You mean, $30,000 to $40,000, the median cost in the US, nearly all of which would be covered by insurance. No sense in fabricating magical numbers, like a multi-million dollar bill, everyone knows the flaws in the US system as is.
It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.
It's not paid by taxes but by health insurance. We have both a private and a semi-public system (managed by "Krankenkassen", independent insurance entities, that compete for members; it's... complicated, but less so than in the US, and it does not depend on the employer).
Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).
I don't know if I would understand the German "insurance" system from that explanation. Maybe to complement your explanation another try at it:
Germany has two insurance-like systems to pay for medical treatments:
(1) insurances, with fees aligned with damage risk associated with the policy holder.
(2) a system of "funds" that provide insurance benefits for insurants, however, are not organized like an insurance.
The system (2) is quite old (dating back to the 19th century) and has a few peculiarities:
* fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others).
* half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck.
* family members can be insured, too, without increasing fees.
* fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc.
The alternative to this fund are insurances that work on a risk-based pricing scheme - item (1) in the list:
* in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe).
* pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc.
* for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above.
For both systems, treatment prices are kind of fixed (as a rule of thumb, doctors can charge the insurance a bit more than the public funds, by a constant factor of 2-3, but I heard from doctors that this depends on the treatment).
If I read this story correctly the other day, giving birth to premature twins in the US can max out your $2M insurance cap and leave you with $450k of medical debt to boot:
back of the woods in Europe, the same would cost you nothing.
Sure, it would be much cheaper when one or more patients doesn't survive in the first place, for example.
Keep in mind that story is a donation appeal and is weak in details -- for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) The article also misstates ACA numbers.
> for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?)
Yes, of course it would. Stop believing the myth that Europe just kills people when they get too ill.
You are splitting hairs. "people/companies who pay into the German universal health insurance system" are effectively being taxed, whatever the wording is.
No, they are insurance membership contributions in Germany. The contributions are specifically used to finance the health system, here the specific health insurer.
Taxes generally are not paid for a person, but for things and values, etc.. Taxes are also not bound to a specific purpose, but are going into the general budget of the country/state/town.
Taxes and insurance fees are different finance models. In Germany there are basically three types of financing for services: 'Steuern' = taxes , Gebühren = fee, Beiträge = contributions.
In Germany the health care system is based on 'Beiträge', i.e. membership contributions to a health insurance.
Public -> pays to general government budget -> government pays to health care services
vs.
Social Healthcare Insurance (example: Germany)
Employer + Employee + self-employed + Students + Pensioner -> pay to Private/Public Sickness funds/Insurers -> Sickness funds/Insurers pays to health care services
You cannot leave at "any time". To qualify, you need to have an income of over 59k € or be a freelancer. For most others (which is most of the population) private insurance is not possible.
You can however purchase additional insurance on top of the public one.
In International discourse and comparison (e.g. those done by the OECD) most of those typically run under the label "taxes". The German distinction doesn't translate well into other systems.
It should be noted that (based on the vague description from the article) her insurance probably got compensation payments from the federal government for her insurance (if it was in fact free through her husband).
> Most universal health care systems are funded primarily by tax revenue (like in Portugal[24] Spain, Denmark, and Sweden). Some nations, such as Germany and France[25] and Japan[26] employ a multipayer system in which health care is funded by private and public contributions
> Vorweg ist anzumerken, dass die in Deutschland vorgenommene Trennung zwischen Steuern und Sozialabgaben in vielen Staaten nicht üblich ist. Daher verstehen internationale Organisationen unter dem Begriff „Steuern“ („Taxes“) in der Regel die Summe aus Steuern und Sozialabgaben und behandeln die Sozialabgaben („Social Security Contributions“) als Teilbetrag der Steuern.
> Tax-Based Financing for Health Systems: Options and Experiences
> social insurance, private insurance and general taxation
Social insurance is the German model.
> By contrast, Germany's policy to combine its sickness funds into a social health insurance system -- generally credited as the first effort to enact universal health insurance coverage -- dates from the second half of the 19th century.
> Current Trends in Health Insurance Systems: OECD Countries vs. Japan
> There are three major types of social health-care systems: social insurance systems like Japan, France, and Germany, tax-based system like the United Kingdom and Sweden, and the United States—limited service to the elderly or disabled, called Medicare (Table 1).
