Havarti666 said:
What part of ""except for the funding of some benefits and the planning and financing of hospitals, the responsibility for administering and providing health care has been delegated to
non-state entities" don't you understand? And why would German doctors turn patients away if 99.7% of the country has health insurance?
And "price controls" exist everywhere there are third party payers. Unless you're running a strict fee-for-service practice, you're going to be at the whim of reimbursement contracts with Medicare and/or one of the eight gazillion insurance companies in this country.
From
German Culture:
Some 92 percent of Germany's residents receive health care through statutory health insurance, that is, the GKV. As of late 1992, the GKV relied on about 1,200 nonprofit sickness funds that collect premiums from their members and pay health care providers according to negotiated agreements. Those not insured through these funds, mostly civil servants and the self-employed, have private for-profit insurance. An estimated 0.3 percent of the population has no health insurance of any kind. They are generally the rich who do not need it and the very poor, who receive health care through social assistance."
So they've got a system where there are
1,200 "sickness funds" collecting premiums, a portion of the population with private for-profit insurance, the uber-rich who pay for their own care, and the uber-poor who are cared for by social assistance. Doctors are reimbursed by pre-negotiated contracts, and premiums are subsidized by employers. No, it's obviously not the same as our system, but there are a few eerie similarities. And if you think there is no choice in the matter, read on:
Sickness funds are divided into two categories: primary funds and substitute funds. Workers earning less than the periodically revised income ceiling are required to belong to the primary funds; those earning more than this ceiling may be members on a voluntary basis. Some primary-fund members have a choice of funds. Others do not and become members of a particular fund because of their occupation or place of residence. According to figures from the Ministry of Labor and Social Affairs for late 1992, of the six types of primary funds, local sickness funds, then about 270 in number, are the most important. Organized geographically, they supply about 46 percent of the insured workforce with health insurance. About 800 company-based funds, located in firms with more than 450 employees, cover about 11 percent of workers. Some 180 occupational funds organized by craft cover another 2.5 percent. There are three other kinds of primary funds (about two dozen in all); they supply insurance for self-employed farmers, sailors, and miners and cover about 4 percent of the workforce. There are also two kinds of substitute funds; they provide health insurance to white-collar and blue-collar workers earning more than the income ceiling. Substitute funds are organized on a national basis, and membership is voluntary. Such funds cover about 34 percent of insured workers.
Contrast this, at least, with the classic (not the nuvo private) UK system, which is primo socialized medicine. The government actually owns the healthcare infrastructure and directly employs the providers. Everyone is automatically covered from birth and out-of-pocket expenses are minimal. Granted, it's like getting healthcare from the DMV, but that's the difference between state entity bureaucracy and non-state entity administration.
The "government mandated" part isn't as simple as I made it out to be earlier (see above). Even if it were, using your logic every mandatory expense in life is no different from a tax. Now excuse me while I pay my rent tax, food tax, clothing tax and transportation tax. If I'm in a car crash I'll be shelling out my emergency room tax. If I get leukemia I'll be paying some chemotherapy tax. You're correct that the money always comes from the consumer, but there are vast disparities in how it is allocated and how efficiently it is utilized. That is the difference.
What part don't I understand? Don't be a jerk.
Frankly, I'm not following your logic. Those expenses you list are not mandatory. You can decide if you want to live in a palace or under a bridge. You can decide if you want to grow your own food, eat a McDonalds, or Mortons. If you get leukemia you can decide if you want to pay for treatment or not. This is a bit hyperbolic I know, but my wife and I make these kinds of choices for our family every day, not at these extremes but on a continuum in the middle. If the government mandates that we pay for something, we don't have a choice. We have to pay what they tell us to pay, not more, not less, AND we have to accept the product(s) that they provide. It is no different from a tax. The others are different from a tax. I don't understand why you don't see it that way but that remains my view.
Price controls generally do not exist is US medicine. We have negotiated rates for services, but doctors are free to tell insurance companies to take a hike if they don't like the fee structure. Likewise, many practices do not take medicare patients, or limit the number they accept, usually to patients they have been caring for before they went on medicare. Are US doctors under price pressure? Yes, every business is. Are they under price control? No, they are not. This is the essence of a free market.
Why would doctors turn away patients if 99.7% of the patients are insured? Simple, because they don't get paid enough by those patients. Of course in Germany the doctors don't have the choice to turn a patient away. This is why German doctors are striking. Since German Culture site is becoming the standard reference for this discussion:
"Portability of coverage, eligibility, and benefits are independent of any regional and/or local reinterpretations by either insurers, politicians, administrators, or health care providers. Universal coverage is honored by any medical office or hospital. Check-ins at doctors' offices, hospitals, and specialized facilities are simple, and individuals receive immediate medical attention. No one in need of care can be turned away without running a risk of violating the code of medical ethics or Land hospital laws."
As you can see, a physician has no choice but to accept a patient and whatever insurance they have. Which is why they get paid so little. They simply cannot say no, so now they are striking.
As for the non-state entities, here is what the German Culture sites says:
"In 1913 doctors and sickness funds established a system of collective bargaining
to determine the distribution of licenses and doctors' remuneration. This approach is still practiced, although the system has undergone many modifications since 1913."
This certainly sounds reasonable on its face, but it isn't. Remember, doctors cannot turn away patients therefore the cost of a service immediately becomes the lowest price any one of those non-state entities is willing to pay. There is no negotiation in good faith. Since patients can get the same care regardless of which plan they go with, they will choose the least expensive plan. This has the net effect of governmental wage controls and price controls, and rips the heart out of the free marketplace.
I'll leave you with this thought from the German Culture site:
"The right to health care is regarded as sacrosanct. Universality of coverage, comprehensive benefits, the principle of the healthy paying for the sick, and a redistributive element in the financing of health care have been endorsed by all political parties and are secured in the Basic Law."
Is this social medicine? No, strictly it's fascist medicine, that is, governmental control over private enterprise, but I think you could split a hair with the difference.
