> "After my surgery, I had to pay 25€ for the taxi ride home"
I'll take that over the multi-million US-american hospital bill, any time.
I'll take that over the multi-million US-american hospital bill, any time.
It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.
Taxes generally are not paid for a person, but for things and values, etc.. Taxes are also not bound to a specific purpose, but are going into the general budget of the country/state/town.
Taxes and insurance fees are different finance models. In Germany there are basically three types of financing for services: 'Steuern' = taxes , Gebühren = fee, Beiträge = contributions.
In Germany the health care system is based on 'Beiträge', i.e. membership contributions to a health insurance.
It should be noted that (based on the vague description from the article) her insurance probably got compensation payments from the federal government for her insurance (if it was in fact free through her husband).
> Most universal health care systems are funded primarily by tax revenue (like in Portugal[24] Spain, Denmark, and Sweden). Some nations, such as Germany and France[25] and Japan[26] employ a multipayer system in which health care is funded by private and public contributions
http://www.bundesfinanzministerium.de/Content/DE/Monatsberic...
http://www.who.int/health_financing/taxed_based_financing_dp...
> Tax-Based Financing for Health Systems: Options and Experiences
> social insurance, private insurance and general taxation
Social insurance is the German model.
> By contrast, Germany's policy to combine its sickness funds into a social health insurance system -- generally credited as the first effort to enact universal health insurance coverage -- dates from the second half of the 19th century.
or see:
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.628...
> Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
SHI -> German model.
> it was in Germany and neighboring countries that SHI began
Also see: https://www.kingsfund.org.uk/publications/how-health-care-is...
Options discussed: Taxation, Private Health Insurance, Social Health Insurance, User charges as an additional source of financing
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628174/
> Current Trends in Health Insurance Systems: OECD Countries vs. Japan
> There are three major types of social health-care systems: social insurance systems like Japan, France, and Germany, tax-based system like the United Kingdom and Sweden, and the United States—limited service to the elderly or disabled, called Medicare (Table 1).
Again, Germany has a social insurance system, not a tax-based system.
The important difference is that they are legally committed to a certain issue (in this case: health insurance) and can't be appropriated to something else. That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that.
> Social insurance contributions are mandatory
Mandatory is to be insured.
> based on income
in a range, or if one is privately insured one pays based on risk/age
Family members (wife/husband + kids) without income are insured. Plus various other regulations.
> to a state entity
Krankenkassen and Krankenversicherungen are not generally state entities.
Would you call something like the Audi BKK a state entity?
https://www.audibkk.de/english/
> enforced through exactly the same channels as regular taxation
No, health care contributions are paid directly to the Krankenkasse/Krankenversicherung where one is a member, not the tax administration (Finanzamt).
> That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that.
Obviously not. In the health care domain, the Social Insurance systems and tax-based health care systems are different models.
While I will admit there are varying interpretation, for me, living in the USA, if I am mandated to pay for something, it's a tax.
I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances?
You could opt out of the public system, and get a private insurance company. But once you have done so you can never re-enter the public system. And private insurances are cheaper for young people, but significantly more expensive later in life, so much that you’ll end up paying several times more over your lifetime.
If you are employed you pay to the health care insurance or sickness fund directly. Your employer also pays. The money is not collected by the tax authorities and is not administrated by them. Still it is public regulated system.
If you are privately insured, you pay directly to the private insurance company. This may provide additional services or a better quality.
OTOH if you are not member of a private insurance, then you still can get additional insurances from those. For example you can insure yourself privately for certain health care services if you travel to foreign countries.
In Germany we would only consider something to be a tax, if we pay somehow to the tax administration. For example if one is a member of the catholic church - which is voluntary - then one will pay 'Kirchensteuer' - 'church tax'. This tax is collected with ones usual tax payments, by the tax authorities - for the catholic church. If you are not a member of a church, like the catholic church (or some others), one does not pay this tax. If you are a member of a free church, then the tax authorities don't collect money for them. If you want to be a member, it is expected that you pay more or less 'voluntary' directly to them.
They are state entities established by law (Körperschaften öffentlichen Rechts mit Selbstverwaltung) and have to follow the strict regulations of the public sector. They regularly issue Verwaltungsakte.
> Would you call something like the Audi BKK a state entity?
Yes, absolutely. It's a state entity that provides care for Audi employees, since 2010 for everybody (and they can't legally refuse members). Audi has absolutely no input on their inner workings, it's really just the name and the fact that they have many members working there (and thus provide special services for them). It's basically a historical quirk of how the German insurance system came to be.
> No, health care contributions are paid directly to the Krankenkasse/Krankenversicherung where one is a member, not the tax administration (Finanzamt).
The Krankenkasse (to be exact their Einzugstelle) is really just a Finanzamt for social insurance contributions. If you don't pay they have the whole range to force you that's just available to state entities. See e.g. https://www.bundesversicherungsamt.de/fileadmin/redaktion/Kr... A private entity does not have these options and would need to go through general courts.
> Obviously not. In the health care domain, the Social Insurance systems and tax-based health care systems are different models.
They are different models (and should be contrasted) but both are financed through taxes (just different kinds). Yes, we don't call these "Steuern" in German but that doesn't translate 1-to-1 to other countries. "Abgaben" would be a much better translation for taxes.
They are not owned by the state, they are independently run (by their members), they are independently funded (by their members), ...
Though they are heavily regulated, they have certain government mandated tasks and not typical companies.
'Private Krankenversicherungen' are not 'Körperschaften öffentlichen Rechts mit Selbstverwaltung', they are private companies.
> A private entity does not have these options and would need to go through general courts.
Like 'Private Krankenversicherungen' - they go through a court.
Is it mandatory? If so, it's a tax in my book.
Public -> pays to general government budget -> government pays to health care services
vs.
Social Healthcare Insurance (example: Germany)
Employer + Employee + self-employed + Students + Pensioner -> pay to Private/Public Sickness funds/Insurers -> Sickness funds/Insurers pays to health care services
See:
https://www.kingsfund.org.uk/publications/how-health-care-is...
But if you have ever done so, you can never return into the public system.
You can however purchase additional insurance on top of the public one.
You are right, though, if one considers the average citizen.
Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).
Germany has two insurance-like systems to pay for medical treatments:
(1) insurances, with fees aligned with damage risk associated with the policy holder. (2) a system of "funds" that provide insurance benefits for insurants, however, are not organized like an insurance.
The system (2) is quite old (dating back to the 19th century) and has a few peculiarities:
* fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others). * half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck. * family members can be insured, too, without increasing fees. * fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc.
The alternative to this fund are insurances that work on a risk-based pricing scheme - item (1) in the list:
* in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe). * pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc. * for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above.
For both systems, treatment prices are kind of fixed (as a rule of thumb, doctors can charge the insurance a bit more than the public funds, by a constant factor of 2-3, but I heard from doctors that this depends on the treatment).
Also the german healthcare system is not all financed by tax payers. "paid for by the public health care system" would be a better sentence.
However, that table doesn’t include subsidies for the SHI. All in all, 10% is funded with taxes.
http://www.hspm.org/countries/germany28082014/livinghit.aspx...
https://www.theguardian.com/us-news/commentisfree/2018/jan/1...
In my own back of the woods in Europe, the same would cost you nothing.
back of the woods in Europe, the same would cost you nothing.
Keep in mind that story is a donation appeal and is weak in details -- for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) The article also misstates ACA numbers.
Yes, of course it would. Stop believing the myth that Europe just kills people when they get too ill.
No, the US government pays almost as much per capita for health care as the German government.
https://visual.ons.gov.uk/how-does-uk-healthcare-spending-co...