They can cancel the subscription if you don't agree to the new proposition after they fulfilled their contract. But they can't just change the terms of the agreement after it was made.
But doing so would mean risking to loose customers who were just too lazy to cancel. So most Businesses don't like it. (Spotify did cancel their old contracts though, for people who had not agreed with the recent price hike)
They can compete where the alternatives are also US based services.
They can compete in the US.
There are also many people who are more concerned about privacy from businesses than from governments. There are also people who are more concerned about privacy from their own government than a foreign government.
Although the Cloud Act and similar issues with the US are much discussed here, I see no sign it loses American big tech much business.
> There are also many people who are more concerned about privacy from businesses than from governments.
We're living in an interesting time that may (or may well not!) turn out to be a pivot point in this question. People being ICE'd based on data traces they leave in commercial products may well make this kind of question more tangible to non-technical folks.
> Although the Cloud Act and similar issues with the US are much discussed here, I see no sign it loses American big tech much business.
If that is true (which it may or may not be) then it would also mean competing on privacy isn't a winning move, whether within or outside the US.
It's not all or nothing. Depending on your threat model, Apple's services might be fine. But I guess most people don't think enough about the implications of storing many years worth of data at a US company like Apple.
Apple has actually proven itself over a long period of time on this issue. Maybe Mozilla has as well (do they encrypt telemetry logs etc for people with a Mozilla login?) but I haven't heard so much about that.
Did you really forgot about Snowden's Apple slide? Also their phones are routinely mirrored at the border. Just to support the unconstitutional government agenda of policing thoughts and speech.
> you also need to tax it, to deliver benefits to your population
The benefits were already delivered by that strong and prosperous economy in form of products and services.
Taxation is of course necessary to fund government spending but we need to keep in mind its drawbacks: from discouraging productive activity and slowing economic growth to giving politicians funds to buy votes with populist social policies.
Strong and prosperous economy built by progressive tax rate that used to tax up to 70% of non-work income, and now tax most of it 27-29% (depending on the corporate taxe of the state). The people who can use loopholes to avoid income taxes also pay reduced consumption tax (they usually pay the 'Use tax' rather than sale tax in the US, and can basically ignore VAT in Europe).
That's a common misconception. Although the top tax rates were indeed high, they kicked in at such high income levels and included so many deductions and loopholes that the effective tax rate were much closer to 50%.
And it makes sense, considering human nature and motivation: how much would you work considering the taxation? Me:
0-20%: I work as hard, want to excel and advance; I will take risks and invest in entrepreneurial endeavors
20-40%: I will do my duty, 9-5 then hit the door to spend time with the family; actively seek low-responsibility low risk high stability and lots of benefits government jobs
>40%: f that s, I will take my welfare payments and do various cash jobs without declaring that income; stay in my parents basement playing Xbox, smoking weed and jerking off
Counting consumption and estate taxes, i'm pretty sure you're just above 40%, so i guess you're on benefits?
In the US, unless you or your family own a holding with a lot of companies, the country taxes you between 50 and 40% (well, 30 and 50%, but food stamps are a bit weird so i will exclude them here). If you manage to get rich enough to be able to optimize your taxation, you are only taxed on company profits (so 21% to federal, 27-29% depending on your state) and sometime use taxe (sales taxe doesn't really apply anymore).
I have benefited from VAT-free school furniture most of my life because my uncle owned a company that bought office furniture regularly, and VAT-free sport clothing/tools because of a similar scheme by his wife and her companies.
I assure you you pay more taxes overall than people holding a few companies, and the more you own, the easier it get to avoid VAT and taxes in general (the owner of the Yacht my sister used to cook for was hired by the Yachting company as the captain or something for his vacations: avoided VAT on buying the Yacht, avoid VAT on a personal cook, avoid VAT on food. And if this specific company loose a small amount of money every year, tax write-off baby!).
Zucman wrote The Triumph of Injustice: How the Rich Dodge Taxes and How to Make Them Pay.
