In the US a huge part of your premium is for liability to buy lifetime medical care for anyone you may injure. In other words, the extra cost of auto insurance should appear as a cost of the medical system.
In a lot of european countries that turns up in motor insurance premiums as well, since the public medical system will seek to recover the cost of treating people who are injured in accidents for which others are at fault.
(Admittedly, the cost of treating them may be less.)
Most European countries (not just EU ones) are in the European Social Security network: people can transfer benefits when they move or travel between them (some benefits such as unemployment can only be transferred for a move that’s planned as long-term, others such as healthcare travel with you). In Spain one of the big questions about Brexit was “hey! what happens with all those Brits in the SE coast?” (answer: most of them are already in our healthcare system, they’ll continue being in it). There isn’t a central bag of money to distribute but we all have access to the local system of wherever we happen to be.
That makes no sense, the cost is the same no matter who is at fault. Are you thinking that if a person is declared to be at fault, they have to pay for the other person’s treatment?
Well, their insurer has to pay. In some countries.
It depends on the model used, but in some countries public healthcare is funded through what is essentially an insurance scheme (and may have emerged out of an actual, privately run, insurance scheme). In general, if you’re insured against a particular risk, and the risk befalls you, and your insurer pays out, your insurer steps into your shoes as regards any right you may have against anyone else in respect of the risk that befell you. So, if you incur medical expenses in connection with an insured risk, and your health insurer pays those expenses, your health insurer now has any right that you would have had to pursue someone else for those medical expenses. Such as the guy who, through his negligent driving, ran you over.
You’re right, it all costs the same in the end. The question is where that cost is ultimate to fall - on the pool of contributes to the social insurance scheme, or on the pool of contributors to the motor insurance scheme? That’s a policy decision; you could argue in favour of either answer. But if you take the view that the external risks associated with motoring should be born by those who create the risks by driving motor cars, then the answer is that the health insurer should be entitled to recover from the motor insurer.
In Germany, and from what I guess, in most European countries, People who want to drive a Motor vehicle are required by law to have insurance in case they injure somebody, because it’s a heavy mass moving at high Speeds. Whether the medical insurance will then, as matter of normal procedure, sue the Drivers liability insurance, and the whole Thing end up in court to assign percentages of blame, is not automatically linked to national health Systems (there are different variants in different EU countries) or private ones like in the US.
No, I’m not saying that at all. I’m saying it’s difficult to compare because there are so many variables.
I understood your post Nr. 19 http://boards.straightdope.com/sdmb/showpost.php?p=20064977&postcount=19 to make a broad sweeping Statement from two data Points - one in Europe, one in an unnamed US state - and I have a Problem with that because it’s not a good comparison or Statement.
I thought the Big Mac index is intended as a starting Point to better compare at one glance (like back of the envelope) cost of living, because comparing Exchange rates is useless for that purpose.
But it’s only a glance. How many % of the Population eat at MacDonalds? How often a week? How many other alternatives are available - in Germany, People love Currywurst and Döner Kebap at least as much, if not more, going by the millions of pieces sold each year. Is there a strong culture (like Italy and France) of cooking at home instead of eating out? Eating out fast Food or real but affordable Restaurants? (I always find the Prices quoted in discussion about US Restaurants incredibly high. An average middle class Italian style Restaurant, one main dish, one drink per Person is about 15 Euros in Munich).
Actually, yes? Depends if the health System is set up to receive payments like These, or if the health insurance is required to recoup their Money.
What I commonly read about is when two cars collide, so both Drivers are injured, and automatically both sue each other. Sometimes, fault is 90 to 10%, sometimes it’s 55 to 45%, depending on who made how many and what mistakes, or if it was unpredictable accident, but that’s Germany with several Insurance companies. I don’t know how e.g. the NHS System in the UK handles this.
Um, you do know that Boss is a luxury brand? I really wouldn’t expect it to be cheap! You could try the direct outlet, though - I remember my father making a detour especially to get some suits when we passed through during a vacation. (There are guides to factory outlets in Germany where you can get products up to 30% cheaper).
The VAT, as a flat tax that therefore proportionally hits poorer People harder, is part of a whole System, along with income tax, that is graduated, or wealth tax, that hits only rich People (though we’ve abolished that, sadly).
Higher Prices can also be a result of higher wages (I don’t know if Boss produces in the US, or imports) because the employer has to pay social insurance Portion (I also don’t know if the employers part of the social insurance in EU is higher than the US, because in the EU it’s %, but in the US ist $ and apparently varies from one employer to the next. But most employers everywhere complain about paying too much, so grain of salt, too?)
What? When? In June, during Tourist season? Granted, I haven’t tried to rent a room, I only see the Prices when I drive past - but even the cheaper chain Hotels, or the ones far outside with 30 min drive to the City Center usually are about 100 Euros per room / night. (And given that December is Christmas market season, May starts Tourist season, September is Oktoberfest when everything is booked out and Prices are tripled… there is limited off-season in Munich, I think.)
