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Comment by exodus_de | Hacker News Reader

> My family in Germany throws a fit when they have to pay 50 Euro for something.

Socialized insurance rates in Germany are 15% of income. Unless your family doesn't earn any money, they have been paying far more than 50 Euros.

> In the US you can happy if your cost for seeing a doctor is less than 4 digits.

That isn't generally true. Every insurance plan is different. Cheap plans have a high deductible. It's similar to private insurance in Germany.

It's basically like this: If you're gonna be poor, go to Germany. Everyone else will pay for you. If you're going to earn well, leave Germany, otherwise you're going to be paying for everyone else.

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This is missing a few important points.

1. The 15% of income has a cap. It's something like after 60k EUR in wages you don't pay anymore. Also, only 7.5% comes out of your paycheck, the employer pays the other half. When I was there a few years ago I was self employed so I had to pay "both sides". It would've worked out to roughly 750EUR/month for health insurance which had _0 deductible_ and _0 coinsurance_ for doctors visits or ER care and would've covered my entire family no matter on my children I had. Compare that with a typical HDHP family plan offered in the US and you're looking at $400/mo in premiums, with a $3k deductible and max OOP of $6k. The final cost is comparable.

2. The 15% is only if you participate in the public system - the private is not tied to your income.

>> Also, only 7.5% comes out of your paycheck, the employer pays the other half

You might delude yourself that this "other half" is paid by the employer, but in reality your employer takes that cost into account when employing you, so they offer you lower gross salary because of that. In other words: it's still paid by you, just indirectly.

EDIT: more clear wording.

> Also, only 7.5% comes out of your paycheck, the employer pays the other half.

That distinction is imaginary. It all comes out of your total cost for employer, which either goes to you or to (possibly earmarked) taxes.

This doesn't mean the amount is not fair (it very well might be). But it's important to realize it all comes from your paycheck.

> Also, only 7.5% comes out of your paycheck, the employer pays the other half

This just means that paychecks are 7.5% lower then they would otherwise be. It is a mistake to think that the employer paid benefits are "free". The market adjusts. You find that out right quick of you are self-employed (at least in the US).

The difference is that the other 7.5% (plus a few more such line items) don't appear in your progressive tax rate, and they also don't appear in "how much do you earn in country X" comparisons.

In most countries, even the first 7.5% don't apear in your tax rate.

But still, if you count everything together, for a 2keur net paycheck you have to charge your customers 4.8k in my country (slovenia), and the government takes 2.8k (social benefits, pension, health, income tax and VAT). Say what you want, but 4.8k->2k is a huge amount of taxes.

> The 15% of income has a cap. It's something like after 60k EUR in wages you don't pay anymore.

...at which point progressive income tax starts kicking in badly.

> Also, only 7.5% comes out of your paycheck, the employer pays the other half.

Guess what, the employer pays 100% of your paycheck, including your vacation, pension, healthcare and taxes. It doesn't really matter to the employer how the cost is labeled. That's why you get to charge more when self-employed.

> The final cost is comparable.

Comparable? It's almost double if you don't take any care. Also, what if you don't have children? It's apples and oranges.

> The 15% is only if you participate in the public system - the private is not tied to your income.

Caveat: You are forced to take part in the public system unless you earn well or you are self-employed.

"It's basically like this: If you're gonna be poor, go to Germany. Everyone else will pay for you. If you're going to earn well, leave Germany, otherwise you're going to be paying for everyone else."

You should add this to your algorithm for location choice: If you get a serious health problem and want to become poor, come to the US.

You’re not that far off from reality. I’m currently in the US because career opportunities are far superior here.

However, if I were to get seriously and chronically sick I would back to my home country. Not that i couldn’t get very good care in the US, but the system here is just a massive burden compared to countries with universal coverage.

> You should add this to your algorithm for location choice: If you get a serious health problem and want to become poor, come to the US.

If you already have a serious health problem, you'll be hard pressed to find any country to take you and just take care of it pro-bono, if you're uninsured.