It's an interesting read, and
Actually I've been lucky to practice what I preach all my life. Early in my career I realized that salaried employment is a rip-off: you pay through your nose for an illusion of safety and stability you don't want nor need. So I embraced risk and switched to contracting.
Having leftover income this way, I looked into investing. That's when I realized that being financially prudent, saving and investing was actually punished in the USA, taxwise, while borrowing and spending was encouraged. So I left the USA and returned to Eastern Europe.
Understanding that selling your time is much worse than selling a product drove me to entrepreneurship. Luck threw a little success my way and turned me financially independent.
Now I am semi-retired living from investments and small gigs and spending time with my family. My tax rate (income only, not consumption or VAT) is well under 20% on most of my income. I didn't do any effort to optimize it further, but I could if I must. I actually do not mind paying taxes, but I do respond to incentives and I am not afraid to relocate.
> If you manage to get rich enough to be able to optimize your taxation
Actually I did a little research and you don't need to be rich, you can do that with very little money. But then the gains for a few percent reduction aren't that great anyway so...
> you pay more taxes overall than people holding a few companies
I probably do, but I don't mind it. I think the rich are a net positive to our society because capitalism ensures they contribute to the society orders of magnitude more than they manage to keep. Also I lived under communism pre-1990 in a world without rich and I've seen how bad it is.
Sure, capitalism isn't perfect. No economic system is, mainly because they're all composed of us semi-evolved chimps. Every economic system has that problem. Getting rid of or severely constraining economic freedoms isn't a solution, it makes it worse.
Ok but if its taken you just three comments to get to "well... nothing is perfect I guess" where did that initial conviction come from?? Like why even play out this same argument if your heart isn't even in it? Is it a sense of obligation? If anything, you do your entire position a disservice by folding so quickly. It just goes to show noone deep down even believes these stories anymore, even we expect others to.
Like, yes, we are discussing an "imperfection" here! You are the one that asserting the greater perfection, not the lesser.
Thanks. I never understood why intelligent people, comparing for example the German to the US system can even blink and decide that the German system doesn’t work.
Yes, there is quite a bit to improve in the German system. No doubt there. But if I compare it to the abysmal situation in the richest country on this planet, I am left standing awestruck asking myself why. I really, genuinely cannot wrap my head around.
It's largely not up to people. 59% of Americans support Medicare for All[1], including over 1 in 3 Republicans, but how many politicians even talk about it?
If you vote republican, you do not "support medicare for all" no matter what you say to the poll.
Your vote has consequences, and republicans have been voting for people who objectively and loudly tell their voters that they have no intention of doing those things.
It's time for people who vote republican to own that they suck at picking who to vote for.
Tons of them also say they want recreational weed, but it's only republicans working to prevent that in most states, often literally ignoring citizen's initiatives and court cases to accomplish that.
I would take my insurance over public German healthcare in an instant. I would not trade.
Now maybe when I stop working that may be a different comparison. And its not like there is a choice, voting for a D doesn't magically get German healthcare.
That doesn't say how you would fund it, only what form of insurance is in place.
If the US were to shift to that model today, a country already heavily in debt would have to either take on more debt PR increase revenues in a manner that they wouldn't have been willing to in order to fund our already growing debts.
The debate over whether public or private healthcare is better is all well and good, but first we should be debating how the US would pay for it in the first place.
A Single-Payer-System would also be cheaper in the US. Nobody expenses as much on administrative cost, nobody pays so much as a % of GDP on Healthcare as you, still you have the worst health outcomes of all developed nations.
Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households
Looks like I don't have access to the full paper, but I would be extremely skeptical of any claims with such accuracy or certainty.
The healthcare industry in the US is massive and already full of corruption and inefficiency. Even if we are to assume giving politicians and bureaucracy more control over the system will reduce both issues, we can't predict how successful that will be.
Similar claims were made regarding the hopes for ACA reducing costs and here we are.