I don’t think the thinking behind the big mac index is that people live off big macs, or analagous products, either in the US or in the EU. Rather, the big mac represents a basket of some staple commodities (wheat, beef), a standardised unit of relatively low-skilled labour, and a standardised amount of rent of commercial premises of a comparable quality internationally. Thus it represents a basket of staples that can function as a quick-and-dirty comparator for cost-of-living (or, if expressed in terms of average wages in each country, standard-of-living) between countries.
I could say the same the last times I went to the UK: before the Euro, the Mark was about 3 to 1 Pound, now it’s officially 1.5 to 1.3 Euros. But when Shopping, the Prices are about 1 to 1 (although different brands). I assumed as an Island, they Import more Food.
Similar to how in Austria, Food costs about 20% more than in Germany - more mountains, less place to grow Food, more Import, more expensive. France, Italy and Spain spend more part of their personal Budget on Food, because they value the Quality instead of buying cheap-cheap mass produced meat etc. at ALDI, Lidl and similar. So even in the EU, it’s partly apples to oranges.
One Group of economy students got some flak several years ago when during discussion of poverty and that the Hartz IV (welfare Money) paid to People didn’t cover enough Food, they calculated that 1/3 of the Budget could buy enough Food … if you shopped only in East Germany (lower Prices) and only bought knock-Offs, and only cheap Food. (The flak was because what they choose was students diet, not healthy: too much sausage, no veggies. That was cheaper).
Which is another factor: inside the same Country, some cities like Munich, Berlin and Hamburg have expensive rents, which drives up all the other costs-of-living, too, including supermarkets. In other Areas, unemployment is high, so stores have to lower Prices in order to sell anything.
I thought the Point was that MacDonalds adjusted the Price so that People in the Country can actually afford it, after what the normal cost calculation Ends up with? Because I’m not sure that McDonalds, as multinational Company, buys locally, feels obliged to, wants to, etc. The only local effects are the Price of labour* and the rent for the building (which can vary if different countries have different building codes).
*I’ve once heard that going to a McDonalds is an indicator of the state of the employment market:
if only Turks, that is foreigners/ immigrants, are behind the Counter, then the market is so good that the natives can find employment elsewhere.
If only White natives are behind the Counter, the market is so bad that they push out the immigrants. Don’t know how much that applies to other countries.
Teenagers, eg., don’t generally work at McDonalds. They are expected to go to School and learn, that’s their Job. If they finished School, they are either at University and no longer Teens, or they should start an apprenticeship to learn a Profession.
I wouldn’t blame that on tariffs alone, though: Tons of Maple Sirup were stolen (okay, only once but still…) 5 Crimes That Only Cause Endless Unanswered Questions | Cracked.com and a lot of Food is counterfeited http://www.cracked.com/article/113_6-fake-foods-you-will-wish-you-didnt-have-in-your-kitchen/ or faked http://www.cracked.com/article_19896_the-6-creepiest-lies-food-industry-feeding-you.html
Because once an industry makes a lot of Money, criminals come along.
Like US states, it varies between the EU countries, but in several countries, there is Minimum number of hours at a professional driving School required, before you take a written and practical test to get your Drivers Permit.
What has recently been introduced in Germany is a learners Permit for 17 year olds who have an experienced Driver (mostly a parent) next to them for a year, because things like sliding out of control, judging Speed and distance when overtaking, Need a lot of experience.
As most car Drivers will complain, a large part of the gas Price is taxes - still not enough to pay for all the infrastructure (road repairs etc.)
One aspect is that comparing one specific EU state to all of the US doesn’t work because of size. Therefore the usual comparision in the last decade has been the whole EU with the US, because that similar in Terms of Population, GDP etc. And although the EU is a federation of countries, and the US a Country with states, it’s still similar in some ways, because US states have a lot of leeways individually, ending up very differently, and the EU has several programs that affect more than one member - Nava mentioned that as side-effect of unrestricted mobility, health Service travels across all EU countries. I no longer Need a private foreign Country health insurance for my vacation as Long as I stay in the EU, my health insurance Card has the Standard EU form printed on the back. (Luckily, I haven’t gotten around to trying it out yet.)
The nice aspect I think is that because different EU countries have different Systems, you can compare and contrast which works better. If however, both the total EU number, and every single EU Country, has better indicators for health (patients side) and lower costs compared to the US, there is something beyond coincidence.
I’m just going to pop back in here for a minute to suggest that all these discussions about different costs of living, utilization levels, and other cost drivers are really a red herring that seems to be diverting attention from the elephant in the room, which is the simple fact that the mainstream funding of health care in the US is treated as a commercially insurable, risk-rated commodity subject to the vagaries of the marketplace. I tried to describe upthread the reasons that this is so costly and problematic, and others as well have mentioned this fundamental difference from all other countries.
