Healthcare - Which System Do You Support?

Raz0rRaz0r Did you really just write that?Joined: Posts: 25,824 ✭✭✭✭✭ OG
edited March 14 in General Discussion
For whatever reason, health care is a touchy subject in the USA. Actually, several western countries in the world. U.K, Australia, and Germany come to mind but each has totally different reasons. Let's just focus on the USA.

To start, just know there are about four basic health care models in the world. They are:
  1. The Beveridge Model

    Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

    Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

    Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.
  2. The Bismarck Model

    Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.

    Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

    The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.
  3. The National Health Insurance Model

    This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

    The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

    The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.
  4. The Out-of-Pocket Model

    Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

    In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

    In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care.

To get this out of the way: The United States is the only country in the world with fragments of each system, causing different classes of patients, and thus is quite ineffective.

This is important to note because we tend to piecemeal shit together instead of following one specific plan and that sorta fucks us up when trying to deliver shit. It all becomes needlessly complex so much so that laypeople cannot understand the system they are participating in. And for the first time since the Second New Deal are Americans ready to do something new about health care, we just don't know where to go.

So please, tell me which you think is the best option and why.

Myself? I like the Bismark model. I've seen it work very well in France and Belgium. The countries I've seen with it who are struggling (Japan and Germany) are doing so because of a declining young population. Since Americans like fucking so much and popping out kids, we should be fine with it.

Healthcare - Which System Do You Support?

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  • NeverYouMindNeverYouMind Joined: Posts: 719
    The Bismarck Model
    I like the Bismarck model, but the U.S. is too large and varies too greatly by state to implement such a model effectively. Not to mention that lobbyists and corporate interests would do anything to sabotage the implementation of such a model. The only downside is controlling which treatments are necessary and the urgency of need for operation. Major hospital emergency rooms are already filled up with a great deal of waiting involved. It would also be a new frontier for the liberal humanitarian and sex reassignment agenda, which would be 100% surefire way to piss off 50+% of the population. On the flip side, Veteran Affairs, Medicaid and Medicare and all that other business could be drastically reformed in the process.
  • VASagaVASaga Not Yet Strange! Let Them Wait Joined: Posts: 1,607
    The National Health Insurance Model
    I like America's Next Top Model.
    "I must have ascended to a higher plane of thinking than most because I play Dr Strange"
  • Brightside6382Brightside6382 It can't be helped Joined: Posts: 950
    The Out-of-Pocket Model
    Not being poor is the best healthcare.
  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    That out of pocket model wouldn't work in the US. We're not gonna go back to house visits and not using the technology we currently have.
    This is offensive.
  • IdunoIduno ...what to put here Joined: Posts: 5,299
    The Beveridge Model
    Just to point out on the Beveridge Model.

    Since the government decides what drugs/treatments are paid for people do sometimes still have to incur costs for healthcare when what they need hasn't been approved by NICE (our body which decides what can and can't be provided on the NHS), seems mostly to happen with drugs which can extend a patient's lifespan but not actually cure them.

    Still beats the American system though, at least most of us only worry about time away from work if we're sick or need surgery and not doctors bills or insurance as well.
    “It's now very common to hear people say, 'I'm rather offended by that.' As if that gives them certain rights. It's actually nothing more... than a whine. 'I find that offensive.' It has no meaning; it has no purpose; it has no reason to be respected as a phrase. 'I am offended by that.' Well, so ****ing what."
    -Stephen Fry

    "I know crackheads that could sneak into a house better than an 8th century shinobi."
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  • crucadescrucades Its a Kinda Bullshit Joined: Posts: 11,465
    The Beveridge Model
    Enjoy it while it lasts Iduno since the torys are hell bent on destroying it and giving us the same horseshit the americans need to suffer with.
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  • d3vd3v Coughing DAT PINK SPIT Joined: Posts: 36,748 mod
    The Beveridge Model
    As someone who got screwed over and currently owes around 20k in health/hospital bills, I'd prefer either Beveridge or Bismarck, preferably the former.
  • ParryAllParryAll Dangerous Posts Joined: Posts: 3,311
    edited March 15
    Other (I'll explain in a post)
    I don't believe Razor actually wrote that. He's never written more than a sentence and acts like a child despite being at least 40 years old.

