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Comment by endergen | Hacker News Reader

I’m 41, lived in Canada till I was 31. Software Engineer, living in Boston mostly. I have always paid for the top tier health insurance benefits in my jobs. I have to say the experience in the US is waiting long for everything regardless and the User Experience :P is terrible. I spend so much time on calls clearing up confusions like who I owe money too, who replaces some health equipment I need, and etc. Privatizing seems to make for too much economic specialization that ends up meaning no vertical integration and thus a disjoint customer experience.

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> Privatizing seems to make for too much economic specialization

That alone isn't sufficient. Germany is built on private insurance (on top of something similar to Canada's government insurance) and it works just flawlessly. Usually they pay everything, you don't need to do anything. You skip all lines at the doctor, can directly go to specialists without asking anyone, etc. And on top of that private insurance in Germany is considerably cheaper than government insurance, while providing like 10 times the benefits.

If I had to name one thing I really miss from Germany, it's private health insurance. This was just like being in heaven.

Don't almost 90% of people in Germany have public insurance with only a bit over 10% having private insurance?

Probably, but that's still about 10 million people with private insurance, which is 1/3 of Canada's population. The point is, private insurance doesn't have to be a nightmare. That is not the only factor. Actually I think private insurance generally had the potential to be much better than public insurance. However there seem to be a number of additional factors that make US private insurance such a nightmare.

Usually people will have both, since basic government insurance, I believe, is mandatory in most of those countries.

> Actually I think private insurance generally had the potential to be much better than public insurance

Why? Maybe private care is better than public care, i don't know, but insurance? Swisslife (one of the best/most efficient in my country) reimburse 65 to 67% of their anual income, so roughly 33% of what you're giving them goes into administration/coordination fees. Public insurance? 20% of the money they receive via taxes are used for administration/coordination.

So if i had a choice, i would pay a premium on public insurance (more taxes, or instead, asking my bosses to give the 120€/mo to the public insurance instead of paying swisslife). Better ROI.

It doesn't have to be a nightmare as long as there is extremely stiff competition from public insurance?

And you can also say that most of Western Europe favours fairly small, and, often, specialised hospitals, and clinics.

> That alone isn't sufficient. Germany is built on private insurance […]

The difference is profit motivation.

Germany does have private insurance, but there are regulations on what insurances companies can have margins on:

> As of 2020, salaried workers and employees who make less than €62,550 per year or €5,212.50[28] are automatically enrolled into one of currently around 105[29] public non-profit "sickness funds". The fund has a common rate for all members, and is paid for with joint employer-employee contributions. The employer pays half of the contribution, and the employee pays the other half.[30]

* https://en.wikipedia.org/wiki/Healthcare_in_Germany#Health_i...

Similar in Switzerland:

> Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.[3]

* https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

With US health insurance companies profit is job #1.

Where did you get the part about it being cheaper from? Most people can't afford private insurance

> And on top of that private insurance in Germany is considerably cheaper than government insurance

[citation needed]

> And on top of that private insurance in Germany is considerably cheaper than government insurance

Not at all. A significant portion of the government insurance is paid by the employer, so it ends up cheaper for the individuals. Also, children are included in the government insurance.

Try asking what rate you'd get if you were to move back. Tell the insurange agent you're 55, have two children and a bad knee.

The prices you remember are for twentysome-year-olds without children.

You are saying this when USA have biggest private hospitals in the world.

You may also be surprised what country contends with you for this place: Republic of India.

Some people say Gulf also has extensive private healthcare, but those forget that, I think, every Gulf country bankroll healthcare for their natives, and they do have near fully state funded hospitals. And yes, tons of Arabs in medical professions.

Most of "superelite" healthcare you see Gulf is just an extension of the medical market of the Subcontinent, and cater to nouveau riches to whom domestic market is not "elite enough" for their tastes.

I have a plan from Kaiser, which is a non profit health care system in the US. They do everything in house, which is pretty cool. I asked my doctor for a blood test, and he gave me a quick ticket, then I went downstairs, gave them my ticket, and they took the blood test immediately. Then about 6-7 hours later the tests were available from their website. I have to have an endoscopy done, and it's also done in a different building adjacent to the doctors office.

About 15 years ago a friend of mine, who's a physical therapist originally from Canada working in the US, made an interesting observation.

In Canada, MRI machines were available only at a few major hospitals. It took months to wait to use one. In Chicago, where we were living at the time, she said it seemed as if there were an MRI machine on every block.

I think the situation is different now, but I think the observation is quite telling.

About 20 years ago, Buffalo NY had more MRI machines than Canada (not coincidentally, it's also the closest US city to the Toronto-Mississauga and St.Catherines-Hamilton areas.)

Living in Canada and I've heard people pay for MRIs on the south side of the border just because an MRI to see if there's ligament damage in your knee would take 6 months. There's definitely areas where care in Canada is excruciatingly slow.

In my own anecdotal experiences (my own and from my friend circle) a lot of more chronic/non-urgent problems take forever to get looked at by a specialist in Canada.

You can't compare public care in Canada with private in the USA. Though you wait six months for that public MRI, but it doesn't cost you anything! Yes, the waits suck, and they are related to having a low number of these machines in our public systems, compared to other countries. We have private imaging clinics in Canada which will serve you promptly, for something like $700 and up. Could it be that people are going to the USA simply because they are finding better deals than that? You know, get cheaper groceries and gas, and swing an MRI along the way, kind of thing.

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