Anyway, donated some money, really wish he gets all the help he needs.
* US: According to the World Health Organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008. The United States had the fourth highest level of government health care spending per capita ($3,426).
Source:
* http://en.wikipedia.org/wiki/Healthcare_in_Germany
* http://en.wikipedia.org/wiki/Healthcare_in_the_United_States
USA has made the enourmous mistake of making of health a large business managed by private corporations that dont care about human life. Just money. Other countries see health as a right (luckily thats the case here in Argentina). So, most medics dont get super rich. They work for a salary, they dont get 30 or 50 grand for a surgery. But they still do their job, they work hard and they give their best (well, most of them). Because when you choose that kind of profession, its not for making lots of money, but to help people. Or at least, thats how it should be, and I'm absolutely sure that there are lots of medical doctors there that think this way, but they are just the little fishes inside a pool full with big sharks.
I feel sorry for you USA, because you lost it and you wont get it back. There are lots of interests against it.
There's not political will, there's not professional will (AMA anyone). Sometimes, from the outside it seems like there's not even a cultural or popular will. A few months ago I discussed this with an American friend and he was totally against universal health care. His argument was something like "why should my taxes pay for some random unemployed or most probably lazy man's health" "if he gets free health care he won't work as hard" "if i make more money why should he have the same benefits as me?" And my answer "because he's a human being too"didn't seem to help.
You said it yourself, 17/18 % of the biggest gdp in the world and still cant take care of all of your people. Think about it. Just imagine what you could do with that money in a different system.
Seeing this kind of things happening there I can only think about the USA, as a strange place. Home of great technological progress and sad social regress.
Dont take it personal.
The position that the USA "lost" the policy of "health as a right" is nonsensical, because it never previously possessed it in its 236 years of existence. You might want to try a different narrative archetype.
I wasn't aware that a government-sponsored healthcare system this old existed in the world, because it's always seemed to me that such programs are fundamentally unsustainable.
So what I want to know is, how do they keep it sustainable? For example, if there's no longer a market where demand responds to price signals, how do they determine how much procedures cost? What keeps providers from increasing prices 5% every year, regardless of cost increases, until they're essentially looting taxpayers' money on a massive scale? If the government sets prices, how do you avoid damaging shortages or surpluses when it gets the pricing wrong? How about moral hazard -- the problem of people who waste healthcare resources by going to the doctor for every little sniffle, scrape and twinge since it's free? What keeps people in other countries who don't pay into the system from getting a burning desire to move to Germany when they find out they have something really expensive to treat like cancer or AIDS?
Moral hazard doesn't seem to be a large problem with hospital services (doctors aren't going to order an unnecessary surgery), and there is a strong culture against unnecessary prescription drugs. So about the worst that can happen is someone wastes their local physician's time 30 minutes at a time. Since small-time office visits aren't where most of the healthcare costs go (in either Denmark or the U.S.), it's a minor concern. As far as foreigners, that's a concern, and handled by the immigration system (you probably won't get a visa if that's the reason you're trying to enter). The main current concern is intra-EU system-shopping of that sort from Europeans, who don't need visas. There are attempts to standardize something around that (the EU "blue card" scheme is one), but it's one of those awkward areas that showcases the EU's quasi-integration. There is also a debate currently about whether Denmark should start charging tourists, since it's one of the few countries that provides completely free emergency care to anyone. Many see this as the right thing to do: if a visitor is injured in a mugging, for example, some people view charging them for the hospital visit as adding insult to injury, like sending them a bill for the police investigation would be. But there is also annoyance that other countries don't reciprocate, so a little bit of a sentiment of, "well if the bastards are going to charge me for getting mugged in NYC, let's charge them when they come here".
There's not much change if you look at the severity of need for meds either - many organ transplants fail because people don't comply with the meds.
I've also heard a theory that this isn't a bad thing: IIRC in Japan there's a culture of going to the GP for every tiny little thing, which means that they have a massive number of 5-minute visits - but potentially serious illnesses are spotted and cured before they become serious, which means that overall health costs are lower and results are better.
Further, if you spread the risk of getting ill across a whole nation, paying for health insurance gets cheaper for each individual. You cannot have that with a health care market.
Anyways, your questions concerning sustainability are valid.
There's a catalog about how much health care providers get from insurance companies for each procedure. I don't know who sets up that catalog or how it is negotiated, though.
Recently, a (small) fee has been added which you have to pay once per quarter if you visit a doctor. Further, you have to pay a small amount (~$5) for each medication you buy (unless you need a lot of it). So, people don't visit the doctor and buy medication that easily (anymore).
People who have not paid into the system are only treated for acutely life-threatening symptoms (and even then have to pay for themselves). To pay into the system, you usually need to have a job, so it's not something that you can just do once you see you have a costly illness.
What is it about them that seems unsustainable to you? Are you an economist or an accountant? Do you have a citation to back up this point of view?
Here's a recent one against it: http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&#...
> I wasn't aware that a government-sponsored healthcare system this old existed in the world, because it's always seemed to me that such programs are fundamentally unsustainable.
They are not fundamentally unsustainable but Germany's current social system is unsustainable and will eventually fail because the demography and economics have undergone massive changes since it has been designed.
> So what I want to know is, how do they keep it sustainable For example, if there's no longer a market where demand responds to price signals, how do they determine how much procedures cost?
We do have a market in which insurance and health care providers negotiate prices and as you can see not only does this work it works a lot better than the US market does.
> What keeps providers from increasing prices 5% every year, regardless of cost increases, until they're essentially looting taxpayers' money on a massive scale?
Health care providers can't set arbitrary prices and insurance providers are regulated. Also insurance is mandatory but not paid for from taxes unless you don't have any income. The mandatory social insurances, of which there are four, all get paid a certain amount relative to your income.
> If the government sets prices, how do you avoid damaging shortages or surpluses when it gets the pricing wrong?
See above. The government doesn't set the prices.
> How about moral hazard -- the problem of people who waste healthcare resources by going to the doctor for every little sniffle, scrape and twinge since it's free?
You want to detect serious stuff early to keep the costs down, so to a certain degree you want that to happen. Apart from that there is a small 10€ fee you have to pay once every quarter for each doctor you visit unless you were referred to him by another doctor. This keeps moral hazard down and especially prevents unnecessary visits to specialized doctors.
> What keeps people in other countries who don't pay into the system from getting a burning desire to move to Germany when they find out they have something really expensive to treat like cancer or AIDS?
Like moral hazard this is not such a big issue as one might think it is. Most people tend to be reluctant to make such big moves, especially if they don't speak the local language which applies even more so if the topic they would like to talk about is their health. Apart from that there aren't that many countries in the world with a health care system as catastrophic as the one in the US.
More importantly though the people who do actually move to Germany for treatment tend to have lots of money and have no problem spending it on their health. So these patients are flown into the hospital using the dedicated helipad, on top of the luxury ward, in which they wait for overpriced procedures and get their overpriced medications.
The German government covers 77% of its citizens health care costs. The US government covers 48%.
In countries like Germany, I am sure that 77% number is evenly distributed across the population. I.e. All citizens are mostly covered by government insurance. In the US, I am sure the number is disproportional to the elderly and on government assistance, such that people between 20-60 are not covered by any government insurance. So it's a bit more lop-sided than the Wikipedia chart says.
[1] http://www.oecd.org/health/healthpoliciesanddata/oecdhealthd...