    Anyways I support the Pool System.
    "Third Strike just has that flow which somehow alienates you from your surroundings and really plugs your brain into the match your playing and your able to comprehend so many different situations and mind games and mixups in such a limited amount of time and all this without even thinking" - Nubilous

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  • IdunoIduno ...what to put here Joined: Posts: 5,299
    The Beveridge Model
    crucades wrote: »
    Enjoy it while it lasts Iduno since the torys are hell bent on destroying it and giving us the same horseshit the americans need to suffer with.

    Its ok, it's not like Labour has a total hack in charge right now who won't stand a chance against the Torys next election...

    Or that the Lib Dems are still useless after they sold out and self destructed in the coalition...

    ...Fuck, NHS was good whilst it lasted.
    “It's now very common to hear people say, 'I'm rather offended by that.' As if that gives them certain rights. It's actually nothing more... than a whine. 'I find that offensive.' It has no meaning; it has no purpose; it has no reason to be respected as a phrase. 'I am offended by that.' Well, so ****ing what."
    -Stephen Fry

    "I know crackheads that could sneak into a house better than an 8th century shinobi."
    -Jimmy1200
  • OceanMachineOceanMachine ROCKET LAUNCHER GOD Joined: Posts: 9,763
    The Bismarck Model
    Saying France follows Bismarck model is not totally accurate since it still has more public than private hospitals and the system covers everyone (including foreigners), not only workers. It is still true though that it's mostly based on insurance rather than on assistance.
    I still think the Bismarckian principle is better because it's based on contributions from labour rather than on taxes that are mostly paid (and hated) by the middle class.
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  • chadouken!chadouken! less < more Joined: Posts: 5,086
    The Bismarck Model
    I'd rather just find hearts in the bushes or give a witch a mushroom from the forest to make me a potion.
    po pimpus wrote: »
    Yes, I'm still pissed. Yes, go fuck yourself Darkfaggotasshole.
  • PerthoPertho The Runed One Joined: Posts: 22,008 mod
    ParryAll wrote: »
    I don't believe Razor actually wrote that. He's never written more than a sentence and acts like a child despite being at least 40 years old.

    Anyways I support the Pool System.

    You're on medishare aren't you?
    Ronin Chaos on Pertho:

    "Oh, Pertho. You complete me."
    jimmy1200 wrote: »
    pertho attacked me first, saying i get all my life tips from 106th and park.
  • ArtVandelayArtVandelay Architect Joined: Posts: 5,529
    The Bismarck Model
    Bismarck and Beveridge make the most sense to me.
    What good is it living in a society if people don't take care of each other?

    It's hardly the individual's fault when economy goes bad and you can't get a job to sustain healthcare anymore.
    CFN: NaughtySenpai
  • NaerasNaeras Terribad Joined: Posts: 3,401
    The Beveridge Model
    The model works here, and our politicians aren't far enough into the pockets of private interests to ruin it yet (even our conservatives are wary about suggesting increased privatization of healthcare). The obvious trade-off is higher taxes, but I'm completely fine with that.
  • ReticentlyReticently Joined: Posts: 3,970
    edited March 15
    The National Health Insurance Model
    Out of what's presented, the National Health Insurance Model.

    Seems to be the best combination of providing for the public good on the insurance end, while still leveraging competition to drive innovation on the provider side.

    Beveridge fails to leverage the beneficial aspects of capitalism and as such is more susceptible to stagnation and bloat, whereas Bismark artificially ties the healthcare market to the labor market in ways which constrain peoples' practical options with regard to employment.
  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    The Beveridge Model
    "beneficial aspects of capitalism"
    i lol'd
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  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    Yeah that NHI model is doomed. Every time I see parliament in UK argue that shit never fails to come up.
    This is offensive.
  • DoctaMarioDoctaMario Sometimes It Snows In April... Joined: Posts: 3,425
    The Beveridge Model
    I think part of the reason insurance companies do so much damage is because the system is like the IRS tax laws in that it's needlessly complicated. There's no reason for health care to be as complicated as it is and I'd prefer to cut out a for-profit middle man company and just pay directly to the government or even a hospital for health care. It would take a lot of the guesswork out of it, and I think the care would be more reliable.
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  • crotchpunchacrotchpuncha Joined: Posts: 21,610
    edited March 15
    At this point I'm for any system that doesn't turn my health care into a for-profit scheme. I have 0 faith in a board member putting my health ahead of his wallet.
    It's not the end of the world, but you can see it from here.
  • ReticentlyReticently Joined: Posts: 3,970
    The National Health Insurance Model
    "beneficial aspects of capitalism"
    i lol'd

