
Why Europeans Don’t Get Huge Medical Bills - ourmandave
https://www.theatlantic.com/health/archive/2019/04/do-europeans-get-big-medical-bills/586906/
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reaperducer
The more I look at my medical bills, the more I think it's all about widely-
distributed greed.

I used to just blame "greedy insurance companies," but now I see it's at all
levels.

Example: Yesterday I was doing bills and came across and Explanation of
Benefits report from my insurance company. My doctor billed the insurance
company $9,000(!!) for a routine pee test that I get with my yearly physical.
The insurance company negotiated it down to $300, and my portion was $18.

But (at least) three things are problematic here: First, that the doctor
thinks it's OK to charge $9k for a non-specialized urine test. There's no way
it costs anywhere near that. Second, that my insurance company thinks $300 is
an OK price. It isn't, IMO. And third, that my insurance company even has to
waste time, effort, and employee hours negotiating in the first place instead
of just receiving a reasonable bill.

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5555624
> that the doctor thinks it's OK to charge $9k for a non-specialized urine
> test

Are you sure it was your doctor and not a lab? I recently switched doctors and
had blood & urine tests. When I sat down in the exam room, the phlebotomist
handed me a sheet of paper to sign that said I would be responsible for
$70-something. The lab they sent the samples to billed my insurance company
for $600. My insurance paid $40 and I paid $30.

When I mentioned the $600 charge, my doctor was surprised. Evidently, he did
not know what the lab bills, just what insurance & patients actually pay. (I'm
not sure what that says about him and his office.)

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reaperducer
My doctor does some things in his own lab (mostly urine), and sends other
things out (mostly blood). The items that get sent out have a different bill.

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gigatexal
I have paid into the German tax system at about 35% for a year now and have
only ever used the healthcare system once. My only bill was 5 euros for
Tylenol. Not bad I guess. My care at a healthcare services company was a high
deductible plan coupled with a HSA (health savings account) that was all sorts
of crappy.

If the only two certainties in life are death and taxes I’d rather the
exorbitant (in my opinion anyway) German taxes help keep that other certainty
— death — at bay.

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izacus
But that's because the distribution of medical costs through your life isn't
the same at all ages - typically the age of average HNer, you probably don't
need medical services at all.

The medical costs are high when you're very young (up until 5 or so) and after
age 50 or so with nothing in between. In EU systems this means that healthy
workforce subsidises older population and in turn they get subsidised as they
age.

In unregulated private systems this means that your insurance is low when
you're young and private insurers hugely spike your insurance cost as you
become a liability for them.

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DoreenMichele
The article is leaving out the detail that America has city, county, state and
federal governments. Insurance is regulated at both state and federal levels.
European countries tend to have the equivalent of city, county and state or
federal (not both -- one or the other). From what I gather, they tend to have
one regulatory system for medical insurance: The national system.

It would be a little like if the EU were another layer on top and you could
live in France but buy insurance from a German company. It introduces a whole
host of complications.

Source: I worked for 5+ years at an American insurance company.

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iagovar
There are several layers. In Spain there's national and regional level. Every
autonomous community (~US State) manages it's own healthcare. The National
Healthcare System is only a framework for the regional ones, and provides some
central services, but not for the consumer.

You can travel to any other EU country and use their healthcare with an
european healthcare card, and its cost will be transparent for you. In some
system the regular card qualifies as an european healthcare card, in some
others it doesn't.

So it's a little bit of mess but it's mostly transparent for citizens.

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DoreenMichele
Thank you.

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simonblack
Most countries have 'single-payer' health care. It always amuses me that tiny
countries like New Zealand and Australia can afford such a 'single-payer'
subsidised health care service while the exceptional, rich, powerful US can't.

Some years back, I had to undergo a cardiac triple-bypass operation. No Charge
for that. And that included several days in ICU.

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RickJWagner
"There are still some downsides to the health-care systems of these countries,
but they are generally considered better than that of the United States."

Is that why Mick Jagger chose to go to New York for heart surgery?

This article takes a bit too much liberty in making such statements.

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mindcrash
What the article probably doesn't tell you is that profit is being prioritized
over health all over Europe right now. Yes we have health insurance, but the
quality of the medical care is getting less and less every year.

And it's for the same reason why stock prices of US based health insurance
companies skyrocketed the day Obamacare was announced (I am not messing around
with you, this is a fact and you can check it for yourself): Insurance
companies and medical orgs are no longer that interested in the best medical
care for a person. What they do care about is the money they can milk out of
said person.

