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Comment by dsplittgerber | Hacker News Reader

I'm from Germany and you do realize that over here (don't know about the exact differences) privately-insured patients (who opted out off the 'mandatory' insurance scheme) basically pay a LOT more for any given medical service just so that patients covered under the mandatory insurance can get treated at all? It's like a giant (inefficient) money redistribution scheme, in all the worst ways imaginable.

Regulation does actually cause bills like that. It's just that in Europe, you don't ever see them.

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Actually I think you'll find that billing like the kind you see in the US doesn't happen in Germany. The US spends nearly twice as much per capita than Germany for a comparable level of service[1]; this is hard to judge but life expectancy is a reasonable proxy, people in Germany on average live about the same.

The UK with near mandatory, see below, universal healthcare the cost of per capita is lower still [1 ibid]. In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future.

Obviously with a mandatory universal care the overall cost to the public at large stands a high chance of being lower; efficiencies of scale. The downside is that at the individual level you may be subject to "postcode lottery" healthcare. In many countries this leads to individualism raising the costs of healthcare for everyone.

Everyone wants to be treated the best; the problem is that regardless of the system you chose this is impossible.

[1] http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...

life expectancy is a reasonable proxy

I disagree. The USA differs significantly from Germany, both in cultural aspects and genetic/racial makeup. Different lifestyles contribute significantly to life expectancy differences, as does heredity.

That is not actually important in the overall picture of healthcare spending - http://theincidentaleconomist.com/wordpress/what-makes-the-u...

"In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future."

What do you mean by this? You can have pretty much any health service privately in the UK if you want to pay for it e.g. from BUPA:

http://www.bupa.co.uk/

If you choose to get elective surgery for a condition rather than waiting in the queue for the NHS your room isn't covered by the Govt, your post-op prescriptions aren't covered, etc. If you do wait however they are covered. If you need corrective surgery afterwards to fix something that went wrong in the first op you normally aren't covered for that by the NHS either.

That's different from opting out, which would mean not paying for the NHS at all. This is buying additional coverage.

You can't opt out of the NHS in the UK, except by not paying taxes, which usually results in a spell in prison.

For some reason none of that sounds particularly unreasonable to me - once you decide to opt out of the NHS then you have to accept that you are paying for all of the costs. Note that this view might be because I'm in the UK and have private health insurance - although everything major (accidents, childbirth) I've relied on the NHS.

While mixing and matching might seem sensible I suspect that the resulting administrative complexities might introduce the same kind of inefficiencies that the US system appears to suffer from.

You forget to mention a few details: Younger privately insured patients actually generally pay less than their publicly insured counterparts (especially if they're male), since private insurance companies are allowed base premiums on risk (which grows with age). Private patients generally get better service, wait less and have access to more drugs and procedures. So yes, it's probably more expensive overall, but it's a voluntary decision and you get something in return.

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