    Lol all you want, but there are things it does well and the world was a pretty shitty place to live before we had it.

    Any kind of pragmatic approach to a modern society aims to leverage the things capitalism does well in order to subsidize the things capitalism is shit at.
  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    edited March 15
    The Beveridge Model
    Reticently wrote: »
    "beneficial aspects of capitalism"
    i lol'd

    Lol all you want, but there are things it does well and the world was a pretty shitty place to live before we had it.

    Any kind of pragmatic approach to a modern society aims to leverage the things capitalism does well in order to subsidize the things capitalism is shit at.

    "the world" is europe, and nothing existed before feudalism. gotcha.

    lets also ignore all the people that died during most of capitalisms existence because of capitalisms complete neglect for human/environmental well being. not to mention all the people who died fighting for human rights so that what we call capitalism in the usa is less destructive.

    lets also ignore the poverty that simply got offset from the usa and put in the third world, where trying to create a union can result in a bullet in your head. gotta compete in the market place!!!1
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  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    You also gonna ignore that iPhone in your pocket? Because it was thought up in a capitalistic country.
    This is offensive.
  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    edited March 15
    The Beveridge Model
    Raz0r wrote: »
    You also gonna ignore that iPhone in your pocket? Because it was thought up in a capitalistic country.

    gonna ignore the fact that computers are largely the result of public financing?

    socialize the risk, privatize the profit. thats a big part of American r&d. very few if any businesses have the ability to take actual risk, because risk may not pay off. so, please, the marketplace does not lead to innovation. for-profit systems always lead to excess consumerism and simply should be abandoned in favor of something thats more rationally based.

    you'd have to have your head in the sand pretty deep to ignore the fact that capitalism is arguably the least stable economic system humanity ever contrived.
    Northeast PA
    570 Necro
  • ReticentlyReticently Joined: Posts: 3,970
    The National Health Insurance Model
    Reticently wrote: »
    "beneficial aspects of capitalism"
    i lol'd

    Lol all you want, but there are things it does well and the world was a pretty shitty place to live before we had it.

    Any kind of pragmatic approach to a modern society aims to leverage the things capitalism does well in order to subsidize the things capitalism is shit at.

    "the world" is europe, and nothing existed before feudalism. gotcha.

    lets also ignore all the people that died during most of capitalisms existence because of capitalisms complete neglect for human/environmental well being. not to mention all the people who died fighting for human rights so that what we call capitalism in the usa is less destructive.

    lets also ignore the poverty that simply got offset from the usa and put in the third world, where trying to create a union can result in a bullet in your head. gotta compete in the market place!!!1

    You seem to be having an argument with something you've only imagined that I said.

    I am curious though, if you have examples of non-Western and/or pre-Industrial cultures with superior national healthcare systems to the ones Raz0r's enumerated, please feel free to describe them. I'm happy to learn.
  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    edited March 15
    The Beveridge Model
    Reticently wrote: »
    Reticently wrote: »
    "beneficial aspects of capitalism"
    i lol'd

    Lol all you want, but there are things it does well and the world was a pretty shitty place to live before we had it.

    Any kind of pragmatic approach to a modern society aims to leverage the things capitalism does well in order to subsidize the things capitalism is shit at.