You are, of course, aware that the current US single payer system (Medicare) subcontracts their administration to private health insurance companies? And that the "overhead" typically discussed when talking about Medicare doesn't include said companies but is instead only the overhead of what it takes to shovel money from the IRS to private insurance companies?
No, this is not Medicare Advantage, in which Medicare just directly pays private health insurance premiums for enrollees.
There's also an often-overlooked issue, which is that some of the crowdfunded treatments are for things deemed "experimental" or whatever other label and thus not covered for even an insured person. This situation exists in both public and private healthcare systems. I'm not arguing in favor of a for-profit system with this, but people often miss this when they haven't personally run into uncommon health problems.
If a treatment isn't approved yet, you can usually submit a request for getting it paid.
You need to show that it has a chance of working (literature etc...) and it will be reviewed by a doctor from the "Medical Service" which is independent from the Health Insurers.
If they decide it should be paid, it will be paid (which is most of the time the case).
Otherwise you can go through the social courts. (No court costs for the insured person. You can get a lawyer reimbursed if you're poor)
Interesting. Do people win in any significant number of cases, or is it more like the "appeals" process in for-profit systems, where it's supposedly possible to win but generally does not happen?
From my limited experience it usually already gets approved by the Medical Service.
Especially within the University Hospitals who administer these treatments they already have the experience how to write these applications and know their counterparts
Expensive health treatments can easily bankrupt any western government. None of those developed countries can afford to spend their money indiscriminately on them. So instead they turn to waiting lists, death panels and very often saying no but not in your face (since that is politically frowned upon) but thought delays and countless committees and bureaucracy until the patient expires...
I know that's what you hear and read on Fox News and other "News Sources" daily.
But here in Germany, there are no "death panels" or long waiting times for cancer treatment.
Also we don't need "pre-auth" and other Bullshit before we start standard treatments.
The real death panels are sitting in your Insurance Companies Offices as seen by the news coverage around United Healthcare et al lately
I live in Eastern Europe and my "news sources" are friends in hospitals asking us to donate for desperate causes.
Governments-paid treatments are god-sent but many times the funds are limited so they only cover older, cheaper treatments. Approval and funds for newer ones come so late, sometimes too late.
Germany has one of the most developed economies on the planet so naturally has more spend on healthcare. But that can change and when the money is tight, tough choices have to be made. I'd make those choices for myself rather than trust the State to do it for me.
For a country with a $4.5 trillion GDP, a 6 billion deficit is a drop in the bucket and easily covered from taxes. It’s just a political question of what you want to fund.
For comparison, the New York City public transport system (MTA) runs a deficit of about $3 billion. Six billion for universal healthcare in a country of 83.5 million people seems like a total bargain.
To help you think a bit more clearly: the health insurance system is not a for-profit system, even though some people mistakenly hold on to the idea that it should be. It is a risk spreading mechanism.
I lived under the very system this principle enabled and I can tell you that without the profit motive we were cold and starving since there was no motivation for people to work and sew clothes or grow food.
I live under a system where even very expensive treatments are covered by the state using taxpayer money, and I'm not starving. Sometimes you need to optimize for human dignity.
10 Billions of that deficit are coming from the State paying insufficient contributions for unemployed insured people. It is a policy choice to offload those costs onto Publicly-Insured-People (excluding rich and healthy people) instead of funding them through taxes (including those groups).
The German Healthcare System also has some historically developed peculiarities that don't make much sense in today's age, but they are difficult to address without pissing people off (The duality of Private and Public Health Insurance, allowing the first one to get rich and very healthy people out of the risk pool, and then loopholes to switch back into the public system when they grow older and don't want to pay the then high prices in private insurance)
The Hospital Reform is already working to reduce costs by reducing the number of small hospitals, and concentrate them into bigger ones. (As a side effect, quality of care will increase too, since outcomes are correlated with experience)
Also more care will be shifted to outpatient setting.
