No Waiting Room | Hacker News Reader

No Waiting Room

nat.org

Ok, I'm German, so I guess I'm qualified to put this into perspective. ;)

First off, this sounds far more than a health paradise than it is in reality.

If you go to a regular doctor, you definitely have to sit in a waiting room - unless you are an emergency. Some weeks ago I injured my ankle and had to sit in there for 3 hours for a total of 10 minutes examination by the doctor...

I don't know about hospitals, never been there. Here in Germany you only go to hospital if you're seriously sick/injured (eg accident or something) and/or if it's in the middle of the night otherwise you go to your doctor.

And there are loads of other problems coming with our health care system, eg it's expensive, sometimes paradoxically inefficient and what not.

That being said, I think it's still a great system that ensures the stability of society and does more good than harm. Well, and I'm born here, so there are probably a lot of things that I take for granted but aren't available in other countries.

Just wanted to point out that this isn't the land of milk and honey... ;)

It is the land of milk and honey when compared to the US.

Oh, I'm sure that there are unintended consequences in any system that complex. But I'll tell you from unfortunate personal experience, if you go to an ER in the middle of the night in any American city, you'll see a crowd of people in the waiting room. Most of them are uninsured and poor, and thus don't have a doctor to go to for routine things, so they go without medical care until it is an emergency.

It's not efficient.

Maybe I missed his point, but first of all, yes, hospitals do have waiting rooms - just (obviously?) they're not filled in the middle of the night, as only people with, well, emergencies tend to go to the hospital in the middle of the night. Secondly, e.g. going to the dentist is almost guaranteed to be an hour's wait (at least where I live), even if you have an appointment. Say, you do have an appointment for 1500, then what many people around here do is, check in at 1455, ask how long the wait might be, and then actually leave to do some shopping or similar and come back in whenever their wait is nearly over.

So really, I don't see how this could be superior to any other system.. And is he pleasantly surprised at the 250ish Euros or did he consider it too high? In case of the latter, I don't know why he doesn't have German insurance in the first place. I currently pay less than that amount per year (though that's the public health care kind, not the private one, which arguably would be more expensive, but also better), and IANAL, but I think if he lives here [in Germany] he is forced by law to have some kind of health insurance.

Don't want to come across as too negative, but I just thought I'd give you the other side of the story as well. (I currently live in Germany and I am covered under public health care.)

> And is he pleasantly surprised at the 250ish Euros or did he consider it too high?

He was very pleasantly surprised. In response to a comment on his post, the author wrote:

"According to newchoicehealth.com, an abdominal ultrasound in a major American city costs $340 on average at the cheapest service providers. At hospitals it’s much more expensive – $1350 at the Massachusetts General Hospital.

And that’s just the ultrasound — without the ER fees, the blood tests, the surgeon consultation, etc, that I also received in Munich. So I think 265 euros is extremely cheap."

[Source: http://nat.org/blog/2009/12/no-waiting-room/comment-page-1/#...]

But is this the health care system we would be getting with the current proposal? I see a lot of these types of posts, health care is great in [somecountry] and it's a [otherthanus] system.

I think most people are concerned b/c the US Congress is corrupt (either to a major or minor extent). So special interest groups (AMA, insurance co's) have a greater chance of getting a bill that looks after their interests.

In the end, doesn't it come down to paying doctors (and their practices that own the testing equipment) less?

This depends how far you change the system. US has a much higher per-person spending on healthcare than does Germany, so it has to be questioned how that money is currently distributed...

Oh and I've gone to the emergency room and not waited also.

However, the bill was much higher. But, the bill is reduced by agreements with the insurance company and if you've met your deductible, you might not pay anything at all.

Better or worse? One visit to the ER does not make a compelling story one way or another.

What I never see talked about in real-world systems that _does_ get talked about in computer systems is pretty simple: scale.

Does health care scale? For that matter, does government in general scale? Germany (according to Wolfram Alpha) has the largest population in Europe, at 82 million people. America has 300 million. And Germany is much, much more dense, at 613 people per square mile vs our 86 people per square mile. Wouldn't that make it much easier for fewer hospitals to care for more people?

I have concerns that the amount of beaurocracy neccesary to manage a nationalized health care system here in the US would be staggering. I'm not involved in the field in any way, so I don't _really_ know what I'm talking about, but the engineer in me looks at a system that complex and lets out a curse word beneath my breath.

This also applies to almost everything else the federal government does. I feel like we'd have been much better off staying a loose confederation of states. They're small enough to be able to pull off something like this.

If three or four major insurers can handle the current system, why wouldn't the government be able to take on that role? It already handles much bigger systems, like transportation.

For some definition of "handles", sure.

Most of our transportation is actually handled by local/state departments. The Federal govt just gives the states money to keep the interstates from falling apart.

Libertarianism is distributed computing applied to economics.

Distributed computing is a waste when you already have a supercomputer available for your exclusive use.

I dunno, Google's strategy of using a lot of off the shelf hardware as opposed to supercomputers seems to be paying off well.

This seems rather off topic.

From the guidelines:

    On-Topic: Anything that good hackers would find
    interesting. That includes more than hacking and 
    startups. If you had to reduce it to a sentence, the 
    answer might be: anything that gratifies one's 
    intellectual curiosity.

As a hacker and nerd, I'm acutely fascinated by unintended consequences that arise in complex mathematical systems. My interests in economics and programming stem from this fascination.

The article isn't saying "we should do health care like ze germans cuz they got it rite hurrrr". It's saying, "Hey, look at this interesting effect of their policies, which everyone in the debate in the US seems to completely miss."

That being said, I don't want HN to be a source of American health care debates any more than you probably do. I'm bored by the pedantics of it all, and I actually live here.

I saw your comment had been downmodded, and I clicked the ^ to bump it back up. It's an edge-case, and not fair imo that you should lose karma over expressing that opinion. However, if you really feel it's off-topic, you should probably flag it instead of posting a one-liner complaint.

I'm more concerned that this is a single anecdote. If it was an explanation of the fascinating government subsidized insurance model that the german health care system uses I would approve.

I disagree. The major consideration for staying at my current job is the health insurance benefits. I carry the health insurance for my family. So it's a large expense that I must consider when starting up my company.

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