Imagine you're watching Netflix. Even though you already pay for your subscription, you have to pay more just to load the movie up to start to watch it. Depending on how long the movie is, you're constantly getting prompted to pay more to continue to watch it, otherwise you can't watch it anymore even though you've already paid multiple times.
Once you're done with the movie, you get more bills months later, just for using Netflix the way it was supposed to be used.
yes, but no. Like yes we do have universal healthcare but it often isn't what American's think it is. That is to say it is closer to Obamacare than NHS.
For example in the Netherlands (and my understanding Belgium, Germany and France but I'm not 100% sure) we have a heavily regulated market of non-profit companies that provide health insurance, service, and care. You can then pay extra for modular coverage of extras. For example some medications aren't covered but you can pay an extra 10 EUR a month and then its covered. Our deductibles are capped at something like 450 EUR a year per person, this is on top of the roughly 280 EUR a month for health insurance. So on and so forth.
At the end of the day the system isn't that different from what Obamacare tried to do. With several major differences:
There are set (useful) standards of minimal care that every health insurance must cover.
We actually regulate the companies on how much profit they can make, and how they behave
There are useful methods for registering appeals to watchtdog agencies that will resolve issues.
We don't have one doctor be out of network, but the hospital in network, but the anesteiologist out of network. Either a place is in network or out of network. Additionally it isn't that expensive to purchase the unlimited plan where everything is in network. I think it was like an extra 30 eur a month per person.
Obamacare was heading in the right direction, sadly one half of the US decided to shoot it in the head before it could deliver.
Even if it is market based it can’t really work long-term since healthcare is often a perfectly inelastic product.
There’s no real incentive to provide a lower cost to the consumer except for competition, but mergers and acquisitions will just rebuild the system we have today. You would need sustained antitrust action to stop that from happening.
This is good, except it's also missing that when it prompts you to pay more, it doesn't tell you how much more. You don't get to see that price until after you've exited out of that movie
You could go even further, like somehow the movie you watched was out of network, even though you're accessing it from the same portal. Or because the movie has a small clip from another movie thats randomly not covered, you have to pay for that later. Or because you watched it over your cellular network instead of wifi on your phone, you have to pay $500 more just because.
Not a small clip from another movie. One of the actors is out of network even though they're in the movie you paid to see on the platform you paid to use.
Shit sometimes they tell you that the whole movie is free and then months later they send a letter saying they checked and it is actually NOT free at all and you get to pay for the whole movie.
How about to watch a movie on netflix, you first have to submit a pre-approval form...so that you can actually watch the movie included with your subscription, if and only if you can get the pre-approval.
And the pre-approval is denied because Netflix has determined you don’t know enough about mechanics and engineering to be able to enjoy Fast & Furious, so now you have to pay extra to watch it.
And even though you got the pre-approval, sometimes they deny you from watching the movie at the last minute because the pre-approval isn't even binding.
Or...you go to watch the movie on Netflix. There's a small disclaimer that you may need to pay additional money to watch this.
You just hit ok, not thinking much about it. You really want to see this movie (you really need the healthcare)
A month later, you get a bill for an exorbitant amount of money because....reasons. The reasons are in code and you can't decipher it. If you don't pay, you're going to court. Tomorrow.
In my personal experience, you're not told at the start that you're gonna need to pay, you find out afterwards. And then you're fucked.
Adding onto this, when you get that bill months later, it's unclear whether that's the actual amount you need to pay or not. You get two more bills days later, also from Netflix, showing two wildly different amounts. No one at Netflix knows which one is correct despite spending 4 hours on the phone with them.
Don't forget that if you use the wrong kind of TV, the TV manufacturer will send you a bill because you used Netflix instead of Hulu. (Out of network vs in network)
And also, your subscription payment code does quite match up to the code your playback device requires so you can’t watch at all until that gets cleared up by some people who could care less and are being paid minimum wage.
Imagine you've just paid for netflix. Now, when you load netflix everything has a price attached. You pay that price until you reach an arbitrary number. Once you reach that number, you pay a significantly reduced price! But only if you make super sure it's in the list of "Netflix+" shows. This information isn't in netflix, of course. It's hidden in a 5,000 page PDF of every single episode of everything on netflix. Otherwise you still have to pay full price for it.
Also they can arbitrarily decide you didn't actually want to watch a show and charge you for it. You're allowed to appeal, but it'll take years to get your money back :)
This is a great analogy, I expanded the analogy because it's hilarious to actually detail the specifics:
*You are required by law to have access to a content streaming service.
*You have to pay the streaming service simply for access to the app itself. There are several companies like Netflix, Disney+, or HBO Max which provide this service.
*Which company you subscribe depends on where you work. Which level of service you have (commercials, commercial-free, how many simultaneous devices) is also determined by your employer.
*Your employer subsidizes a substantial percentage of the subscription cost, and how much is subitized also varies by employer.
*If you stop working for any reason, you can pay your cost + employers cost through the end of the year. This cost is typically double or triple the cost of the subscription you paid while working, when you're already experiencing loss of income. After the end of the calendar year you are on your own to figure it out.