Otherwise we are fighting with the demographic change. But these problems are also hurting all other developed nations including the US, where funding problems in Medicaid are also expected in the next decades
tl:dr We have problems due to the demographic change, but these are in line with other developed nations. There are some efforts to address them, but politicians are hesitant to do real reforms, because old people have the most voting power
I am yet to see any western nations go bankrupt for universal healthcare.
I have three second-hand cancer experiences from family here in Australia (Dad, Mum and my half-sister - under 35/yo). All three were detected early thanks to regular checkups and screening (covered under Medicare), treated in major hospitals (Dad was in a rural hospital, Mum and half-sister in Metro major city hospitals) and are all alive and certainly not in debt. The biggest cost was parking at the hospital, drinks from the vending machine and the PBS medication (all PBS medicine costs $31.60 for adults, and $7.70 for concessions).
Any PBS medication has the full-cost price printed on the label for reference, more often than not the printed prices go from $300 - $2,000, but I remember that these aren't the full price anyway since our government collectively bargains for cheaper prices on OS medication).
I can't imagine having to pay for treatment AND the insane full price of medications, it must be so much more stressful for families going through cancer treatment.
Americans, don't let the media and your government tell you otherwise. Universal healthcare is cheaper [0] and more effective than whatever archaic system you have now.
I am so god damn proud of our system in Australia, it's not perfect, but damn it's so efficient for critical care, thank heavens for Medicare and the PBS.
Oh and for those that say "well doctors aren't paid very well"... they are. My brother-in-law is a surgeon and he's doing pretty well for himself, bought a new Audi last month for his wife, heading to Europe for a month-long holiday with his family and just moved into a new house.
> So then you would expect life expectancy in the US to be higher than in Germany, France, UK?
Pretty soon, actually. EU countries are falling further and further behind economically. Health care costs are increasing, taking up an ever increasing slice of the government budget. Labor force participation rate is decreasing due to generous welfare and high taxes. Natality is plummeting. Attempts to increase retirement age are met with riots.
We're a technological backwater. AI research is done in USA and China - the benefits will mainly go there too. We can't even cool our cities: we're losing more people every year to heatwaves than the USA to gun violence. We're closing down nuclear power plants after years of shamelessly funding the Russian war machine for cheap energy.
Years of redirecting defense spending into social programs are coming back to bite us. Russia is hungry and aggressive, while the US is not protecting us anymore. What do you think will be the life expectancy under drone and rocket attacks?
Get real, even the poorest districts in the UK have the same average life expectancy than in the US
American life expectancy compares extremely unfavourably with the UK. The English seaside town of Blackpool has been synonymous with deep-rooted social decline for much of the past decade. It has England’s lowest life expectancy, highest rates of relationship breakdown and some of the highest rates of antidepressant prescribing. But as of 2019, that health-adjusted life expectancy of 65 (the number of years someone can be expected to live without a disability) was the same as the average for the entire US.
Also what you conveniently forget to mention, all European countries still spend less on Healthcare than the US, as a percentage of their GDP.
In absolute numbers this comparison would look even worse
So this isn't Defense Spending redirected to Healthcare
Private/public here in Japan works okayishly well. I have never heard of anyone getting bankrupted over medical bills, and have had loved ones going through surgeries and other complex issues.
Theres a (now old) memo that specifically outlines which talking points carry most salience amongst the audience. Those terms are present here in your comment. (Luntz - The language of Healthcare 2009)
Even with waiting lists, people get healthcare. They get better health outcomes per $ spent. America can provide excellent cutting edge healthcare, which is especially great if you can afford it. At some point, you have to decide whether having most of the bell curve taken care of, is more / less important in terms of rhetoric and priority.
I don't know, are your opinions about life and reality made up or you're just so credulous you are repeating whatever you see on social media?
Is it so hard to believe in today's day and age that somebody tries to learn and understand how the world around works using observation, published facts and deduction from as close to first principles as possible?
Is there a legitimately good reason for all those treatments to be so expensive, or is that, to a large degree, capitalism extracting capital from the market? Why is American insulin so expensive when compared to that from other countries?
