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Comment by TomMarius | Hacker News Reader

It costs around the same in Europe if you don't have insurance. I'm pretty sure it's the same in the USA - this is the rate that would be charged to your insurance company. Rates are way lower for uninsured people if you ask them and tell them that you're not insured (I got a bill lowered 10 times when I broke my hand); and of course most people have some kind of insurance.

To the people downvoting: please read properly. If you move your place of residence outside your country, you're no longer insured, and that's what I'm talking about - I specifically said "if you don't have insurance".

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Actually in Italy you don't pay a dime, unless you want to. The level of care you get varies by region, but is generally pretty good, especially for regular, mass events like birth.

Same in France. Standard care is free, extra can be taken care of by your private insurance.

That's absolutely not true. If it is, name an EU country where that is the case. If you are a citizen of an EU country, you are entitled to use the healthcare system in that country(and any other EU state), purely by virtue of being a citizen.

The only case that would maybe trigger a payment would be if you were a visitor to EU and had a baby - but most likely no hospital would bill you as hospitals are just not equipped for billing, they don't have the staff or the equipment to do such weird things as issue bills for treatment to people. I know at least several non-EU people who had treatment in EU and no one ever asked them for any insurance info to bill them, unless it's something major and very very expensive there's just no point, it would most likely cost the hospital more to figure out how much and how to bill you in the first place.

as hospitals are just not equipped for billing

In Sweden every visit to a doctor or hospital is billed, as is every night spend at the hospital, so they are definitely equipped to handle it.

That is absolutely not true. I am a citizen of the Czech Republic and if I stop being insured, e.g. because of changing my place of permanent residence, I'm not entitled to anything.

Then Czech Republic must be an exception in the EU - pretty much every other country that I lived in worked on the simple principle of "you are a citizen/resident = you are entitled to care". Even if you didn't make any payments ever(due to lack of a job, or being homeless or disabled for example) you would still be 100% covered.

Not the case for Poland either. If one is not employed and not registered as unemployed (authorities are doing all they can to keep the official unemployment statistics low), one has to proactively subscribe to "voluntary health insurance". In case one doesn't - pronto! one has no healthcare insurance. Of course, the constitution guarantees the healthcare, free-universal-healthcare blah blah - good luck suing everyone or anyone while being in such life situation.

Slightly different, but also extreme, case - Germany. There, one always is insured, only for the months one doesn't pay a debt is accumulating (you thought healthcare can incur debt only in US?). It's quite difficult to get out of German healthcare insurance actually, even while being EU citizen and moving out of Germany.

In fact, for a EU citizen who takes advantage of free movement of workers and relocates often between EU countries, one can fall pretty badly on its face healthcare insurance-wise.

Really? As long as you are properly employed in any EU country you should also be covered in that country. There are some issues regarding cross-border, meaning a German is working in Spain and needs medical attention in Germany that would be invoiced to the Spanish insurance.

In Germany free-lancers face issue, they need to get their insurance somewhere. But thay have to get, there is no such thing as uninsured German resident.

It is not an exception, it's almost the same at least in Slovakia, Poland, Hungary and Austria. It is not true that you'd be always covered - you'd be covered only if you're registered in the system and entitled to be a part of it (by the virtue of being a resident); if you have your residence outside the EU, you're entitled to nothing; if you have your place of residence in other EU country, you're entitled only to treatment of immediately life threating issues - you still need travel insurance to travel to other EU countries if you want e.g. dentist covered, also you can't injure yourself doing sports and such, that would not be covered at all by the basic insurance.

It's true that you'd be covered even if you never paid but you have to be entitled to be a part of the system - and thus you're insured. Also the money for treatment will be later demanded from you, on top of insurance payments and interest (personal experience); of course there are options for the socially less able (the government pays insurance for them, that's why it might seem free) but as a software engineer, no it's not true.

If you read my comment properly you'd know that I'm talking about uninsured people.

EU citizens are able to move to another EU country are eligible for the same benefits as locals as long as they are working and paying taxes there and for X time after that (I can't remember the exact number).

In the Nordic countries that's extended quite a bit for citizens of other Nordic countries (even if the other country isn't in the EU), and I wouldn't be surprised if there are other groups of countries in the EU with their own similar agreements.