This already has gone absolutely off the deep end in the United States where
some simple medicine with a production price of $30 can go for $1000, but
Europe isn't far behind.

Because like I said: we here are paying more and more every year for lesser
and lesser quality healthcare.

I've experienced this for myself in a Neurosurgery ward which was staffed with
3 nurses for just about 24 beds -- all people who need a lot of attention. I
was baffled that the place could function like that because IMHO it was way
too understaffed (Even the actual reason they gave was "downsizing", and yes
there were patients literally shitting and peeing in their beds because of
it).

TL;DR: Don't believe "Europe is better" because it's Europe. We have our own
issues around here. And we are slowly heading towards the same healthcare
model, and for the same reasons, as the United States.

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mnm1
So you claim that profit is prioritized over healthcare in Europe. It
obviously is in America too. I'd rather take the system without the ridiculous
bills then. Europe is still far superior. At least if I survive, I won't be
bankrupt.

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mercer
I read his claim as "Europe seems to be moving in the direction of the US",
which I don't think is an unreasonable claim.

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theredbox
EU healthcare is good when you are average joe, poor or just mediocre.

You earn €60k/pa and you pay shitloads of taxes on that income just to live in
some shit suburb because you cant afford anything anyway and there is no way
to get beyond that income.

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jsbaby608
European care is good when you're young and healthy. When you're old and need
urgent surgery, it many times goes before a committee and can take many more
months or even years to get approved.

I want private care with no insurance. Costs will go down to managable levels
and we can still have help for people that can't afford to pay it.

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Freak_NL
The plain reality of healthcare is that there are a bunch of ailments,
injuries, and diseases that cannot be treated cheap enough for the average
citizen to be able to afford if they have the bad luck of needing that type of
care.

> Costs will go down to managable levels […]

Why? Because of market mechanisms? It just means that a host of rare diseases
will never become affordable, because of the basic supply and demand formula.
Most people don't need care most of the time. Healthcare is not a commodity
product.

Insurance solves a real problem: nobody knows if they will ever need it, but
statistically we know that if everyone pitches in, everyone that does need
several yearly salaries of care can get it when they need it.

This is called _solidarity_ , and it works rather well in a large part of the
world. Ideally, insurance is required and well-regulated to prevent excesses
and to support the poor (and it is in many countries, including many European
nations).

Private care without insurance is what we had in the past, and it basically
meant that the rich could afford care, while the rest just prayed they never
got anything more serious than the common cold.

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jsbaby608
government-run care doesn't work well for major surgery. As I said earlier,
decisions are made by commitee and many people don't get the care they need.

Health insurance, like the student financial aid situation in the US, has
created a situation where the true costs are inflated because the hospitals
know that the average person isn't footing the bill, the billion dollar
insurance company is. It's why you see $80 bills for asparin.

Your rainbows and flowers ideas about healthcare sound great in theory, but
the reality is that the middleman is creating these balooning and
insustainable costs. Government-run care just replaces this middleman with the
government and doesn't do anything to reduce the cost or make the care better
for anyone.

The US has the best quality care in the world. It's why everyone with the
means comes over to the US to get treated for major illnesses. Upending the
systen to make it like all of the other, worse, systems in the world isn't thr
answer.

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evgen
This is simply untrue. Government run health care reduces costs (by
eliminating the rent-seeking middlemen in the process and by controlling costs
through direct fiat if necessary) and improves outcomes. Government run health
care also incentivizes the government to tax behaviors and products that have
negative long-term health consequences so that it can control the eventual
costs that it will end up paying.

US health care is not the best in the world and has not been for a very long
time. Some people may travel to the US to see a specialist, but 10x as many
Americans travel to other countries to get care that they are unable to get in
the US (usually due to cost.) The US usually ends up dead last in health care
among the more industrialized nations and more recently was ranked 37th in the
world by the WHO. Please find me a single ranking that puts US health care at
the top of the list, I could use the laugh.

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jsbaby608
The WHO list is heavily biased toward quantity of care (IE: socialized) and
not quality. So, it's not really a good judge of the best quality.

If 10x Americans are getting surgery overseas because it's cheaper, this
doesn't mean it's better. Our disussion is about the best quality, not on
price.

Show me the studies where government-run care saves money, yet has the exact
same quality as US care.

Judging outcomes and life expectancy is a red herring, because different
populations have different diets, lifestyles, and genetics, which definitely
leads to different outcomes.

If are sacrificing quality for cheaper care...no thanks.

I also see my mention of Surgery by committee is ignored in your comments. I'm
assuming this means you know this is true. Why would I want this?