    "the world" is europe, and nothing existed before feudalism. gotcha.

    lets also ignore all the people that died during most of capitalisms existence because of capitalisms complete neglect for human/environmental well being. not to mention all the people who died fighting for human rights so that what we call capitalism in the usa is less destructive.

    lets also ignore the poverty that simply got offset from the usa and put in the third world, where trying to create a union can result in a bullet in your head. gotta compete in the market place!!!1

    You seem to be having an argument with something you've only imagined that I said.

    I am curious though, if you have examples of non-Western and/or pre-Industrial cultures with superior national healthcare systems to the ones Raz0r's enumerated, please feel free to describe them. I'm happy to learn.

    the point im making is that the benefits of capitalism come at the expense of someone and you made a general statement about human well being tied to the existence of capitalism which is honestly total bullshit to anyone who studies any history at all.

    when discussing healthcare, we're discussing how medical work gets paid for and, shit even feudalism has pure capitalism beat because the landlord was usually required to pay for medical expenses. dont get medicine and health insurance confused.

    the best healthcare systems are the ones that get furthest away from the market.
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  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    Raz0r wrote: »
    You also gonna ignore that iPhone in your pocket? Because it was thought up in a capitalistic country.

    gonna ignore the fact that computers are largely the result of public financing?

    socialize the risk, privatize the profit. thats a big part of American r&d. very few if any businesses have the ability to take actual risk, because risk may not pay off. so, please, the marketplace does not lead to innovation. for-profit systems always lead to excess consumerism and simply should be abandoned in favor of something thats more rationally based.

    you'd have to have your head in the sand pretty deep to ignore the fact that capitalism is arguably the least stable economic system humanity ever contrived.

    Did the government invent the iPhone, though?

    Yeah, that's what I thought.
    This is offensive.
  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    The Beveridge Model
    :|
    Northeast PA
    570 Necro
  • OceanMachineOceanMachine ROCKET LAUNCHER GOD Joined: Posts: 9,763
    The Bismarck Model
    Raz0r wrote: »
    Raz0r wrote: »
    You also gonna ignore that iPhone in your pocket? Because it was thought up in a capitalistic country.

    gonna ignore the fact that computers are largely the result of public financing?

    socialize the risk, privatize the profit. thats a big part of American r&d. very few if any businesses have the ability to take actual risk, because risk may not pay off. so, please, the marketplace does not lead to innovation. for-profit systems always lead to excess consumerism and simply should be abandoned in favor of something thats more rationally based.

    you'd have to have your head in the sand pretty deep to ignore the fact that capitalism is arguably the least stable economic system humanity ever contrived.

    Did the government invent the iPhone, though?

    Yeah, that's what I thought.

    Technically the army invented internet
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  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    Raz0r wrote: »
    Raz0r wrote: »
    You also gonna ignore that iPhone in your pocket? Because it was thought up in a capitalistic country.

    gonna ignore the fact that computers are largely the result of public financing?

    socialize the risk, privatize the profit. thats a big part of American r&d. very few if any businesses have the ability to take actual risk, because risk may not pay off. so, please, the marketplace does not lead to innovation. for-profit systems always lead to excess consumerism and simply should be abandoned in favor of something thats more rationally based.

    you'd have to have your head in the sand pretty deep to ignore the fact that capitalism is arguably the least stable economic system humanity ever contrived.

    Did the government invent the iPhone, though?

    Yeah, that's what I thought.

    Technically the army invented internet

    But did they invent the iPhone? No, they did not.
    This is offensive.
  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    The Beveridge Model
    well this was almost a good thread.
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  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    It's still a very great thread. You just haven't disproved my point that capitalism led to the iPhone. Capitalism, for all of its faults, does give people incentive to pursue big dreams in the hopes of big payoffs.
    This is offensive.
  • jae hoonjae hoon Flames of Justice Joined: Posts: 12,851 ✭✭✭✭✭ OG
    I prefer the zombie apocalypse model of healthcare.
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  • RichterRichter ~~~00~~~ Joined: Posts: 1,878
    well this was almost a good thread.

    Hecatombz 2.0 :coffee:
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  • NecrotrophicNecrotrophic Isn't a communist. Joined: Posts: 5,911
    The Beveridge Model
    Did capitalism invent the wheel? Nope. garbage/10 can't even wheel.
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  • MCPMCP Joined: Posts: 2,172 ✭✭✭✭✭ OG
    edited March 16
    The National Health Insurance Model
    I voted "The National Health Insurance Model" only because it could have been and/or will be implemented in the USA and that's what I care about.