None of the above says anything about the level of welfare the individual EU countries have, however. If an EU member has a below-average welfare system then you might end up with nothing simply because you don't meet the requirements for receiving benefits.

Incorrect. For example in The Netherlands it is mandatory to be insured. If you refuse to pay insurance, not only will you have to pay 100% of healthcare costs, you'll also be fined.

Yes, except that if you are not in a position to pay(make below X/year, are disabled, homeless etc etc) you don't pay anything. You have to have insurance, but depending on the circumstances you might not have to pay for it.

Are you sure you replied to the correct person?

In Portugal we have fees even in the public system, supposedly to reduce frivolous use. That said, they are usually under 10€, and large swaths of the population - including pregnant people - are exempt, so yeah, having a baby is free.

I think it would have helped if you specified Czech rather than "Europe", because it's a big place and it looks like many of the smaller countries have this kind of non-public system. The rules appear to be complicated: https://www.kancelarzp.cz/en/links-info-en/health-insurance-...

It sounds like there's a hole for people to fall in: if you're a Czech national, but not resident nor employed in Czech Republic, but in the country anyway, and you don't have private insurance, then you have a problem.

(It looks like if you're a resident proper in another EU country with resident-based healthcare, such as the UK, then that would work for EHIC purposes if you visited Czech Republic.)

There are rules that are EU-wide - because they're set by an EU regulation. If you're a resident in any EU country, you get the blue card. That makes you entitled to whatever (this is depending on the country and not set by the regulation) in your country of residence and basic care of life threatening issues in the rest of EU, Czech Republic included; however if you injure yourself doing e.g. sports in other EU country, that's not covered! That's why travel insurance still exists, otherwise it'd be pointless.

My comment was talking about uninsured people, so mostly non-EU residents and people that didn't pay and weren't entitled for coverage by their government - the way it works is that your governments pays the insurance for you if you can't, but will not if you can; there is an exception - Germany, where everyone is covered through taxes.

I'm no expert on the gritty details of the German system (who would have thought health care could be that complicated, right?) but as German resident I have some insights. Everybody who knows better, please correct me.

In Germany everybody who is employed in way that pays social insurance is also health insured, you cannot opt out of it. In that system, in addition to taxes, social security and unemployment insurance, you pay a certain percentage of your gross salary to get health insurance. This percentage varies by your choosen provider. Your employer is paying the same amount (more or less, not sure if the employer amount is fixed). You can opt out of the public system above a certain salary and pick private insurance, prices vary greatly.

Unemployed people are insured by the state, I guess using taxes or social security or unemployement budgets, I have no idea. You have to be registered as unemployed to be covered. If you do not register you have the choice of being insured with a family member (public health care) or voluntarily (private or via the public system). You are obliged to be insured oine way or the other.

Exceptions are soldiers (some kind of in-service system with cost reimbursement, don't ask for the details), public servants (something similar in a lot of cases, again, please don't insist on details), certain professions (doctors, pharmacists, artists,lawyers) with their own insurance solutions. You are screwed as a afreelancer, your only solution is a private insurance that can get quite expensiver.

TL/Dr: You are always insured one way or the other. It is not paid for by taxes.

Yes I got that part wrong. Sorry I misunderstood the text I read on the topic, you're right. My original comment was talking about people that are not insured (and not obliged to e.g. due to not being residents). My point is that healthcare always costs something, and the sum is very similar to the cost in the US once you get them to give you a discount for uninsured people - but of course there is better social security for entitled people (most of residents) in the EU.

Last time I checked, the US was among the most expensive countries regarding health care. But I don't have a source at the moment.

And sure, health care ia costing money, nobody is argueing that. What Europe figured out is that a solidaric system, one where people with less individual costs are covering for those with higher costs, are the optimal solution from a national perspective. It still pizzles me how that can actually be a issue in any developed democracy.

And again, all legal residents are eligible for health care in EU countries. A good thing if you ask me.

> Last time I checked, the US was among the most expensive countries regarding health care. But I don't have a source at the moment.

Yes, but that's comparing listed prices and not adjusted for purchasing parity. They will substantially reduce the price if you're not insured and ask them.

> And again, all legal residents are eligible for health care in EU countries. A good thing if you ask me.