> Is there a legitimately good reason for all those treatments to be so expensive
We can't really know, since only free markets can determine the price of a good or service (it's driven by supply and demand) and health care market is tightly regulated.
> Why is American insulin
Because of the regulatory barriers not allowing other providers to enter and sell insulin on the US market.
Who do you think you are to believe yourself so important that dictate what can be talked about, German? What is wrong with you? Did you not read what I wrote? Stop throwing yourself off the other side of the cliff out of spite, 80 years after your society was pushed to throw itself off the cliff!
Talking about "missing the point"? One instance of the clear backpedaling about mentioning nationality/ethnicity in regime propaganda outlets is cited in order to act as if it has not been decades of abusive shielding of evil, harm, and crime against the indigenous peoples of Europe. What are you even doing, acting contrary to your own survival, German?
It's a typical abusive, narcissistic action; a kind of narcissistic evasion when the manipulation, toxicity, lies, and abuse lose effect and "admitted" at least to oneself; which if immediately followed with not only pleading of leniency, reasonableness, and moderation; but also immediate further abuse through your type of nitpicking and tone policing, with accusations of unreasonable response or things like "not letting it go". It's a common and core indicator of the depraved mind of the narcissistic personality disorder and derangement.... "You are wrong, but if you are right then you didn't say the words right and immediately need to forgive and allow me to further abuse and manipulate or you are the bad one". It's sick and depraved. Stop behaving that way, all of you.
It will simply not end well, regardless of what you think, tell yourself, or try to lie and gaslight others with. Either the abuse and denial that rises to genocide by the UN and EU definition, through the denial of the very abuse being perpetrated will continue and the indigenous people and all their cultures and traditions that have been around for centuries and millennia will be eradicated and you will end up with a similarly corrupted and rotten society like the USA; or it will end in a backlash in Europe after the abuses just accumulate, people snap and there is an explosion that of course comes form it. You can only abuse so much and so long unless you totally kill your victims... your own culture, your own people, Europe as a whole, yourself even.
History and reality does not care what fanatical and fantastical illusions some of us hold about how everyone can live happily ever after...at gunpoint at other people's expenses. It is not possible that it will end well without total destruction and eradication of a whole civilization's culture and history again, like was done in France, Russia, and China through the communist mental pestilence. These are not difficult things to understand or predict, especially since they have happened several times now in history. Yet so many seem unable to understand or see the clear path to the invariable consequences.
Someone said to you, "get well soon". Can you provide a rational argument, how you concluded from that single statement, that the person has a medical condition of a narcissist?
I always thought, diagnosing takes more effort and data points. But I also think the HN guidelines discourage commenting in an "engaged state".
Also Germany uses and is already Rolling out a Matrix-based Messenger and S/MIME-Mail with End-to-End-Encryption for Communication between Healthcare Professionals.
So at least for Germany this is not a problem.
More problematic was our prior health Minister who wanted to make data accessibile to OpenAI et al for "research". That's also why I opted out of the electronic health record
I don’t think you can opt out of the electronic health record long term. We should instead elect officials that can deal with the “Neuland” of the digital age and have some technical chops and don’t immediately cave in when there is some money to be made (in no way implying that you don’t already do this)
> We should instead elect officials that can deal with the “Neuland” of the digital age and have some technical chops and don’t immediately cave in when there is some money to be made
Yes, but I don't think this will happen during our lifetimes. Especially since the Gematik has shown again and again that they can't be trusted with it
>I've never seen Zivver used in German Healthcare.
How would you even be sure of this just from what you can see from the outside? That doesn't mean your health insurance company isn't using Zivver internally same how they use Office 365 or SAP. It's not like they tell you all the SW they use.
Internally, you have the Hospital Information System where you can look up all the informations you need.
