguably would be more
expensive, but also better), and IANAL, but I think if he lives here [in
Germany] he is forced by law to have some kind of health insurance.

Don't want to come across as too negative, but I just thought I'd give you the
other side of the story as well. (I currently live in Germany and I am covered
under public health care.)

~~~
outotrai
> And is he pleasantly surprised at the 250ish Euros or did he consider it too
> high?

He was very pleasantly surprised. In response to a comment on his post, the
author wrote:

"According to newchoicehealth.com, an abdominal ultrasound in a major American
city costs $340 on average at the cheapest service providers. At hospitals
it’s much more expensive – $1350 at the Massachusetts General Hospital.

And that’s just the ultrasound — without the ER fees, the blood tests, the
surgeon consultation, etc, that I also received in Munich. So I think 265
euros is extremely cheap."

[Source: [http://nat.org/blog/2009/12/no-waiting-room/comment-
page-1/#...](http://nat.org/blog/2009/12/no-waiting-room/comment-
page-1/#comment-6137)]

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pragmatic
But is this the health care system we would be getting with the current
proposal? I see a lot of these types of posts, health care is great in
[somecountry] and it's a [otherthanus] system.

I think most people are concerned b/c the US Congress is corrupt (either to a
major or minor extent). So special interest groups (AMA, insurance co's) have
a greater chance of getting a bill that looks after their interests.

In the end, doesn't it come down to paying doctors (and their practices that
own the testing equipment) less?

~~~
pragmatic
Oh and I've gone to the emergency room and not waited also.

However, the bill was much higher. But, the bill is reduced by agreements with
the insurance company and if you've met your deductible, you might not pay
anything at all.

Better or worse? One visit to the ER does not make a compelling story one way
or another.

------
steveklabnik
What I never see talked about in real-world systems that _does_ get talked
about in computer systems is pretty simple: scale.

Does health care scale? For that matter, does government in general scale?
Germany (according to Wolfram Alpha) has the largest population in Europe, at
82 million people. America has 300 million. And Germany is much, much more
dense, at 613 people per square mile vs our 86 people per square mile.
Wouldn't that make it much easier for fewer hospitals to care for more people?

I have concerns that the amount of beaurocracy neccesary to manage a
nationalized health care system here in the US would be staggering. I'm not
involved in the field in any way, so I don't _really_ know what I'm talking
about, but the engineer in me looks at a system that complex and lets out a
curse word beneath my breath.

This also applies to almost everything else the federal government does. I
feel like we'd have been much better off staying a loose confederation of
states. They're small enough to be able to pull off something like this.

~~~
jrockway
If three or four major insurers can handle the current system, why wouldn't
the government be able to take on that role? It already handles much bigger
systems, like transportation.

~~~
IsaacSchlueter
For some definition of "handles", sure.

Most of our transportation is actually handled by local/state departments. The
Federal govt just gives the states money to keep the interstates from falling
apart.

Libertarianism is distributed computing applied to economics.

~~~
jrockway
Distributed computing is a waste when you already have a supercomputer
available for your exclusive use.

~~~
steveklabnik
I dunno, Google's strategy of using a lot of off the shelf hardware as opposed
to supercomputers seems to be paying off well.

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danw
This seems rather off topic.

~~~
IsaacSchlueter
From the guidelines:

    
    
        On-Topic: Anything that good hackers would find
        interesting. That includes more than hacking and 
        startups. If you had to reduce it to a sentence, the 
        answer might be: anything that gratifies one's 
        intellectual curiosity. 
    

As a hacker and nerd, I'm acutely fascinated by unintended consequences that
arise in complex mathematical systems. My interests in economics and
programming stem from this fascination.

The article isn't saying "we should do health care like ze germans cuz they
got it rite hurrrr". It's saying, "Hey, look at this interesting effect of
their policies, which everyone in the debate in the US seems to completely
miss."

That being said, I don't want HN to be a source of American health care
debates any more than you probably do. I'm bored by the pedantics of it all,
and I actually live here.

I saw your comment had been downmodded, and I clicked the ^ to bump it back
up. It's an edge-case, and not fair imo that you should lose karma over
expressing that opinion. However, if you really feel it's off-topic, you
should probably flag it instead of posting a one-liner complaint.

~~~
danw
I'm more concerned that this is a single anecdote. If it was an explanation of
the fascinating government subsidized insurance model that the german health
care system uses I would approve.