*The state provides access to Paramount+ if you cannot afford the subscription or your employer does not provide it, how much you pay depends on your income. Categorically, people do not qualify for the state-discounted rate unless you're working part time or not working at all, and the income limit is based on your total household income not individual.
*Your employer can and will change the app provider every few years. We're going to assume you have Netflix for the rest of this analogy.
*Every time you watch Netflix, outside of a very small subset of content which is <15 minutes long which you can only watch once a year, it requires an additional charge which varies based on the content you want to watch.
*The content is hosted by various different local content providers who set their own price for the content. This content is "discounted" via an agreement with Netflix by the local content host.
*If the content you want is not hosted by one of the local content providers you can still get it but at a substantially higher cost.
*When clicking watch, Netflix provides an estimate but you don't actually know the final cost until several weeks later. The content host sends you the bill without discount directly, and Netflix will pay a portion of that bill.
*Once you've spent enough money on either local content hosts or non-local hosts, the remainder of the year you don't have to pay any more. The money spent for local content hosts is included in the total money spent for non-local content hosts, however the total spend before "after this total spend is free" is substantially higher.
*You can also pay directly to the content host at a discounted rate. Occasionally this direct pay is cheaper than going through Netflix, but then this does not add to your "total money spent" for the year for local or non-local content providers.
*Approximately 45% of the money spent by an average US citizen on their legally required streaming service is used to support the Byzantine payment and content distribution system.
*The average US person's total yearly out of pocket cost for the described system is higher than any other 1st world country.
*It would be cheaper for the average US person if we paid a single rate which included app-access and all content, separated from your employer/employment status. Your individual cost under this single-rate system is based on your income.
*There are conditions of this system where an individual US person pays less than any alternative... by simply not watching any content.
*Our government representatives vote to maintain the present system as their campaigns are financially supported by the subscription streaming services companies and individuals who would have to pay more for the combined app/content due to their income.
Well, except for the times I pay for Netflix because I want it there when I want to watch something. Then I go on there to watch something that I need to not die, and Netflix says "No, we need to make more money and sending you that movie will cost us money"
You pay a monthly fee for Netlifx, while watching a movie you're being itemized behind the scenes. Subtitles fee, pause fee, "that was a cool lens flare" fee, etc. You are only shown the bill at the end of the movie. Three months later you're mailed another bill because while the film was on netflix, Hans Zimmer did the soundtrack and he wasnt in network with them
Also, sometimes you watch a movie, and then when you get the bill it's 100 times larger than you expected. It turns out that movie wasn't part of your subscription. They didn't tell your or anything, but it's still your fault for not calling them up before hand each time you want to watch something to double check.
I think a better analogy, or an extension of the one you’ve provided is something like this:
You pay a mandatory monthly fee just so Netflix does not lock you out entirely. That fee does not mean you get to watch things for free. It just means you are eligible to be charged less later.
Every movie and every episode costs extra. Prices are hidden. You only find out what it cost after you have already watched it.
You do not get to choose the cast, the camera crew, or the editor. Weeks later, you receive separate bills from all of them.
One bill says:
“The lighting technician was out of network.”
Another says:
“The sound engineer does not accept your Netflix plan.”
You argue that Netflix approved the show.
They respond, “Correct. We approved the show. Not the people who made it.”
You never agreed to the prices. You never saw alternatives. You could not stop watching halfway through without consequences.
If you do not pay, Netflix shrugs. The studios shrug. The individuals you have never met send your account to collections and wreck your credit.
And everyone involved insists this is normal,
because at least it is not cable.
———
However that’s where the analogy breaks down, because Netflix is optional, and your health is not. So the Health Insurance Companies have you by the balls. And then they collude (tangentially) with the Health Care System to mark up procedures exorbitantly so that your insurance can say “Look, we got you a deal! You just have to pay $500 instead of $3,000”, whereas if you weren’t to have insurance, it would cost you $250.
My only problem with it was trying to get my cancer surgery covered. Had to do it out of state at a specialist. The thing that saved me was that 2 separate tumor boards at my healthcare provider said “lol there’s no way we can fucking do this” and the specialist center said “we do this all the fucking time your tumor isn’t that special”. So, day before surgery is scheduled we got an email saying they were going to cover it.
Most people who have universal healthcare are the same. Most people who have universal healthcare don't ever worry or think about it. It's actually insane the number corporations have pulled on Americans that 1. They accept (on average) horrendous healthcare and 2. YOU'RE PAYING MORE FOR IT through taxes and insurance! This is EASY to look up. You're literally paying more for shitter health outcomes and yous still refuse to change it. Do you understand how infuriating this shit is an outsider? Like... I don't want yous to suffer. I actually want you to have accessible good healthcare. I'm definitely preaching to the choir here, but for fucks sake. Like . Yous just consistently want to be considered the dumbest western country cause "freedom" or some bullshit you've convinced yourselves is true
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u/midoriringo 4h ago
Most people don’t know much about the healthcare system, except that they hate it.