I can just say I know the inside of one of Germany's biggest Hospitals, since I'm a Doctor. And requesting Patient Data or giving it out to other Parties is unfortunately a Task that Doctors still have to do on their own
And for communication with the outside world it's down to Fax, Phone or Letter.
Theoretically they could already send this via S/MIME encrypted Mail (KIM) to the family doctor, but most Hospitals haven't rolled out this service yet.
They just started installing Card Readers for the Doctor Identity Cards, so they can issue electronic prescriptions
For communication with Patients some Hospitals have Web Portals/Apps for getting/sending information.
That's pretty interesting. We have electronic prescriptions too (though it goes straight to the pharmacy however - we don't see it).
As far as I know, I don't think the hospital portal has ever been used for communication like that. An email seems more "obvious" perhaps to the docs, and that's what they use most of the time.
Right, and the reason this has been going on for nearly a quarter century in the USA is because it was widely considered an unconstitutional national passport until 9-11, and got bipartisan push-back from a number of states following its passage.
The federal government passed it along with the authoritarian wishlists various agencies had been salivating over for 40+ years and unable to get passed, until under the guise of saving us from the 'terrorists', who now 25 years later, turned out the actual terrorists were probably just domestic authoritarians. The guys living in caves weren't really a threat and could be dealt with, without passing a bunch of stuff to affect every single citizen of the country.
"As an EU national, you have the right to travel freely in the 27 EU member countries as well as in Iceland, Liechtenstein, Norway and Switzerland (non-EU countries but members of the Schengen area) carrying either a valid passport or a national identity card (ID card)."
The French illegally checked everyone passports on Arrival when I Flew to Corsica once, but I don't expect much from them with all their "Plan Vigipirate" Bullshit which is also just about reducing freedom under the guise of "Protection against Terrorism".
Also Germany isn't much better right now with their also illegal border controls.
Right-Wing-Populism destroys many nice things
>It's also required to at least carry ID (presumably because it may be checked)
That's true, but for Schengen Flights you don't have to go through a government passport control like you have to do for international flights.
Airlines ask for ID sometimes because they make some money off it (to avoid people reselling tickets, charging for correcting misspelled names etc...), but they are not required to.
Last time I flew from Spain they only checked at the gate (which I didn't expect).
Also, most of these countries demand that you have an ID with you at all times outside. Yeah I don't do it either, because where I live is full of pickpockets and a new ID card means travelling for hours to the capital and paying 180€. I'm from Holland and they don't support their citizens abroad well. They even closed all the consulates to save money, as if they're a piss poor country :) Even most poor countries have money for consulates. But if you're a business owner they still have a contact in every city. Stupid neoliberals.
Schengen thing should be working like this but more and more I have been asked for ID/passport, usually by the airline before boarding or local police acting as border guards after arrival.
>>In Europe I don't need to show ID for flights inside the Schengen Area
Really?
I fly between Schengen countries multiple times a year. I don't remember one where I wasn't required to show my ID at both check-in and then gates. There are even ID scanners at the gates.
Driving licence doesn't count as ID either. It's either passport or official government ID card.
I flew multiple times with easyJet in the last years, and I never had to show my ID at the security checkpoints. Sometimes the easyJet agent at the gate wanted to see an ID, but this is done on behalf of the company, not the government.
The only time they ask for ID at the Check-In-Counter, is when you have checked luggage.
>>The only time they ask for ID at the Check-In-Counter, is when you have checked luggage.
They ask you to show it no matter if you have checked luggage or not. Your can online check-in but then you need to provide your ID info online.
The point is you're not getting a boarding pass without an ID and then you're not getting through security without a boarding pass and then most likely you're not getting on the plane without both.
>>but this is done on behalf of the company, not the government.
It's true. Is it an important distinction though? Government knows who is flying anyway as proved by multiple arrests on arrival in European airports.
No, some airlines don't bother checking your ID during Check-In and it's legal. So you are able to get an Boarding Pass without an ID. If I remember correctly easyJet also didn't ask for ID Information on Schengen Flights during the online Check-In
reply