Most of the other cost factors being discussed don’t amount to a hill of beans in comparison to the failure of this fundamental paradigm. Keep in mind that US costs are a complete outlier compared to everywhere else, multiples more than elsewhere, not just a few percentage points. The various extraneous factors that were brought up here are either minimal or completely irrelevant. Higher medical utilization in the US? For sure, but without benefiting outcomes, and mostly driven by legal factors – yet studies have shown that advocacy of tort reform is misplaced because neither over-utilization nor malpractice settlement costs are a significant component of overall health care costs. And in many cases some types of utilization are actually higher under UHC systems – for instance, patients tend to stay in hospitals longer because there isn’t the insurance-driven incentive to kick them out of those expensive rooms as soon as possible. Also, while I don’t recall seeing hard data on this, it certainly seems reasonable that people might be less reluctant to see their doctor if there is no out-of-pocket co-pay associated with it. Indeed the whole purpose of a co-pay is to try to limit utilization, and many single-payer systems forbid co-pays altogether. So the utilization argument is a mixed bag.
Same goes for other factors. Sure, many local costs vary and salaries vary a lot, but in the great scheme of things it doesn’t change the costs nearly enough to account for this dramatic difference. The most sophisticated and expensive equipment like high-end diagnostic imaging or surgical robotics is sourced from just a relatively few places that serve global markets. North American hospitals may have equipment from Siemens and Phillips or European hospitals may have equipment from GE Medical. It’s expensive stuff and it makes little difference where you are.
The difference between health care in the US and elsewhere is astounding for those who have experienced both. “WTF is all this?” pretty much sums up the impressions of new arrivals accustomed to straightforward UHC. Paperwork, phone calls, more paperwork, arguments, more forms, denials, changes in drugs and treatments demanded by the insurer, etc. etc. Back home these folks just went to the doctor or the hospital, got something done, and went home. Do not underestimate the many hundreds of billions of dollars that this administrative nightmare drains from the system. Putting direct and indirect impacts together, it’s the fundamental underlying cost driver. Not just the administrative costs alone, but the uncontrolled escalation of provider fees to cover all those costs and drive profit at the same time.
Nicely summed up I think, but you missed one important point. In a UHC system, the incentive for providers is to keep costs down and move patients on. In the US system, providers are encouraged to do unnecessary tests and procedures; partly to cover every possibility (for fear of being sued) and partly to bump up revenue.
yeah, just a regular June weekend, nothing special see here..
However I’ve personally used this hotel and others in the chain at busy tourist times (New year, Christmas, Easter, August) and the most I’ve ever paid was the equivalent of £72.
How exactly does co-pay work - you pay a flat fee to see your doctor, or you pay a part of the total cost for every item?
In Germany I remember a back-and-forth about paying a small fee for the doctor, which was (of course) bad for the patients, but gave good data for the health insurance experts (Good in the sense that the hard data proves why it’s good to do things this way and not that way).
Originally, that is, back in the 80s, we had one General doctor. If we needed a specialist, we would go to the General doctors practice and get a referral form (Datei:Überweisung.gif – Wikipedia) for that specialist, for that quarter. If the Treatment continued, we would Need a new from for the next quarter (that is, March is still 1st quarter, but April is 2nd quarter of the year).
We didn’t always have to talk to the doctor himself; if it was a known issue, like having glasses and getting your yearly Check-up at the eye doctor, you just told the secretary to fill out the form, but it was still an extra date.
Then, in the interest of cutting unnecessary paperwork causing costs for the doctors practices, and acknowledging that patients might be mature enough to find out an eye-doctor on their own, somewhere in the 2000s, the referral forms were done away with, and People could go and see a specalist directly again.
Then, politicans started talking about exploding costs and saving Money in the health System (Sound familiar?) and doing away with all the “unnecessary doctors visits by lonely old People who just wanted to talk to somebody or were hypochondriacs”. All Experts told them that early checkups cost far less than delayed Treatment*, but were ignored. So from 2004 till 2013, patients had to pay a fee of 10 Euros (Praxisgebühr) Praxisgebühr – Wikipedia to see their doctor, per quarter. The doctors complained that writing a receipt, booking that Money, transferring it was more hassle than the income, and that poor People (often elderly) would be kept away; also, if you went to your General doctor, paid the fee, you could get multiple referrals to all specialists, but a specialist could not refer you to anybody else. So People lumped their Check-ups in one quarter, and General doctors had much more work to do.
When it was finally abolished again, data from all health insurance companied showed that the expert’s prediction had come true: it had cost everybody, patients, doctors Offices and health insurances through delayed Treatment, much more than it brought in, and produced no measurable benefit in the other direction (that is, weeding out the “unnecessary visits from old People or hypochondriacs”).
- For decades now, both the state paid for several Screenings and preventive measures, and indidvidual health insurance companies paid bonuses to Clients who took part in preventive measures, because the data showed that it’s cheaper in the Long term.
E.g. my health insurance provides now a Service via Internet to remind People to set a date for those Check-ups. The insurance wants People to go to the doctor, not because they bill them for it, but because it’s a good idea. (Each Client pays a fixed percentage of their income each month, regardless of how many or few doctors visit they have. )
This https://www.tk.de/tk/bonusprogramm/tk-bonusprogramm/massnahmen/140976 is a list of what activites per 12 month gets Points - cancer Screenings, dental Check-up, maternal Check-up, but also being a member of a sports Club or participating in a sporting event; those Points can then be converted into cash. This is voluntary by the health insurance, not prescribed by law.