Exoskeletons qualify for direct disability compensation in Germany | Hacker News Reader

Exoskeletons qualify for direct disability compensation in Germany

therobotreport.com

144 pointsbookofjoe51 comments

One the insurance companies realize that this sort of device would be much cheaper than a home health aide, I expect adoption will grow.

Insurance companies want health expenses to increase, not decrease.

What? They want their bottom line to decrease, not increase. The fastest way to increase their bottom line is to cut costs.

From what I'm seeing, I suspect insurance companies have multiple internal groups, at least one that want to reduce expenses and at least one that wants to increase revenues. Each is motivated independently of the other.

Insurance tends to have maximum profit percentages mandated, at least in the US. I'm not an expert in this, but I assume that this results in a bit of a perverse incentive where the only way to increase your profit is to increase your costs.

If that was the case expenses would never be rejected. The truth is more complicated than that.

No, because their income as capped at the premiums collected. They want to spend 80% on expenses, but not more than that. But they also want projected expenses for next year to go up.

Why is that so rarely mentioned in discussions of high healthcare costs in the US? It seems like it could explain everything!

Insurance can only have a fixed percentage profit mandated by US law.

Decreasing the bottomline would literally decrease their profits.

I think the main argument is that the insurance companies, in particular in the US, wants a certain percentage discount with the health care providers. The easiest way to provide substantial discount to an insurance company is by increasing the general price.

This is not the case in most European countries that they use a mostly publicly funded system.

Germany has free health care, so it's in the insurance's best interest to keep the cost low.

In the same way that it's in the bureaucracy's best interest to be lean and efficient and serve the citizens, because they're funded by taxes. And we all know how that goes.

Public insurance companies in Germany are motivated not to deviate too much from the average results of other public insurance companies, but they don't have any incentive (besides the same one that applies to the state in general) to lower the costs.

Not really. Public insurance in Germany was explicitly designed to have independent governing bodies, which is why you get to vote on certain decisions. Few people do, but it's one of the examples of non-state democratic governance that is a success story (another being cooperatives...)

That must be why they're cost-efficient, lean machines and not bloated bureaucracies.

Having dealt with the AOK on behalf of a neighbor to get a wheel chair since he cannot walk, I couldn't tell them apart from the welfare office with regards to processes and motivation of employees. Contrasting that with a private insurance (or a housing cooperative, as you mentioned them) is day and night.

In the end, they are dependent on federal policies and subsidies, so yes, they are technically not part of the state, but for all intents and purposes, they are: funding is decided on by the state, the covered procedures are decided on by a state-created and -controlled almost-but-not-quite-state-office (Gemeinsamer Bundesausschuß, which was created by the Ministry of Health but is nominally independent-ish, yet still needs to have its decisions reviewed by the ministry, and is able to set standards and guidelines which have the characters of a law). And like all bureaucracies, they are steadily growing and require frequent budget-increases.

There is nothing free in Germany. I see every month ~800€ leaving my account. It’s on par to Swiss one and as I heard not far from the one in USA. And it’s not good!!! This free health care pays only for basic and/or old treatments.

With what income, which insurance and what type of issue? German public healthcare is pretty comprehensive and cheap (one of the few things I miss) and definitely not on par in terms of price with Switzerland which is even further away from the US nightmare

Nice that you call 800€/month cheap. You are probably seriously rich.

Public health insurance cost is ~proportional to income up to a cap of about 800€ per month. So GP is reaching the cap, for which, by the way, you don't need to be seriously rich. It's IIRC 80k€ or so before taxes per year.

Not in Germany, they don't. Barmer is a "gesetzliche Krankenkasse"/public insurance, which means most of their members' premiums are legally limited to a certain percentage of their members' income, and while they can and do raise their premiums occasionally, that's always a topic of political debate and needs a better justification than "a very small percentage of our members need expensive exo-skeletons now."

They have no ability to raise premiums on specific members with high healthcare costs.

This must be wrong because US health insurance is evil /s

I was talking about US insurance where profit percentage is fixed, hence reducing bottomline reduces profits.

Well the article is a about German health insurance so without mentioning it explicitly it's not clear that you were talking about the US system :P

There's more to the world than the parochial ways of central north america so such locale specific observations deserve to be qualified for the benefit of the wider HN readership.

If they are private, yes. But in countries like France, they don't try to make money on health, and the goal is to get less people sick, not to milk them.

I think all insurance companies care about is being able to price out the risk of fat tail events.

It’s not clear that higher overall costs are always beneficial to insurance companies, because rising premiums might reduce demand for their products. This would depend a lot on the regulatory framework (ie.: which country or laws apply).

Insurance companies want expenses to be predictable first and foremost, given the fixed nature of premiums.

Robert Heinlein would be so psyched that exoskeleton battlesuits (potentially, at least: got mods?) are underwritten by the social welfare state.

Can't wait until they become mainstream and equipped with wifi. I can finally build my army

Always bums me out a bit when I read about health insurance providers fighting tooth and nail to prevent or delay improvements in patient care.

Only acceptable answer would be to check if it really works and not some kind of scam.

That is most likely a general tactic. If you are an early adopter, you also carry the initial extra cost. Take exoskeleton, gene therapy, ... whatever. When they fight it for ... let us say ... 10 years, the cost has gone significantly down to a probably reasonable level.