I tend to agree, but that's not my point. I'm just saying that a clinic will bill you (indirectly) roughly the same as they'd in the US after you get it adjusted, but of course it's fully covered for most people here.

I higjly doubt the last part, but I don't have any numbers. Just as some added cintaxt, the actual ciats are also quite different between European countries. And treatment is not the only cost driver, the way the system is set-up also has a big impact. One of the reasons why Germany is also constantly among the most expensive countries.

But the costs are different across the US as well. Of course it costs a lot in San Francisco, just like it would cost a lot in a major EU city - and it costs less in a rural area.

It's free in The Netherlands. Well, not technically free but it's covered by the universal healthcare so it won't cost you a dime. (FYI the basic healthcare plans all cover the same regardless of insurance company. It covers nearly everything that you could go bankrupt on. There are extra packages that cover additional care like physical therapy or dentist costs. A basic plan is around EUR 90,- per month with a deductible of EUR 385,- per annum, but there's no deductible for MD visits and, yes, childbirth/neonatal care).

Note that medicines count towards your deductible, as well as any more serious investigation by the GP (x-rays, blood tests, etc).

Virtually all of Europe has either publicly sponsored and regulated universal health care or publicly provided universal healthcare.[1]

So if an EU citizen moves to another EU country, there's no problem.

An average hospital in The Netherlands (#1 in quality in Europe [2], but #6 in costs) charges the insurance company between €607 (natural birth) and €4450 (c-section).

[1] https://en.wikipedia.org/wiki/List_of_countries_with_univers...

[2] https://en.wikipedia.org/wiki/Healthcare_in_Europe#European_...

No. Prenatal care, childbirth and postnatal care are entirely free in Portugal and in most European countries I know of. In Portugal it's both free and either best or second best in world ranking.

Do you have a source? I did a quick google for the Netherlands, but couldn't find any information about the real costs (without insurance).

I do, the Czech laws regarding health insurance - and pricing will be sent on request to the hospital.

Can you elaborate? In Germany at least this is not true at all.

In Europe there are countries where you can not be a part of the public system in some cases, such as changing your permanent residence outside the country.

Well, ok, I see what you're getting at - but unless you moved to outside of EU, you are still fully covered by the country where your new permanent residence is. If you moved out of Czech Republic to Spain for example, just get an EHIC card from Spain and you can get treatment wherever you go in EU, including Czech Republic.

Yes, but I was talking about the case when you're not insured. Btw the treatment you're entitled to in other EU countries (outside the issuer country of your insurance card) is limited (but of course childbirth is covered) and you need travel insurance (it's cheap in EU, around 2 euro per day), especially if you're doing sports as any injury done during sports is not covered at all outside your country.

In Denmark it costs 0, also since we're raising the next generation of payers into the tax system we get paid money quarterly (about $700 [guesstimate] for the first couple years decreasing over time, our 9 year old gets a governmental stipend of $200 per quarter [another guesstimate])

I guess what I'm trying to say as someone who lived a lot of years in the U.S - why the hell they gotta screw you so hard there?

on edit: of course I should also specify that Denmark is pretty capitalistic, so you pay for your kindergarten once you enroll the kids in there and that will cost more per month then you are getting in stipend.

> why the hell they gotta screw you so hard there?

The same reason most things happens: Lots of short term profit, no matter the long term cost.

You (or one of your countrymen) pay for it with taxes, that isn't the same as it costing $0.

Now, it likely a) does cost a lot less in Denmark than in the States in real terms and b) paying for it with taxes might absolutely make the most operational sense. But it isn't free.

Haha, what? Childbirth costs 0 € in a public hospital

Well, yes. That's true for most European countries (unless you go private).

https://www.babycenter.com/101_what-birth-costs-around-the-w...

Technically in Sweden it costs ~10€ pr. night.

It doesn't. Not everywhere and every time. See my other reply.

Well of course if you are not a EU resident you don't get free childbirth. This is a country not a resort hotel.

Yes exactly - I specifically said "if you don't have insurance". I really don't see your point, you're saying the same thing I do.

No idea why you believe this. I've had babies in two European countries and didn't pay a thing for either of them.

I believe it because the law and EU regulation explicitly states it.

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