Again, Germany has a social insurance system, not a tax-based system.
While it certainly makes sense to discuss the difference, for a US-based audience it doesn't make much sense to pedantically point out that these aren't taxes. Social insurance contributions are mandatory, based on income, and to a state entity (though independent from the government) enforced through exactly the same channels as regular taxation (as opposed to private debt).
The important difference is that they are legally committed to a certain issue (in this case: health insurance) and can't be appropriated to something else. That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that.
That's simply not the case. It is exactly for an US audience important, because the German system is vastly different: universal health care, regulated by the government, 99.9% coverage, run by a system of 100+ insurers and various health care providers.
> Social insurance contributions are mandatory
Mandatory is to be insured.
> based on income
in a range, or if one is privately insured one pays based on risk/age
Family members (wife/husband + kids) without income are insured. Plus various other regulations.
> to a state entity
Krankenkassen and Krankenversicherungen are not generally state entities.
Would you call something like the Audi BKK a state entity?
> Krankenkassen and Krankenversicherungen are not generally state entities
They are state entities established by law (Körperschaften öffentlichen Rechts mit Selbstverwaltung) and have to follow the strict regulations of the public sector. They regularly issue Verwaltungsakte.
> Would you call something like the Audi BKK a state entity?
Yes, absolutely. It's a state entity that provides care for Audi employees, since 2010 for everybody (and they can't legally refuse members). Audi has absolutely no input on their inner workings, it's really just the name and the fact that they have many members working there (and thus provide special services for them). It's basically a historical quirk of how the German insurance system came to be.
> No, health care contributions are paid directly to the Krankenkasse/Krankenversicherung where one is a member, not the tax administration (Finanzamt).
The Krankenkasse (to be exact their Einzugstelle) is really just a Finanzamt for social insurance contributions. If you don't pay they have the whole range to force you that's
just available to state entities. See e.g. https://www.bundesversicherungsamt.de/fileadmin/redaktion/Kr... A private entity does not have these options and would need to go through general courts.
> Obviously not. In the health care domain, the Social Insurance systems and tax-based health care systems are different models.
They are different models (and should be contrasted) but both are financed through taxes (just different kinds). Yes, we don't call these "Steuern" in German but that doesn't translate 1-to-1 to other countries. "Abgaben" would be a much better translation for taxes.
Everybody is insured. If you can't work, you are insured. If you are ill and not employed, you are insured. If you are a baby just born, you are insured. If you are a student, you are insured - either through your family or on your own. If you receive social security payments, you are insured. Basically everybody, 99.9% of the population is insured.
If you are employed you pay to the health care insurance or sickness fund directly. Your employer also pays. The money is not collected by the tax authorities and is not administrated by them. Still it is public regulated system.
If you are privately insured, you pay directly to the private insurance company. This may provide additional services or a better quality.
OTOH if you are not member of a private insurance, then you still can get additional insurances from those. For example you can insure yourself privately for certain health care services if you travel to foreign countries.
In Germany we would only consider something to be a tax, if we pay somehow to the tax administration. For example if one is a member of the catholic church - which is voluntary - then one will pay 'Kirchensteuer' - 'church tax'. This tax is collected with ones usual tax payments, by the tax authorities - for the catholic church. If you are not a member of a church, like the catholic church (or some others), one does not pay this tax. If you are a member of a free church, then the tax authorities don't collect money for them. If you want to be a member, it is expected that you pay more or less 'voluntary' directly to them.
> I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances?
You could opt out of the public system, and get a private insurance company. But once you have done so you can never re-enter the public system. And private insurances are cheaper for young people, but significantly more expensive later in life, so much that you’ll end up paying several times more over your lifetime.
You can't opt-out completely. Some people (including probably most HN readers) can purchase highly-regulated private insurance instead but even that isn't possible for the vast majority of the population.
I don't really know what you are trying to say. If you are saying that health care in Germany in total cost is cheaper than in the US, then you are right. If you are insinuating that the system is infused with tax money, then you are wrong. It is completely financed by the premiums of the insured people. Not saying that the german system is without issue, but compared with the USA, it is lightyears ahead.
I'll take that over the multi-million US-american hospital bill, any time.