Health Insurance companies (especially non-totally-private ones) have an ugly battle of balancing the costs with the good of the many and not the individual.

Most health insurance really should not exist. It's a fundamentally messed up idea.

Insurance is a bet. You look at the odds and price things accordingly so you can cover the occasional big payout with the premiums from people who don't "win" so to speak. Playing with the lives and health of people to try to skew the bottom line one way or the other is fundamentally a stupid human practice.

Government should provide some basic health services to protect the health of the nation as a whole, just like government tends to provide fire fighting services because letting one fool burn his own home down can burn down a lot more than just his home.

It's a complicated topic and a pet peeve of mine. This approach to trying to keep people healthy is deeply flawed.

Edit: Though I'm really not sure what your comment has to do with this article, to be honest.

Insurance is a bet for the person taking the insurance, not the one offering it. Just as casinos are not gambling. Law of large numbers and all that.

I agree that it's a weird business to be in (and certainly the US has not figured out the best approach), but this article is about Germany, and generally I think we strike the right balance here. Not in every detail, there is still a lot of room for improvement (too many insurances, too little competition between them, some questionable decisions about reimbursement) - but I wouldn't dare to claim that I could consistently make better decisions.

I worked in insurance for over five years. It's a bet by both parties and the law of large numbers matters less in health than it does in other kinds of insurance because (most) health outcomes are not actually the result of a random number generator going "Tag! You are it!"

People make health choices every minute of every day and the landscape of health insurance is rapidly evolving due to the ability to track biometrics with wearables, among other things.

I'm thrilled to see this article. It seems like really good news for people with paralysis.

Because of the importance of muscle action to the process of returning lymphatic fluid to the circulatory system, I would assume that exoskeletons are likely to be much better for one's health than a wheelchair.

https://news.ycombinator.com/item?id=25427090

Here’s a thought - at what price point is it cheaper to buy everyone that needs one an exoskeleton than to rebuild every building to be ADA accessible?

second order idea: give a lot of exoskeleton so rebuilding to ADA standard becomes cheap :)

Around the same time that we cross that threshold, I expect we'll cross another where robots of various types might exist as infrastructure and so demand the same ramps as ADA but for different reasons.

Interesting question. I suspect that would be intrinsically tied to rate of manufacture. The cost of manufacturing exoskeletons will decrease over time while the cost of labor and building modifications will likely decrease.

I propose that each building be equipped with a R2-D2/The Matrix brain jack terminal, so that the disabled can jack in to simulated experience of the building, thus freeing architecture from ADA constraints. I also vehemently oppose letting people connect from the comfort of their own homes, because it doesn't fit the aesthetic of my cyberpunk flavor.

Parallel thought.

Would there be some resistance from some subset of disabled people to be forced to use exoskeletons in place of wheelchairs if we decided to go this route?

There will always be resistance when people are told what they have to do. Look at recent experience with the pandemic.

That one is easy to solve, though. Assuming the market doesn't jump at the opportunity on its own, all it'll take is some tax break or subsidy that'll make it profitable be an exoskeleton reseller (or to rent them out). It'll have to be indirect enough to not get flagged immediately on national news and turned into a political issue, if you manage that, the private sector will do all the hard work for you.

You'll have gazillion of small companies, many of them fly-by-night scams, borrowing money from banks and investors and spending a chunk of it on marketing exoskeletons as mobility products. This will gradually start shifting real demand, leading to manufacturers and large health providers getting increasingly involved. Doctors might start being offered kickbacks; private healthcare clinics surely will. Exoskeletons will start showing up as an available option, and will benefit from persistent marketing and generic funding - all while regular wheelchairs become less popular and, thanks to reduced demand, more expensive.

Eventually, most people will opt for getting an exoskeleton instead of a wheelchair, without, at any point, being "told what they have to do". This is the truth about modern markets in general: consumers, at scale, don't have much agency. They'll just buy whatever they feel is best for them.

Most wheelchair users are either elderly or suffering from some other deteriorating condition associated with pain, overall weakness, or instability, and will therefore likely not be able to use these. (Note that even in the promotional images, people are using crutches to balance in addition to the exo-skeletons.)

The classic "strong above the waist, paralyzed from the waist down" image of a wheelchair user that people might have from eg the paralympics is the minority.

ADA accessibility adds value to more than just the disabled. Wielding a stroller provokes appreciation.

Maybe new parents could get an exoskeleton that lets them carry the stroller upstairs as easy as lifting a feather. Heaven knows new parents need all the help they can get!

Thinking too small. Get the baby an exoskeleton so that it can get around without a stroller.

I think there are far more benefits than more easy access to public accommodations.. From the article, the patients that used the exoskeletons had an improved quality of life, reduction in pain from being wheel chair bound and were able to taper dosage on pain medication.

I think you are seriously overestimating the utility of these right now. It is not just about cost, they are more limited than wheelchairs in many ways.

I’m assuming they will continue to improve.

Just in case you're in dire need of the German health care system. The basics, of course:

https://www.expatica.com/de/healthcare/healthcare-basics/ger...

I worked in it for about 30 years is different rules and jobs, so please don't ask.

Now onto some interesting aspects of the USA health care system widely unknown in Germany:

https://www.medicaleconomics.com/view/unknown-health-care-pr... https://www.kff.org/uninsured/issue-brief/key-facts-about-th...

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