    Fucking hate the way US does it, where any one person, depending on job, income, or lack there of, gets a different model.

    I've seen the Great Britain health system and it seems to be very good. I would like the US to move in that direction.

    Anyways,
    http://www.annfammed.org/content/11/1/84.1.full
    One common theme Reid noticed among the health care systems he utilized was that these systems provide health care coverage for everyone, yet spend substantially less on health care than the United States does.

    Also, it's not that any particular model or mixture of models is best, they have to be robust vs a crisis of some kind.
    https://www.oecd.org/governance/budgeting/49095378.pdf
    Regardless of model, sound fiscal policy is essential for enabling potential for counter - cyclical spending (to be better prepared for the next crisis)
  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    There are various reasons why it's more expensive here, but two are that republicans don't want to spend tax dollars on healthcare and Congress bans Medicare from negotiating prices.

    Both are a boon for the healthcare industries.
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  • Sephiroth73003Sephiroth73003 Joined: Posts: 4,288
    edited March 16
    The Bismarck Model
    Bismarck model makes the most sense.

    Largely because it doesn't make sense to have the same level of health services in all towns, unfortunately. Having the world premiere surgery center in some podunk town is a waste of resources. Not only that if a place severely lacks in healthcare you can help that healthcare issue by subsidizing smaller towns with larger premiums (naturally tie it to number of patients so no weird districting stuff happens), the average person isn't going to drive 100 miles for basic care. So a fully government model with promises of a certain level of coverage to everyone gets a bit iffy on implementation with cost.

    The average person in America with subsidies from employer & government pays ~$150-200 per month per person for insurance. If this was taxed instead the average person would see no net loss from their income (assuming they were already paying for insurance). Add in most Bismarck type systems have drug negotiation powers you could see a massive drop in costs by America being one of the only governments in the world that has no price regulation on prescriptions.

    Add on top that private insurance on average is GROSSLY inefficient. Medicare, VA stuff, and Medicaid generally spend 95-98% of EVERY dollar taken in on healthcare. For private insurance it is closer to 70-80%. Since they do a lot more negotiating and legal fighting and take a 12-15% profit generally. 20-25% of trillions of dollars is a MASSIVE waste every year.

    Having at least some public option with negotiating powers to set a base line with maybe premium healthcare insurance options in the private is the only practical solution. Having full single payer is not out of the question, but I see that being the most practical model to sell to the public. Also if healthcare became more standardized dealing with insurance could be done in a more efficient manner potentially allowing hospitals to cust 20-25% of their total operating cost (30% of most hospitals cost is solely associated negotiating with insurance).
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  • Raz0rRaz0r Did you really just write that? Joined: Posts: 25,824 ✭✭✭✭✭ OG
    The Bismarck Model
    I wonder why the SRK resident dumb assess haven't posted in here yet. Probably because they'd have to actually read coherent paragraphs and put together a well thought out argument.

    It's like their kryptonite.
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  • CronopioCronopio ST Joined: Posts: 2,131
    The Beveridge Model
    It sort of works here, a country barely above third world. Would work better if the State didn't under-fund public healthcare to favor the private lobby (work unions and private health corporations have huge influence and our neo-liberal government is eager to gut the State out). But there's still free healthcare for everyone here, including even some expensive stuff like AIDS medicine. And you also have pre and post payment private clinics.

    To me it's the system that makes the most sense. If you don't have the money, go public. If you have it, go private which here is sometimes faster though not necessarily better since private companies will find any little thing to get more money out of you if you pay up front, and will try to avoid coverage if you are under an insurance system. Plus the best public hospitals here tend to have the best professionals and some private clinics have dubious ones. The main problem is, as I said, the public system is overrun and underfunded, so depending on your issue you can wait months for treatment.

    But considering that the US has a shitton of money, I don't see why it would be impossible to implement such a system there, barring opposition from Medical lobbies of course.
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