German public insurance only covers the bare minimum. I know enough people who are poor because of serious health issues. Sure, their medical costs were covered, but they're now welfare cases. They can't afford many treatments that would make their lives better. They would've had to buy extra insurance, but they chose not to, or couldn't afford it.

Relating that to the US: Don't skimp on insurance. Don't get an insurance that is capped at a low number, otherwise you will go bankrupt if shit hits the fan.

>Don't get an insurance that is capped at a low number, otherwise you will go bankrupt if shit hits the fan.

But shit will not hit the fan for the overwhelming majority of people. There's no good reason for someone in their 20s (or 30s) with, no dependents, no history of medical problems and doesn't partake in a dangerous lifestyle to load up on coverage. Loading up on coverage in that situation might make you feel warm and fuzzy. It might win you internet points. It is not financially sound.

> Socialized insurance rates in Germany are 15% of income. Unless your family doesn't earn any money, they have been paying far more than 50 Euros.

And that's kinda the point of the parents' post, I think. If I were paying 15% of my income for socialized health care, I would be pissed if I ever had to pay anything out of pocket for my own medical needs.

>>Socialized insurance rates in Germany are 15% of income. Unless your family doesn't earn any money, they have been paying far more than 50 Euros.

Comments like this always miss the larger point, which is that healthcare overall is cheaper in socialized systems because the government as a large entity negotiates on behalf of citizens and puts strong downward pressure on prices.

Guess what, private insurance companies will also negotiate prices.

What happens in socialized systems is that the government does price fixing, which makes healthcare worse and it limits supply. Try getting a specialist appointment with socialized healthcare in Germany, it can take several months. Get private insurance (or pay out of pocket) and suddenly appointments become available. Doctors are leaving the country in droves.

Some of the hospitals in Germany are in an abysmal state, MRSA rates are extremely high:

https://correctiv.org/en/latest-stories/super-bugs/2017/01/1...

>>Guess what, private insurance companies will also negotiate prices.

They negotiate prices based on the size of the pool. This is why if you are a small business the rates you will get will be worse than if you were a large enterprise.

With socialized healthcare, the pool is the entire citizenry, which is what gives the government substantial leverage when negotiating.

The German government doesn't negotiate anything. They set prices, period. Set them too low and you create shortages. Guess what the German healthcare system has, it's a shortage of doctors, especially specialists. German doctors are leaving for greener pastures, like Switzerland. They are replaced by doctors from Eastern Europe. Quality suffers. Waiting times are high. Most Germans are too uninformed or arrogant to admit it (especially to Americans) but the system sucks.

That's not to say the American system is good, but I can't stand all this talk about how socialized healthcare is so great. It isn't. A lot of what people are calling "socialized" systems are actually private systems with a compulsion to purchase insurance, for example Switzerland, Netherlands, Australia. Even Germany technically has a dual system (public and private) but only the top earners are allowed to go private.

You have a point. There are a lot of people comparing the worst parts of the US system with the best parts of the single payer systems.

As a Canadian, I will say there are a lot of people dissatisfied with the Canadian system. Likely to a lesser degree than in the US, but the system is far from perfect.

Health care can never be perfect unless you (personally or government) are willing to pay an indefinite amount of money towards it. The positive with an imperfect socialized system is that it's under democratic control. In other words society decides what to prioritize.

> The German government doesn't negotiate anything. They set prices, period

Incorrect. In the public system, the fees are negotiated between the GKV Spitzenverband (federal association of public health insurers) and the KBV (federal association of public doctors).

Germany still is in the top group regarding quality of care indicators.

Australia doesn't have any compulsion to purchase insurance. It's perfectly normal to skip it and receive treatment on Medicare. However, if you don't have private insurance, and have a relatively high income, you pay a tax surcharge.

Meanwhile, US governments pay more per capita for healthcare than other "socialized medicine countries", but with terrible clinical outcomes.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

I wouldn’t say that the govts of socialized systems negotiate rates down, it’s more of “this is what you will get paid”.

Salaries for doctors are the highest in the US. If we want to move to a single payer system they will have to take significant pay cuts.

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